Abstract
Objectives
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.
Sources
PubMed, the Cochrane Library, Web of Science, Scopus, LILACS, BBO, ClinicalTrials.gov and SiGLE were searched without restrictions.
Study selection
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.
Data
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.
Conclusions
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.
Clinical significance
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.
1
Introduction
Direct and indirect resin composite restorations are widely used in contemporary dentistry to restore posterior teeth . Traditionally, the choice between the use of direct and indirect techniques for resin composites in posterior teeth is based on the size of the cavity to be restored. Small and medium cavities are usually restored with direct composite resin restorations. On the other hand, in large cavities, where the width of the isthmus exceeds two-thirds of the distance between facial and lingual cusp tips, indirect restorations become indicated . However, because of the evidence that direct resin composite restorations have properties suitable for use in posterior teeth , do not require invasive preparation and are made in only one session at low cost, many dentists are also using them in large cavities, making the clinical decision challenging .
Bis-GMA-based resin composites could have considerable polymerization linear shrinkage around 0.36–0.88% and volumetric shrinkage of about 1.5–3.4% . This phenomenon is a consequence of the reduction of intermolecular distances by creation of single covalent bonds between resin monomers during the formation of the polymer network. These volumetric changes may lead to the formation of local interfacial gaps and consequent microleakage . However, it is still not clear whether these gaps could exceed the clinically relevant width of around 60 μm at the outer margin of the restoration . The magnitude of this contraction depends on factors like resin matrix formulation, amount of filler used in the resin composite, degree of conversion and incremental filling technique . The stress generated by this polymerization shrinkage in direct resin composites is much higher than in indirect ones (13 times) . For indirect resin composite restorations, postcure using light, heat, pressure or atmosphere of nitrogen and the thin layer of adhesive cement help to relax the stress of the contraction of polymerization . The only shrinkage which may influence interfacial adaptation occurs in the cement layer . Thus, it is expected theoretically that the mechanical and physical properties and consequently the clinical performance of indirect resin composite restorations should be improved .
However, when both techniques are compared, in vitro and in vivo studies seem not to be unanimous regarding the best results of one technique over the other, including when it is used to restore large cavities in posterior teeth . Thus, the aim of the present systematic review (SR) and meta-analysis was to answer the following question focus: is there a difference in the clinical longevity of restorations performed of direct and indirect resin composite restorations in permanent posterior teeth?
2
Materials and methods
2.1
Protocol and registration
The study protocol was registered on the PROSPERO database ( http://www.crd.york.ac.uk ) under number CDR42015020210 on 05/06/2015 and we followed as closely as possible the preferred reporting items of systematic review and meta-analysis protocols (PRISMA-P) 2015 .
2.2
Eligibility criteria
The controlled vocabulary ( MeSH terms ) and free terms were used to define the search strategy ( Table 1 ) based on the elements of PICOS questions (S – study design ) as follows:
- 1.
Population (P): permanent posterior teeth of humans, with Class I or Class II cavities, with or without cusp involvement, from decay, exchange of pre-existing dental material or dental erosion.
- 2.
Intervention (I): indirect resin composite restorations
- 3.
Comparison (C): direct resin composite restorations
- 4.
Outcome (O): longevity of the direct and indirect resin composite restorations
- 5.
