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8 July 2026

20 Pages

Clinical Performance of High-Viscosity Glass Hybrid Restorative Systems in Posterior Teeth: A Scoping Review

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Grigore T. Popa University of Medicine and Pharmacy Iasi, 16 Universității Str., 700115 Iasi, Romania
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Author to whom correspondence should be addressed.
Prosthesis2026, 8(7), 71;https://doi.org/10.3390/prosthesis8070071
This article belongs to the Special Issue Next-Generation Ceramic and Composite Materials for Prosthodontics and Reconstruction
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Abstract

Background/Objectives: High-viscosity glass hybrid restorative systems (GHRS) were developed to improve the mechanical limitations of conventional glass ionomer cements while preserving their bioactive properties. This scoping review aimed to map and synthesize the currently available evidence regarding the clinical performance of high-viscosity glass hybrid restorative systems in posterior teeth. Methods: A literature search was conducted in PubMed/MEDLINE, Web of Science and Google Scholar using MeSH terms and free-text keywords related to glass hybrid restorative systems and posterior restorations. After screening and eligibility assessment, 39 studies were included in the review. Results: The reviewed studies indicated that GHRS exhibited better wear resistance, higher fracture resistance, improved surface durability, and superior marginal integrity compared with conventional high-viscosity glass ionomer cements. Equia Forte HT (GC Corporation, Tokyo, Japan), combined with nano-filled resin coatings, was the most frequently investigated system and showed favorable short- and medium-term clinical performance in small-to-moderate posterior restorations. Discussion: Glass-hybrid restorative systems have demonstrated considerable potential in minimally invasive dentistry, atraumatic restorative treatment, and pediatric restorative applications, particularly in patients with increased caries susceptibility. Their sustained fluoride release, chemical adhesion to dental tissues, and improved moisture tolerance may contribute to favorable clinical outcomes in challenging operative conditions. Conclusions: Within the limitations of the available evidence, high-viscosity glass-hybrid restorative systems may represent a promising restorative option for selected posterior restorations. Nevertheless, the available evidence remains heterogeneous, and further high-quality long-term randomized controlled trials are required to confirm their clinical performance and indications.

1. Introduction

Conventional glass ionomer cements (CGICs) are widely used in restorative dentistry due to their ability to chemically bond to dental tissues, release fluoride, and provide favorable biocompatibility under various clinical conditions [1,2,3,4]. Their fluoride-releasing and recharge capabilities have contributed to their extensive application in preventive and minimally invasive approaches, especially in pediatric and high-caries-risk patients [2,4,5]. In clinical practice, CGICs have been utilized as restorative materials, liners, bases, luting agents, and fissure sealants.
Despite these advantages, the use of conventional GICs in posterior load-bearing restorations remains challenging because of their limited mechanical performance. Reduced fracture toughness, lower wear resistance, and susceptibility to surface degradation may negatively influence the long-term durability of these restorations [6,7,8,9,10]. These shortcomings may compromise the longevity of restorations exposed to substantial occlusal loading, especially in large posterior cavities [7,8,9].
In an attempt to improve the mechanical limitations of conventional GICs, high-viscosity glass ionomer cements (HVGICs) were developed through formulation modifications involving increased powder content, refined glass particles, and changes in the polyacid matrix [11,12,13,14,15]. Compared with conventional glass ionomer formulations, HVGICs exhibit higher compressive strength, improved wear resistance, and better handling properties, thereby broadening their clinical use in posterior restorations and atraumatic restorative treatment (ART) procedures [12,13,14,15].
More recently, glass-hybrid restorative systems (GHSs) have been introduced as the next step in HVGIC technology. These materials combine the chemistry of high-viscosity glass ionomer with reinforcing strategies, such as ultrafine reactive glass particles and protective nano-filled resin coatings, to improve fracture resistance, marginal integrity, and surface durability while maintaining fluoride release and bioactivity [16,17,18,19,20]. Commercial systems such as EQUIA Forte (GC Corporation, Tokyo, Japan) and EQUIA Forte HT (GC Corporation, Tokyo, Japan) have shown promising clinical outcomes in posterior restorations, particularly within minimally invasive restorative approaches [18,21,22,23,24].
Although several in vitro and clinical studies have reported favorable results for glass hybrid systems, questions remain regarding their long-term durability, wear resistance, marginal adaptation, and survival compared with other restorative materials used in posterior teeth [17,19,22,23]. In addition, variations in material composition and clinical protocols contribute to heterogeneity among published studies.
Although the available literature on high-viscosity glass-hybrid restorative systems has expanded considerably in recent years, the evidence remains dispersed across studies investigating different restorative materials, outcome measures, and levels of evidence. Consequently, clinicians lack a comprehensive synthesis integrating material characteristics, mechanical properties, bioactivity, wear resistance, and clinical performance of these restorative systems in posterior teeth. Owing to this heterogeneity, this scoping review aimed to critically summarize and map the existing evidence regarding the use and clinical outcomes of high-viscosity glass-hybrid restorative systems in posterior restorations.

