Two-year clinical comparison of direct and indirect composite restorations in severely damaged molars: A split-mouth randomized clinical study.

OBJECTIVES

This randomized, split-mouth clinical study compared the clinical performance of direct restorations using a short fiber-reinforced composite veneered with a microhybrid composite and indirect CAD-CAM restorations fabricated from a hybrid CAD-CAM block in severely damaged molars.

METHODS

One hundred restorations in 42 patients-50 direct short fiber-reinforced composite restorations veneered with a microhybrid composite and 50 indirect CAD-CAM nanoceramic composite restorations-were randomly assigned to severely damaged molars in a split-mouth design; all restorations involved reconstruction of at least one cusp. All restorations were performed by a single qualified operator, and two independent calibrated examiners evaluated the restorations at baseline, 6 months, 1 year and 2 years using modified USPHS criteria. Patient satisfaction was also assessed at each evaluation.

RESULTS

After two years of follow-up, all restorations remained functional, resulting in a 100% survival rate. One indirect restoration experienced debonding one week after placement, which was successfully re-bonded and showed no further complications during follow-up. Both restorative approaches demonstrated excellent clinical performance across all USPHS criteria, with no significant differences between direct and indirect composite restorations.

CONCLUSIONS

Direct and indirect restorations showed high survival and success rates after 2 years. Patient satisfaction was high, with no significant difference between the two restorative approaches.

CLINICAL SIGNIFICANCE: At the 2-year follow-up, direct restorations based on short fiber-reinforced composite showed clinical results comparable to those of indirect CAD-CAM composite restorations in severely damaged molars.