Buonocore Memorial Lecture. Review of the clinical survival of direct and indirect restorations in posterior teeth of the permanent dentition.

TLDR

Longevity of dental restorations depends on material, patient, and dentist factors, with primary failure causes including secondary caries, fracture, marginal deficiencies, wear, and postoperative sensitivity. This review surveys the longevity of stress‑bearing posterior restorations and aims to distinguish early failure causes from those leading to long‑term loss. The authors reviewed longitudinal, controlled clinical and retrospective cross‑sectional studies of posterior restorations in permanent teeth since 1990 to determine longevity and annual failure rates for amalgam, composites, compomers, glass ionomers, inlays, and cast gold. Annual failure rates in stress‑bearing posterior cavities ranged from 1.1% for compomers to 7.2% for regular glass ionomers, with indirect restorations showing a significantly lower mean annual failure rate than direct techniques (p=0.0031).

Abstract

This review provides a survey on the longevity of restorations in stress-bearing posterior cavities and assesses possible reasons for clinical failure. The dental literature, predominantly since 1990, was reviewed for longitudinal, controlled clinical studies and retrospective cross-sectional studies of posterior restorations. Only studies investigating the clinical performance of restorations in permanent teeth were included. Longevity and annual failure rates of amalgam, direct composite restorations, compomers, glass ionomers and derivative products, composite and ceramic inlays and cast gold restorations were determined for Class I and II cavities. Mean (SD) annual failure rates in posterior stress-bearing cavities are: 3.0% (1.9) for amalgam restorations, 2.2% (2.0) for direct composites, 3.6% (4.2) for direct composites with inserts, 1.1% (1.2) for compomer restorations, 7.2% (5.6) for regular glass ionomer restorations, 7.1% (2.8) for tunnel glass ionomers, 6.0% (4.6) for ART glass ionomers, 2.9% (2.6) for composite inlays, 1.9% (1.8) for ceramic restorations, 1.7% (1.6) for CAD/CAM ceramic restorations and 1.4% (1.4) for cast gold inlays and onlays. Publications from 1990 forward showed better results. Indirect restorations exhibited a significantly lower mean annual failure rate than direct techniques (p=0.0031). Longevity of dental restorations is dependent upon many different factors, including material, patient- and dentist-related. Principal reasons for failure were secondary caries, fracture, marginal deficiencies, wear and postoperative sensitivity. We need to learn to distinguish between reasons that cause early failures and those that are responsible for restoration loss after several years of service.