2. Materials and Methods

2.1. Protocol and Registration

This scoping review was performed following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines [24]. The corresponding PRISMA-ScR checklist is available in Supplementary Table S1: Clinical Performance of High-Viscosity Glass Hybrid Restorative Systems in Posterior Teeth: A Scoping Review.
The review protocol was prospectively submitted to the International Prospective Register of Systematic Reviews (PROSPERO; Centre for Reviews and Dissemination, University of York, York, UK) and registered under the identification number CRD420261381434.

2.2. Research Questions

The review questions were developed to comprehensively map and synthesize the available evidence regarding the material characteristics, mechanical properties, bioactive behavior, and clinical performance of high-viscosity glass-hybrid restorative systems used in posterior teeth. Comparisons with other restorative materials and clinical indications were considered secondary objectives.
The review addressed the following question: What evidence is currently available regarding the mechanical properties, bioactive behavior, and clinical performance of high-viscosity glass-hybrid restorative systems in posterior teeth?
The research question was structured according to the PCC (Population–Concept–Context) framework [25]:
  • Population: Patients with primary and/or permanent posterior teeth.
  • Concept: Clinical performance and bioactive properties of high-viscosity glass hybrid restorative systems.
  • Context: Posterior restorative dentistry and minimally invasive restorative approaches.

2.3. Study Selection and Eligibility Criteria

2.3.1. Study Selection Process

The titles and abstracts identified through the electronic search were independently reviewed by two investigators (A.T.V. and G.I.) based on the predefined inclusion criteria. Full-text articles were subsequently assessed for eligibility when relevance was considered likely. Duplicate publications were excluded before study screening. Study selection was conducted in accordance with the PRISMA-ScR guidelines for scoping reviews.

2.3.2. Inclusion Criteria

Studies were selected according to predefined inclusion criteria related to restorative materials, study objectives, dentition type, reported outcomes, study design, and publication characteristics, as summarized in Table 1.
Table 1. Inclusion criteria applied for the selection of studies.

2.3.3. Exclusion Criteria

Studies that did not meet the predefined methodological and publication standards were excluded according to the criteria presented in Table 2.
Table 2. Eligibility exclusion criteria for study selection.
Studies were considered to have insufficient methodological or outcome data when they lacked a clear description of the study design, restorative material, sample characteristics, follow-up period (for clinical studies), or failed to report outcomes relevant to the objectives of the present review.

2.4. Information Sources

Studies published between January 2000 and April 2026 were considered eligible for inclusion in this review. An extensive electronic search was performed using the PubMed/MEDLINE, Web of Science (Clarivate, Philadelphia, PA, USA) and Google Scholar (Google LLC, Mountain View, CA, USA) databases.
The selected publication period was chosen to capture the development and clinical evolution of high-viscosity glass ionomer cements and glass-hybrid restorative systems used in posterior restorations.

