Clinical Performance and Survival of Bulk-Fill Resin Composites Compared to Conventional Resin Composites in Posterior Permanent Teeth: A Systematic Review and Meta-analysis

This systematic review and meta-analysis evaluated the clinical performance and survival rates of bulk-fill resin composite restorations compared with conventional incrementally placed resin composites in permanent posterior teeth. A comprehensive search was executed across databases for randomized controlled trials (RCTs) published up to November 2025. The review selected studies comparing direct Class I and II restorations using bulk-fill composites against incremental controls with a minimum follow-up period of 12 months. Restoration failure served as the primary outcome measure. The risk of bias was appraised using the Cochrane RoB 2 tool, and data synthesis employed a random-effects model to compute risk ratios (RR) with 95% confidence intervals (CIs). Nine RCTs involving 632 restorations satisfied the inclusion criteria. Quantitative synthesis indicated no statistically significant disparity in failure rates between the bulk-fill and incremental techniques (RR = 0.82; 95% CI: 0.33-2.01; p = 0.67). Subgroup assessments based on follow-up duration (<24 months versus ≥24 months) yielded no significant variations between the groups. Secondary outcomes, including marginal adaptation, discoloration, and postoperative sensitivity, were comparable across most studies. Bulk-fill resin composites demonstrated clinical durability and survival rates like conventional incrementally placed composites in posterior teeth over short- to long-term periods. The simplified placement protocol of bulk-fill materials provides a time-efficient alternative for posterior restorations without compromising clinical quality.