TY  - INPR
N1  - © 2025 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
TI  - Direct restorations versus full crowns in endodontically treated molar teeth: A three-year randomized clinical trial
Y1  - 2025/05//
AV  - public
VL  - 156
JF  - Journal of Dentistry
A1  - Abu-Awwad, Motasum
A1  - Halasa, Ruba
A1  - Haikal, Laila
A1  - El-Ma'aita, Ahmad
A1  - Hammad, Mohammad
A1  - Petridis, Haralampos
KW  - Endodntically treated teeth
Composite resin restorations
KW  - 
Metal-ceramic crowns
KW  - 
Survival rate
KW  - 
Success rate
KW  - 
Randomized controlled trial
N2  - Objectives: To compare the survival and success rates of direct composite resin restorations versus metal-ceramic
crowns in endodontically treated molar teeth with minimal structure loss.
Methods: This clinical trial included 60 participants, each with an endodontically treated molar with at least three
remaining axial walls (>2mm). Half of the participants received direct restorations, and half metal-ceramic
crowns. USPHS criteria were used at baseline and annually for three years. Kaplan-Meier and log-rank tests
analyzed survival/success rates. Cox regression evaluated predictors, and Mann-Whitney U and Wilcoxon tests
compared USPHS outcomes.
Results: Fifty-three participants completed the 3-year follow-up (7 dropped out). The three-year survival rate for
crowns was 93.3 % (95 % CI: 78.7 %-98.2 %), while the direct restoration group had 76.7 % (95 % CI: 59.1
%-88.2 %). The difference was insignificant (P = 0.061). Success rates were also comparable (crowns=90.0 % vs.
restorations=76.7 %; P = 0.138). Bruxism significantly predicted failure (HR=12.8, 95 % CI: 1.2?133.3, P =
0.032). Direct restorations had worse outcomes than crowns regarding caries (P = 0.018), surface texture (P =
0.019), and marginal integrity (P = 0.006). Crowns had worse outcomes in terms of periodontal indices (P =
0.032) and presence of periapical infection (P = 0.023). Over time, direct restorations significantly deteriorated
in terms of caries (P = 0.041), margin discoloration (P = 0.007), margin integrity (P = 0.026), and fracture (P =
0.034), while crowns showed no significant changes.
Conclusion: For endodontically treated molars with minimal structure loss, both direct composite resin restorations and full crowns demonstrated similar survival and success after 3 years of function. However, crowns were
more predictable, especially for bruxers. Direct restorations may suit cases with lower occlusal loads, endodontic
monitoring, or budget constraints.
Clinical significance: This study showed similar 3-year survival/success rates of direct composite restorations
compared to metal-ceramic crowns in restoring endodontically treated molar teeth with minimal structural loss.
These results indicate that direct restorations may be suitable alternatives for molars with minimal structural
loss, particularly in cases with reduced occlusal loads, a need for endodontic monitoring, or financial limitations.
ID  - discovery10206564
UR  - https://doi.org/10.1016/j.jdent.2025.105699
PB  - Elsevier BV
SN  - 0300-5712
ER  -