Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
463-491
Comparative analysis of the
clinical performance of Bulk Fill and
Fiber-reinforced resins: A systematic
review in restorative dentistry
Análisis comparativo del desempeño clínico
de las resinas Bulk Fill y reforzadas con Fibra: Una
revisión sistemática en odontología restaurativa
Nathaly Cristina Herrera Carangui 1, Alexis Israel González Ortiz 2, Cristian Danilo Urgiles Urgiles 3,
Cristina Estefanía Urgiles Esquivel 4
1 Dentist. Catholic University of Cuenca. cristih-errera@hotmail.com. Azogues, Ecuador.
2 Dentist. Catholic University of Cuenca. israelalexis17@gmail.com. Azogues, Ecuador.
3 Specialist in Oral Rehabilitation, Ph.D. Professor at the Catholic University of Cuenca
curgilesu@ucacue.edu.ec Azogues, Ecuador.
4 Specialist in Orthodontics. Professor at the Catholic University of Cuenca.
cristina.urgiles@ucacue.edu.ec.Azogues, Ecuador.
How to cite:
Herrera Carangui, N. C., González Ortiz, A. I., Urgiles Urgiles, C. D., & Urgiles Esquivel, C. E. (2025).
Comparative analysis of the clinical performance of bulk-ll and ber-reinforced composites: A systematic
review in restorative dentistry. Multidisciplinary Journal of Contemporary Research, 3(2).463–491
https://doi.org/10.58995/redlic.rmic.v3.n2.a110
Article Information
Received: 18-02-2025
Accepted: 20-04-2025
Published: 01-07-2025
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Editorial
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Research (REDLIC
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Funding Sources
The research was conducted using the authors’
own resources.
Conicts of Interest
No conicts of interest are declared.
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Revista multidisciplinaria
Investigación Contemporánea 07 - 2025 Vol. 3 - No. 2 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Leucemia de células dendríticas plasmocitoides
- estudio y diagnóstico de un caso 49 -49
Copyright (c) 2025 Faicán Rocano Pedro Fernando, Dután Pérez Ibelice Salomé,
González González Camila Raquel, Matute Aguiar Joselyn Nayeli, Rodríguez Ver-
dugo Alejandra Valentina.
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Resumen de licencia - Texto completo de la licencia
Original article. Revista Multidisciplinaria Investigación Contemporánea.
Vol. 3 - No. 2, pp. 463 - 491. July-December, 2025. e-ISSN: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
Revista multidisciplinaria
Investigación Contemporánea 07 - 2025 Vol. 3 - No. 2 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Leucemia de células dendríticas plasmocitoides
- estudio y diagnóstico de un caso 32 -49
Artículo Caso clínico. Revista multidisciplinaria investigación Contemporánea.
Vol. 3 - No. 2, pp. 32 - 49. julio-diciembre, 2025. e-ISSN: 2960-8015
Leucemia de células dendríticas
plasmocitoides - estudio y diagnóstico
de un caso
Leucemia de células dendríticas plasmocitoides - estudio y
diagnóstico de un caso
Información del artículo:
Recibido: 05-12-2024
Aceptado: 21-02-2025
Publicado: 01-07-2025
Nota del editor:
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reclamos jurisdiccionales en mensajes publi-
cados y aliaciones institucionales.
Editorial:
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Contemporánea (REDLIC) www.editorialredlic.com
Fuentes de nanciamiento:
La investigación fue realizada con recursos propios.
Conictos de interés:
No presentan conicto de intereses.
Este texto está protegido por una licencia Creative Commons 4.0.
Usted es libre para Compartir —copiar y redistribuir el material en cual-
quier medio o formato— y Adaptar el documento —remezclar, transformar
y crear a partir del material— para cualquier propósito, incluso para nes
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Atribución: Usted debe dar crédito a la obra original de manera adecuada,
proporcionar un enlace a la licencia, e indicar si se han realizado cambios.
Puede hacerlo en cualquier forma razonable, pero no de forma tal que sugie-
ra que tiene el apoyo del licenciante o lo recibe por el uso que hace de la obra
1 Docente Investigador; pedro.faican@ucacue.edu.ec. Azogues, Ecuador.
2 Estudiante; ibelice.dutan.44@est.ucacue.edu.ec. Azogues, Ecuador.
3 Estudiante; camila.gonzalez.66@est.ucacue.edu.ec. Azogues, Ecuador.
4 Estudiante; joselyn.matute.44@est.ucacue.edu.ec. Azogues, Ecuador.
5 Estudiante; alejandra.rodriguez.60@est.ucacue.edu.ec. Azogues, Ecuador.
Faicán Rocano Pedro Fernando 1, Dután Pérez Ibelice Salomé 2, González González Camila
Raquel 3, Matute Aguiar Joselyn Nayeli 4, Rodríguez Verdugo Alejandra Valentina 5
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Cómo citar:
Faican Rocano, P. . F., Dután Pérez, I. S. ., González González, C. R. ., Rodríguez Verdugo, A. V. ., & Matute Aguiar, J.
