The Illusion and Reality of Survival in Adhesive Dentistry

Scientific facts from the Morimoto study

In the systematic review and meta-analysis by Morimoto and colleagues, one statistic stands out as critically important: the survival of partial-coverage restorations (inlays, onlays, and overlays) over a ten-year period was assessed at 91%. The key point of this research is that the reported figure belongs to restorations placed in patients' mouths between the 1980s and the late 2000s — an era when previous-generation materials, ceramics, and cements were in use, and the complex protocols and concepts of biomimetic dentistry were not yet common in their present-day form. In this review, the main causes of failure were fracture and chipping at roughly 4%, and endodontic complications at roughly 3%.

Analysis: thinking outside the framework

When older techniques and materials were able to record a 91% success rate over a decade in patients' mouths, we are facing a clear clinical reality: with the remarkable advancement of materials (such as lithium disilicates) and today's modern bonding systems, that "9% failure gap" has become far smaller. Today's materials inherently possess higher strength, and on their own cover a large portion of the risk of mechanical and other failures.

This reality shows that the biomimetic school, with all of its complex and technique-sensitive protocols, is in fact set to work on only a "very narrow and negligible window" of failures. Even if powerful, long-term in vivo clinical studies are published in the future confirming these protocols, ultimately all of this redundant, time-consuming effort operates within that same narrow window — perhaps raising the ceiling of success by only a few percentage points.

Given all this, it can be said that not using biomimetic protocols is in no way equivalent to malpractice. A standard, high-quality adhesive approach has already shown that, on its own, it guarantees a reliable and very high rate of success. Imposing excessive complexity for a possible, marginal profit margin is merely a clinical choice — not a definitive standard of care.

Not using biomimetic protocols is in no way equivalent to malpractice;
a standard, high-quality adhesive approach, on its own, guarantees a reliable and very high rate of success.

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