2.5. Search Strategy

The electronic search strategy combined Medical Subject Headings (MeSH) for PubMed/MEDLINE with database-specific free-text keywords for Web of Science and Google Scholar. Boolean operators (AND, OR) and phrase searching were used to combine search terms. No truncation or wildcard operators were applied because the selected keywords were considered sufficiently specific. The search syntax was adapted according to the indexing system of each database. The complete search strategies are presented in Table 3.
Table 3. Database-specific search strategies used for study identification.

2.6. Data Extraction

Data from the included studies were extracted and systematically organized into standardized in Table 4. Extracted variables included author and year of publication, study design, type of restorative material evaluated, sample characteristics, dentition type, follow-up period, outcome measures, and key findings pertaining to the clinical and mechanical performance of glass hybrid restorative systems.
Table 4. Overview of included studies evaluating the clinical and mechanical performance of glass-hybrid restorative systems.

2.7. Data Synthesis

A qualitative descriptive synthesis was conducted for all eligible studies. The marked heterogeneity regarding study methodology, evaluated restorative materials, and outcome measures prevented the performance of a quantitative meta-analysis.
Accordingly, findings were synthesized using a narrative approach and structured into predefined thematic domains, encompassing mechanical properties, bioactive behavior, clinical performance, restorative longevity, and minimally invasive clinical applications.

2.8. Quality Assessment

Randomized controlled trials were assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials, whereas observational clinical studies were evaluated using the Newcastle–Ottawa Scale (NOS).

3. Results

3.1. Selection Process

Figure 1 illustrates the PRISMA flow diagram describing the study selection process applied in this scoping review. A total of 702 records were identified through the electronic database search, including 311 records from PubMed/MEDLINE, 148 records from Google Scholar, and 243 records from the Web of Science database. After duplicate records were removed, the remaining records underwent title and abstract screening.
Figure 1. PRISMA flow diagram.
During the screening process, studies that did not meet the predefined eligibility criteria were excluded, including those unrelated to posterior restorations, studies not evaluating glass-hybrid restorative materials, and publications lacking clinically or mechanically relevant outcomes. The remaining articles were assessed for full-text eligibility, resulting in the inclusion of 39 studies in the final qualitative synthesis.

3.2. Overview of Included Studies

The principal characteristics of the selected studies are presented in Table 4. The selected articles included in vitro studies [18,26,27,29,30,32,33,34,35,38,39,40,41,42,47,48,50,51,52], randomized clinical trials [19,28,44,45,46], clinical studies [43,49,55], review articles [3,6,15,37,54], and systematic reviews [36,53]. Most investigations evaluated glass-hybrid restorative systems (GHRS), high-viscosity glass ionomer cements (HVGICs), and modified glass ionomer restorative materials used in posterior restorations.
The most frequently assessed outcomes included mechanical properties, wear resistance, fracture resistance, fluoride release, marginal integrity, microleakage, and clinical performance. Several studies reported improved mechanical behavior and enhanced fluoride-related properties for glass-hybrid restorative systems compared with conventional glass ionomer cements [26,27,29,39,41]. In addition, nano-filled coatings were associated with increased wear resistance and improved surface protection [27,39,41,43].
Clinical investigations demonstrated generally acceptable survival rates and favorable outcomes for glass-hybrid restorations in posterior teeth and primary molars [19,28,44,45,46]. However, some studies emphasized that the long-term clinical performance of these restorative materials may still depend on cavity design, occlusal loading conditions, and restorative indication [6,36,55].
Recent studies further supported the favorable clinical performance and wear resistance of glass-hybrid restorative systems in posterior restorations [56,57,58,59].

