{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:43:36Z","timestamp":1788857016356,"version":"build-2803163510"},"reference-count":63,"publisher":"Operative Dentistry","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>SUMMARY<\/jats:title>\n<jats:sec>\n<jats:title>Objective:<\/jats:title>\n<jats:p>The use of resin composites (RC) for complex restorations, including those involving cusp coverage, has increased dramatically in recent years. However, reports in the literature regarding the performance of posterior multisurface RC and amalgam (AM) restorations show conflicting results. This systematic review and meta-analysis aims to assess the clinical performance of complex (involving two or more surfaces) direct posterior resin composite and amalgam restorations in permanent teeth.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods:<\/jats:title>\n<jats:p>Inclusion criteria were for prospective randomized controlled trials (RCTs) of multisurface direct RC and AM restorations of permanent posterior teeth with a follow-up period of three years or more. The trials needed to include a minimum of 20 restored teeth for each evaluated material. Retrospective studies, studies lacking survival rates or clearly reported reasons for failure, and those with unclear randomization methods were excluded. Five bibliographic databases (Medline-OVID, Embase, Cochrane Library, Web of Science, and LILACS [Latin American and Caribbean Health Sciences Literature Database]) and manual searches were screened. The Cochrane Risk of Bias Tool was used to assess the included studies. Random-effects meta-analyses were conducted using the Freeman-Tukey double arcsine transformation and the DerSimonian-Laird random-effects model to evaluate restorative failures and compare the survival of AM and RC restorations.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results:<\/jats:title>\n<jats:p>From the 6303 identified studies, 198 underwent meticulous examination, and 15 RCTs met the inclusion criteria. Only two studies compared AM and RC restorations. Although the combined data from these studies showed a trend toward higher failure rates in multisurface RC restorations, the difference was not statistically significant (<jats:italic>p<\/jats:italic>=0.06). The most common reasons for the failure of RC restorations were secondary caries, restoration fracture, and tooth fracture. For AM, the most common reasons for failure were secondary caries and tooth fracture.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions:<\/jats:title>\n<jats:p>The quality of the evidence was low. The scarcity of studies comparing RC and AM in complex restorations has resulted in insufficient evidence to substantiate superior performance by either material.<\/jats:p>\n<\/jats:sec>","DOI":"10.2341\/24-007-lit","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T05:23:42Z","timestamp":1748928222000},"page":"E30-E46","source":"Crossref","is-referenced-by-count":6,"title":["Clinical Longevity of Complex Direct Posterior Resin Composite and Amalgam Restorations: A Systematic Review and Meta-analysis"],"prefix":"10.2341","volume":"50","author":[{"given":"MJMC","family":"Santos","sequence":"first","affiliation":[{"name":"*Maria Jacinta Moraes Coelho Santos, DDS, MSc, PhD, Professor, Division of Restorative Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Saadaldin","sequence":"additional","affiliation":[{"name":"Selma Saaldaldin, DDS, MSc, PhD, Assistant Professor, Division of Restorative Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HMC","family":"R\u00eago","sequence":"additional","affiliation":[{"name":"Heleine Maria Chagas R\u00eago, DDS, MSc, PhD, Assistant Professor, Division of Restorative Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Tayan","sequence":"additional","affiliation":[{"name":"Noura Tayan, DDS, MScPTH, Adjunct Professor, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"NM","family":"Melo","sequence":"additional","affiliation":[{"name":"Natalia Myrrha Melo, DDS, Assistant Professor, Division of Restorative Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"El-Najar","sequence":"additional","affiliation":[{"name":"M El-Najar, DDS, MScPTH, Assistant Professor, Division of Restorative Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1188","reference":[{"issue":"9","key":"b1","series-title":"British Dental Journal","first-page":"633","article-title":"Dental amalgam: The history and legacy you perhaps never knew?","volume":"232","author":"Chadwick RG","year":"2022","unstructured":"Chadwick RG & Lloyd CH (2022) Dental amalgam: The history and legacy you perhaps never knew? British Dental Journal 232(9)633-637."