Clinical Performance of Direct Versus Indirect Composite Restorations in Posterior Teeth – A Systematic Review

Objectives: The aim of this systematic review was to compare the clinical performance of direct versus indirect composite restorations in posterior teeth.
Methods: The following databases were searched: PubMed CENTRAL (Until July 2015), MEDLINE and Cochrane Database of Systematic Reviews.Randomized controlled trials and clinical trials were included.The search identified 117 publications out of which a total of 13 articles fulfilled all criteria for inclusion.
Results: With the available evidence, this review concludes that 13 studies included in this review have high level of evidence .7 studies have a high risk of bias.4 studies reported no significant difference. 3 studies concluded that indirect inlays demonstrated significantly better clinical performance.5 studies have moderate risk of bias.3 studies reported no significant difference. 2 studies concluded that indirect inlays demonstrated significantly better anatomic form.1 study having a low risk of bias concluded that there was no significant difference between direct and indirect technique.
Conclusions: One study having a low risk of bias concluded that there was no significant difference between direct and indirect technique.Since the evidence is inconclusive, properly designed good quality randomized controlled studies with long term follow up must be performed to give concrete evidence on the clinical performance of direct and indirect composite restorations in posterior teeth.