3.3. Methodological Quality Assessment of the Included Clinical Studies

A brief methodological quality assessment was performed for the included clinical studies to provide an overview of the strength of the available evidence. Randomized controlled trials were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials, whereas observational clinical studies were assessed using the Newcastle–Ottawa Scale (NOS).
As shown in Table 5, most randomized clinical trials were rated as high methodological quality, whereas the observational clinical studies were classified as moderate quality. The methodological quality assessment is further summarized in the heat map presented in Figure 2.
Table 5. Methodological quality ratings of the included clinical studies according to the JBI Checklist and the Newcastle–Ottawa Scale (NOS).
Figure 2. Heat map summarizing the methodological quality assessment of the included clinical studies according to the Newcastle–Ottawa Scale (NOS). Green squares indicate high methodological quality, whereas orange squares indicate moderate methodological quality. The heat map includes the studies by Durhan et al. (2022) [19], Mohamed et al. (2022) [28], Miletić et al. (2024) [44], Wafaie et al. (2022) [45], Öz et al. (2023) [46], Rathke et al. (2021) [49], Atmaca and Karadaş (2024) [55], Işıklı et al. (2026) [56], Papadopoulou et al. (2026) [57], and Alqasabi et al. (2025) [58].
The heat map provides an overview of the methodological quality of the included clinical studies. Most studies showed a low risk of bias across the evaluated domains, although moderate concerns were identified mainly in the observational clinical studies because of their non-randomized design and limited follow-up.

3.4. Composition and Characteristics of High-Viscosity Glass Hybrid Restorative Systems

These restorative systems are based on a high-viscosity glass-ionomer matrix reinforced with ultrafine reactive glass particles, ceramic fillers, and zirconia particles, coated with a nano-filled resin, to enhance their mechanical and clinical performance, particularly fracture resistance, wear resistance, surface hardness, and marginal adaptation [3,15,18,26,27,28,29] (Table 6).
Table 6. Summary of studies investigating the properties and clinical performance of glass-hybrid restorative systems.
The glass ionomer phase is responsible for fluoride release and recharge, chemical adhesion to enamel and dentin, and a clinically relevant tolerance to moisture during placement. The reinforcing phase contributes to improved mechanical performance and helps maintain surface integrity over time. Among the most extensively investigated systems, Equia Forte (GC Corporation, Tokyo, Japan) consists of a high-viscosity glass ionomer restorative material combined with a nano-filled resin coating intended to seal surface porosities and enhance wear resistance during maturation and under functional loading [30,31,32] (Table 6).
Other commercially investigated systems include zirconia-reinforced materials such as Zirconomer (Shofu Inc., Kyoto, Japan) and hybrid formulations such as GC Gold Label Hybrid (GC Corporation, Tokyo, Japan), which were developed to improve fracture resistance and clinical longevity while preserving the bioactive properties associated with glass ionomer materials [33,34] (Table 6).
Available evidence suggests that glass hybrid restorative systems are intended to balance bioactivity with mechanical reinforcement. Clinical outcomes vary between materials and are influenced by differences in filler composition, coating systems, and clinical application protocols [15,26,35,36,37] (Table 6).

