A Large Cavity in a Posterior Tooth: Resin, an All-Ceramic Inlay, or a Crown?｜證據鏈

Extensive decay in a posterior tooth cannot be managed by choosing resin, an all-ceramic inlay, or a crown solely according to material wear resistance. The dentist first needs to see how many tooth walls remain after decay and old fillings are removed, the thickness and support of each cusp, whether cracks are present, the pulpal or root-canal status, and where your occlusal forces will fall. A 2017 systematic review included 5 randomised trials and 9 observational studies and found that less remaining tooth structure was associated with a higher restoration failure rate. The overall evidence was only of low to moderate quality, however, and remained insufficient to prescribe a material using a single threshold for the number of tooth walls. If the surrounding walls and cusps retain adequate support and the margins can be isolated well, direct resin may preserve more tooth structure and be easier to adjust locally. If a cusp has already become weak, simply filling the cavity does not alter the pathway by which force reaches it. A ceramic onlay／overlay covering one or more cusps can then be discussed. A full crown enters the assessment when the defect, crack, or old prosthesis has come to surround several surfaces.