## 4 Discussion
Figure 3: The fracture of occlusal marginal distal ridge was identified during the third follow-up period. Figure 2: The M-D fracture on tooth 27, which was restored with e.Max Press indirect ceramic overlay. The fracture was identified in the fifth year after overlay cementation—during the second follow-up period. A meta-analysis presented by [PERSON] et al., in 2022, found that partially ceramic restorations (feldspar porcelain and glass-ceramic) outperformed partially composite restorations at both 5-year and 10-year follow-up. When comparing ceramic types, glass-ceramic outperformed feldspar porcelain at 5-year follow-up, and feldspar porcelain outperformed glass-ceramic at 10-year follow-up. Failures were mainly due to fractures (6.2%), endodontic problems (3%), secondary caries (1.7%), and detachment, which was 0.9% [52]. [PERSON] et al. found in their clinical study that fractures, recurrent caries, and reduced marginal integrity over time were the main causes of ceramic restoration failure. They believe that careful monitoring of the ceramic-tooth interface can prolong clinical durability [53]. [PERSON] et al., in their evaluation of clinical survival and success rates, find that the use of IPS e.Max could be recommended in the restoration of non-vital as well [54]. The failures may stem from various mechanical, biological, and procedural factors. Understanding the specific types of failures and their causes is essential for optimizing treatment planning and improving long-term outcomes. They could be grouped as follows: fracture of the ceramic restoration, debonding of the restoration, marginal leakage, wear of the opposing dentition, tooth fracture, esthetic failures, and caries development. Failures of indirect ceramic restorations in the distal area arise from a combination of mechanical stress, biological factors, and procedural errors. Fractures, debonding, marginal leakage, and tooth or restoration wear are common issues, driven by factors such as excessive occlusal forces, material properties, inadequate adhesive techniques, and improper preparation. Understanding these failure modes and their causes  
Figure 4: **(A). ** The radiograph shows cohesive fracture of medial side of lower-right second molar (#47); **(B). ** The radiographs show postoperative monitoring status of #36 and 37—in second, fifth, and tenth year. There is a gap formation on the distal gingival base (yellow arrows) of tooth #37. In the monitoring of tooth #36, there are no radiographic signs of gap formation. is essential for improving the design, material selection, and clinical protocols associated with ceramic restorations in the posterior regions. Long-term success can be enhanced by addressing patient-specific risk factors such as bruxism, optimizing adhesive procedures, and ensuring careful occlusal adjustments during placement and follow-up. In this clinical study, the application of e.Max Press indirect ceramic restorations for distal teeth demonstrated a high success rate of 99.4% for the 2-year follow-up period, and 97.4 and 95.35% for the 5- and 10-year follow-up periods, respectively. Failure in 4.65% of cases over a 10-year period shows that correctly defined indications, strict adherence to the recommendations of the manufacturer, both in terms of the application of the adhesive system and in terms of laboratory parameters and protocol, make one highly sensitive, risky, and multi-stage manipulation, a technique with a high rate of predictability of 10 years.