Randomized clinical trial on the performance of direct and indirect restorations in adults with severe tooth wear: a...

This pilot study assessed the survival and failure patterns of direct composite restorations and indirect polymer-infiltrated ceramic network (PICN) restorations in patients with severe tooth wear.

Patients were recruited and randomly assigned to one of two restorative techniques. Direct restorations using nanohybrid resin composite (Clearfil Majesty 2 ES, Kuraray) or indirect restorations using PICN (Vita Enamic®, VITA Zahnfabrik). Restorations were clinically evaluated at 1-4 years using FDI criteria and divided into two categories of failures, repair and replacement. Impact of the treatment on oral-health-related quality of life (OHRQoL) was also assessed. Statistical analysis was performed using mean Annual Failure Rates (mAFRs) and a marginal-model Cox proportional hazards survival analysis (p < 0.05).

After 4 years, 15 patients (median age= 54 years old) were evaluated (n = 7 group direct restorations, n = 8 group indirect restorations) with 88 direct and 85 indirect restorations, respectively. Indirect restorations showed an inferior survival p = 0.008 (mAFR=8.7 %) compared to direct restorations (mAFR=2.3 %). Restorations placed in the posterior region were significantly more associated with failure p = 0.016. Failure occurred in patients aged ≥ 50 years old (p = 0.014), males (p = 0.017), those brushing ≤1xday (p = 0.008) and not performing interdental cleaning (p = 0.043). Improvement of OHRQoL was observed after treatment.

Within the limitation of this pilot study, the results suggested that direct restorations exhibited satisfactory performance over 4 years whereas PICN restorations showed less favorable performance. OHRQoL improved after treatment.

After 4 years, direct restorations showed higher satisfactory behavior than PICN restorations in adults experiencing severe tooth wear.