title: Composite resin fillings and inlays. An 11-year evaluation Clinical study of indirect composite resin inlays in posterior stress-bearing cavities placed by dental students: results after 4 years. Direct and indirect evaluation of posterior composite restorations at three years. Randomized Control Trial of Composite Cuspal Restorations A randomized clinical trial of cusp-replacing resin composite restorations: efficiency and short-term effectiveness. Three-year clinical evaluation of direct and indirect composite restorations in posterior teeth. Cervical microleakage in MOD restorations: in vitro comparison of indirect and direct composite. Clinical evaluation of ceramic inlays compared to composite restorations. Clinical performance and marginal adaptation of class II direct and semidirect composite restorations over 3.5 years in vivo. Longitudinal clinical evaluation of bonded composite inlays: a 3-year study. Direct composite inlays versus conventional composite restorations: three-year clinical results
abstract: The purpose of this r and omized , clinical study was to evaluate the clinical performance of composite resin material s used for fillings and indirect inlays . Twenty-eight sets of five class II restorations ( two fillings , three inlays ) were placed in 88 premolars and 52 molars in 28 adults .  Brilliant Dentin and Estilux Posterior were used for both fillings and inlays , and SR-Isosit for inlays only . After 11 years , 27 sets of restorations ( 96 % ) were evaluated clinical ly using modified United States Public Health Service criteria . Replaced or repaired restorations were observed in 16 % of the fillings and 17 % of the inlays , and a further 5 % of the restorations were replaced for reasons not related to the restoration . The remaining 107 restorations exhibited optimal ratings in 30 % of the fillings and 12 % of the inlays ( P<0.05 ) and acceptable ratings in 70 % and 88 % , respectively . The reasons for failure were fracture of restoration ( four fillings , five inlays ) , secondary caries ( two fillings , four inlays ) , fracture of tooth ( two inlays ) , loss of proximal contact ( two fillings ) , and loss of restoration ( one inlay ) . Failures were seen more frequently in molar than premolar restorations ( P<0.05 ) , with no significant difference between fillings and inlays or between the five types of restoration ( P>0.05 ) OBJECTIVES This longitudinal r and omized controlled clinical trial evaluated the longevity of composite resin inlays in single- or multi-surface cavities up to 4 years . METHODS 21 dental students placed 75 Artglass and 80 Charisma composite resin inlays in class I and II cavities in posterior teeth ( 89 adult patients ) luted with dual-curing resin cements .  Clinical evaluation was performed up to 4 years using modified USPHS criteria . RESULTS 87.2 % of Artglass and 76.6 % of Charisma inlays were assessed to be clinical ly excellent or acceptable . Up to the 4-year recall 5 Artglass and 11 Charisma inlays failed mainly because of postoperative symptoms , bulk fracture , and loss of marginal integrity . No significant differences between both composite resin material s could be detected at 4 years for all clinical criteria ( Mann-Whitney U-test , p>0.05 ) . The comparison of restoration performance with time yielded a significant increase in marginal discolouration and postoperative symptoms ( p<0.05 ) , deterioration of surface texture quality , marginal and restoration integrity ( p<0.05 ) for both inlay systems . However , the changes were mainly effects of scoring shifts from alfa to bravo . Small inlays compared to large inlays and premolar restorations compared to molar restorations showed significant better outcome for some of the tested clinical parameters for the Artglass inlays ( p<0.05 ) . For Charisma inlays no such influences were revealed . CONCLUSIONS Clinical assessment of Artglass and Charisma composite resin inlays exhibited an annual failure rate of 3.2 % and 5.9 % that is within the range of published data . Within the limitations of this study indirect composite inlays are a competitive restorative procedure in stress-bearing preparations The purpose of this study was to compare the use of direct ( USPHS ) and indirect ( M-L ) systems of evaluating the  occlusal wear of posterior composite restorations . Additionally , this study has utilized the USPHS method to compare the in vivo performance of  posterior resin composite restorations made from four different visible-light-cured material s. Of the 202 restorations placed for this r and omized clinical trial , only those restorations that were scored by both direct and indirect evaluation systems were included in these