Non-Cochrane · intervention · PM42930399
Long-Term Aesthetic Performance of Freehand Direct Anterior Composite Resin Restorations: A Systematic Review and Meta-Analysis of Colour Alteration, Marginal Discolouration, and Surface-Quality Deterioration.
Chauca-Bajaña Luis, Zambrano Manzaba Gabriela Guadalupe, Campos Lascano Luis Fernando, et al. · Dentistry journal · 2026 · PubMed · doi:10.3390/dj14100633
Findings
34 findings
| Population | ||||
|---|---|---|---|---|
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Surface-quality deterioration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Elkaffas 2024 | Proportion 0.17 [0.07, 0.35] GRADE not reported 7 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Colour alteration Longest eligible follow-up per study; at least 24 months · REML with Hartung–Knapp sensitivity analysis | Proportion 0.15 [0.06, 0.33] GRADE not reported 8 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Marginal discolouration Longest eligible follow-up per study; at least 24 months · Binomial-normal GLMM sensitivity analysis | Proportion 0.19 [0.1, 0.32] GRADE not reported 6 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Marginal discolouration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Tekçe 2022 | Proportion 0.16 [0.08, 0.28] GRADE not reported 5 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Marginal discolouration Longest eligible follow-up per study; at least 24 months · REML with Hartung–Knapp sensitivity analysis | Proportion 0.19 [0.08, 0.4] GRADE not reported 6 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Marginal discolouration Longest eligible follow-up per study; at least 24 months · Freeman–Tukey random-effects primary analysis | Proportion 0.21 [0.1, 0.34] GRADE not reported 6 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Surface-quality deterioration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Korkut 2021 | Proportion 0.16 [0.07, 0.32] GRADE not reported 7 studies |
| Adolescents and adults with freehand direct composite resin restorations on permanent anterior teeth (veneers, diastema closure, build-ups, recontouring; incl. amelogenesis imperfecta) | Freehand direct anterior composite resin restorations (direct veneers, diastema closures, build-ups, facial additions, reshaping/recontouring) | None (single-arm pooled proportion) | Marginal discolouration (any deterioration from ideal marginal staining rating) Longest eligible follow-up per study, at least 24 months (24 months to 5 to 10 years) · Clinical dental settings (Netherlands, Germany, Turkey, Hungary, Egypt) · Leave-one-out (GLMM): omitting Ergin et al. 2018 | Proportion 0.16 [0.08, 0.30] GRADE not reported 5 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Colour alteration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Demirci 2015 | Proportion 0.17 [0.1, 0.27] GRADE not reported 7 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Surface-quality deterioration Longest eligible follow-up per study; at least 24 months · Freeman–Tukey random-effects primary analysis | Proportion 0.21 [0.09, 0.35] GRADE not reported 8 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Surface-quality deterioration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Tekçe 2022 | Proportion 0.19 [0.09, 0.37] GRADE not reported 7 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Surface-quality deterioration Longest eligible follow-up per study; at least 24 months · REML with Hartung–Knapp sensitivity analysis | Proportion 0.18 [0.07, 0.4] GRADE not reported 8 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Colour alteration Longest eligible follow-up per study; at least 24 months · Binomial-normal GLMM sensitivity analysis | Proportion 0.11 [0.05, 0.25] GRADE not reported 8 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Surface-quality deterioration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Demirci 2015 | Proportion 0.23 [0.14, 0.36] GRADE not reported 7 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Colour alteration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Korkut 2021 | Proportion 0.09 [0.03, 0.23] GRADE not reported 7 studies |
