Crown vs. composite for post-retained restorations: A randomized clinical trial

Abstract Objectives This randomized clinical trial compared the survival of composite resin restorations and metal-ceramic crowns on endodontically treated teeth that received a glass fiber post using 2 different cementation methods. Methods Forty-seven patients (age 42.5 ± 11.5) with fifty-seven endodontically treated teeth with extensive coronal damage but always with one intact surface were randomly allocated according to the type of coronal restoration: metal-ceramic crown or composite resin. In case of crown restoration, a core buildup was performed with microhybrid composite resin. The dentin bonding agent and composite resin used were the same for both direct and indirect restorations. Descriptive analysis was performed using FDI clinical criteria and survival of restorations/teeth analyzed using Kaplan-Meier statistics and log-rank tests. Results 57 restorations (30 composite resin and 27 crowns) were made in 47 patients. The recall rate was 100% and follow up time ranged between 1 and 5 years. One tooth was extracted 11 months post-restoration due to root fracture (composite group). Eight composite restorations and one crown had reparable failures, all due to secondary caries or restoration fracture. The overall annual failure rate (AFR) was 0.92% after 50 months for success of the restorations, with 1.83% for the composite group and 0.26% for the metal-ceramic crown group. The log-rank test showed no difference for survival according to the type of restoration (p = 0.344). However, for success rates, metal-ceramic crowns demonstrated better performance (p = 0.022). Conclusions Indirect restorations provided higher acceptable clinical performance and lower need for re-intervention, but both types of restorations presented good survival rates. (NCT01461239). Clinical significance When endodontically treated teeth with at least one intact surface must be restored, composite resin restorations and metal-ceramic crows are acceptable alternatives to achieve good survival and success rates.