Study design (S): randomized clinical trial (RCTs) with at least two years of follow-up
| PubMed |
|---|
| #1Molar [MH] OR Molar [TIAB] OR Molars [TIAB] OR Bicuspid [MH] OR Bicuspid [TIAB] OR Premolar* [TIAB] OR Dentition, Permanent [MH] OR Permanent Dentition [TIAB] OR Tooth erosion [MH] OR Tooth erosion [TIAB] OR Erosive tooth wear [TIAB] OR Posterior teeth [TIAB] OR Posterior tooth [TIAB] OR Dental caries [MH] OR Dental caries [TIAB] OR Dental decay [TIAB] OR Class I [TIAB] OR Class II [TIAB] #2 Indirect composite resin* [TIAB] OR Indirect resin* [TIAB] OR Indirect posterior composite [TIAB] OR Indirect restoration* [TIAB] OR Indirect resin composite [TIAB] OR Indirect composite [TIAB] OR Indirect [TIAB] OR Inlays [MH] OR Inlays [TIAB] OR Inlay [TIAB] OR Overlay* [TIAB] OR Onlay* [TIAB] #3 (Composite resins [MH] OR Composite resins [TIAB] OR Composite resin [TIAB] OR Composite restorative materials [TIAB] OR Resin composit* [TIAB] OR Resin composite restoration* [TIAB] OR Posterior composite restoration*[TIAB] OR Resin-based composite*[TIAB] OR Tooth-colored restorat* [TIAB] OR Dental composite* [TIAB] OR Composite restoration* [TIAB]) Direct composite resin* [TIAB] OR Direct resin composite restoration* [TIAB] OR Direct composite restorations [TIAB] OR Direct posterior composite* [TIAB] OR Direct restoration* [TIAB] OR Direct resin composite [TIAB] OR Direct composite [TIAB] OR Direct [TIAB]) #1 AND #2 AND #3 |
| SCOPUS |
| #1 TITLE-ABS-KEY (“Molar” OR “Molars” OR “Bicuspid” OR “Premolar” OR “Premolars” OR “Permanent Dentition” OR “Tooth erosion” OR “Erosive tooth wear” OR “Posterior teeth” OR “Posterior tooth” OR “Dental caries” OR “Dental decay” OR “Class I” OR “Class II”) #2 TITLE-ABS-KEY (“Indirect composite resin” OR “Indirect composite resins” OR “Indirect resin” OR “Indirect resins” OR “Indirect posterior composite” OR “Indirect restoration” OR “Indirect restorations” OR “Indirect resin composite” OR “Indirect composite” OR “Indirect” OR “Inlay” OR “Inlays” OR “Overlay” OR “Overlays” OR “Onlay” OR “Onlays”) #3 TITLE-ABS-KEY (“Composite resins” OR “Composite resin” OR “Composite restorative materials” OR “Resin composite” OR “Resin composites” OR “Resin composite restoration” OR “Resin composite restorations” OR “Posterior composite restoration” OR “Posterior composite restorations” OR “Resin-based composite” OR “Resin-based composites” OR “Tooth-colored restoration” OR “Tooth-colored restorations” OR “Dental composite” OR “Dental composites” OR “Composite restoration” OR “Composite restorations”) AND (“Direct composite resin” OR “Direct composite resins” OR “Direct resin composite restoration” OR “Direct resin composite restorations” OR “Direct composite restorations” OR “Direct posterior composite” OR “Direct posterior composites” OR “Direct restoration” OR “Direct restorations” OR “Direct resin composite” OR “Direct composite” OR “Direct”) #1 AND #2 AND #3 |
| Web of Science |
| #1 Topic: (“Molar” OR “Molars” OR “Bicuspid” OR “Premolar” OR “Premolars” OR “Permanent Dentition” OR “Tooth erosion” OR “Erosive tooth wear” OR “Posterior teeth” OR “Posterior tooth” OR “Dental caries” OR “Dental decay” OR “Class I” OR “Class II”) #2 Topic: (“Indirect composite resin” OR “Indirect composite resins” OR “Indirect resin” OR “Indirect resins” OR “Indirect posterior composite” OR “Indirect restoration” OR “Indirect restorations” OR “Indirect resin composite” OR “Indirect composite” OR “Indirect” OR “Inlay” OR “Inlays” OR “Overlay” OR “Overlays” OR “Onlay” OR “Onlays”) #3 Topic: (“Composite resins” OR “Composite resin” OR “Composite restorative materials” OR “Resin composite” OR “Resin composites” OR “Resin composite restoration” OR “Resin composite restorations” OR “Posterior composite restoration” OR “Posterior composite restorations” OR “Resin-based composite” OR “Resin-based composites” OR “Tooth-colored restoration” OR “Tooth-colored restorations” OR “Dental composite” OR “Dental composites” OR “Composite restoration” OR “Composite restorations”) AND (“Direct composite resin” OR “Direct composite resins” OR “Direct resin composite restoration” OR “Direct resin composite restorations” OR “Direct composite restorations” OR “Direct posterior composite” OR “Direct posterior composites” OR “Direct restoration” OR “Direct restorations” OR “Direct resin composite” OR “Direct composite” OR “Direct”) |
