Clinical Performance of Bulk-Fill Versus Incremental Composite Restorations in Primary Teeth: A Systematic Review of In Vivo Evidence
<b>Background and Objectives</b>: This is the first systematic review to focus exclusively on in vivo randomized controlled trials that compare bulk-fill and conventional incremental composite restorations in primary teeth. Our aim was to synthesize current evidence on their clinical per...
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2025-07-01
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| author | Maria Sarapultseva Desheng Hu Alexey Sarapultsev |
| author_facet | Maria Sarapultseva Desheng Hu Alexey Sarapultsev |
| author_sort | Maria Sarapultseva |
| collection | DOAJ |
| description | <b>Background and Objectives</b>: This is the first systematic review to focus exclusively on in vivo randomized controlled trials that compare bulk-fill and conventional incremental composite restorations in primary teeth. Our aim was to synthesize current evidence on their clinical performance, including retention, two-year survival rates, marginal integrity, and procedural efficiency. <b>Methods</b>: A comprehensive literature search was conducted in PubMed, Scopus, and the Elicit AI platform up to March 2025. Eligible studies were in vivo randomized controlled trials involving children aged 3–12 years with carious primary teeth, directly comparing bulk-fill and incremental composite restorations. Primary outcomes included retention rates, two-year survival, and marginal integrity, while secondary outcomes were postoperative sensitivity, secondary caries, and aesthetic outcomes. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessments using the Cochrane RoB 2.0 tool. A narrative synthesis was undertaken due to substantial heterogeneity in study design and outcome reporting. The review protocol was registered in PROSPERO (CRD420251021433). <b>Results</b>: Thirteen randomized controlled trials met the inclusion criteria. Both restoration techniques demonstrated high short-term retention rates (>90%) and comparable two-year survival (85–90%). Marginal integrity was generally equivalent, though incremental techniques showed modest advantages in complex cavities. Secondary outcomes were inconsistently reported, with no significant group differences. Bulk-fill restorations consistently reduced the procedural time by 2–4 min per restoration, representing a meaningful advantage in pediatric clinical settings. <b>Conclusions</b>: Bulk-fill composites offer a clinically effective and time-efficient alternative to incremental layering in the restoration of primary teeth. This focused synthesis addresses a gap in existing reviews by concentrating solely on primary dentition and in vivo evidence. Despite similar clinical outcomes, the time savings associated with bulk-fill techniques may enhance their utility in pediatric dentistry. Further standardized and long-term trials are warranted to confirm these findings and inform clinical guidelines. |
| format | Article |
| id | doaj-art-711da1ab589b4d198fb2139eeb8984fc |
| institution | DOAJ |
| issn | 2304-6767 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Dentistry Journal |
| spelling | doaj-art-711da1ab589b4d198fb2139eeb8984fc2025-08-20T02:45:55ZengMDPI AGDentistry Journal2304-67672025-07-0113732010.3390/dj13070320Clinical Performance of Bulk-Fill Versus Incremental Composite Restorations in Primary Teeth: A Systematic Review of In Vivo EvidenceMaria Sarapultseva0Desheng Hu1Alexey Sarapultsev2Department of Pediatric Dentistry, Medical Firm Vital EVV, Ekaterinburg 620144, RussiaDepartment of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, ChinaRussian-Chinese Education and Research Center of System Pathology, South Ural State University, 76 Lenin Prospekt, Chelyabinsk 454080, Russia<b>Background and Objectives</b>: This is the first systematic review to focus exclusively on in vivo randomized controlled trials that compare bulk-fill and conventional incremental composite restorations in primary teeth. Our aim was to synthesize current evidence on their clinical performance, including retention, two-year survival rates, marginal integrity, and procedural efficiency. <b>Methods</b>: A comprehensive literature search was conducted in PubMed, Scopus, and the Elicit AI platform up to March 2025. Eligible studies were in vivo randomized controlled trials involving children aged 3–12 years with carious primary teeth, directly comparing bulk-fill and incremental composite restorations. Primary outcomes included retention rates, two-year survival, and marginal integrity, while secondary outcomes were postoperative sensitivity, secondary caries, and aesthetic outcomes. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessments using the Cochrane RoB 2.0 tool. A narrative synthesis was undertaken due to substantial heterogeneity in study design and outcome reporting. The review protocol was registered in PROSPERO (CRD420251021433). <b>Results</b>: Thirteen randomized controlled trials met the inclusion criteria. Both restoration techniques demonstrated high short-term retention rates (>90%) and comparable two-year survival (85–90%). Marginal integrity was generally equivalent, though incremental techniques showed modest advantages in complex cavities. Secondary outcomes were inconsistently reported, with no significant group differences. Bulk-fill restorations consistently reduced the procedural time by 2–4 min per restoration, representing a meaningful advantage in pediatric clinical settings. <b>Conclusions</b>: Bulk-fill composites offer a clinically effective and time-efficient alternative to incremental layering in the restoration of primary teeth. This focused synthesis addresses a gap in existing reviews by concentrating solely on primary dentition and in vivo evidence. Despite similar clinical outcomes, the time savings associated with bulk-fill techniques may enhance their utility in pediatric dentistry. Further standardized and long-term trials are warranted to confirm these findings and inform clinical guidelines.https://www.mdpi.com/2304-6767/13/7/320bulk-fill compositepediatric dentistryprimary teethrestorationsystematic reviewretention |
| spellingShingle | Maria Sarapultseva Desheng Hu Alexey Sarapultsev Clinical Performance of Bulk-Fill Versus Incremental Composite Restorations in Primary Teeth: A Systematic Review of In Vivo Evidence Dentistry Journal bulk-fill composite pediatric dentistry primary teeth restoration systematic review retention |
| title | Clinical Performance of Bulk-Fill Versus Incremental Composite Restorations in Primary Teeth: A Systematic Review of In Vivo Evidence |
| title_full | Clinical Performance of Bulk-Fill Versus Incremental Composite Restorations in Primary Teeth: A Systematic Review of In Vivo Evidence |
| title_fullStr | Clinical Performance of Bulk-Fill Versus Incremental Composite Restorations in Primary Teeth: A Systematic Review of In Vivo Evidence |
| title_full_unstemmed | Clinical Performance of Bulk-Fill Versus Incremental Composite Restorations in Primary Teeth: A Systematic Review of In Vivo Evidence |
| title_short | Clinical Performance of Bulk-Fill Versus Incremental Composite Restorations in Primary Teeth: A Systematic Review of In Vivo Evidence |
| title_sort | clinical performance of bulk fill versus incremental composite restorations in primary teeth a systematic review of in vivo evidence |
| topic | bulk-fill composite pediatric dentistry primary teeth restoration systematic review retention |
| url | https://www.mdpi.com/2304-6767/13/7/320 |
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