Bioactive Glass-Based Materials Versus Conventional Materials for Primary Tooth Restorations: A Comparative Meta-Analysis.

The clinical management of carious primary teeth is complicated by distinct morphological features and behavioral challenges. Bioactive glass-based materials are biomimetic alternatives to conventional restorations, with promising remineralization potential and improved mechanical durability. This systematic review and meta-analysis aimed to evaluate the clinical efficacy of bioactive materials compared with that of conventional restorative materials in primary dentition. A protocol-driven (International Prospective Register of Systematic Reviews (PROSPERO): CRD420261329678), Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020)-compliant search was conducted across six major databases and grey literature up to May 2026. Randomized controlled trials (RCTs) comparing bioactive materials (e.g., ACTIVA BioACTIVE, Cention N, glass hybrids) with conventional materials (e.g., resin-modified glass ionomer cements, composites, compomers) with a minimum six-month follow-up were included. The risk of bias was assessed using RoB 2 (The Cochrane Collaboration, London, UK). A random-effects meta-analysis utilizing the restricted maximum likelihood estimator with Hartung-Knapp-Sidik-Jonkman adjustment was performed for clinical success. The certainty of evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Seventeen studies (16 RCTs and 1 in vitro) were included. For the primary outcome, 16 RCTs comprising 1,293 randomized pediatric participants and 1,028 successful events were pooled. No statistically significant difference in overall clinical success/retention was observed between bioactive and conventional materials (RR = 1.00; 95% CI: 0.96 to 1.04; p = 0.9635; I² = 50.8%). Subgroup analyses by comparator class and meta-regression for follow-up duration revealed no significant effect modification. Secondary analyses indicated that bioactive materials may significantly reduce operator placement time (mean difference = -2.37 minutes; p < 0.0001). The overall certainty of the evidence for clinical success was rated as high. Bioactive materials demonstrate clinical efficacy and retention rates equivalent to those of established conventional restorative materials in primary teeth. Given their non-inferior clinical performance and potential workflow efficiencies, bioactive materials are a highly viable and biomimetic option for pediatric restorative dentistry.