| Adolescents and adults with freehand direct composite resin restorations on permanent anterior teeth (veneers, diastema closure, build-ups, recontouring; incl. amelogenesis imperfecta) | Freehand direct anterior composite resin restorations (direct veneers, diastema closures, build-ups, facial additions, reshaping/recontouring) | None (single-arm pooled proportion) | Colour alteration (any deterioration from ideal colour match rating) Longest eligible follow-up per study, at least 24 months (24 months to 5 to 10 years) · Clinical dental settings (Netherlands, Germany, Turkey, Hungary, Egypt) · Leave-one-out (GLMM): omitting Ergin et al. 2018 | Proportion 0.11 [0.04, 0.28] GRADE not reported 7 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Marginal discolouration Longest eligible follow-up per study; at least 24 months · Logit REML random-effects sensitivity analysis | Proportion 0.19 [0.1, 0.34] GRADE not reported 6 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Colour alteration Longest eligible follow-up per study; at least 24 months · Freeman–Tukey random-effects primary analysis | Proportion 0.14 [0.05, 0.26] GRADE not reported 8 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Marginal discolouration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Elkaffas 2024 | Proportion 0.19 [0.09, 0.36] GRADE not reported 5 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Surface-quality deterioration Longest eligible follow-up per study; at least 24 months · Binomial-normal GLMM sensitivity analysis | Proportion 0.18 [0.09, 0.33] GRADE not reported 8 studies |
| Adolescents and adults with freehand direct composite resin restorations on permanent anterior teeth (veneers, diastema closure, build-ups, recontouring; incl. amelogenesis imperfecta) | Freehand direct anterior composite resin restorations (direct veneers, diastema closures, build-ups, facial additions, reshaping/recontouring) | None (single-arm pooled proportion) | Surface-quality deterioration (surface texture/roughness/lustre deterioration from ideal rating) Longest eligible follow-up per study, at least 24 months (24 months to 5 to 10 years) · Clinical dental settings (Netherlands, Germany, Turkey, Hungary, Egypt) · Leave-one-out (GLMM): omitting Frese et al. 2013 | Proportion 0.15 [0.07, 0.30] GRADE not reported 7 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Marginal discolouration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Gresnigt 2012 | Proportion 0.18 [0.09, 0.33] GRADE not reported 5 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Colour alteration Longest eligible follow-up per study; at least 24 months · Logit REML random-effects sensitivity analysis | Proportion 0.15 [0.08, 0.26] GRADE not reported 8 studies |
| Adolescents and adults with freehand direct composite resin restorations on permanent anterior teeth (veneers, diastema closure, build-ups, recontouring; incl. amelogenesis imperfecta) | Freehand direct anterior composite resin restorations (direct veneers, diastema closures, build-ups, facial additions, reshaping/recontouring) | None (single-arm pooled proportion) | Colour alteration (any deterioration from ideal colour match rating) Longest eligible follow-up per study, at least 24 months (24 months to 5 to 10 years) · Clinical dental settings (Netherlands, Germany, Turkey, Hungary, Egypt) · Leave-one-out (GLMM): omitting Gresnigt et al. 2012 | Proportion 0.10 [0.03, 0.24] GRADE not reported 7 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Marginal discolouration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Lempel 2017 | Proportion 0.22 [0.12, 0.38] GRADE not reported 5 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Colour alteration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Tekçe 2022 | Proportion 0.1 [0.03, 0.27] GRADE not reported 7 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Colour alteration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Elkaffas 2024 | Proportion 0.13 [0.05, 0.3] GRADE not reported 7 studies |
| Adolescents and adults with freehand direct composite resin restorations on permanent anterior teeth (veneers, diastema closure, build-ups, recontouring; incl. amelogenesis imperfecta) | Freehand direct anterior composite resin restorations (direct veneers, diastema closures, build-ups, facial additions, reshaping/recontouring) | None (single-arm pooled proportion) | Surface-quality deterioration (surface texture/roughness/lustre deterioration from ideal rating) Longest eligible follow-up per study, at least 24 months (24 months to 5 to 10 years) · Clinical dental settings (Netherlands, Germany, Turkey, Hungary, Egypt) · Leave-one-out (GLMM): omitting Lempel et al. 2017 | Proportion 0.20 [0.10, 0.38] GRADE not reported 7 studies |
