A Systematic Review and Meta-Analysis on the Clinical Performance and Longevity of Bioactive Composite Resin Restorations

Background: Bioactive composite resins combine the esthetic and mechanical properties of resin composites with therapeutic functions such as ion release, remineralization, and caries inhibition. While in vitro studies suggest promising bioactivity, their clinical performance in permanent teeth remains uncertain. Objective: This systematic review and meta-analysis critically appraised randomized controlled trials and prospective clinical studies to determine whether bioactive composites offer superior clinical performance compared to conventional resin composites and glass ionomer-based materials. Methods: Electronic databases (PubMed/MEDLINE, Scopus, Web of Science, Google Scholar) were searched for eligible studies (2018–2025). Clinical outcomes assessed restoration survival, marginal integrity, secondary caries, postoperative sensitivity, and esthetic outcomes (color match). Data were pooled using a random-effects model, and risk of bias was assessed with Cochrane criteria. Results: Twenty-two trials met the inclusion criteria. No significant differences were found between bioactive and control restorations for survival/retention (RD = 0.01; 95% CI, –0.01 to 0.03), marginal adaptation (RD = 0.02; 95% CI, –0.02 to 0.06), secondary caries (RD = 0.01; 95% CI, –0.01 to 0.03), or postoperative sensitivity (RD = 0.01; 95% CI, –0.02 to 0.04), with negligible heterogeneity (I² = 0–4%). For color match, glass ionomer restorations showed significantly poorer outcomes (RD = –0.23; 95% CI, –0.31 to –0.14; p < 0.00001; I² = 98%), while conventional resin composites had a slight but significant advantage over bioactive composites (RD = 0.07; 95% CI, 0.02 to 0.12; p = 0.003; I² = 76%). Most studies presented moderate risk of bias and short-term follow-up (<36 months). Conclusions: Current evidence indicates that bioactive composites perform comparably, but not superior, to conventional restoratives in permanent teeth. The discrepancy between laboratory bioactivity and clinical effectiveness highlights the need for long-term, well-designed clinical trials with standardized outcome reporting.