Effectiveness of bioactive resin materials in preventing secondary caries and retention loss in direct posterior restorations: A systematic review and meta-analysis

Objectives: This systematic review aimed to determine whether bioactive resin materials can prevent secondary caries or enhance the longevity of direct posterior restorations. Data sources: The protocol was registered in PROSPERO (CRD42024561179). The review followed PRISMA guidelines, utilizing a PICO framework. Studies were identified through searches in six databases (PubMed, Scopus, Cochrane, Embase, Scielo, Web of Science) up to May 2024. Study selection: Two independent reviewers applied inclusion criteria, selecting randomized clinical trials evaluating bioactive resin composites in restorative dentistry. Data were extracted into pre-designed forms, and article quality was assessed using the CONSORT, RoB 2, and GRADE tools. Meta-analyses focused on secondary caries incidence and restoration longevity using USPHS and FDI criteria. Results: Of 1,565 articles identified, 10 met the inclusion criteria. These studies, conducted in five countries, included 411 participants with follow-up periods ranging from 1 to 8 years. Materials evaluated included ACTIVA (TM) BioACTIVE, Giomer, and Cention N. Meta-analysis found no statistically significant differences between bioactive and conventional resin composites in preventing secondary caries or reducing retention loss (p > 0.05), the two primary outcomes considered in this review for assessing restoration longevity. Subgroup analysis showed no differences between follow-up periods. Conclusions: Bioactive materials demonstrated similar clinical performance to conventional composites in preventing secondary caries and retaining restorations, offering no additional benefit in enhancing the longevity of direct posterior restorations. Clinical significance: This review provides evidence that bioactive resin materials offer no significant clinical advantage over traditional composites, guiding (or informing) clinicians in (or about) material selection for restorative treatments.