CLINICAL AND MECHANICAL PERFORMANCE OF EXTENSIVE DIRECT RESTORATIONS AS AN ALTERNATIVE TO CROWNS IN ENDODONTICALLY TREATED POSTERIOR TEETH

Abstract

This article aimed to evaluate the clinical and biomechanical performance of extensive direct restorations as an alternative to crowns in endodontically treated posterior teeth. This is an integrative literature review, designed through searches in the PubMed/MEDLINE, Scopus, Web of Science, Embase, and VHL databases, selecting primary studies that compared direct adhesive resin approaches with indirect methods. The findings reveal that direct restorations present tooth survival and functional retention rates comparable to those of full crowns and endocrowns in the short and medium term. It was found that the amount of remaining sound coronal structure remains the main modulator of the prognosis, requiring cuspal coverage in cases of severe structural loss. Furthermore, fiber-reinforced composites (FRC) emerge as a promising biomimetic alternative, dissipating stresses and matching the cyclic fatigue resistance to that of indirect pieces, even though direct techniques demand a higher number of superficial clinical reinterventions. It is concluded that extensive direct restorations, when carefully and appropriately indicated, represent a highly conservative, viable therapeutic option with excellent biomechanical behavior.