How do inlays and onlays compare with full crowns in survival?
This is the question where published data most directly answers the concern clinicians raise most often — whether partial coverage restorations fail more than full crowns. The evidence is reassuring, and it is worth examining closely.
A 2018 systematic review that specifically compared inlays and onlays against complete coverage restorations reported mean survival rates of 90.89% for inlays, 93.50% for onlays, and 95.38% for crowns. Across all types, the 5-year survival rate exceeded 90%, and caries was the main biological complication while ceramic fracture was the most common technical complication. The authors noted that study heterogeneity prevented meaningful comparison between restoration types — the figures are pooled means rather than a head-to-head trial (Vagropoulou et al., 2018).
A separate 2016 meta-analysis of ceramic and resin inlays, onlays, and overlays found estimated survival rates for glass-ceramics and feldspathic porcelain between 92% and 95% at 5 years (n = 5,811 restorations) and 91% at 10 years (n = 2,154). In that analysis, fractures and chipping accounted for 4% of failures, followed by endodontic complications at 3%, secondary caries at 1%, and debonding at 1% (Morimoto et al., 2016).
Longer-term data come from a 2021 systematic review of ceramic and composite partial-coverage restorations. It reported survival of ceramic inlays and onlays of 90% at 5 years, 89% at 8 years, and 85% at 10 years, with success rates of 88% at 5 years and 77% at 10 years. Restoration fracture and endodontic complications were the dominant failure modes, while non-vital teeth and multiple-surface restorations tended to raise failure risk (Fan et al., 2021).
The longest mean follow-up among these studies is a practice-based retrospective evaluation of leucite-reinforced glass-ceramic restorations (IPS Empress) followed for 11.2 years on average. Overall survival was 80.3% (inlays 80.4%, onlays 80.0%), and the most frequent complications were ceramic fracture at 10.6% and chipping at 2.3% (Strasding et al., 2020).
One nuance is worth stating honestly: ceramic and resin are not equivalent here. A meta-regression comparing the two found ceramic partial-coverage restorations outperformed resin-based ones at both 5 and 10 years, with 5-year survival of 86% for resin versus 90% for feldspathic porcelain and 92% for glass ceramic. If resin composite is what you plan to use, expect different longevity than the ceramic figures above (Naik et al., 2022).