Longevity of defective direct restorations treated by minimally invasive techniques or complete replacement in permanent teeth: A systematic review.

OBJECTIVES: This systematic review aimed to verify if there is difference in the longevity of minimally invasive techniques compared to the complete replacement for the treatment of defective direct restorations in permanent teeth. DATA: The data included randomized controlled clinical trials comparing the clinical performance of defective dental restorations treated by a complete replacement technique or minimally invasive techniques on permanent teeth. Evaluation of the risk of bias was performed using the Cochrane Collaboration common scheme for bias and the evidence was qualified using the GRADE tool. SOURCE: A comprehensive search was performed in the electronic databases: PubMed, Scopus, ISI Web of Science, The Cochrane Library, LILACS, BBO, SIGLE, followed by manual search in the reference lists of the included studies, without any restrictions. STUDY SELECTION: From 5554 retrieved studies, 10 met the eligibility criteria and were submitted to data extraction and quality assessment. The repair technique presented similar results to replacement and superior results when compared to sealing. In addition, refurbishment demonstrated to be a useful treatment for localized anatomical form defects. All the studies presented low risk of bias and high quality evidence for repair and refurbishment and moderate for the sealing technique. CONCLUSIONS: The direct restorations treated by the repair, seal and refurbishment techniques did not present a significant difference in clinical longevity in comparison to the replacement technique in permanent teeth with overall moderate quality of evidence. CLINICAL SIGNIFICANCE: The present findings demonstrated that the best treatment for defective restorations is conservative management. The evidence demonstrated here helps and encourages clinicians during the decision-making process. Moreover, it suggests not replacing imperfect restorations, but to managing them in a minimally invasive way, allowing the structure to be preserved.