| Adolescents and adults with freehand direct composite resin restorations on permanent anterior teeth (veneers, diastema closure, build-ups, recontouring; incl. amelogenesis imperfecta) | Freehand direct anterior composite resin restorations (direct veneers, diastema closures, build-ups, facial additions, reshaping/recontouring) | None (single-arm pooled proportion) | Surface-quality deterioration (surface texture/roughness/lustre deterioration from ideal rating) Longest eligible follow-up per study, at least 24 months (24 months to 5 to 10 years) · Clinical dental settings (Netherlands, Germany, Turkey, Hungary, Egypt) · Leave-one-out (GLMM): omitting Ergin et al. 2018 | Proportion 0.16 [0.07, 0.34] GRADE not reported 7 studies |
| Adolescents and adults with freehand direct composite resin restorations on permanent anterior teeth (veneers, diastema closure, build-ups, recontouring; incl. amelogenesis imperfecta) | Freehand direct anterior composite resin restorations (direct veneers, diastema closures, build-ups, facial additions, reshaping/recontouring) | None (single-arm pooled proportion) | Surface-quality deterioration (surface texture/roughness/lustre deterioration from ideal rating) Longest eligible follow-up per study, at least 24 months (24 months to 5 to 10 years) · Clinical dental settings (Netherlands, Germany, Turkey, Hungary, Egypt) · Leave-one-out (GLMM): omitting Gresnigt et al. 2012 | Proportion 0.15 [0.07, 0.31] GRADE not reported 7 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Surface-quality deterioration Longest eligible follow-up per study; at least 24 months · Logit REML random-effects sensitivity analysis | Proportion 0.18 [0.09, 0.35] GRADE not reported 8 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Colour alteration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Frese 2013 | Proportion 0.1 [0.03, 0.25] GRADE not reported 7 studies |
| Adolescents and adults with freehand direct composite resin restorations on permanent anterior teeth (veneers, diastema closure, build-ups, recontouring; incl. amelogenesis imperfecta) | Freehand direct anterior composite resin restorations (direct veneers, diastema closures, build-ups, facial additions, reshaping/recontouring) | None (single-arm pooled proportion) | Colour alteration (any deterioration from ideal colour match rating) Longest eligible follow-up per study, at least 24 months (24 months to 5 to 10 years) · Clinical dental settings (Netherlands, Germany, Turkey, Hungary, Egypt) · Leave-one-out (GLMM): omitting Lempel et al. 2017 | Proportion 0.11 [0.04, 0.29] GRADE not reported 7 studies |
| Adolescents and adults with permanent anterior teeth | Freehand direct anterior composite resin restorations | No independent comparator | Marginal discolouration Longest eligible follow-up per study; at least 24 months · GLMM leave-one-out: omitting Demirci 2015 | Proportion 0.24 [0.14, 0.36] GRADE not reported 5 studies |
Included primary studies 14
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Demirci 2015 A 4-year clinical evaluation of direct composite build-ups for space closure after orthodontic treatment DOI:10.1007/s00784-015-1458-8 | 2015 | this review only | not stated | not extracted yet |
| Demirci 2015 A 4-year clinical evaluation of direct composite build-ups for space closure after orthodontic treatment. PMID:25802222 | 2015 | this review only | not stated | not extracted yet |
| Elkaffas 2024 Randomized Clinical Trial on Direct Composite and Indirect Ceramic Laminate Veneers in Multiple Diastema Closure Cases: Two-Year Follow-Up. PMID:39063806 | 2024 | this review only | not stated | not extracted yet |
| Ergin 2018 Comparison of two different composite resins used for tooth reshaping and diastema closure in a 4-year follow-up DOI:10.4103/njcp.njcp_36_18 | 2018 | this review only | not stated | not extracted yet |
| Ergin 2018 Comparison of two different composite resins used for tooth reshaping and diastema closure in a 4-year follow-up. PMID:30156192 | 2018 | this review only | not stated | not extracted yet |
| Frese 2013 Recontouring teeth and closing diastemas with direct composite buildups: A 5-year follow-up DOI:10.1016/j.jdent.2013.08.009 | 2013 | this review only | not stated | not extracted yet |
| Frese 2013 Recontouring teeth and closing diastemas with direct composite buildups: a 5-year follow-up. PMID:23954577 | 2013 | this review only | not stated | not extracted yet |
| Gresnigt 2012 Randomized controlled split-mouth clinical trial of direct laminate veneers with two micro-hybrid resin composites DOI:10.1016/j.jdent.2012.05.010 | 2012 | this review only | not stated | not extracted yet |
| Gresnigt 2012 Randomized controlled split-mouth clinical trial of direct laminate veneers with two micro-hybrid resin composites. PMID:22664565 | 2012 | this review only | not stated | not extracted yet |
