Clinical performance of bulk-fill and conventional resin composite restorations in posterior teeth: a systematic review and meta-analysis
The purpose of this systematic review was to compare the clinical performance of bulk-fill resin composites with conventional resin composites used for direct restorations of posterior teeth.
This review followed the PRISMA statement. This review was registered at PROSPERO (registration number CRD42016053436). A search of the scientific literature was performed by two independent reviewers using the PubMed/MEDLINE, Embase, The Cochrane Library, and Web of Science databases from commencement until January 2018. The research question was “Do bulk-fill resin composites have a clinical performance comparable to conventional resin composites in posterior restorations?” Only studies evaluating class I and II direct restorations in permanent teeth with a follow-up period of at least 1 year were included. The RevMan 5 program was used for meta-analysis, calculating the relative risk (RR) and 95% confidence interval (CI) of the dichotomous outcome (restoration failure or success).
Ten articles were selected, comprising 941 analyzed restorations. The mean follow-up period was 33.6 months (12–72 months). No statistically significant differences in the failure rate were observed between conventional and base/flowable bulk-fill resin composites (p = 0.31; RR 1.49; 95% CI 0.69–3.25) or full-body/sculptable bulk-fill resin composites (p = 0.12; RR 1.89; 95% CI 0.84–4.24).
The present systematic review and meta-analysis indicate similar clinical performances of bulk-fill and conventional resin composites over a follow-up period of 12 to 72 months.
Based on the results of this study, the bulk-fill resin composites could be an alternative for direct restorations in posterior teeth. However, clinical trials of longer duration are required.
KeywordsDental restoration Direct restoration Resin composite Bulk-fill resin Incremental filling technique Systematic review
The authors would like to thank CAPES (Coordination for the Improvement of Higher Education Personnel) for their financial support.
The work was supported by the CAPES (Coordination for the Improvement of Higher Education Personnel).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study, formal consent is not required.
- 5.Opdam NJM, van de Sande FH, Bronkhorst E, Cenci MS, Bottenberg P, Pallesen U, Gaengler P, Lindberg A, Huysmans MCDNJM, van Dijken JW (2014) Longevity of posterior composite restorations: a systematic review and meta-analysis. J Dent Res 93:943–949. https://doi.org/10.1177/0022034514544217 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Lynch CD, Opdam NJ, Hickel R, Brunton PA, Gurgan S, Kakaboura A, Shearer AC, Vanherle G, Wilson NH, Academy of Operative Dentistry European Section (2014) Guidance on posterior resin composites: Academy of Operative Dentistry—European section. J Dent 42:377–383. https://doi.org/10.1016/j.jdent.2014.01.009 CrossRefPubMedGoogle Scholar
- 8.Fronza BM, Rueggeberg FA, Braga RR, Mogilevych B, Soares LES, Martin AA, Ambrosano G, Giannini M (2015) Monomer conversion, microhardness, internal marginal adaptation, and shrinkage stress of bulk-fill resin composites. Dent Mater 31:1542–1551. https://doi.org/10.1016/j.dental.2015.10.001 CrossRefPubMedGoogle Scholar
- 22.Moher D, Shamseer L, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4(1). https://doi.org/10.1186/2046-4053-4-1
- 23.Lemos CAA, Verri FR, Bonfante EA, et al (2017) Comparison of external and internal implant-abutment connections for implant supported prostheses. A systematic review and meta-analysis. J Dent 70: 14–22. https://doi.org/10.1016/j.jdent.2017.12.001
- 24.Atieh MA, Alsabeeha NH, Payne AG, et al (2015) Interventions for replacing missing teeth: alveolar ridge preservation techniques for dental implant site development. In: Cochrane Database Syst. Rev. p CD010176Google Scholar
- 26.Wilson MA, Cowan AJ, Randall RC, Crisp RJ, Wilson NH (2002) A practice-based, randomized, controlled clinical trial of a new resin composite restorative: one-year results. Oper Dent 27(5):423-429Google Scholar
