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Clinical Performance of Ion-Releasing Restorative Materials in Permanent Teeth: A Systematic Review and Network
Alain Manuel Chaple Gil1, Laura Pereda Vázquez2, Meylin Santiesteban Velázquez3
1Facultad de Ciencias de la Salud, Carrera de Odontología, Grupo de Investigación en Rehabilitación Oral Basada en Evidencia (GIROBE), Universidad Autónoma de Chile, Santiago, Chile.
Objective:
To compare the clinical performance of ion-releasing restorative materials with other direct restorative strategies in permanent teeth using a frequentist network meta-analysis framework.
Materials And Methods:
A systematic review and network meta-analysis were conducted in accordance with PRISMA 2020 and PRISMA-NMA guidelines. Electronic searches were performed in PubMed/MEDLINE, Scopus, Web of Science, Embase, and CENTRAL without year restriction. Randomized controlled trials evaluating ion-releasing restorative materials (giomer/PRG-based materials, alkasite, and glass carbomer) in permanent teeth were included. Comparators comprised conventional resin composites, glass ionomer cements (GICs), and resin-modified glass ionomer cements (RMGIs). Primary outcomes included retention loss, marginal adaptation, marginal discoloration, postoperative sensitivity, and secondary caries assessed using USPHS or FDI criteria. Random-effects pairwise and frequentist network meta-analyses were performed. Inconsistency was evaluated using a design-by-treatment interaction model, and certainty of evidence was assessed with the CINeMA framework.
Results:
A total of 13 randomized clinical trials comprising 436 participants and 915 restorations met the inclusion criteria. Follow-up ranged from 12 months to 8 years. Glass Carbomer could not be incorporated into the connected treatment network and was therefore retained only in the qualitative synthesis. Across outcomes, ion-releasing restorative materials showed similar clinical outcomes to conventional resin composites and RMGIs. No statistically significant and consistent superiority was identified for any material class. Event rates for postoperative sensitivity and secondary caries were low. Global inconsistency tests were nonsignificant across networks. The certainty of evidence was predominantly moderate, with selected high-confidence contrasts involving alkali formulations.
Conclusions:
Ion-releasing restorative materials exhibited short- to medium-term clinical performance comparable to established direct restorative strategies in permanent teeth. Current evidence does not support consistent superiority over conventional resin-based composites or RMGI.
Clinical Significance:
Giomer and alkasite materials demonstrated esthetic and functional performance comparable to conventional resin composites and RMGIs in short- to medium-term follow-up, supporting their clinical viability as alternative restorative options. The comparable marginal discoloration rates observed suggest acceptable esthetic outcomes; however, long-term trials incorporating instrumental color assessment and patient-reported esthetic satisfaction are needed to determine whether the bioactive properties of ion-releasing materials confer durable esthetic and clinical advantages.
Trial Registration:
PROSPERO number: CRD420261308558.