comparisons . Restorations were evaluated by two calibrated examiners from baseline to 36 months . While there were some differences noted among the four material s , the majority ( 99 % ) of the restorations evaluated in this study received " alpha " or " bravo " scores for all USPHS parameters , indicating acceptable in vivo performance . The results of this study also indicate that there was a consistent relationship between the direct ( USPHS ) and indirect ( M-L scale ) scoring systems . For those restorations that changed anatomic form scores , the mean wear at the alfa/bravo transition was 100 + /- 80 microns . By the 24-month recall examination , the use of the USPHS evaluation system category of anatomic form enabled examiners to differentiate restorations and material s that had experienced little occlusal wear from those that had experienced greater amounts of wear The objective of this r and omized control trial was to compare the five-year clinical performance of direct and indirect resin composite restorations replacing cusps . In 157 patients , 176 restorations were made to restore maxillary premolars with Class II cavities and one missing cusp . Ninety-two direct and 84 indirect resin composite restorations  were placed by two operators , following a strict protocol . Treatment technique and operator were assigned r and omly . Follow-up period was at least 4.5 yrs . Survival rates were determined with time to reparable failure and complete failure as endpoints . Kaplan-Meier five-year survival rates were 86.6 % ( SE 0.27 % ) for reparable failure and 87.2 % ( SE 0.27 % ) for complete failure . Differences between survival rates of direct and indirect restorations [ 89.9 % ( SE 0.34 % ) vs. 83.2 % ( SE 0.42 % ) for reparable failure and 91.2 % ( SE 0.32 % ) vs. 83.2 % ( SE 0.42 % ) for complete failure ] were not statistically significant ( p = .23 for reparable failure ; p = .15 for complete failure ) . Mode of failure was predominantly adhesive . The results suggest that direct and indirect techniques provide comparable results over the long term ( trial registration number : IS RCT N29200848 ) PURPOSE This study aim ed to assess the efficacy and short-term effectiveness of the morphology and function of direct and indirect cusp-replacing resin composite restorations . MATERIAL S AND METHODS In 94 patients , 106 cusp-replacing restorations for maxillary premolars were fabricated to restore Class II caries lesions with 1 cusp missing . Fifty-four direct ( Clearfil AP-X ) and 52 indirect ( Estenia ) resin composite restorations were placed following a strict protocol . The treatment technique and operator were assigned r and omly . Treatment time was recorded for all restorations . One-month postoperative evaluation included assessment of postoperative sensitivity and presence of occlusal and proximal contacts . RESULTS Treatment time for the indirect technique ( 68 + /- 17 min ) was longer than for the direct technique ( 45 + /- 13 min ) . Regression analysis revealed that the restorative method , operator , and location of the preparation outline had a statistically significant effect on the total treatment time . Occlusal contacts were observed in 94 % of the direct restorations and in 98 % of the indirect restorations ( chi-square , P>.05 ) . Mesial proximal contacts were present in 98 % of the direct and in 97 % of the indirect restorations ( chi-square , P > .05 ) . Distal contacts were present in 100 % of the restorations for both techniques . Postoperative sensitivity within 1 week posttreatment was reported for 11 % of the direct restorations and for 13 % of the indirect restorations , but decreased to 4 % and 6 % , respectively , after 1 month ( chi-square , P > .05 ) . CONCLUSION The results of this study suggest that in the short term , both direct and indirect adhesive techniques are adequate to restore the morphology and function of premolars presenting with Class II caries lesions and a missing cusp STATEMENT OF THE PROBLEM Objective long-term clinical data are necessary to assess the performance of modern posterior composites as direct and indirect restorations . PURPOSE This prospect i ve , long-term clinical trial evaluated direct and indirect composite restorations for clinical acceptability as posterior restoratives in single or multisurface cavities and provided a survey on the 3-year results . MATERIAL AND METHODS Under the supervision of an experienced dentist , 9 dental students placed 88 composite restorations ( Tetric , blend-a-lux , Pertac-Hybrid Unifil ) , 43 direct composite restorations , and 45 indirect inlays .  