Clinical performance of a flowable bulk-fill composite compared with highly viscous glass ionomer cement in class II restorations of primary molars: A 1-year randomized clinical trial.

BACKGROUND

Caries is the most prevalent chronic disease in children, affecting more than 530 million people worldwide. Timely restoration of primary molars is critical for maintaining function and preventing premature tooth loss. The choice of restorative material in class II restorations directly influences clinical outcomes. Bulk-fill composites such as SDR Flow+ (SDR; Dentsply Sirona) and high-viscosity glass ionomer cements including EQUIA Forte HT Fil (EFHT; GC Corporation) provide esthetic and durable solutions. The authors evaluated the 12-month clinical performance of these restorative materials.

METHODS

In this randomized clinical trial, 118 children aged 4 through 8 years with class II caries lesions were allocated to receive either SDR (n = 59) or EFHT (n = 59). Clinical performance was assessed systematically at 3, 6, and 12 months using standardized Fédération Dentaire Internationale (now known as FDI World Dental Federation) criteria, covering functional, biological, and esthetic properties with appropriate statistical analyses.

RESULTS

At 12 months, both SDR (98.3%) and EFHT (92.9%) restorations had high survival rates, with no significant difference (P =.164), indicating inconclusive results for longevity. The SDR had significantly greater overall clinical performance according to the FDI World Dental Federation criteria (P < .001), reflecting superior esthetic and functional outcomes, whereas the results for biological performance remained inconclusive (P = .322).

CONCLUSIONS

Both SDR and EFHT achieved high short-term success and survival; SDR had superior esthetic and functional performance and inconclusive biological outcomes at 12 months.

PRACTICAL IMPLICATIONS: Both SDR and EFHT had high survival and satisfactory outcomes in Class II primary molar restorations. SDR offers a biocompatible, durable, and easy-to-handle material that better meets esthetic and longevity expectations. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT06166160.