| Cochrane Library |
| ID Search Hits #1 MeSH descriptor: [Molar] explode all trees #2 molar #3 molars #4 #1 or #2 or #3 #5 MeSH descriptor: [Bicuspid] explode all trees #6 bicuspid #7 premolar* #8 #5 or #6 or #7 #9 MeSH descriptor: [Dentition, Permanent] explode all trees #10 dentition, permanent #11 permanent dentition #12 #9 or #10 or #11 #13 MeSH descriptor: [Tooth Erosion] explode all trees #14 tooth erosion #15 erosive tooth wear #16 #13 or #14 or #15 #17 posterior tooth or posterior teeth #18 MeSH descriptor: [Dental Caries] explode all trees #19 dental caries #20 dental decay #21 #18 or #19 or #20 #22 “class I” or “class II” #23 #4 or #8 or #12 or #16 or #17 or #21 or #22 #24 Indirect composite resin* or Indirect resin* or Indirect restoration* or Indirect resin composite or Indirect composite or Indirect #25 Indirect posterior composite #26 #24 or #25 #27 MeSH descriptor: [Inlays] explode all trees #28 inlays #29 inlay #30 overlay or overlays or onlay* #31 #27 or #28 or #29 or #30 #32 #26 or #31 #33 MeSH descriptor: [Composite Resins] explode all trees #34 composite resins #35 composite resin or Resin composit* or Resin composite restoration* or Resin-based composite* or Tooth-colored restorat* or Dental composite* or Composite restoration* #36 Composite restorative materials #37 #33 or #34 or #35 or #36 #38 Direct composite resin* or Direct resin composite restoration* or Direct composite restorations or Direct posterior composite* or Direct composite or Direct #39 #37 and #38 #40 #23 and #32 and #39 |
| LILACS and BBO |
| #1 TW:(MH:molar OR diente molar OR dente molar OR molars OR dientes molares OR dentes molares OR MH:bicuspid OR diente premolar OR dente pré-molar OR dentición permanente OR dentição permanente OR MH: dentition, permanente OR MH:tooth erosion OR erosión de los dientes OR erosão dentária OR MH:dental caries OR cáries dental OR cárie dentária OR caries decay OR posterior tooth OR diente posterior OR dente posterior OR posterior teeth OR dientes posteriores OR dentes posteriores OR class I OR clase I OR classe I OR class II OR clase II OR classe II) #2 TW:(MH:Composite resins OR Resinas compuestas OR Resinas compostas OR Composite resin OR Composite resins OR Composite restorative materials OR Resin composit$ OR Resina composta$ OR Resin composite restoration$ OR Posterior composite restoration$ OR Resin-based composite$ OR Tooth-colored restorat$ OR Dental composite$ OR Compuesto dental$ OR Compósito dental$ OR Composite restoration$ OR Restauración de compusto$ OR Restauração de compósito$ OR Direct composite resin$ OR Direct resin composite restoration$ OR Direct composite restorations OR Direct restoration$ OR Restaración directa$ OR Restauração direta$ OR Direct composite OR Compuesto directo OR Compósito direto OR Direct OR Directa OR Direta) #1 AND #2 |
| Clinical trials.gov |
| Posterior teeth and Inlay and Direct composite resin |
| Sigle |
| (Molar OR Molars OR Bicuspid OR Premolar OR Premolars OR “Class I” OR “Class II”) AND (“Indirect composite resin*” OR “Indirect resin*” OR “Indirect restoration*” OR Indirect OR Inlay OR Inlays OR Overlay OR Overlays OR Onlay OR Onlays) AND (“Composite resin*” OR “Resin composite*” OR “Resin composite restoration*” OR “Tooth-colored restoration*” OR “Dental composite*” OR “Composite restoration*”) |
Only RCTs that compared the longevity of direct and indirect resin composite restorations in Class I or Class II cavities with or without cusp involvement and with at least two years of follow-up were selected and included. There were no restrictions regarding setting, language or year of publication.
