Clinical performance of minimally invasive full-mouth rehabilitation using different materials and techniques for patients with moderate to severe tooth wear: a systematic review and meta-analysis.

Objective: To evaluate short, mid and long-term clinical outcomes and patients' satisfaction of minimally invasive full-mouth rehabilitation using different materials and techniques for patients with moderate to severe tooth wear. Furthermore, materials were analyzed to identify their influences on clinical results.

Materials and methods: Search was conducted in PubMed, Cochrane Central Register of Controlled Trial, Embase, Web of science and Scopus until December 19, 2024. Randomized clinical trials (RCT), cohort studies and case series with at least mean period of 3 years were included. The revised Cochrane risk of bias tool, Newcastle-Ottawa scale and Joanna Briggs Institute Critical Appraisal were used to evaluate the quality of RCT, cohort studies and case series. Meta-analysis and Poisson regression were conducted.

Results: Ten studies in this review included three case series, six cohort studies and one RCT with three low, six moderate risks and one some concerns. Annual failure rates (AFRs) and annual complication rates (ACRs) of direct composite restorations were 0-6.2% and 1.0%-4.2%, respectively. AFRs of indirect restorations were 0%-0.5%. Overall ACRs of indirect restorations fabricated by traditional indirect resin composites, polymer-infiltrated ceramic-network, resin nanoceramics and ceramics were at 1.6%-15.1%, 0.7%-4.8%, 0.5%-5.0% and 0.2%-1.1%, respectively. The estimated AFRs of direct composites, resin nanoceramics and ceramics were 0.64%, 0.13% and 0.04% respectively. Significantly lowest AFRs of ceramic was found after mid-term follow-up with incidence rate ratios of direct composites, resin nanoceramics and ceramics being 1: 0.68 (P = 0.60): 0.001 (P < 0.05). The estimated ACRs of the three materials were 2.16%, 2.14% and 0.62%. Overall AFRs of restorations using different techniques were 0%-0.5%. Overall ACRs of direct and indirect techniques were 1.1%-2.2% and 0.2%-4.8%, respectively. Overall ACRs of hybrid technique were 0.5% to 15.1%. Restoration fracture was the most predominant complication regardless of materials. High appreciation was expressed by patient reported outcomes measures.

Conclusions: Minimally invasive full-mouth rehabilitation for patients with moderate to severe tooth wear presented good clinical performance apart from traditional indirect resin composite used in posterior teeth.

Clinical relevance: Minimally invasive full-mouth rehabilitation should be strongly advocated for the patients with moderately and severely worn dentition.