Clinical performance of “free-hand” direct composite crowns used for the restoration of severely destroyed mandibular molars

Introduction
There are several restorative approaches for the restoration of severely destroyed teeth, each with its own advantages and disadvantages.

Objectives
This study aimed to evaluate the clinical performance of direct composite resin crowns used for restoration of severely destroyed mandibular molars in young patients.

Material and methods
In total 45 severely destroyed vital and non-vital mandibular molars were restored in 44 patients (24-40 years old). Mandibular molars were restored in a “free-hand” direct restoration approach using a biomimetic concept (4-layer technic). After the restoration, on the 3rd- and 6th-month, and the 1st-, 2nd-, and 3rd-year follow-ups, the clinical performance of the restoration was evaluated. During the follow-ups, the integrity of restoration, contact point stability, dental plaque accumulation, and gingival bleeding indices were evaluated, and restoration survival was accessed.

Results
Restorations showed up to 100% survival after 3 years of exploitation. Significantly, lower gingival bleeding and plague accumulation index were registered during the follow-up visits after the restoration, which is a sign of good integration of the restoration into the bite. Only one case of partial fracture of the restoration occurred, which was repaired with composite resin. No differences between the clinical performance in non-vital and vital mandibular molars were observed.

Conclusions
“Free-hand” direct composite crowns used for the restoration of severely destroyed mandibular molars showed promising results for the restoration of severely destroyed mandibular molars in a 3-year observation period.