The failure rate of direct and indirect resin composite restorations in posterior teeth was the primary outcome. Secondly, the failure rate in a subgroup that compared direct resin composite (DRC) with indirect resin composite (IRC) and direct composite resins (DRC) and direct inlay/onlay restorations (DIO) was evaluated, along with whether the type of teeth, bruxism and risk of caries have some effect of clinical longevity of the resin composite restorations.
2.3
Exclusion criteria
Non-controlled clinical trials, case reports, series of cases, reviews, abstracts, in vitro studies, observational studies, discussions, interviews, editorial and expert opinion were excluded. Additionally, studies that do not relate to the issue because they were conducted in relation to another type of cavity, cavities extending to the root surface, restorations of anterior teeth, deciduous teeth, not vital tooth and tooth without antagonist were also excluded.
2.4
Information sources and search
The literature search strategy was developed using a combination of MeSH terms with free terms most frequently cited in published literature related to direct and indirect resin composite restorations in posterior teeth. The search process was performed by two independent researchers (A.M.A.V and A.C.C) under the guidance of an expert librarian (D.T.P.F). The search strategies were adapted according to the requirement of the base researched and are described individually ( Table 1 ). The terms were searched in the fields Title and Abstract without application of any filter or limit regards to the idiom. For manuscripts in idioms other than English (such as Spanish, French and Portuguese), there was at least one researcher in the team to translate them. The last update was performed on August 18, 2015 and the following electronic databases were searched: MEDLINE via PubMed, Cochrane Library, Web of Science, Scopus, Latin American and Caribbean Health Sciences (LILACS) and the Brazilian Library of Dentistry (BBO). To locate unpublished and ongoing clinical trials related to the review question we follow the website ClinicalTrials.gov ( www.clinicaltrial.gov ), and the grey literature was explored using the database System for Information on Grey Literature in Europe (SIGLE) ( Table 1 ).
2.5
Study collection and data collection process
All references were collected in web software ( www.myendnoteweb.com ) during the selection process. Articles were selected by title and abstract and when appearing in more than one database they were considered only once. When there was insufficient information in the title and abstract, full-text articles were obtained to make a clear decision. Two of the reviewers (A.M.A.V and A.C.C) classified those who met the inclusion criteria. If multiple reports of the same study were identified but with, for example, a different follow-up, only the report with the longer follow-up was considered to avoid overlapping data. However, in the case of doubts regarding methodology, the article that gave rise to the study series was accessed or its authors were consulted. We hand-searched the reference lists of the selected articles in order to find any studies that had not been identified by the electronic search strategy. Selected articles about which the two authors did not agree were included or excluded in a consensus meeting with a third author (L.C.M), following the predefined eligibility criteria.
Each study was identified by ID, combining the first author and year of publication. A pilot test was conducted using a sample of study reports to verify that the eligibility criteria were consistent with the research question. The following details were extracted by customized forms based on recommendations by Cochrane Handbook 5.0.2 ( www.handbook.cochrane.org ):
- •
Details of the sources including first researcher, year of publication and reviewer’s identification.
- •
Details of eligibility including study design, population, intervention, control and follow-up.
- •
Details of participants including number of restorations per group, age and gender.
- •
Details of intervention and control including type of intervention, material and technique used and time spent until the outcome.
- •
Details of outcomes including success and failure rates, and number of and reasons for dropouts.
In addition, information was extracted about source of funding and number of attempts to contact the authors, if necessary (up to three attempts in over a period of two months through the electronic means available). When the corresponding authors did not answer the researchers, the same number of attempts were made to contact other co-authors.
