Clinical Effectiveness of Bulk-Fill and Conventional Resin Composite Restorations: Systematic Review and Meta-Analysis

Abstract

The objective of this systematic review and meta-analysis was to determine the clinical effectiveness of bulk-fill and conventional resin in composite restorations. A bibliographic search was carried out until May 2020, in the biomedical databases Pubmed/MEDLINE, EMBASE, Scopus, CENTRAL and Web of Science. The study selection criteria were: randomized clinical trials, in English, with no time limit, with a follow-up greater than or equal to 6 months and that reported the clinical effects (absence of fractures, absence of discoloration or marginal staining, adequate adaptation marginal, absence of post-operative sensitivity, absence of secondary caries, adequate color stability and translucency, proper surface texture, proper anatomical form, adequate tooth integrity without wear, adequate restoration integrity, proper occlusion, absence of inflammation and adequate point of contact) of restorations made with conventional and bulk resins. The risk of bias of the study was analyzed using the Cochrane Manual of Systematic Reviews of Interventions. Sixteen articles were eligible and included in the study. The results indicated that there is no difference between restorations with conventional and bulk resins for the type of restoration, type of tooth restored and restoration technique used. However, further properly designed clinical studies are required in order to reach a better conclusion.

Probing the hierarchy of evidence to identify the best strategy for placing class II dental composite restorations using current materials

“…This review compared several FDI clinical criteria. Among other findings, there were no differences noted in marginal adaptation, marginal discoloration and secondary caries between teeth restored with a bulk‐fill technique and a layered conventional composite 73 . The third review included 11 clinical trials comparing marginal adaptation as the outcome.…”

“…67,69 f.Systematic reviews Clinical: Three systematic reviews and meta analyses have been completed to compare bulk-filling techniques to conventional layering. [72][73][74] One review included 10 clinical trials of Class I and II restorations comparing restoration failure as the outcome. No difference was found in the failure rates between teeth restored with layered conventional composite and either flowable bulk-fill liners or bulk-fill only materials.…”

“…Among other findings, there were no differences noted in marginal adaptation, marginal discoloration and secondary caries between teeth restored with a bulk-fill technique and a layered conventional composite. 73 The third review included 11 clinical trials comparing marginal adaptation as the outcome. No difference was found between the marginal adaptation of composites placed in bulk as compared to those placed in increments.…”

Scoping review of trials evaluating adhesive strategies in pediatric dentistry: where do simplified strategies lie?

“…Bulk-fill materials can be considered a viable alternative to other restorative techniques, as compomers are being gradually discontinued and are currently rarely used. Current evidence shows bulk-fill composites have clinical outcomes, especially longevity, comparable to conventional composites, and have been also advocated in children [ 53 ].…”

Secondary Caries Adjacent to Bulk or Incrementally Filled Composites Placed after Selective Excavation In Vitro

“…BF are an accepted and widely used restorative material, with a high profile research community characterizing and further enhancing this material class, which has received specific attention in the post-Minamata era as a possible amalgam replacement material [ 24 ]. While clinical data are emerging, pointing towards limited short-term differences between BF and IF [ 25 ], certain aspects, like secondary caries, are hard to assess clinically, as they require years-long follow-up periods beyond what is usually feasible in many controlled trials and what is useful when needing to make decisions towards employing new materials today or not [ 26 ]. Hence, in vitro studies are particularly useful for studying the risk of secondary caries adjacent to different restorative materials.…”