The difference of the two techniques did not reach statistical significance in order to recommend one technique over the other .
CLINICAL SIGNIFICANCE Resin composite material s , placed directly or indirectly , exhibit a promising long-term clinical performance when rehabilitation of posterior teeth is needed .
OBJECTIVE To evaluate the long-term clinical performance of direct versus indirect composite inlays/onlays  in posterior teeth .
Although many years in clinical practice , the selection of the best treatment protocol still remains subjective .
Randomized Control Trial of Composite Cuspal Restorations
The objective of this r and omized control trial was to compare the five-year clinical performance of direct and indirect resin composite restorations replacing cusps . In 157 patients , 176 restorations were made to restore maxillary premolars with Class II cavities and one missing cusp . Ninety-two direct and 84 indirect resin composite restorations  were placed by two operators , following a strict protocol . Treatment technique and operator were assigned r and omly . Follow-up period was at least 4.5 yrs . Survival rates were determined with time to reparable failure and complete failure as endpoints . Kaplan-Meier five-year survival rates were 86.6 % ( SE 0.27 % ) for reparable failure and 87.2 % ( SE 0.27 % ) for complete failure . Differences between survival rates of direct and indirect restorations [ 89.9 % ( SE 0.34 % ) vs. 83.2 % ( SE 0.42 % ) for reparable failure and 91.2 % ( SE 0.32 % ) vs. 83.2 % ( SE 0.42 % ) for complete failure ] were not statistically significant ( p = .23 for reparable failure ; p = .15 for complete failure ) . Mode of failure was predominantly adhesive . The results suggest that direct and indirect techniques provide comparable results over the long term ( trial registration number : IS RCT N29200848 )
The difference of the two techniques did not reach statistical significance in order to recommend one technique over the other .
CLINICAL SIGNIFICANCE Resin composite material s , placed directly or indirectly , exhibit a promising long-term clinical performance when rehabilitation of posterior teeth is needed .
OBJECTIVE To evaluate the long-term clinical performance of direct versus indirect composite inlays/onlays  in posterior teeth .
Although many years in clinical practice , the selection of the best treatment protocol still remains subjective .