{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:45:15Z","timestamp":1791945915416,"version":"4.3.4"},"reference-count":48,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Esthet Restor Dent"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The promise of faster, simpler restorations has driven the rise of bulk\u2010fill composites, but do speed and simplicity come at the cost of longevity and marginal integrity?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare and rank the clinical performance of bulk\u2010fill and conventional incremental layering restoration techniques in Class II posterior restorations through a network meta\u2010analysis (NMA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA 2020 guidelines, a comprehensive electronic search was conducted across five databases. Twelve randomized clinical trials met the eligibility criteria. Risk of bias was assessed using RoB2, and confidence in evidence was evaluated through CINeMA. Network meta\u2010analyses at 6, 12, and 24\u2009months estimated relative risks for marginal adaptation, fractures, and retention using random\u2010effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across all follow\u2010ups, no statistically significant differences were observed between bulk\u2010fill and incremental techniques. Risk ratios clustered around unity, and\n                      <jats:italic>P<\/jats:italic>\n                      \u2010scores indicated minimal ranking variability, confirming comparable outcomes among bulk\u2010fill subtypes regardless of viscosity or curing mode. Most evidence was rated as low risk of bias with acceptable indirectness. CINeMA indicated predominantly low concerns for indirectness and risk of bias, supporting the robustness and transitivity of the network. The ormocer\u2010based and overlay bulk\u2010fill composites showed the highest, though not statistically superior, ranking probabilities at 12 and 24\u2009months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Across 6\u2010, 12\u2010, and 24\u2010month follow\u2010ups, no statistically significant differences were detected between bulk\u2010fill techniques and incremental placement for the primary outcomes (marginal adaptation, fractures, and retention). Treatment rankings (\n                      <jats:italic>P<\/jats:italic>\n                      \u2010scores) showed minimal separation overall; ormocer\u2010based and overlay bulk\u2010fill configurations tended to occupy higher ranks at 12\u201324\u2009months, but without statistically confirmed superiority.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Significance<\/jats:title>\n                    <jats:p>This systematic review and network meta\u2010analysis provides robust, evidence\u2010based guidance to support clinical decision\u2010making in the restoration of posterior Class II cavities. The findings indicate that bulk\u2010fill resin composites regardless of viscosity or formulation demonstrate clinical performance comparable to conventional incremental layering techniques, while markedly simplifying placement procedures and enhancing operative efficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>This review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420251170292)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jerd.70060","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T08:35:13Z","timestamp":1764059713000},"page":"764-779","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Performance of Bulk\u2010Fill Versus Incremental Layering Techniques in Class\n                    <scp>II<\/scp>\n                    Restorations: A Systematic Review and Network Meta\u2010Analysis"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8571-4429","authenticated-orcid":false,"given":"Alain Manuel","family":"Chaple Gil","sequence":"first","affiliation":[{"name":"Facultad de Ciencias de la Salud Universidad Aut\u00f3noma de Chile  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8250-6931","authenticated-orcid":false,"given":"Laura","family":"Pereda V\u00e1zquez","sequence":"additional","affiliation":[{"name":"Penn Dental Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5935-9313","authenticated-orcid":false,"given":"Meylin","family":"Santiesteban Vel\u00e1zquez","sequence":"additional","affiliation":[{"name":"Universidad de Ciencias M\u00e9dicas de La Habana  La Habana Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3118-0422","authenticated-orcid":false,"given":"Lazareth Liz","family":"Ortiz Santiago","sequence":"additional","affiliation":[{"name":"Private Practice  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5689-124X","authenticated-orcid":false,"given":"Elizabeth","family":"Jim\u00e9nez Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Private Practice  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903\u2010024\u201004746\u20100"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2023.104725"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41432\u2010023\u201000905\u20104"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784\u2010018\u20102429\u20107"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sdentj.2024.08.004"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sdentj.2024.01.012"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.2341\/19\u2010092\u2010l"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.2341\/21\u2010077\u2010l"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903\u2010025\u201005951\u20101"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.29271\/jcpsp.2025.01.34"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2025.105912"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.34172\/johoe.2308.1587"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jerd.13193"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/polym15122613"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14\u20102385"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874\u2010022\u201001631\u20108"},{"key":"e_1_2_9_19_1","unstructured":"J.Higgins \u201cCochrane Handbook for Systematic Reviews of Interventions \u201d(2011) Version 5.1. 0 [updated March 2011]. 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