Abstract Number 8
Category: Clinical Research
Award Category: Clinician
Clinical Survival and Performance of Premolars Restored with Direct or Indirect Cusp-Replacing Resin Composite Restorations with a Mean Follow-up of 14 Years
Jelte Hofsteengea*(j.w.hofsteenge@umcg.nl) | Willem Fennisb | Ruud Kuijsc | Mutlu Özcand | Marco Cunee | Marco Gresnigte | Cees Kreulenf
aDepartment of Restorative Dentistry and Biomaterials, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
bDepartment of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, Netherlands
cDepartment of Dental Materials Science, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
dDivision of Dental Biomaterials, Center for Dental Medicine, Clinic for Reconstructive Dentistry, University of Zürich, Zürich, Switzerland
eDepartment of Restorative Dentistry and Biomaterials, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
fDepartment of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
Objectives: This study aims to evaluate the long-term survival and clinical performance of direct and indirect composite restorations replacing cusps in vital maxillary premolars.
Methods: Between 2001 and 2007, 176 maxillary premolars in 157 patients were restored with 92 direct and 84 indirect resin composite restorations as part of an RCT. Vital maxillary premolars with buccal or palatal cusp fracture along with a class II cavity or restoration in the same tooth were included.
Results: Restorations were evaluated up to 2023. Forty patients having 23 direct and 22 indirect composite restorations respectively, were lost to follow up (25.6%). The cumulative Kaplan-Meier survival rates were 63.6% (mean observation time: 15.3 years, SE 5.6%) with an AFR of 2.4% for direct restorations and 54.5% (mean observation time: 13.9 years, SE: 6.4%) with an AFR of 3.3% for indirect restorations. The Cox regression analysis revealed a statistically significant influence of the patient’s age at placement on the survival of the restoration (HR 1.036, p = 0.024), the variables gender, type of maxillary premolar, type of restoration, and which cusp involved in the restoration had no statistically significant influence. Direct composite restorations failed predominantly due to tooth fracture, indirect restorations primarily by adhesive failure (p < 0.05).
Conclusions: There was no statistically significant difference in survival rates between direct and indirect
composite cusp-replacing restorations. Both direct and indirect resin composite cusp- replacing restorations are suitable options to restore compromised premolars. The longer treatment time and higher costs for the indirect restoration argue in favor of the direct technique.
Funding/Conflict of Interest: None
Keywords: adhesion, clinical performance, clinical study, composite materials, cusp-replacing, direct, indirect, restorative dentistry, success, survival