3.5. Mechanical Properties Relevant to Posterior Restorations

Available evidence indicates that glass hybrid restorative systems generally exhibit enhanced mechanical properties compared with conventional high-viscosity glass ionomer cements, particularly in terms of compressive strength, fracture resistance, wear resistance, and surface durability [27,38] (Figure 3, Table 7).
Figure 3. Mechanical performance profile of glass-hybrid restorative systems and their relevance to posterior restorations. Green panels summarize the improved mechanical properties of glass-hybrid restorative systems; dark blue panels present the factors contributing to the improved mechanical performance; purple panels illustrate the comparative mechanical performance relative to conventional high-viscosity glass ionomer cements (HVGICs) and resin composites; orange panels highlight the main limitations and clinical considerations; and the light blue panel summarizes the principal clinical implications. Icons: ↓ increased compressive strength; ✳ improved fracture resistance; enhanced wear resistance; ✔ improved surface durability; ⊗ reduced surface porosity; ● reactive glass particles; nano-filled resin coating; surface protection; network symbol reduced crack propagation; limitations and considerations; comparative position among restorative materials; overall clinical potential; and the central tooth icon represents the glass-hybrid restorative system. The figure is based on the findings reported by Najeeb et al. (2016) [3], Lohbauer (2009) [6], Mohanty and Kalimireddy (2020) [15], Šalinović et al. (2019) [26], Brkanović et al. (2021) [27], Mohamed et al. (2022) [28], Moshaverinia et al. (2023) [29], Habib (2020) [30], Valeri et al. (2022) [34], Durrant et al. (2024) [36], Ge et al. (2024) [37], Setiawan et al. (2022) [39], Yeo et al. (2021) [40], and Elshawadfy et al. (2022) [41].
Table 7. Main mechanical findings reported for glass-hybrid restorative systems.
Among the most extensively investigated materials, Equia Forte HT (GC Corporation, Tokyo, Japan), in combination with Equia Forte Coat (GC Corporation, Tokyo, Japan), has shown increased resistance to compressive loading, reduced surface degradation, and improved wear resistance under thermocycling, toothbrushing simulation, and acidic conditions. These improvements are mainly associated with the incorporation of ultrafine reactive glass particles and the use of nano-filled resin coatings, which contribute to reduced surface porosity and decreased crack propagation [39,40,41].
Flexural strength and fracture resistance findings indicate that glass-hybrid systems generally perform better than uncoated HVGICs but may still be inferior to resin composites in large stress-bearing posterior restorations. Nevertheless, coated-glass hybrid materials appear to occupy an intermediate position between conventional glass ionomers and resin-based restoratives with respect to mechanical behavior and load-bearing capacity [6,15,26,27,29] (Figure 3, Table 7).
The reported mechanical performance remains material- and technique-dependent, and further long-term clinical evidence is necessary to confirm the durability of these materials under functional posterior loading [27,38]. Recent studies have further strengthened the available evidence by demonstrating improved wear resistance with resin-coated glass-hybrid restorative systems and favorable short-term clinical performance comparable to resin composites [56,59].

3.6. Wear Resistance and Surface Protection

The reviewed literature suggests that glass hybrid restorative systems generally demonstrate improved wear resistance and surface stability compared with conventional high-viscosity glass ionomer cements, particularly when used with nano-filled resin coatings such as Equia Forte Coat (GC Corporation, Tokyo, Japan) [27,29,41].
The resin coating improves surface durability by sealing porosities and microcracks, thereby reducing abrasive wear and protecting the underlying glass ionomer matrix during maturation and functional loading. Several studies have reported higher surface hardness, reduced wear depth, and reduced surface degradation in coated-glass hybrid systems compared with uncoated materials [34,39].
The protective effect of the coating appears to be influenced by material composition, coating integrity, aging conditions, pH exposure, and clinical technique. Although some laboratory studies have demonstrated favorable wear behavior comparable to that of certain resin composites, available evidence suggests that resin-based materials may exhibit better performance under high-load and long-term wear simulations [42,43]. As illustrated in Figure 4, the application of nano-filled resin coatings appears to improve the wear resistance and surface stability of glass hybrid restorative systems, potentially enhancing clinical durability in posterior restorations.
Figure 4. Schematic overview of wear resistance and surface protection in coated and uncoated glass-hybrid restorative systems. Blue boxes indicate the initial assessment and expected material performance; orange boxes/diamonds represent decision points and potential limitations; green boxes indicate favorable outcomes or recommended clinical pathways; red boxes present clinical recommendations. Green arrows indicate favorable decision pathways, whereas red arrows indicate unfavorable pathways or the absence of resin coating.