Clinical evaluation was performed at baseline and in yearly intervals after placement by 2 other experienced dentists , using modified USPHS criteria . A third follow-up of 60 restorations took place within 33 to 36 months after placement . RESULTS A total of 93 % of indirect and 87 % of direct restorations were assessed to be clinical ly excellent or acceptable . During the third year , 1 direct restoration in a molar failed because of margin opening . Indirect inlays exhibited a significantly better anatomic form of the surface than direct composite restorations . Premolars revealed a significantly better marginal integrity and anatomic form of the surface than molars . Restorations in molars exhibited a significantly higher failure rate compared with premolars . CONCLUSION Posterior composite restorations provided a satisfactory clinical performance over a 3-year period , even if placed by relatively inexperienced but supervised students This study compared microleakage between  indirect composite inlays and direct composite restorations . Forty-eight st and ard inlay MOD cavities , with cervical margins located either in enamel or dentin , were prepared in extracted human third molars . The specimens were r and omly divided into 3 groups ( n=16 ) . In the control group , the cavities were restored with the composite Filtek Z250 ( 3 M ESPE ) . For the experimental groups , indirect restorations were made with the Artglass ( Heraeus-Kulzer ) or Belleglass HP ( Kerr Laboratories ) systems and cemented with the dual curing cement RelyX ARC ( 3 M ESPE ) . The adhesive system Single Bond ( 3 M ESPE ) was applied on all groups . The specimens were su bmi tted to thermolcycling , coated with nail varnish , then immersed in 2 % basic fuchsine aqueous solution for 24 hours . The teeth were then sectioned and leakage scores were evaluated ( 40x ) , based on a st and ard ranking . Data were su bmi tted to statistical analysis ( Mann-Whitney and Kruskal-Wallis tests ) with a 95 % confidence level . No statistical difference was found between substrates ( p=0.595 ) , and the material s performed similarly in dentin ( p=0.482 ) . Direct restorations showed higher leakage than indirect restorations at the enamel margins ( p=0.004 ) . Within the limitations of this experimental design , overall leakage was similar between both substrates , while the indirect systems provided a better sealing than direct composites only in enamel This study compared the clinical performance of  indirectly manufactured ceramic Evopress inlays with those of directly placed , fine particle hybrid Filtek Z250 composite restorations in posterior teeth . From January 2000 to October 2003 , 109 patients received 264 Evopress ( Wegold ) ceramic inlays and 68 patients received 145 Filtek Z250 ( 3 M ESPE ) composite restorations in a dental office . Two-hundred and fifty ceramic inlays ( 95 % ) and 135 composite restorations ( 93 % ) were re-examined up to 57 months after placement . Modified USPHS criteria were used for the study . The worst finding of all the assessment s was the overall assessment of individual restorations . On the basis of these criteria , 220 ( 88 % ) Evopress ceramic inlays were assessed as Alpha at the time of clinical re-examination , 26 ( 10 % ) were judged Beta and four ceramic inlays ( 2 % ) were rated Delta in the re-examination interval and thus categorized as failures . At the time of re-examination , 91 of the 135 composite restorations ( 67 % ) were judged Alpha , 36 restorations ( 26 % ) were rated Beta and three restorations ( 2 % ) were judged Charlie . Five restorations ( 4 % ) were categorized as failures ( Delta ) . In two cases , there were marginal gap formations ; there were also two cases of secondary caries after 28 and 35 months , as well as a fracture after 13 months . According to Kaplan and Meier , the survival rate after 57 months was 94 % for ceramic inlays and 93 % for composite restorations . The log rank test showed no significant differences in the survival curves . The current study showed that indirectly manufactured Evopress ceramic inlays performed better than direct Filtek Z250 composite restorations in marginal adaptation , color match and anatomic form . However , with regard to survival probability , there was no significant difference OBJECTIVE The study evaluated the clinical performance and marginal adaptation of  direct and semi-direct class II composite restorations  in a split-mouth design over 3.5 years . DESIGN 44 upper posterior teeth in 11 adults with primary carious lesions were treated with 22  direct and 22  semi-direct restorations . Conventional cavities were prepared for both types of restorations . A fine fine hybrid composite ( APH ) and a multifunctional adhesive system ( Prisma universal bond 3 ) were used for all restorations . The incremental " 3-sited light curing " technique was applied to direct restorations . Semi-direct inlays were prefabricated on silicone casts and post-cured using light and heat .  