title: Longevity of direct and indirect resin composite restorations in permanent posterior teeth: A systematic review and meta-analysis.
abstract: The aim of this systematic review and meta-analysis was to assess the differences in clinical performance in direct and indirect resin composite restorations in permanent posterior teeth.
  
  
  
  PubMed, the Cochrane Library, Web of Science, Scopus, LILACS, BBO, ClinicalTrials.gov and SiGLE were searched without restrictions.
  
  
  
  We included randomized clinical trials (RCTs) that compared the clinical performance of direct and indirect resin composite restorations in Class I and Class II cavities in permanent teeth, with at least two years of follow-up. The risk of bias tool suggested by Cochrane Collaboration was used for quality assessment.
  
  
  
  After duplicate removal, 912 studies were identified. Twenty fulfilled the inclusion criteria after the abstract screening. Two articles were added after a hand search of the reference list of included studies. After examination, nine RCTs were included in the qualitative analysis and five were considered to have a 'low' risk of bias. The overall risk difference in longevity between direct and indirect resin composite restorations in permanent posterior teeth (p>0.05) at five-year follow-up was 1.494 [0.893-2.500], and regardless of the type of tooth restored, that of molar and premolars was 0.716 [0.177-2.888] at three-year follow-up.
  
  
  
  Based on the findings, there was no difference in longevity of direct and indirect resin composite restorations regardless of the type of material and the restored tooth.
  
  
  
  Contemporary dentistry is based on minimally invasive restorations. Any indication of a less conservative technique must have unquestionable advantages. In vitro and in vivo studies reveal contradictory evidence of the clinical performance of direct and indirect resin composite restorations in posterior teeth. Thus this study clarified this doubt.
authors: Department of Prosthodontics and Dental Materials, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Prédio do CCS, Bloco K, Ilha da Cidade Universitária, Rio de Janeiro, Brazil.
authors: Ana Maria Antonelli
authors: AM
authors: da Veiga
authors: Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Prédio do CCS, Bloco K, Ilha da Cidade Universitária, Rio de Janeiro, Brazil.
authors: Amanda Carneiro
authors: AC
authors: Cunha
authors: Center of Health Science, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Prédio do CCS, Bloco I, Ilha da Cidade Universitária, Rio de Janeiro, Brazil.
authors: Daniele Masterson Tavares Pereira
authors: DM
authors: Ferreira
authors: Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Prédio do CCS, Bloco K, Ilha da Cidade Universitária, Rio de Janeiro, Brazil.
authors: Tatiana Kelly
authors: TK
authors: da Silva Fidalgo
authors: Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Prédio do CCS, Bloco K, Ilha da Cidade Universitária, Rio de Janeiro, Brazil.
authors: Thomaz Kauark
authors: TK
authors: Chianca
authors: Department of Prosthodontics and Dental Materials, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Prédio do CCS, Bloco K, Ilha da Cidade Universitária, Rio de Janeiro, Brazil.
authors: Kátia Rodrigues
authors: KR
authors: Reis
authors: Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Prédio do CCS, Bloco K, Ilha da Cidade Universitária, Rio de Janeiro, Brazil. Electronic address: rorefa@terra.com.br.
authors: Lucianne Cople
authors: LC
authors: Maia
mesh_terms: D003188:Composite Resins; D003731:Dental Caries; D003793:Dental Restoration, Permanent; D019229:Dentition, Permanent; D006801:Humans; D008963:Molar
chemical_list: D003188:Composite Resins
keywords: Direct composite; Inlay; Longevity; Meta-analysis; Resin composite restoration; Systematic review