Skip to main content

Clinical performance of bulk-fill and conventional resin composite restorations in posterior teeth: a systematic review and meta-analysis



The purpose of this systematic review was to compare the clinical performance of bulk-fill resin composites with conventional resin composites used for direct restorations of posterior teeth.


This review followed the PRISMA statement. This review was registered at PROSPERO (registration number CRD42016053436). A search of the scientific literature was performed by two independent reviewers using the PubMed/MEDLINE, Embase, The Cochrane Library, and Web of Science databases from commencement until January 2018. The research question was “Do bulk-fill resin composites have a clinical performance comparable to conventional resin composites in posterior restorations?” Only studies evaluating class I and II direct restorations in permanent teeth with a follow-up period of at least 1 year were included. The RevMan 5 program was used for meta-analysis, calculating the relative risk (RR) and 95% confidence interval (CI) of the dichotomous outcome (restoration failure or success).


Ten articles were selected, comprising 941 analyzed restorations. The mean follow-up period was 33.6 months (12–72 months). No statistically significant differences in the failure rate were observed between conventional and base/flowable bulk-fill resin composites (p = 0.31; RR 1.49; 95% CI 0.69–3.25) or full-body/sculptable bulk-fill resin composites (p = 0.12; RR 1.89; 95% CI 0.84–4.24).


The present systematic review and meta-analysis indicate similar clinical performances of bulk-fill and conventional resin composites over a follow-up period of 12 to 72 months.

Clinical significance

Based on the results of this study, the bulk-fill resin composites could be an alternative for direct restorations in posterior teeth. However, clinical trials of longer duration are required.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. Van Dijken JWV, Pallesen U (2013) A six-year prospective randomized study of a nano-hybrid and a conventional hybrid resin composite in class II restorations. Dent Mater 29:191–198.

    Article  PubMed  Google Scholar 

  2. de Andrade A, Duarte R, FM e S et al (2014) Resin composite class I restorations: a 54-month randomized clinical trial. Oper Dent 39:588–594.

    Article  PubMed  Google Scholar 

  3. Ástvaldsdóttir Á, Dagerhamn J, Van Dijken JWV et al (2015) Longevity of posterior resin composite restorations in adults—a systematic review. J Dent 43:934–954.

    Article  PubMed  Google Scholar 

  4. Schmidt M, Dige I, Kirkevang LL, Vaeth M, Hørsted-Bindslev P (2015) Five-year evaluation of a low-shrinkage Silorane resin composite material: a randomized clinical trial. Clin Oral Investig 19:245–251.

    Article  PubMed  Google Scholar 

  5. Opdam NJM, van de Sande FH, Bronkhorst E, Cenci MS, Bottenberg P, Pallesen U, Gaengler P, Lindberg A, Huysmans MCDNJM, van Dijken JW (2014) Longevity of posterior composite restorations: a systematic review and meta-analysis. J Dent Res 93:943–949.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lynch CD, Opdam NJ, Hickel R, Brunton PA, Gurgan S, Kakaboura A, Shearer AC, Vanherle G, Wilson NH, Academy of Operative Dentistry European Section (2014) Guidance on posterior resin composites: Academy of Operative Dentistry—European section. J Dent 42:377–383.

    Article  PubMed  Google Scholar 

  7. Ferracane JL (2011) Resin composite—state of the art. Dent Mater 27:29–38.

    Article  Google Scholar 

  8. Fronza BM, Rueggeberg FA, Braga RR, Mogilevych B, Soares LES, Martin AA, Ambrosano G, Giannini M (2015) Monomer conversion, microhardness, internal marginal adaptation, and shrinkage stress of bulk-fill resin composites. Dent Mater 31:1542–1551.

    Article  PubMed  Google Scholar 

  9. Kim RJY, Kim YJ, Choi NS, Lee IB (2015) Polymerization shrinkage, modulus, and shrinkage stress related to tooth-restoration interfacial debonding in bulk-fill composites. J Dent 43:430–439.

    Article  PubMed  Google Scholar 

  10. Sajnani A, Hegde M (2016) Leaching of monomers from bulk-fill composites: an in vitro study. J Conserv Dent 19:482–486.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Alrahlah A, Silikas N, Watts DC (2014) Post-cure depth of cure of bulk fill dental resin-composites. Dent Mater 30:149–154.

    Article  PubMed  Google Scholar 

  12. Lopes GC, Baratieri LN, Monteiro S, Vieira LCC (2004) Effect of posterior resin composite placement technique on the resin–dentin interface formed in vivo. Quintessence Int 35:156–161

    PubMed  Google Scholar 

  13. Flury S, Hayoz S, Peutzfeldt A, Hüsler J, Lussi A (2012) Depth of cure of resin composites: is the ISO 4049 method suitable for bulk fill materials? Dent Mater 28:521–528.

    Article  PubMed  Google Scholar 

  14. Flury S, Peutzfeldt A, Lussi A (2014) Influence of increment thickness on microhardness and dentin bond strength of bulk fill resin composites. Dent Mater 30:1104–1112.

