Fracture Resistance of Fiber-Reinforced Composite Restorations: A Systematic Review and Meta-Analysis

Composite resin is universally used for posterior teeth restorations. Fibers have been suggested for the mechanical improvement of the restorations. This study assessed the fracture resistance of class II fiber-reinforced composite restorations and compared it with the fracture resistance of three control groups: (1) healthy teeth, (2) non-fiber-reinforced restorations and (3) unrestored cavities. A search was performed using PubMed, Web of Science and Google Scholar from 15 May to 12 June 2023. Only in vitro studies from the last 10 years were included for this systematic analysis. This study was registered in the PROSPERO database, it followed PRISMA guidelines and the risk of bias was assessed using the QUIN tool. Fracture resistance median values, in Newtons (N), were calculated for the experimental and control groups (95% confidence interval). For pairwise comparison, nonparametric tests (p < 0.05) were applied. Twenty-four in vitro studies met the inclusion criteria. The fracture resistance of the experimental group was 976.0 N and differed (p < 0.05) from all controls. The experimental group showed lower values of fracture resistance than healthy teeth (1459.9 N; p = 0.048) but higher values than non-fiber-reinforced restorations (771.0 N; p = 0.008) and unrestored cavities (386.6 N; p < 0.001). In vitro systematic outcomes evidenced that glass and/or polyethylene fibers improved the fracture resistance of composite restorations.