Biomimetic and Conventional Restorative Approaches for Endodontically Treated Teeth: A Systematic Review of Clinical Evidence

Background: Restoration of endodontically treated teeth remains challenging because loss of tooth structure increases fracture susceptibility. Conservative adhesive and biomimetic approaches aim to preserve sound tooth structure while providing adequate functional restoration. Objective: To compare the clinical performance of conservative adhesive and biomimetic restorative approaches with conventional full-coverage restorations in endodontically treated teeth. Materials and Methods: We conducted a systematic review according to PRISMA 2020 guidelines and registered it in PROSPERO (CRD420261458871). PubMed, Scopus, Google Scholar, and Web of Science were searched for English-language clinical studies published between 2015 and 2026. Randomised controlled clinical trials comparing conservative and conventional restorations were included. Outcomes included survival, success, fracture, failure patterns, and complications. We assessed risk of bias using RoB 2. Results: Seven randomised controlled trials were included. Conservative restorations demonstrated favourable survival and, in several studies, outcomes comparable to conventional crowns. However, conventional restorations generally showed higher restoration-level success and fewer maintenance requirements. Conservative approaches offered greater preservation of tooth structure, favourable periodontal outcomes, and more repairable failures. Conclusion: Conservative adhesive restorations can provide clinically acceptable outcomes in appropriately selected endodontically treated teeth. However, further long-term trials using standardised biomimetic protocols are required.