Effect of short fiber-reinforced resin-based composite on fracture resistance of extensive direct restorations: A systematic review and network meta-analysis.

STATEMENT OF PROBLEM: Existing evidence suggests that conventional and bulk-fill resin composites (RCs) do not fully restore the physiological fracture resistance of teeth with extensive MOD cavities, leaving posterior restorations susceptible to bulk fracture, particularly in structurally compromised or endodontically treated teeth. Whether short fiber-reinforced resin-based composites (SFRCs) can address these limitations and improve fracture resistance remains unclear.

PURPOSE: The purpose of this systematic review and network meta-analysis was to evaluate the fracture resistance of extensive direct restorations restored with SFRCs, either as a single component or combined with other materials, compared with bulk-fill RCs, conventional RC, and intact teeth.

MATERIAL AND

METHODS

A systematic search was conducted in the PubMed, Scopus, Web of Science, and EMBASE databases for studies published through July 2025. In vitro studies evaluating fracture resistance in MOD cavities restored with SFRC compared with other restorative techniques were included. A random-effects network meta-analysis was performed using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity (I² and τ²) and inconsistency were assessed using node-splitting and loop inconsistency models. The confidence in the results was evaluated using the confidence in network meta-analysis (CINeMA) framework.

RESULTS

Thirty studies met the inclusion criteria. SFRC with overlay materials demonstrated significantly higher fracture resistance than conventional RC (SMD=1.30; 95% CI: 0.50 to 2.09) but not significantly higher than bulk-fill RC (SMD=0.81; 95% CI:-0.26 to 1.88). SFRC alone also showed greater resistance than conventional RC (SMD=2.12; 95% CI:0.22 to 4.03). Notably, no statistically significant difference was found between SFRC alone and intact teeth (SMD=-0.74; 95% CI:-2.64 to 1.16). Confidence in comparisons ranged from low to moderate, primarily associated with concerns regarding imprecision and heterogeneity. Intact teeth exhibited the highest fracture resistance across all conditions (SUCRA: 95.5%).

CONCLUSIONS

SFRCs exhibited better fracture resistance compared with conventional RCs, while no significant difference was observed between SFRC-based restorations and bulk-fill RCs. SFRCs may serve as a clinically suitable alternative for extensive restorations. Future research should focus on optimizing material combinations and addressing methodological variability in in vitro studies.