Endodontically treated teeth often require restorative interventions due to compromised structural integrity resulting from the removal of tooth material during endodontic therapy. This systematic review aims to compare direct and indirect restorations in post-endodontic treatments, focusing on clinical performance, longevity, cost-effectiveness, and patient outcomes. The review includes data from 22 studies, including randomized controlled trials (RCTs), prospective and retrospective cohort studies, assessing a variety of restorative materials and techniques. Findings indicate that while both direct and indirect restorations show similar clinical success rates, indirect restorations, particularly in posterior teeth, demonstrate higher long-term survival rates, greater durability, and enhanced resistance to masticatory forces. Direct restorations, while cost-effective and minimally invasive, show higher failure rates and often require more frequent re-treatment. Cost-effectiveness analysis reveals that indirect restorations, despite higher initial costs, provide better value over time due to their superior longevity. The review emphasizes the importance of evidence-based selection of restoration techniques based on factors such as tooth location, material options, and patient-specific needs to optimize clinical outcomes and minimize failure rates.
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