eprintid: 10206564 rev_number: 7 eprint_status: archive userid: 699 dir: disk0/10/20/65/64 datestamp: 2025-03-27 08:52:29 lastmod: 2025-03-27 08:52:29 status_changed: 2025-03-27 08:52:29 type: article metadata_visibility: show sword_depositor: 699 creators_name: Abu-Awwad, Motasum creators_name: Halasa, Ruba creators_name: Haikal, Laila creators_name: El-Ma'aita, Ahmad creators_name: Hammad, Mohammad creators_name: Petridis, Haralampos title: Direct restorations versus full crowns in endodontically treated molar teeth: A three-year randomized clinical trial ispublished: inpress divisions: UCL divisions: B02 divisions: C10 divisions: D21 divisions: H09 keywords: Endodntically treated teeth Composite resin restorations, Metal-ceramic crowns, Survival rate, Success rate, Randomized controlled trial note: © 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/). abstract: 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. date: 2025-05 date_type: published publisher: Elsevier BV official_url: https://doi.org/10.1016/j.jdent.2025.105699 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2373906 doi: 10.1016/j.jdent.2025.105699 lyricists_name: Petridis, Charalampos lyricists_id: HPETR54 actors_name: Petridis, Charalampos actors_id: HPETR54 actors_role: owner full_text_status: public publication: Journal of Dentistry volume: 156 article_number: 105699 issn: 0300-5712 citation: Abu-Awwad, Motasum; Halasa, Ruba; Haikal, Laila; El-Ma'aita, Ahmad; Hammad, Mohammad; Petridis, Haralampos; (2025) Direct restorations versus full crowns in endodontically treated molar teeth: A three-year randomized clinical trial. Journal of Dentistry , 156 , Article 105699. 10.1016/j.jdent.2025.105699 <https://doi.org/10.1016/j.jdent.2025.105699>. (In press). Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10206564/1/2025_RCT%20crowns%20vs%20composites%20J%20Dent.pdf