- 27.Bayraktar Y, Ercan E, Hamidi MM, Çolak H (2017) One-year clinical evaluation of different types of bulk-fill composites. J Investig Clin Dent 8. https://doi.org/10.1111/jicd.12210
- 28.van Dijken JWV, Pallesen U (2016) Posterior bulk-filled resin composite restorations: a 5-year randomized controlled clinical study. J Dent 51:29-35. https://doi.org/10.1016/j.jdent.2016.05.008
- 31.Karaman E, Keskin B, Inan U (2017) Three-year clinical evaluation of class II posterior composite restorations placed with different techniques and flowable composite linings in endodontically treated teeth. Clin Oral Investig 21:709–716. https://doi.org/10.1007/s00784-016-1940-y CrossRefPubMedGoogle Scholar
- 33.Çolak H, Tokay U, Uzgur R et al (2017) A prospective, randomized, double-blind clinical trial of one nano-hybrid and one high-viscosity bulk-fill composite restorative systems in class II cavities: 12 months results. Niger J Clin Pract 20:822–831. https://doi.org/10.4103/1119-3077.212449 PubMedGoogle Scholar
- 36.Yazici A, Antonson S, Kutuk Z, et al (2017) Thirty-six-month clinical comparison of bulk fill and nanofill composite restorations. Oper Dent. https://doi.org/10.2341/16-220-C
- 37.Egger M, Smith GD (2017) Principles of and procedures for systematic reviews. In: Egger M, Smith GD, Douglas GA (Eds.), Systematic Reviews in Health Care. Evidence-Based Health Care, 23–42Google Scholar
- 38.Hickey D, Sharif O, Janjua F, Brunton PA (2016) Bulk dentine replacement versus incrementally placed resin composite: a randomised controlled clinical trial. J Dent 46:18-22. https://doi.org/10.1016/j.jdent.2016.01.011
- 39.Manhart J, Med Dent P-D, Chen H-Y, Dent M (2008) Clinical performance of the posterior composite QuiXfil after 3, 6, and 18 months in class 1 and 2 cavities. Quintessence Int 3939:757–765Google Scholar
- 41.Van Dijken JWV, Pallesen U (2015) Randomized 3-year clinical evaluation of class I and II posterior resin restorations placed with a bulk-fill resin composite and a one-step self-etching adhesive. https://doi.org/10.3290/j.jad.a33502
- 44.Monterubbianesi R, Orsini G, Tosi G, Conti C, Librando V, Procaccini M, Putignano A (2016) Spectroscopic and mechanical properties of a new generation of bulk fill composites. Front Physiol 7. https://doi.org/10.3389/fphys.2016.00652
- 46.Li X, Pongprueksa P, Van Meerbeek B, De Munck J (2015) Curing profile of bulk-fill resin-based composites. J Dent. https://doi.org/10.1016/j.jdent.2015.01.002
- 47.El-Damanhoury H, Platt J (2014) Polymerization shrinkage stress kinetics and related properties of bulk-fill resin composites. Oper Dent. https://doi.org/10.2341/13-017-L
- 50.Wang Y, Li C, Yuan H, Wong MCM, Zou J, Shi Z, Zhou X, Cochrane Oral Health Group (2016) Rubber dam isolation for restorative treatment in dental patients. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009858.pub2
- 52.Costa T, Rezende M, Sakamoto A, et al (2017) Influence of adhesive type and placement technique on postoperative sensitivity in posterior composite restorations. Oper Dent. https://doi.org/10.2341/16-010-C
- 53.Reis A, Dourado Loguercio A, Schroeder M, Luque-Martinez I, Masterson D, Cople Maia L (2015) Does the adhesive strategy influence the post-operative sensitivity in adult patients with posterior resin composite restorations? A systematic review and meta-analysis. Dent Mater 31:1052–1067. https://doi.org/10.1016/j.dental.2015.06.001 CrossRefPubMedGoogle Scholar
- 54.Schenkel AB, Peltz I, Veitz-Keenan A (2016) Dental cavity liners for class I and class II resin-based composite restorations. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD010526.pub2
- 55.Göstemeyer G, Blunck U, Paris S, Schwendicke F (2016) Design and validity of randomized controlled dental restorative trials. Materials (Basel) 9. https://doi.org/10.3390/ma9050372
- 57.Reis A, Loguercio AD, Maran BM et al (2017) Randomized clinical trials in bleaching: compliance with the consort statement. Braz Oral Res 33:e67–e67Google Scholar