{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T10:57:35Z","timestamp":1790593055426,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"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"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the clinical performance of ion\u2010releasing restorative materials with other direct restorative strategies in permanent teeth using a frequentist network meta\u2010analysis framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A systematic review and network meta\u2010analysis were conducted in accordance with PRISMA 2020 and PRISMA\u2010NMA guidelines. Electronic searches were performed in PubMed\/MEDLINE, Scopus, Web of Science, Embase, and CENTRAL without year restriction. Randomized controlled trials evaluating ion\u2010releasing restorative materials (giomer\/PRG\u2010based materials, alkasite, and glass carbomer) in permanent teeth were included. Comparators comprised conventional resin composites, glass ionomer cements (GICs), and resin\u2010modified 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\u2010effects pairwise and frequentist network meta\u2010analyses were performed. Inconsistency was evaluated using a design\u2010by\u2010treatment interaction model, and certainty of evidence was assessed with the CINeMA framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 13 randomized clinical trials comprising 436 participants and 915 restorations met the inclusion criteria. Follow\u2010up ranged from 12\u2009months to 8\u2009years. Glass Carbomer could not be incorporated into the connected treatment network and was therefore retained only in the qualitative synthesis. Across outcomes, ion\u2010releasing 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\u2010confidence contrasts involving alkali formulations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ion\u2010releasing restorative materials exhibited short\u2010 to medium\u2010term clinical performance comparable to established direct restorative strategies in permanent teeth. Current evidence does not support consistent superiority over conventional resin\u2010based composites or RMGI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Significance<\/jats:title>\n                    <jats:p>Giomer and alkasite materials demonstrated esthetic and functional performance comparable to conventional resin composites and RMGIs in short\u2010 to medium\u2010term follow\u2010up, supporting their clinical viability as alternative restorative options. The comparable marginal discoloration rates observed suggest acceptable esthetic outcomes; however, long\u2010term trials incorporating instrumental color assessment and patient\u2010reported esthetic satisfaction are needed to determine whether the bioactive properties of ion\u2010releasing materials confer durable esthetic and clinical advantages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO number: CRD420261308558<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jerd.70229","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T12:25:00Z","timestamp":1783340700000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Performance of Ion\u2010Releasing Restorative Materials in Permanent Teeth: A Systematic Review and Network Meta\u2010Analysis"],"prefix":"10.1111","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 Carrera de Odontolog\u00eda Grupo de Investigaci\u00f3n en Rehabilitaci\u00f3n Oral Basada en Evidencia (GIROBE) 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 Aut\u00f3noma del Paraguay  Asunci\u00f3n Paraguay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7249-0541","authenticated-orcid":false,"given":"Jorge J.","family":"Menendez","sequence":"additional","affiliation":[{"name":"Nova Southeastern University \u2013 College of Dental Medicine  Fort Lauderdale Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.23804\/ejpd.2025.1960"},{"issue":"1","key":"e_1_2_9_3_1","first-page":"9","article-title":"Giomer: A Novel Material Used in the Prevention and Treatment of Cavities","volume":"14","author":"Zacatenco G.","year":"2025","journal-title":"Avances en Biomedicina"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2025.105916"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/app10186175"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.4103\/jioh.jioh_95_22"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.7326\/m14\u20102385"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874\u2010022\u201001631\u20108"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643\u2010016\u20100384\u20104"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.4103\/jispcd.JISPCD_218_18"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.60110\/medforum.350510"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.53766\/AcBio\/2025.15.29.13"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.4012\/dmj.2009\u2010050"},{"issue":"3","key":"e_1_2_9_16_1","first-page":"282","article-title":"Two\u2010Year Clinical Performance of Occlusal and Cervical Giomer Restorations","volume":"30","author":"Sunico M.","year":"2005","journal-title":"Operative Dentistry"},{"issue":"2","key":"e_1_2_9_17_1","first-page":"20","article-title":"Different Restorative Systems in Non Carious Cervical Lesions","volume":"8","author":"T\u00fcrkoglu \u00d6.","year":"2020","journal-title":"Annals of Dental Specialty"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp\u2010journals\u201010024\u20103787"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/jerd.13193"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903\u2010025\u201006594\u2010y"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10266\u2010025\u201001095\u20104"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.4103\/JCDE.JCDE_722_24"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/dj13040156"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.4103\/jioh.jioh_319_21"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1590\/1678\u20107757\u20102023\u20100025"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972\u20100707.218305"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40368\u2010023\u201000788\u20100"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dental.2024.05.013"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.3389\/fdmed.2024.1459473"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.2341\/21\u2010155\u2010C"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dental.2024.06.014"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40368\u2010025\u201001077\u20108"}],"container-title":["Journal of Esthetic and Restorative Dentistry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jerd.70229","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jerd.70229","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jerd.70229","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T10:10:26Z","timestamp":1790590226000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jerd.70229"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":31,"alternative-id":["10.1111\/jerd.70229"],"URL":"https:\/\/doi.org\/10.1111\/jerd.70229","archive":["Portico"],"relation":{},"ISSN":["1496-4155","1708-8240"],"issn-type":[{"value":"1496-4155","type":"print"},{"value":"1708-8240","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]},"assertion":[{"value":"2026-03-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jerd.70229"}}