3.7. Clinical Performance and Survival in Posterior Teeth

Clinical studies generally report favorable short- to medium-term outcomes for glass hybrid restorative systems in posterior teeth, particularly for small- to moderate-sized Class I and Class II restorations. Equia Forte HT (GC Corporation, Tokyo, Japan), in combination with Equia Forte Coat (GC Corporation, Tokyo, Japan), is the most frequently investigated system and has demonstrated acceptable survival rates, satisfactory marginal adaptation, and a low incidence of postoperative sensitivity and secondary caries over follow-up periods of 1–5 years [28,44,45,46] (Figure 5). Survival outcomes appear to be influenced by cavity size, occlusal load, dentition type, operator technique, and follow-up duration. Fracture, wear, and marginal degradation were the most commonly reported causes of failure [47,48,49].
Figure 5. Clinical performance profile of glass-hybrid restorative systems in posterior restorations. Green panels summarize the main favorable clinical outcomes, blue panels present factors influencing clinical performance, red panels indicate the most commonly reported causes of failure, purple panels summarize the main clinical implications, and the central blue circle represents the overall clinical performance of glass-hybrid restorative systems. Icons: shield = restoration survival; tooth = marginal adaptation; lightning bolt = postoperative sensitivity; tooth with lesion = secondary caries; droplet = fluoride release; tooth = cavity size and configuration; occlusal surface = occlusal load; hand = operator technique; clock = follow-up duration; brush = use of surface coating; broken tooth = fracture; worn tooth = wear; damaged margin = marginal degradation; rough surface = surface roughness/degradation; detached restoration = loss of retention. The figure is based on the findings reported by Brkanović et al. (2021) [27], Mohamed et al. (2022) [28], Miletić et al. (2024) [44], Wafaie et al. (2022) [45], Öz et al. (2023) [46], Singh et al. (2021) [47], Fernandes et al. (2019) [48], and Rathke et al. (2021) [49].

3.8. Clinical Indications and Limitations

Glass hybrid restorative systems are primarily indicated for posterior restorations when fluoride release, chemical adhesion, and improved moisture tolerance are clinically relevant. The literature supports their use especially in small-to-moderate Class I and Class II posterior cavities, atraumatic restorative treatment, pediatric dentistry, mixed dentition, and high-caries-risk patients [44,45,46,47,49].
In posterior Class II restorations, glass hybrid systems such as Equia Forte HT (GC Corporation, Tokyo, Japan) with Equia Forte Coat (GC Corporation, Tokyo, Japan) have shown favorable clinical outcomes, particularly in small to moderate two-surface lesions. Clinical studies and systematic reviews report survival rates comparable to those of resin-based composites in selected indications, although outcomes vary with cavity size, occlusal load, use of the surface coating, and clinical technique [28,44,47,48].
High-caries-risk patients represent an important clinical indication. Owing to their sustained fluoride release and recharge potential, glass hybrid systems may support remineralization and reduce the risk of secondary caries at restoration margins. These characteristics make them particularly useful for pediatric patients, individuals with poor oral hygiene, xerostomia, recurrent caries, or situations in which moisture control is compromised [50,51,52,53].

3.9. Gaps in the Literature on the Use of Glass-Hybrid Restorative Systems (GHRS) in Posterior Teeth

Current evidence regarding glass-hybrid restorative systems in posterior teeth remains limited by the lack of long-term randomized clinical trials, particularly for large Class I, Class II, and multi-surface restorations [13,44,54]. Existing studies also demonstrate substantial heterogeneity in outcome measures, follow-up periods, and reporting of failure modes, making direct comparisons between studies difficult.
Available findings are highly material- and coating-dependent, with limited standardized comparisons between different glass-hybrid formulations and resin composites [6,55].
Further limitations include the scarcity of stratified data by cavity configuration, patient age, and dentition type, as well as the limited translation of wear data into real-world clinical outcomes [19,56].

