Bioactive Resin-Based Composites for Direct Posterior Restorations: A Contemporary Narrative Review

Background and Rationale: Failure of dental restorations due to secondary caries remains one of the common problems in restorative dentistry. In order to solve the shortcomings of conventional bioinert materials, bioactive composite resins have recently been developed, allowing fluoride, calcium, and phosphate ion delivery as well as reducing the acidic activity of biofilm. Aim of the Review: This literature review evaluates chemistry, mechanisms of action, clinical effectiveness, and physical handling properties of resin-based bioactive materials used for direct posterior restoration in permanent dentition. Material Categories Examined: This literature review includes such material categories as resin-modified glass ionomers, S-PRG-giomers (Surface Pre-reacted Glass Ionomer), alkasilicate materials like Cention N, ionomeric-resin hybrid materials (ACTIVA BioACTIVE), and experimental bioactive glass composites. Main Results: Current meta-analytic evidence suggests that bioactive composites are associated with a relative reduction in secondary caries of approximately 40–45% compared with conventional resin composites (derived from pooled risk ratios across two recent meta-analyses), with the greatest absolute benefit observed in patients at moderate or high caries risk. Absolute risk reductions are more modest and vary by patient population. In terms of marginal adaptation, longevity, and postoperative sensitivity, bioactive composites demonstrate broadly equivalent performance to conventional composites within currently available follow-up periods, though operative placement time is marginally longer. These materials also provide acceptable aesthetic results, wear resistance, and remineralizing capacity. Conclusion: Current evidence supports the use of bioactive composite resins as a clinically valuable, evidence-informed option, particularly in patients at elevated caries risk. Long-term randomized clinical studies beyond five years remain a priority for establishing definitive evidence on durability.