2.6
Risk of bias in individual studies
Qualitative analysis of the studies was carried out using the Collaboration’s tool for assessing risk of bias in RCTs. Due to the methodological characteristics of the studies, only four domains were considered key domains for the assessment of the risk of bias: sequence generation, allocation concealment, incomplete outcome data and selective outcome reporting. Blinding of participants, personnel and outcome assessors was not considered key due to the specific characteristics of the studies that compare direct and indirect restorations.
The risk of bias for each entry recording was judged as ‘no’ to indicate high risk of bias, ‘yes’ to indicate low risk bias and ‘unclear’ to indicate either lack of information or uncertainty over the potential risk of bias. When a study was judged as ‘unclear’ in any of fields, contact with the authors by electronic message was made in order to obtain more information and to enable the judgment of low or high risk of bias. During the extraction of the data, in the case of disagreements between reviewers, these were resolved through discussion with an experienced researcher (L.C.M).
2.7
Summary measures and synthesis of the results
A meta-analysis was performed using the Comprehensive Meta-Analysis software (version 3.2, Biostat, Englewood, USA) to assess differences in the clinical longevity of direct and indirect resin composite restorations. The studies showed that failure rates for each group and the total number of teeth were included in the meta-analysis. Since the studies had the same follow-up, failure rates were obtained and pooled in the meta-analysis according to the follow-up. The overall failure rate was only computed for studies that had a follow-up of five years. In addition to the general rate, two subgroups were created for comparing analysis: (i) direct resin composite (DRC) against indirect resin composite (IRC) and (ii) DRC against direct inlay/onlay (DIO) based on five years of follow-up. A final analysis was performed comparing the clinical performance of the DRC against the IRC in molars and premolars at three-year follow-up.
A fixed effects model was employed. Heterogeneity was assessed using the Inconsistency Index (I 2 ) and the relative risk was also calculated (p < 0.05). The I 2 describes the percentages of total variation across studies that are due to heterogeneity rather than chance . When necessary, sensitivity analysis and subgroup analysis were used.
2
Materials and methods
2.1
Protocol and registration
The study protocol was registered on the PROSPERO database ( http://www.crd.york.ac.uk ) under number CDR42015020210 on 05/06/2015 and we followed as closely as possible the preferred reporting items of systematic review and meta-analysis protocols (PRISMA-P) 2015 .
2.2
Eligibility criteria
The controlled vocabulary ( MeSH terms ) and free terms were used to define the search strategy ( Table 1 ) based on the elements of PICOS questions (S – study design ) as follows:
- 1.
Population (P): permanent posterior teeth of humans, with Class I or Class II cavities, with or without cusp involvement, from decay, exchange of pre-existing dental material or dental erosion.
- 2.
Intervention (I): indirect resin composite restorations
- 3.
Comparison (C): direct resin composite restorations
- 4.
Outcome (O): longevity of the direct and indirect resin composite restorations
- 5.