},{"issue":"8","key":"b2","series-title":"Journal of the American Dental Association","first-page":"614","article-title":"Treatment options for large posterior restorations: A systematic review and network meta-analysis","volume":"151","author":"Vetromilla BM","year":"2020","unstructured":"Vetromilla BM, Opdam NJ, Leida FL, Sarkis-Onofre R, Demarco FF, van der Loo MPJ, van der loo MPJ, & Cenci MS (2020) Treatment options for large posterior restorations: A systematic review and network meta-analysis Journal of the American Dental Association 151(8)614-624."},{"issue":"1","key":"b3","series-title":"Journal of Prosthodontics","first-page":"e195","article-title":"Quality and survival of direct light-activated composite resin restorations in posterior teeth: A 5- to 20-year retrospective longitudinal study","volume":"28","author":"Borgia E","year":"2019","unstructured":"Borgia E, Baron R, & Borgia JL (2019) Quality and survival of direct light-activated composite resin restorations in posterior teeth: A 5- to 20-year retrospective longitudinal study Journal of Prosthodontics 28(1)e195-e203."},{"key":"b4","series-title":"Journal of Dentistry","first-page":"541","article-title":"Longevity of direct and indirect resin composite restorations in permanent posterior teeth: A systematic review and meta-analysis","author":"da Veiga AM","year":"2016","unstructured":"da Veiga AM, Cunha AC, Ferreira DM, da Silva Fidalgo TK, Chianca TK, Reis KR, & Maia LC (2016) Longevity of direct and indirect resin composite restorations in permanent posterior teeth: A systematic review and meta-analysis Journal of Dentistry 541-12."},{"issue":"10","key":"b5","series-title":"Journal of Dental Research","first-page":"1063","article-title":"12-year survival of composite vs. amalgam restorations","volume":"89","author":"Opdam NJ","year":"2010","unstructured":"Opdam NJ, Bronkhorst EM, Loomans BA, & Huysmans MC (2010) 12-year survival of composite vs. amalgam restorations Journal of Dental Research 89(10)1063-1067."},{"issue":"1","key":"b6","series-title":"Dental Materials","first-page":"87","article-title":"Longevity of posterior composite restorations: Not only a matter of materials","volume":"28","author":"Demarco FF","year":"2012","unstructured":"Demarco FF, Corr\u00eaa MB, Cenci MS, Moraes RR, & Opdam NJ (2012) Longevity of posterior composite restorations: Not only a matter of materials Dental Materials 28(1)87-101."},{"issue":"22","key":"b7","series-title":"Environmental Science & Technology","first-page":"14139","article-title":"Mercury in dental amalgam, online retail, and the Minamata convention on mercury","volume":"54","author":"Joy A","year":"2020","unstructured":"Joy A & Qureshi A (2020) Mercury in dental amalgam, online retail, and the Minamata convention on mercury Environmental Science & Technology 54(22)14139-14142."},{"issue":"6","key":"b8","series-title":"Operative Dentistry","first-page":"621","article-title":"Composite versus amalgam restorations placed in Canadian dental schools","volume":"46","author":"Alreshaid L","year":"2021","unstructured":"Alreshaid L, El-Badrawy W, Lawrence HP, Santos MJ, & Prakki A (2021) Composite versus amalgam restorations placed in Canadian dental schools Operative Dentistry 46(6)621-630."},{"issue":"12","key":"b9","series-title":"British Dental Journal","first-page":"967","article-title":"Teaching posterior resin composites in UK and Ireland dental schools: Do current teaching programmes match the expectation of clinical practice arrangements?","volume":"224","author":"Lynch CD","year":"2018","unstructured":"Lynch CD, Blum IR, McConnell RJ, Frazier KB, Brunton PA, & Wilson NH (2018) Teaching posterior resin composites in UK and Ireland dental schools: Do current teaching programmes match the expectation of clinical practice arrangements? 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prospective 8-year follow-up of posterior resin composite restorations in permanent teeth of children and adolescents in public dental health service: Reasons for replacement Clinical Oral Investigations 18(3)819-827."},{"issue":"6","key":"b57","series-title":"Dental Materials","first-page":"e138","article-title":"Clinical evaluation of the bulk fill composite QuiXfil in molar class I and II cavities: 10-year results of a RCT","volume":"34","author":"Heck K","year":"2018","unstructured":"Heck K, Manhart J, Hickel R, & Diegritz C (2018) Clinical evaluation of the bulk fill composite QuiXfil in molar class I and II cavities: 10-year results of a RCT Dental Materials 34(6)e138-e147."},{"issue":"2","key":"b58","series-title":"Australian Dental Journal","first-page":"132","article-title":"Comparison between published clinical success of direct resin composite restorations in vital posterior teeth in 1995-2005 and 2006-2016 periods","volume":"62","author":"Alvanforoush 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