Clinical results and new developments of direct posterior restorations.
OBJECTIVE
To (1) review the literature and analyze the longevity and reasons for failure of direct resin-based composite (RBC), amalgam, and glass-ionomer cement (GIC) restorations in stress-bearing posterior cavities and (2) to assess new material developments and treatment techniques to restore these cavities.


METHODS
This work reviewed the dental literature predominately of the last decade for longitudinal, controlled clinical studies and retrospective cross-sectional studies. Only studies investigating the clinical performance of restorations in permanent teeth were included. Annual failure rates of direct resin-based composite, amalgam, and GIC restorations were determined and failure reasons were discussed.


RESULTS
Annual failure rates in posterior stress-bearing cavities were determined to be: 0-9% for direct RBC restorations, 0-7% for amalgam restorations, and 1.9-14.4% for GIC restorations. The median annual failure rate of longitudinal studies for amalgam was calculated with 1.1%, for RBCs 2.1% and for GICs 7.7%. GIC is significantly worse compared with amalgam and RBC. Main reasons for failure were secondary caries, marginal deficiencies, fracture, and wear. Longitudinal studies showed a strong trend towards a higher longevity compared with cross-sectional investigations.
Hickel
R
R
Department of Restorative Dentistry and Periodontology, Ludwig-Maximilians-University, Munich, Germany. hickel@dent.med.uni-muenchen.de
Manhart
J
J
García-Godoy
F
F
D003188:Composite Resins / Q000737:chemistry; D018849:Controlled Clinical Trials as Topic; D003430:Cross-Sectional Studies; D003723:Dental Amalgam / Q000737:chemistry; D003731:Dental Caries / Q000209:etiology; D003737:Dental Cavity Preparation / Q000145:classification; D018772:Dental Marginal Adaptation; D003764:Dental Materials / Q000737:chemistry*; D019232:Dental Restoration Failure; D019554:Dental Restoration Wear; D003793:Dental Restoration, Permanent / Q000145:classification / Q000379:methods; D005899:Glass Ionomer Cements / Q000737:chemistry; D006801:Humans; D008137:Longitudinal Studies; D012008:Recurrence; D012189:Retrospective Studies; D013314:Stress, Mechanical; D013499:Surface Properties; D016019:Survival Analysis; D013997:Time Factors
D003188:Composite Resins; D003764:Dental Materials; D005899:Glass Ionomer Cements; D003723:Dental Amalgam