Clinical performance was evaluated using modified USPHS parameters , while marginal adaptation was judged on replicas , using SEM and a st and ardized evaluation technique . RESULTS Clinical results after 3.5 years revealed a 100 % retention rate with no fractures , sensitivity or recurrent caries for both types of restorations . SEM-evaluation of the occlusal margins showed at the tooth-restoration interface relatively low rates of marginal openings over the observation period ( 4 - 8 % ) . Marginal restoration fractures ranged between 1 and 2 % , marginal tooth fractures between 3 and 9 % . Differences between the restorative techniques and after the different time observation periods were not statistically significant . Proportions of marginal fractures and openings at the restoration-luting composite interface were less than 10 % after 3.5 years . CONCLUSION The results indicated no significant differences for direct and semi-direct fine hybrid composite restorations  in medium size cavities in posterior teeth with respect to clinical performance and marginal adaptation over 3.5 years OBJECTIVE The aims of this prospect i ve clinical study were ( 1 ) to evaluate the clinical performance of Signum composite inlays over a 3-year period ; ( 2 ) to investigate the clinical efficacy of  composite inlays in premolars versus molars ; and ( 3 ) to evaluate differences between 1- or 2-surface inlays and multisurface inlays . METHOD AND MATERIAL S One hundred thirteen composite inlays were placed in 30 patients by a clinician . All the inlays were made by the same laboratory technician using only one composite material ( Signum , Heraeus Kulzer ) . All the restorations were bonded with a 3-step bonding system and a composite luting cement . The restorations were assessed after placement by a clinician who had not been involved with the placement of the restorations , in accordance with the modified US Public Health Service criteria . RESULTS Three of the 113 experimental restorations had to be replaced ; the total failure rate was 2.6 % after 3 years . At baseline , 88.5 % to 100 % of the inlay restorations were rated as excellent ( Alpha ) . Statistically significant ( P < .05 ) differences were observed during the study for surface roughness , anatomic form at the margin , marginal integrity , and inlay integrity . The comparison of the clinical outcome of inlays in premolars versus molars and with 1 or 2 surfaces versus multisurfaces showed no significant differences , except for the parameters anatomic form at the margin and marginal integrity . CONCLUSION Composite inlays demonstrated a very high success rate ( 97.4 % ) after 3 years . Neither the size of the restorations nor the tooth type significantly affected the clinical outcome of the restorations A clinical trial of direct composite inlays versus conventionally ( incrementally ) placed restorations made from the same material was started in January 1989 . Restorations were r and omly allocated to matched pairs of cavities . This study reports the 3-year performance of 71 of the 100 pairs of restorations placed over a 2-year period and followed-up every 6 months .  Clinical assessment s were made using USPHS criteria ( indirect measurements of occlusal wear were made using Ivoclar st and ard dies ) and annual bite wing radiographs . Direct inlays showed significantly less occlusal wear than conventional restorations , but the difference was small . The clinical performance of both types of restoration was similar and compared favourably with studies of other material s. No secondary decay was diagnosed . The direct inlays , however , took longer to place and did not reduce postoperative sensitivity or failure rate ( 8 % failure of inlays and 4 % of conventional composites over 3 years ) . Contouring of proximal and occlusal aspects was not facilitated with direct inlays but may be easier with indirect inlays on removable
target: The difference of the two techniques did not reach statistical significance in order to recommend one technique over the other .
  CLINICAL SIGNIFICANCE Resin composite material s , placed directly or indirectly , exhibit a promising long-term clinical performance when rehabilitation of posterior teeth is needed .
background: OBJECTIVE To evaluate the long-term clinical performance of direct versus indirect composite inlays/onlays  in posterior teeth .
  Although many years in clinical practice , the selection of the best treatment protocol still remains subjective .