4. Discussion

4.1. Summary of Principal Findings

This scoping review synthesized the available evidence regarding the composition, mechanical behavior, wear resistance, clinical performance, and clinical applicability of glass-hybrid restorative systems (GHRS) in posterior teeth. Overall, the reviewed literature suggests that GHRS were developed to combine the bioactive advantages of conventional glass ionomer cements with improved mechanical performance by incorporating ultrafine reactive glass particles, resin coatings, and hybrid reinforcing technologies.
GHRS demonstrated improved mechanical properties compared with conventional high-viscosity glass ionomer cements, particularly regarding compressive strength, fracture resistance, wear resistance, and marginal integrity. These improvements were mainly associated with nano-filled resin coatings and modified filler technologies capable of reducing porosity and crack propagation [27,29,39].
Wear resistance and surface protection are considered major advantages of coated glass hybrid systems. Laboratory studies have reported reduced surface degradation, decreased wear depth, and increased surface hardness following application of resin coatings such as Equia Forte Coat (GC Corporation, Tokyo, Japan) [34,41,43].
Clinical studies generally reported favorable short- and medium-term outcomes for small-to-moderate posterior Class I and Class II restorations. Equia Forte HT (GC Corporation, Tokyo, Japan), combined with Equia Forte Coat (GC Corporation, Tokyo, Japan), was the most frequently investigated system and demonstrated acceptable survival rates, satisfactory marginal adaptation, and low incidence of secondary caries during follow-up periods of up to 5 years [44,45].
The evidence suggested that GHRS may be particularly useful in minimally invasive dentistry, atraumatic restorative treatment, pediatric dentistry, and high-caries-risk patients because of their fluoride release, chemical adhesion, and relative moisture tolerance. Nevertheless, important limitations remain regarding long-term durability of large stress-bearing posterior restorations, and current evidence remains characterized by methodological heterogeneity and limited long-term randomized clinical trials [13,54].

4.2. Clinical Implications

The findings of this scoping review suggest that glass-hybrid restorative systems may serve as a clinically acceptable alternative to conventional high-viscosity glass ionomer cements for selected posterior indications. Their enhanced wear and fracture resistance, together with improved marginal integrity, fluoride release, and relative moisture tolerance, support their application in minimally invasive dentistry, atraumatic restorative treatment (ART), pediatric dentistry, and in patients with high caries risk [44,45,46].
Among the available materials, Equia Forte HT (GC Corporation, Tokyo, Japan), in combination with nano-filled resin coatings, has demonstrated favorable short- to medium-term clinical outcomes in small- to moderate- Class I and Class II restorations. The evidence further indicates that the application of a surface coating is relevant for enhancing surface protection and limiting wear-related degradation under functional loading [27,41].
Nevertheless, the use of glass hybrid restorative systems in large stress-bearing posterior restorations and extensive multi-surface cavities should be approached with caution, as resin-based composites may still improve clinical performance. Consequently, material selection should be determined on a case-by-case basis, considering cavity extent, occlusal loading, moisture control, caries risk, and patient-related factors such as cooperation [13,54].
The findings of this review should be interpreted with caution because of the considerable methodological heterogeneity of the included studies. Although laboratory studies generally reported favorable mechanical properties, these findings cannot be directly extrapolated to long-term clinical performance. Furthermore, some studies highlighted limitations in extensive posterior restorations and under high occlusal loading conditions, emphasizing the need for additional high-quality long-term randomized clinical trials.

