Failure Rate of Direct High-Viscosity Glass-Ionomer Versus Hybrid Resin Composite Restorations in Posterior Permanent Teeth - a Systematic Review

Steffen Mickenautsch*, Veerasamy Yengopal
SYSTEM Initiative/Department of Community Dentistry, Faculty of Health Sciences, University of the Witwatersrand - 7 York Rd., Parktown/Johannesburg 2193, South Africa

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© Mickenautsch and Yengopal; Licensee Bentham Open.

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* Address correspondence to this author at SYSTEM Initiative/ Department of Community Dentistry, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd., Parktown/ Johannesburg, 2193, South Africa; Tel No. +27 11 717 2594; Fax No. +27 11 717 2625; E-mail:



Traditionally, resin composite restorations are claimed by reviews of the dental literature as being superior to glass-ionomer fillings in terms of restoration failures in posterior permanent teeth. The aim of this systematic review is to answer the clinical question, whether conventional high-viscosity glass-ionomer restorations, in patients with single and/or multi-surface cavities in posterior permanent teeth, have indeed a higher failure rate than direct hybrid resin composite restorations.


Eight databases were searched until December 02, 2013. Trials were assessed for bias risks, in-between datasets heterogeneity and statistical sample size power. Effects sizes were computed and statistically compared. A total of 55 citations were identified through systematic literature search. From these, 46 were excluded. No trials related to high-viscosity glass-ionomers versus resin composite restorations for direct head-to-head comparison were found. Three trials related to high-viscosity glass-ionomers versus amalgam and three trials related to resin composite versus amalgam restorations could be included for adjusted indirect comparison, only.


The available evidence suggests no difference in the failure rates between both types of restoration beyond the play of chance, is limited by lack of head-to-head comparisons and an insufficient number of trials, as well as by high bias and in-between-dataset heterogeneity risk. The current clinical evidence needs to be regarded as too poor in order to justify superiority claims regarding the failure rates of both restoration types. Sufficiently large-sized, parallel-group, randomised control trials with high internal validity are needed, in order to justify any clinically meaningful judgment to this topic.

Keywords: Failure rate, high-viscosity glass-ionomers, posterior permanent teeth, resin composite, systematic review, tooth restorations.