Restorative options for moderate and severe tooth wear: A systematic review

Objectives: This systematic review aimed to evaluate the failure of different types of restorative treatments for tooth wear. Study design: A search was conducted in Medline, Cochrane, Web of Science, SCOPUS, and Embase (October 2023) with no limits for publication year or language. Randomized and non-randomized studies comparing restorative options to treat moderate to severe tooth wear were included. Two reviewers independently selected studies, extracted data and assessed the risk of bias. Failure data was obtained from each study and organised into either 'major failure,' with the need to replace the restoration, or 'minor failure,' where the restoration was repaired or refurbished. Studies that did not bring comparisons or sufficient data to calculate failures were excluded. Results: 3977 articles were found; 43 studies were eligible for analysis. For RCT studies (n = 6), direct composite showed a mean annual failure rate (AFR) of 10.54 % for minor failures and 8.38 % for major failures. For nonRCT studies (n = 37), these were 3.97 % and 0.4 % respectively. For RCT studies, indirect composite showed a mean AFR of 12.84 % for minor failures and 10.41 % for major failures. For non-RCT studies, these were 2.9 % and 0.15 % respectively. For RCT studies, indirect ceramic showed a mean AFR of 0.09 % for minor failures and 0.13 % for major failures. For non-RCT studies, these were 0.83 % and 0.33 % respectively. Conclusion: Indirect restorations demonstrated lower failure rates; however, they can be more invasive and require more operator time than alternatives. Direct methods showed greater failures but offer a minimally invasive modality. (CRD42022358586) Clinical Significance: This study will provide clinicians with a more informed view of the success, survival and failure rates of materials when deciding how to restore tooth wear.