    Article  PubMed  Google Scholar 

  15. Czasch P, Ilie N (2013) In vitro comparison of mechanical properties and degree of cure of bulk fill composites. Clin Oral Investig 17:227–235.

    Article  PubMed  Google Scholar 

  16. El-Safty S, Akhtar R, Silikas N, Watts DC (2012) Nanomechanical properties of dental resin-composites. Dent Mater 28:1292–1300.

    Article  PubMed  Google Scholar 

  17. Van Ende A, De Munck J, Lise DP, Van Meerbeek B (2017) Bulk-fill composites: a review of the current literature. J Adhes Dent 19:95–110.

    Article  PubMed  Google Scholar 

  18. Alshali RZ, Silikas N, Satterthwaite JD (2013) Degree of conversion of bulk-fill compared to conventional resin-composites at two time intervals. Dent Mater 29:e213–e217.

    Article  PubMed  Google Scholar 

  19. Didem A, Gözde Y, Nurhan Ö (2014) Comparative mechanical properties of bulk-fill resins. Open. J Compos Mater 4:117–121.

    Article  Google Scholar 

  20. Miletic V, Peric D, Milosevic M, Manojlovic D, Mitrovic N (2016) Local deformation fields and marginal integrity of sculptable bulk-fill, low-shrinkage and conventional composites. Dent Mater 32:1441–1451.

    Article  PubMed  Google Scholar 

  21. Higgins JPTGS (2009) Cochrane handbook for systematic reviews of interventions version 5.0.2 [updated September 2009]. In: Cochrane Collab available from

    Google Scholar 

  22. Moher D, Shamseer L, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4(1).

  23. Lemos CAA, Verri FR, Bonfante EA, et al (2017) Comparison of external and internal implant-abutment connections for implant supported prostheses. A systematic review and meta-analysis. J Dent 70: 14–22.

  24. Atieh MA, Alsabeeha NH, Payne AG, et al (2015) Interventions for replacing missing teeth: alveolar ridge preservation techniques for dental implant site development. In: Cochrane Database Syst. Rev. p CD010176

  25. Moraschini V, da Costa LS, dos Santos GO (2018) Effectiveness for dentin hypersensitivity treatment of non-carious cervical lesions: a meta-analysis. Clin Oral Investig 22:617–631.

    Article  PubMed  Google Scholar 

  26. Wilson MA, Cowan AJ, Randall RC, Crisp RJ, Wilson NH (2002) A practice-based, randomized, controlled clinical trial of a new resin composite restorative: one-year results. Oper Dent 27(5):423-429

  27. Bayraktar Y, Ercan E, Hamidi MM, Çolak H (2017) One-year clinical evaluation of different types of bulk-fill composites. J Investig Clin Dent 8.

  28. van Dijken JWV, Pallesen U (2016) Posterior bulk-filled resin composite restorations: a 5-year randomized controlled clinical study. J Dent 51:29-35.

  29. van Dijken JWV, Pallesen U (2017) Bulk-filled posterior resin restorations based on stress-decreasing resin technology: a randomized, controlled 6-year evaluation. Eur J Oral Sci 125:303–309.

    Article  PubMed  Google Scholar 

  30. Manhart J, Chen H-Y, Hickel R (2010) Clinical evaluation of the posterior composite Quixfil in class I and II cavities: 4-year follow-up of a randomized controlled trial. J Adhes Dent 12:237–243.

    Article  PubMed  Google Scholar 

  31. Karaman E, Keskin B, Inan U (2017) Three-year clinical evaluation of class II posterior composite restorations placed with different techniques and flowable composite linings in endodontically treated teeth. Clin Oral Investig 21:709–716.

    Article  PubMed  Google Scholar 

  32. Arhun N, Celik C, Yamanel K (2010) Clinical evaluation of resin-based composites in posterior restorations: two-year results. Oper Dent 35:387–404.

    Article  Google Scholar 

  33. Çolak H, Tokay U, Uzgur R et al (2017) A prospective, randomized, double-blind clinical trial of one nano-hybrid and one high-viscosity bulk-fill composite restorative systems in class II cavities: 12 months results. Niger J Clin Pract 20:822–831.

    Article  PubMed  Google Scholar 

  34. Atabek D, Aktaş N, Sakaryali D, Bani M (2017) Two-year clinical performance of sonic-resin placement system in posterior restorations. Quintessence Int 48:743–751.

    Article  PubMed  Google Scholar 

  35. Alkurdi RM, Abboud SA (2016) Clinical evaluation of class II composite: resin restorations placed by two different bulk-fill techniques. J Orofac Sci 8:34–39.

    Article  Google Scholar 

  36. Yazici A, Antonson S, Kutuk Z, et al (2017) Thirty-six-month clinical comparison of bulk fill and nanofill composite restorations. Oper Dent.