4.3. Limitations

Several limitations of this scoping review should be acknowledged:
  • Considerable heterogeneity was identified among the included studies regarding study design, restorative materials, evaluation criteria, follow-up periods, and reported outcomes, which limited direct comparisons between studies.
  • Only studies published in the English language were included, which may have introduced language bias by excluding potentially relevant evidence published in other languages.
  • Although the literature search was expanded to include PubMed/MEDLINE, Web of Science, and Google Scholar, potentially relevant studies indexed exclusively in other databases or unpublished grey literature may not have been identified, introducing a potential selection bias.
  • Both in vitro and clinical studies were included in this scoping review. Consequently, some laboratory findings may not fully reflect long-term clinical behavior under functional intraoral conditions.
  • Most available clinical evidence was limited to short- and medium-term follow-up periods, whereas long-term data for large posterior restorations remain scarce.
  • The majority of the included studies focused on specific commercial systems, particularly Equia Forte (GC Corporation, Tokyo, Japan) and Equia Forte HT (GC Corporation, Tokyo, Japan), which may limit the generalizability of the findings to other glass-hybrid restorative materials.
  • Differences in coating application protocols, cavity configuration, operator technique, and patient-related factors may have influenced the reported outcomes across studies.
  • A formal risk-of-bias assessment and quantitative meta-analysis were not performed because the primary objective of this scoping review was to map and summarize the available evidence rather than evaluate treatment effectiveness quantitatively.

4.4. Comparison with Previous Literature

The results of the present scoping review are in agreement with previously published narrative and systematic reviews indicating that glass-hybrid restorative systems may provide improved clinical performance compared with conventional high-viscosity glass ionomer cements, especially in small- to moderate-sized posterior restorations [6,13].
This review extends the current evidence base by consolidating data on material composition, wear resistance, coating systems, and clinical indications into a coherent and structured synthesis.

4.5. Future Research Directions

Future investigations should prioritise multicentre, well-designed randomised clinical trials employing standardised outcome measures and extended follow-up periods exceeding five years. Additional research is warranted on large multi-surface posterior restorations, the long-term behaviour of resin-based surface coatings, and the influence of cavity configuration on restoration survival and failure patterns.
The current evidence is constrained by methodological heterogeneity and a paucity of long-term clinical data. Accordingly, further standardised randomised clinical trials are required to substantiate long-term durability and to better delineate the clinical indications of these materials in posterior teeth.

5. Conclusions

Current evidence suggests that high-viscosity glass-hybrid restorative systems may represent a promising restorative option for selected posterior restorations because of their favorable mechanical properties and short- to medium-term clinical performance. However, the available evidence remains heterogeneous and is predominantly based on studies evaluating specific commercial products. Therefore, further high-quality, long-term randomized clinical trials are required to strengthen the current evidence and better define their clinical indications.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/prosthesis8070071/s1, Table S1: Clinical Performance of High-Viscosity Glass Hybrid Restorative Systems in Posterior Teeth: A Scoping Review.

Author Contributions

Conceptualization: A.T.V., T.P., B.R.D., S.S., A.G., I.N., A.M., S.A. and G.I.; Methodology: A.T.V., T.P., B.R.D., S.S., A.G., I.N., A.M., S.A. and G.I.; Investigation: A.T.V., T.P., B.R.D. and I.N.; Data curation: A.T.V., T.P. and A.G.; Formal analysis: B.R.D., S.S. and G.I.; Writing—original draft preparation: A.T.V. and T.P.; Writing—review and editing: B.R.D., S.S., A.M., S.A. and G.I.; Supervision: S.A. and G.I.; Validation: S.S., A.M. and S.A. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Data Availability Statement

The original contributions presented in this study are included in the article/Supplementary Material.

Acknowledgments

During the preparation of this manuscript, the authors used ChatGPT (OpenAI, San Francisco, CA, USA; GPT-5.5), a generative artificial intelligence (GenAI) tool, for the creation of schematic figures and graphical illustrations. The authors reviewed, edited, and validated all generated content and take full responsibility for the final content of the manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
ARTAtraumatic Restorative Treatment
CGICsConventional Glass Ionomer Cements
GHRSGlass Hybrid Restorative System
GICsGlass Ionomer Cements
HVGICHigh-Viscosity Glass Ionomer Cement
PCCPopulation, Concept, Context
PRISMA-ScRPreferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews

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