Study design (S): randomized clinical trial (RCTs) with at least two years of follow-up
| PubMed |
|---|
| #1Molar [MH] OR Molar [TIAB] OR Molars [TIAB] OR Bicuspid [MH] OR Bicuspid [TIAB] OR Premolar* [TIAB] OR Dentition, Permanent [MH] OR Permanent Dentition [TIAB] OR Tooth erosion [MH] OR Tooth erosion [TIAB] OR Erosive tooth wear [TIAB] OR Posterior teeth [TIAB] OR Posterior tooth [TIAB] OR Dental caries [MH] OR Dental caries [TIAB] OR Dental decay [TIAB] OR Class I [TIAB] OR Class II [TIAB] #2 Indirect composite resin* [TIAB] OR Indirect resin* [TIAB] OR Indirect posterior composite [TIAB] OR Indirect restoration* [TIAB] OR Indirect resin composite [TIAB] OR Indirect composite [TIAB] OR Indirect [TIAB] OR Inlays [MH] OR Inlays [TIAB] OR Inlay [TIAB] OR Overlay* [TIAB] OR Onlay* [TIAB] #3 (Composite resins [MH] OR Composite resins [TIAB] OR Composite resin [TIAB] OR Composite restorative materials [TIAB] OR Resin composit* [TIAB] OR Resin composite restoration* [TIAB] OR Posterior composite restoration*[TIAB] OR Resin-based composite*[TIAB] OR Tooth-colored restorat* [TIAB] OR Dental composite* [TIAB] OR Composite restoration* [TIAB]) Direct composite resin* [TIAB] OR Direct resin composite restoration* [TIAB] OR Direct composite restorations [TIAB] OR Direct posterior composite* [TIAB] OR Direct restoration* [TIAB] OR Direct resin composite [TIAB] OR Direct composite [TIAB] OR Direct [TIAB]) #1 AND #2 AND #3 |
| SCOPUS |
| #1 TITLE-ABS-KEY (“Molar” OR “Molars” OR “Bicuspid” OR “Premolar” OR “Premolars” OR “Permanent Dentition” OR “Tooth erosion” OR “Erosive tooth wear” OR “Posterior teeth” OR “Posterior tooth” OR “Dental caries” OR “Dental decay” OR “Class I” OR “Class II”) #2 TITLE-ABS-KEY (“Indirect composite resin” OR “Indirect composite resins” OR “Indirect resin” OR “Indirect resins” OR “Indirect posterior composite” OR “Indirect restoration” OR “Indirect restorations” OR “Indirect resin composite” OR “Indirect composite” OR “Indirect” OR “Inlay” OR “Inlays” OR “Overlay” OR “Overlays” OR “Onlay” OR “Onlays”) #3 TITLE-ABS-KEY (“Composite resins” OR “Composite resin” OR “Composite restorative materials” OR “Resin composite” OR “Resin composites” OR “Resin composite restoration” OR “Resin composite restorations” OR “Posterior composite restoration” OR “Posterior composite restorations” OR “Resin-based composite” OR “Resin-based composites” OR “Tooth-colored restoration” OR “Tooth-colored restorations” OR “Dental composite” OR “Dental composites” OR “Composite restoration” OR “Composite restorations”) AND (“Direct composite resin” OR “Direct composite resins” OR “Direct resin composite restoration” OR “Direct resin composite restorations” OR “Direct composite restorations” OR “Direct posterior composite” OR “Direct posterior composites” OR “Direct restoration” OR “Direct restorations” OR “Direct resin composite” OR “Direct composite” OR “Direct”) #1 AND #2 AND #3 |
| Web of Science |
| #1 Topic: (“Molar” OR “Molars” OR “Bicuspid” OR “Premolar” OR “Premolars” OR “Permanent Dentition” OR “Tooth erosion” OR “Erosive tooth wear” OR “Posterior teeth” OR “Posterior tooth” OR “Dental caries” OR “Dental decay” OR “Class I” OR “Class II”) #2 Topic: (“Indirect composite resin” OR “Indirect composite resins” OR “Indirect resin” OR “Indirect resins” OR “Indirect posterior composite” OR “Indirect restoration” OR “Indirect restorations” OR “Indirect resin composite” OR “Indirect composite” OR “Indirect” OR “Inlay” OR “Inlays” OR “Overlay” OR “Overlays” OR “Onlay” OR “Onlays”) #3 Topic: (“Composite resins” OR “Composite resin” OR “Composite restorative materials” OR “Resin composite” OR “Resin composites” OR “Resin composite restoration” OR “Resin composite restorations” OR “Posterior composite restoration” OR “Posterior composite restorations” OR “Resin-based composite” OR “Resin-based composites” OR “Tooth-colored restoration” OR “Tooth-colored restorations” OR “Dental composite” OR “Dental composites” OR “Composite restoration” OR “Composite restorations”) AND (“Direct composite resin” OR “Direct composite resins” OR “Direct resin composite restoration” OR “Direct resin composite restorations” OR “Direct composite restorations” OR “Direct posterior composite” OR “Direct posterior composites” OR “Direct restoration” OR “Direct restorations” OR “Direct resin composite” OR “Direct composite” OR “Direct”) |
