Directly placed restorative materials: Review and network meta-analysis

For restoring cavitated dental lesions,whether carious or not,a large number of material combinations are available. we aimed to systematically review and synthesize data of comparative dental restorative trials. a systematic review was performed. randomized controlled trials published between 2005 and 2015 were included that compared the survival of ≥2 restorative and/or adhesive materials (i.e.,no need for restorative reintervention). pairwise and bayesian network meta-analyses were performed,with separate evaluations for cervical cavitated lesions and load-bearing posterior cavitated lesions in permanent and primary teeth. a total of 11,070 restorations (5,330 cervical,5,740 load bearing) had been placed in 3,633 patients in the included trials. thirty-six trials investigated restoration of cervical lesions (all in permanent teeth) and 36 of load-bearing lesions (8 in primary and 28 in permanent teeth). resin-modified glass ionomer cements had the highest chance of survival in cervical cavitated lesions; composites or compomers placed via 2-step self-etch and 3-step etch-and-rinse adhesives were ranked next. restorations placed with 2-step etch-and-rinse or 1-step self-etch adhesives performed worst. for load-bearing restorations,conventional composites had the highest probability of survival,while siloranes were found least suitable. ambiguity remains regarding which adhesive strategy to use in load-bearing cavitated lesions. most studies showed high risk of bias,and several comparisons were prone for publication bias. if prioritized for survival,resin-modified glass ionomer cements might be recommended to restore cervical lesions. for load-bearing ones,conventional or bulk fill composites seem most suitable. the available evidence is quantitatively and qualitatively insufficient for further recommendations,especially with regard to adhesive strategies in posterior load-bearing situations. moreover,different material classifications might yield different findings on the same materials. future trials should aim for sufficient power,longer follow-up times,and high internal validity to prove or refute differences between certain material combinations. an agreed material classification for future syntheses is desirable. © international & american associations for dental research 2016.