Direct and Indirect Restorations with Composite Resin: Guidelines for Clinical Practice

Abstract

Restorative dentistry has experienced significant advancements in recent years, particularly in the development and improvement of composite resin materials, widely used for their favorable aesthetic and mechanical properties. Among the most common restorative techniques are the direct and indirect restorations, whose selection depends on clinical factors such as the extent of tooth loss, aesthetic demands, functionality, cost, clinical time available, and the dentist skill. This study aimed to perform a comparative analysis between direct and indirect composite resin restorative techniques, considering their indications, advantages, limitations, and clinical performance based on recent scientific literature. A narrative literature review was made, including a systematic search on PubMed, Scopus, and Web of Science databases, covering publications from 2013 to 2024. After applying inclusion and exclusion criteria, 16 original articles directly comparing the two techniques were selected. Results showed that both techniques are effective when properly indicated and executed. Direct restorations excelled in fracture resistance, especially when cusp coverage was involved, as well as better anatomical adaptation and greater fatigue resistance in cracked teeth. Indirect restorations showed higher performance in color stability after aging, bacterial adhesion, and marginal quality, with an aesthetic advantage. It is concluded that the choice between techniques should consider not only mechanical aspects but also aesthetic and biological factors, tailored to the clinical case and individual patient needs, aiming to ensure longevity, predictability, and excellence in restorative treatments.