| Cochrane Library |
| ID Search Hits #1 MeSH descriptor: [Molar] explode all trees #2 molar #3 molars #4 #1 or #2 or #3 #5 MeSH descriptor: [Bicuspid] explode all trees #6 bicuspid #7 premolar* #8 #5 or #6 or #7 #9 MeSH descriptor: [Dentition, Permanent] explode all trees #10 dentition, permanent #11 permanent dentition #12 #9 or #10 or #11 #13 MeSH descriptor: [Tooth Erosion] explode all trees #14 tooth erosion #15 erosive tooth wear #16 #13 or #14 or #15 #17 posterior tooth or posterior teeth #18 MeSH descriptor: [Dental Caries] explode all trees #19 dental caries #20 dental decay #21 #18 or #19 or #20 #22 “class I” or “class II” #23 #4 or #8 or #12 or #16 or #17 or #21 or #22 #24 Indirect composite resin* or Indirect resin* or Indirect restoration* or Indirect resin composite or Indirect composite or Indirect #25 Indirect posterior composite #26 #24 or #25 #27 MeSH descriptor: [Inlays] explode all trees #28 inlays #29 inlay #30 overlay or overlays or onlay* #31 #27 or #28 or #29 or #30 #32 #26 or #31 #33 MeSH descriptor: [Composite Resins] explode all trees #34 composite resins #35 composite resin or Resin composit* or Resin composite restoration* or Resin-based composite* or Tooth-colored restorat* or Dental composite* or Composite restoration* #36 Composite restorative materials #37 #33 or #34 or #35 or #36 #38 Direct composite resin* or Direct resin composite restoration* or Direct composite restorations or Direct posterior composite* or Direct composite or Direct #39 #37 and #38 #40 #23 and #32 and #39 |
| LILACS and BBO |
| #1 TW:(MH:molar OR diente molar OR dente molar OR molars OR dientes molares OR dentes molares OR MH:bicuspid OR diente premolar OR dente pré-molar OR dentición permanente OR dentição permanente OR MH: dentition, permanente OR MH:tooth erosion OR erosión de los dientes OR erosão dentária OR MH:dental caries OR cáries dental OR cárie dentária OR caries decay OR posterior tooth OR diente posterior OR dente posterior OR posterior teeth OR dientes posteriores OR dentes posteriores OR class I OR clase I OR classe I OR class II OR clase II OR classe II) #2 TW:(MH:Composite resins OR Resinas compuestas OR Resinas compostas OR Composite resin OR Composite resins OR Composite restorative materials OR Resin composit$ OR Resina composta$ OR Resin composite restoration$ OR Posterior composite restoration$ OR Resin-based composite$ OR Tooth-colored restorat$ OR Dental composite$ OR Compuesto dental$ OR Compósito dental$ OR Composite restoration$ OR Restauración de compusto$ OR Restauração de compósito$ OR Direct composite resin$ OR Direct resin composite restoration$ OR Direct composite restorations OR Direct restoration$ OR Restaración directa$ OR Restauração direta$ OR Direct composite OR Compuesto directo OR Compósito direto OR Direct OR Directa OR Direta) #1 AND #2 |
| Clinical trials.gov |
| Posterior teeth and Inlay and Direct composite resin |
| Sigle |
| (Molar OR Molars OR Bicuspid OR Premolar OR Premolars OR “Class I” OR “Class II”) AND (“Indirect composite resin*” OR “Indirect resin*” OR “Indirect restoration*” OR Indirect OR Inlay OR Inlays OR Overlay OR Overlays OR Onlay OR Onlays) AND (“Composite resin*” OR “Resin composite*” OR “Resin composite restoration*” OR “Tooth-colored restoration*” OR “Dental composite*” OR “Composite restoration*”) |
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