| Korkut 2021 Longevity of direct diastema closure and recontouring restorations with resin composites in maxillary anterior teeth: A <scp>4‐year</scp>… DOI:10.1111/jerd.12697 | 2020 | this review only | not stated | not extracted yet |
| Korkut 2021 Longevity of direct diastema closure and recontouring restorations with resin composites in maxillary anterior teeth: A 4-year clinical… PMID:33354867 | 2021 | this review only | not stated | not extracted yet |
| Lempel 2017 Direct resin composite restorations for fractured maxillary teeth and diastema closure: A 7 years retrospective evaluation of survival and… DOI:10.1016/j.dental.2017.02.001 | 2017 | this review only | not stated | not extracted yet |
| Lempel 2017 Direct resin composite restorations for fractured maxillary teeth and diastema closure: A 7 years retrospective evaluation of survival and… PMID:28256273 | 2017 | this review only | not stated | not extracted yet |
| Tekçe 2022 Clinical Performance of Direct Composite Restorations in Patients with Amelogenesis Imperfecta - Anterior Restorations. PMID:35322945 | 2022 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adolescent and adult patients receiving freehand direct composite resin restorations on permanent anterior teeth for aesthetic or minimally invasive indications (discolouration, morphological anomalies, diastema, minor malposition, enamel defects, reshaping, recontouring, replacement of unaesthetic restorations) | Adolescents and adults with anterior direct composite restorations for diastema closure, recontouring, laminate veneers, fractured teeth and amelogenesis imperfecta (n=8 studies; 893 restorations for colour, 566 for marginal discolouration, 896 for surface quality) |
| Intervention | Freehand direct anterior composite resin restorations placed intraorally: direct veneers, diastema closures, build-ups, facial additions, tooth reshaping, aesthetic recontouring (no lab, prefabricated, injectable, template or digitally guided techniques) | Freehand direct anterior composite restorations with various composites (Enamel Plus HFO, Filtek Supreme XT, CeramX, Filtek Z550, Charisma Diamond, Essentia, Estelite Asteria, Clearfil Majesty ES-2, Filtek Ultimate) (n=8) |
| Comparison | Baseline aesthetic condition of the same restorations, earlier follow-up, another composite material, enamel preparation/adhesive protocol, layering approach, finishing/polishing protocol or clinical subgroup; single-arm longitudinal studies also eligible | None analyzed: single-arm pooled proportions; multiple composite arms combined per study and the indirect ceramic arm of Elkaffas 2024 excluded |
| Outcomes | Primary: colour alteration/colour match (visual criteria or instrumental Delta E), marginal discolouration/staining, surface quality (texture, roughness, gloss, lustre). Secondary: overall aesthetic acceptability, anatomical form, patient-reported aesthetic satisfaction, need for repolishing/refurbishment/repair, veneer replacement or aesthetic failure, overall survival and success | Colour alteration (n=8 studies, 893 restorations); marginal discolouration (n=6, 566); surface-quality deterioration (n=8, 896); secondary outcomes not synthesized |
| Study designs | Randomized and non-randomized clinical trials, prospective and retrospective cohort studies, longitudinal observational studies, clinical case series with quantitative data; English, peer-reviewed | 5 RCTs (split-mouth or parallel; RoB 2) and 3 retrospective cohort studies (JBI) (n=8) |
| Timing | Minimum clinical follow-up of 24 months; longest eligible follow-up used in primary synthesis | Final follow-up from 24 months to 5 to 10 years (longest per study) |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | NR | no |
| 2Protocol established before the reviewcritical | Partial Yes | NR | no |
| 3Choice of study designs explained | No | NR | no |
| 4Comprehensive literature searchcritical | No | NR | no |
| 5Study selection in duplicate | Yes | NR | no |
| 6Data extraction in duplicate | Yes | NR | no |
| 7List of excluded studies with reasonscritical | No | NR | no |
| 8Included studies described in detail | Yes | NR | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Partial Yes | NR | no |
| 10Funding of included studies reported | No | NR | no |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NR | no |
| 12Impact of risk of bias on the pooled results | Yes | NR | no |
| 13Risk of bias accounted for in interpretationcritical | Yes | NR | no |
| 14Heterogeneity explained | Yes | NR | no |
| 15Publication bias investigatedcritical | Yes | NR | no |
| 16Conflicts of interest reported | Yes | NR | no |
| Overall | Critically Low | NR | no |