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

Abstract

Objectives: 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.

Methods: 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).

Results: 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.

Conclusions: 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.

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

Keywords: Direct resin composite; Polymer-infiltrated ceramic network; Randomized clinical trial; Tooth wear; Tooth wear rehabilitation.