Systematic Reviews Comparing Direct and Indirect Restorations: An Umbrella Review That Examines Restoration Type and Confidence in Results.

OBJECTIVES

There are two technologies for restoring individual structurally defective teeth. A direct restoration is applied chairside in one appointment, while an indirect restoration needs to be lab-produced before application. This umbrella review of previous English systematic reviews was conducted to determine if there was any difference between the two restoration types in adults regarding failure and the review methodological quality.

MATERIALS AND METHODS

On November 7, 2023, three databases (PubMed, Web of Science, and Cochrane) were searched for systematic reviews comparing direct and indirect restorations. Two researchers independently selected the studies and extracted the information from the full texts of the articles. The methodological quality of the reviews was assessed with the measurement tool to assess systematic reviews (AMSTAR-2) checklist.

RESULTS

Initially, 436 articles were identified; after screening, a total of 20 systematic reviews were included. Overall, the reviews indicated that both restorations produced similar results. There was a preference for direct restoration of small defects and indirect restoration for teeth with fewer than two remaining walls. Direct restoration was more cost and production-efficient, but indirect restoration offered better long-term results for larger defects. The overall confidence in the systematic review results ranged from critically low to high.

CONCLUSIONS

Either restoration is a valid option for restoring damaged teeth. The success of the restoration depends on the patient, operator, remaining tooth structure, and restoration material. Because of the high heterogeneity of patients, teeth, and material factors, there is no recommendation on the restoration type.