ANALYTICAL COMPARISON OF OUTCOMES OF DIRECT AND INDIRECT RESTORATIONS OF ANTERIOR TEETH: A LITERATURE REVIEW
DOI:
https://doi.org/10.32782/2786-7684/2026-2-7Keywords:
aesthetic dentistry, composite restorations, ceramic restorations, adhesive substrate, color stability, clinical survival, patient satisfactionAbstract
The aim of this study was to compare the clinical outcomes of direct and indirect restorations in anterior teeth across three parameters: survival, color stability, and patient satisfaction. Methods. The study was based on a comparative analysis of the scientific literature. The evidence base was formed through a systematic search of electronic databases, including PubMed, Scopus, and Web of Science, covering the period from 2021 to 2026. Publications were included if they met predefined inclusion criteria, specifically reporting quantitative clinical outcomes related to anterior tooth restorations and using one of the following study designs: randomized clinical trials, prospective or retrospective cohort studies, systematic reviews, or metaanalyses. Results. Indirect ceramic restorations demonstrate superior long-term survival compared with direct restorations; however, this advantage is clinically relevant primarily in cases with extensive hard-tissue loss and reduced enamel availability. In cases of minor defects, differences between the two approaches are negligible. The quality of the adhesive substrate, rather than the type of restorative technique, appears to be the key determinant of survival. The superiority of indirect ceramic restorations in terms of color stability represents the most consistently supported finding, as ceramics maintain their optical and surface properties over extended periods. In contrast, direct composite restorations are more prone to discoloration and surface degradation due to intrinsic material properties and polymerization conditions within the oral environment. Patient satisfaction tends to be higher with ceramic restorations; however, the evidence supporting this outcome remains methodologically limited. Notably, a discrepancy is frequently observed between clinician-based objective assessments and patient-reported subjective perceptions of treatment outcomes. Conclusions. The choice between direct and indirect anterior restorations should be based on a combination of clinical factors, including defect size, residual enamel volume, occlusal conditions, and patient aesthetic expectations.
References
Mazzetti T, Collares K, Rodolfo B, da Rosa Rodolpho PA, van de Sande FH, Cenci MS. 10-year practice-based evaluation
of ceramic and direct composite veneers. Dent Mater. 2022;38(5):898-906. doi: https://doi.org/10.1016/j.dental.2022.03.007
Elkaffas AA, Alshehri A, Alqahtani AR, Abuelqomsan MA, Deeban YAM, Albaijan RS, et al. Randomized clinical trial
on direct composite and indirect ceramic laminate veneers in multiple diastema closure cases: Two-year follow-up. Materials
(Basel). 2024;17(14):3514. doi: https://doi.org/10.3390/ma17143514
Zarow M, Hardan L, Szczeklik K, Bourgi R, Cuevas-Suárez CE, Jakubowicz N, et al. Porcelain veneers in vital vs.
non-vital teeth: A retrospective clinical evaluation. Bioengineering (Basel). 2023;10(2):168. doi: https://doi.org/10.3390/
bioengineering10020168
Kam Hepdeniz O, Temel UB. Clinical survival of No-prep indirect composite laminate veneers: A 7-year prospective
case series study. BMC Oral Health. 2023;23(1):257. doi: https://doi.org/10.1186/s12903-023-02949-5
Durán Ojeda G, Bresser RA, Wendler M, Gresnigt MMM. Ceramic partial laminate veneers in anterior teeth: A literature
review. J Prosthodont Res. 2024;68(2):246-54. doi: https://doi.org/10.2186/jpr.JPR_D_23_00090
Kimmel M, Faggion CM Jr. Systematic reviews comparing direct and indirect restorations: An umbrella review that
examines restoration type and confidence in results. Clin Exp Dent Res. 2025;11:e70149. doi: https://doi.org/10.1002/cre2.70149
Alqutaibi AY, Saker S, Alghauli MA, Algabri RS, AbdElaziz MH. Clinical survival and complication rate of ceramic
veneers bonded to different substrates: A systematic review and meta-analysis. J Prosthet Dent. 2025;134(4):1030-9.
doi: https://doi.org/10.1016/j.prosdent.2024.03.019
Patel K, Asthana G, Parmar A, Tamuli R, Manglani S, Dhanak N. Clinical assessment of direct composite veneer
and indirect veneers using a minimally invasive preparation technique. J Conserv Dent Endod. 2025;28(10):965-71. doi:
https://doi.org/10.4103/JCDE.JCDE_279_25
Etienne O, Wang CJ, Bourgi R, Watzki D, Roman T. Survival of ceramic veneers: Impact of dentin exposure and tooth
vitality after 1 to 15 years of follow-up. J Esthet Restor Dent. 2025;37(12):2519-32. doi: https://doi.org/10.1111/jerd.70016
Daghrery A. Color stability, gloss retention, and surface roughness of 3D-printed versus indirect prefabricated veneers.
J Funct Biomater. 2023;14(10):492. doi: https://doi.org/10.3390/jfb14100492
Alghazzawi TF. Clinical survival rate and laboratory failure of dental veneers: A narrative literature review. J Funct
Biomater. 2024;15(5):131. doi: https://doi.org/10.3390/jfb15050131
Freitas BN, Silva POD, Pintado-Palomino K, Almeida CVVB, Souza-Gabriel AE, Corona SAM, et al. Patients´ satisfaction
concerning direct anterior dental restoration. Braz Dent J. 2023;34(3):82-93. doi: https://doi.org/10.1590/0103-6440202305260
Alothman Y, Bamasoud MS. The success of dental veneers according to preparation design and material type. Open
Access Maced J Med Sci. 2018;6(12):2402-8. doi: https://doi.org/10.3889/oamjms.2018.353
Hickel R, Mesinger S, Opdam N, Loomans B, Frankenberger R, Cadenaro M, et al. Revised FDI criteria for evaluating
direct and indirect dental restorations-recommendations for its clinical use, interpretation, and reporting. Clin Oral Investig.
;27(6):2573-92. doi: https://doi.org/10.1007/s00784-022-04814-1