  37. Egger M, Smith GD (2017) Principles of and procedures for systematic reviews. In: Egger M, Smith GD, Douglas GA (Eds.), Systematic Reviews in Health Care. Evidence-Based Health Care, 23–42

  38. Hickey D, Sharif O, Janjua F, Brunton PA (2016) Bulk dentine replacement versus incrementally placed resin composite: a randomised controlled clinical trial. J Dent 46:18-22.

  39. Manhart J, Med Dent P-D, Chen H-Y, Dent M (2008) Clinical performance of the posterior composite QuiXfil after 3, 6, and 18 months in class 1 and 2 cavities. Quintessence Int 3939:757–765

    Google Scholar 

  40. Manhart J, Chen HY, Hickel R (2009) Three-year results of a randomized controlled clinical trial of the posterior composite QuiXfil in class I and II cavities. Clin Oral Investig 13:301–307.

    Article  PubMed  Google Scholar 

  41. Van Dijken JWV, Pallesen U (2015) Randomized 3-year clinical evaluation of class I and II posterior resin restorations placed with a bulk-fill resin composite and a one-step self-etching adhesive.

  42. Van Dijken JWV, Pallesen U (2014) A randomized controlled three year evaluation of bulk-filled posterior resin restorations based on stress decreasing resin technology. Dent Mater 30:e245–e251.

    Article  PubMed  Google Scholar 

  43. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174.

    Article  Google Scholar 

  44. Monterubbianesi R, Orsini G, Tosi G, Conti C, Librando V, Procaccini M, Putignano A (2016) Spectroscopic and mechanical properties of a new generation of bulk fill composites. Front Physiol 7.

  45. Ibarra ET, Lien W, Casey J et al (2015) Physical properties of a new sonically placed composite resin restorative material. Gen Dent 63:51–56

    PubMed  Google Scholar 

  46. Li X, Pongprueksa P, Van Meerbeek B, De Munck J (2015) Curing profile of bulk-fill resin-based composites. J Dent.

  47. El-Damanhoury H, Platt J (2014) Polymerization shrinkage stress kinetics and related properties of bulk-fill resin composites. Oper Dent.

  48. Nedeljkovic I, Teughels W, De Munck J et al (2015) Is secondary caries with composites a material-based problem? Dent Mater 31:e247–e277.

    Article  PubMed  Google Scholar 

  49. Sarrett DC (2005) Clinical challenges and the relevance of materials testing for posterior composite restorations. Dent Mater pp 21:9–20

    Article  Google Scholar 

  50. Wang Y, Li C, Yuan H, Wong MCM, Zou J, Shi Z, Zhou X, Cochrane Oral Health Group (2016) Rubber dam isolation for restorative treatment in dental patients. Cochrane Database Syst Rev.

  51. Unemori M, Matsuya Y, Akashi A, Goto Y, Akamine A (2001) Composite resin restoration and postoperative sensitivity: clinical follow-up in an undergraduate program. J Dent 29:7–13.

    Article  PubMed  Google Scholar 

  52. Costa T, Rezende M, Sakamoto A, et al (2017) Influence of adhesive type and placement technique on postoperative sensitivity in posterior composite restorations. Oper Dent.

  53. Reis A, Dourado Loguercio A, Schroeder M, Luque-Martinez I, Masterson D, Cople Maia L (2015) Does the adhesive strategy influence the post-operative sensitivity in adult patients with posterior resin composite restorations? A systematic review and meta-analysis. Dent Mater 31:1052–1067.

    Article  PubMed  Google Scholar 

  54. Schenkel AB, Peltz I, Veitz-Keenan A (2016) Dental cavity liners for class I and class II resin-based composite restorations. Cochrane Database Syst Rev.

  55. Göstemeyer G, Blunck U, Paris S, Schwendicke F (2016) Design and validity of randomized controlled dental restorative trials. Materials (Basel) 9.

  56. Opdam NJM, Collares K, Hickel R, Bayne SC, Loomans BA, Cenci MS, Lynch CD, Correa MB, Demarco F, Schwendicke F, Wilson NHF (2018) Clinical studies in restorative dentistry: new directions and new demands. Dent Mater 34:1–12.

    Article  PubMed  Google Scholar 

  57. Reis A, Loguercio AD, Maran BM et al (2017) Randomized clinical trials in bleaching: compliance with the consort statement. Braz Oral Res 33:e67–e67

    Google Scholar 

  58. Schulz KF, Altman DG, Moher D, Consort Group (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials (Chinese version). J Chinese Integr Med 8:604–612.

    Article  Google Scholar 

Download references


The authors would like to thank CAPES (Coordination for the Improvement of Higher Education Personnel) for their financial support.


The work was supported by the CAPES (Coordination for the Improvement of Higher Education Personnel).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Gabriela Queiroz de Melo Monteiro.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Veloso, S.R.M., Lemos, C.A.A., de Moraes, S.L.D. et al. Clinical performance of bulk-fill and conventional resin composite restorations in posterior teeth: a systematic review and meta-analysis. Clin Oral Invest 23, 221–233 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Dental restoration
  • Direct restoration
  • Resin composite
  • Bulk-fill resin
  • Incremental filling technique
  • Systematic review