N. . (2025). Leucemia de células dendríticas plasmocitoides - estudio y diagnóstico de un caso.
Revista Multidisci-
plinaria Investigación Contemporánea
, 3(2), 32-49. https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
464-491
Abstract
Dental restorative materials are organic-mineral materials used
in dental procedures. The use of Bulk Fill resins is associated with
monobloc techniques, reducing clinical time. On the other hand, ber
-reinforced resins have good mechanical properties such as higher
resistance to occlusal forces due to their mechanical properties. Materials
and methods: A descriptive research with a quantitative approach was
carried out, following the PRISMA statement, resulting in an initial 245
documents, inclusion and exclusion criteria were applied, 13 documents
were selected to be included for the study. Results: Examining the success
rate, clinical performance and difculties in application, the results
showed that Bulk Fill resin restorations have a success rate of more than
95% between 6 months and 5 years, its complications included lack of
adaptation, marginal staining, microleakage, etc. On the other hand,
reinforced resins show a high success rate, fatigue resistance of 87%,
identifying non-catastrophic fractures as complications. Conclusions:
The two resin systems have presented good clinical performance so their
use is recommended, limiting the research the lack of literature on ber-
reinforced resins for being a new element in restorative dentistry.
Keywords: Bulk ll resin, ber -reinforced resin, composite resins,
clinical effectiveness, restorative dentistry.
Resumen
Los materiales de restauración dental son de naturaleza orgánico-
mineral que se emplean en procedimientos dentales. El empleo de resinas
Bulk Fill está asociado a las técnicas de monobloque, reduciendo el tiempo
clínico. Por otro lado, las resinas reforzadas con bra presentan buenas
propiedades mecánicas como mayor resistencia a fuerzas oclusales por
sus propiedades mecánicas. Materiales y métodos: Se llevó a cabo una
investigación descriptiva con un enfoque cuantitativo, siguiendo la
declaración PRISMA, dando como resultado inicial 245 documentos. Se
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
465-491
aplicaron los criterios de inclusión y exclusión, y se seleccionaron 13
documentos que se incluirán para el estudio. Resultados: Examinando
la tasa de éxito, el rendimiento clínico y dicultades en la aplicación,
los resultados mostraron que las restauraciones con resina Bulk Fill
presentan una tasa de éxito de más del 95% entre 6 meses y 5 años, sus
complicaciones incluyeron falta de adaptación, tinciones marginales,
microltraciones, etc. Por otro lado, las resinas reforzadas muestran
una tasa de éxito alta, resistencia a la fatiga del 87%, identicando como
complicaciones fracturas no catastrócas. Conclusiones: Los dos sistemas
resinosos han presentado un buen desempeño clínico, por lo que su uso
es recomendado, limitando la investigación la falta de literatura de las
resinas reforzadas con bra por ser un elemento nuevo en la odontología
restaurativa.
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
466-491
1. Introduction
Dental restoration materials are of organic-mineral nature that are
used in dental procedures (1). These materials replace several properties
of the dental structure, such as color, which improves the functional
and aesthetic aspects that have been negatively affected by different
microorganisms and other agents that can cause the destruction of the
piece and a restorative treatment may be necessary (2,3).
In the current context, the use of Bulk Fill resins is associated with
monoblock techniques (2). These techniques involve the application
of resinous materials that can reach thicknesses of 4 to 5 mm (4). The
advantage of using this type of resins lies in the reduction of clinical time
required in the dental ofce due to the specic application technique used
(2,4). The chemical composition of Bulk Fill resins includes polymerization
groups and plasticizing monomers (5). In addition, due to the translucency
characteristics of these resins, they result in the reduction of the ller
content and contribute to a more efcient polymerization process (6,7).
BulK Fill resins are primarily used in posterior restorative
procedures, particularly in the treatment of Black class I and II cases, in
which the “ C ” factor is greater and it is possible to control to some extent
the shrinkage resulting from polymerization (7). However, it should be
noted that these resins have been shown to exhibit higher wear rates
and lower hardness compared to conventional composite resins (6,8).
Therefore, it is not advisable to use them in situations where the tooth is
subjected to high tensile loads (8,9).
In contrast, the eld of ber-reinforced dental resins (posterior
everX) is characterized by the development of materials incorporating
brous llers or microbers (10). These materials serve several functions,
including transmitting loads and stresses from the affected teeth to the
resinous material, thereby conferring increased strength to the tooth
structure (10,11). The primary objective of FRCs is to reproduce dentin-
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
467-491
like properties, thereby improving the effectiveness of the restorative
process and preventing future failures (11).
The application of new ber-reinforced resins may be benecial
in a variety of clinical situations, such as the reinforcement of fractured
teeth, where higher restorative strength is required (12). Due to its specic
composition, this type of resin promotes durability, as it allows a greater
amount of healthy dental tissue to be preserved (11). The success of ber-
reinforced resins directly depends on factors such as the composition,
distribution, quantity, and adhesion of the berglass particles within the
tooth structure (11,12).
The growing diversity of materials and techniques currently
available on the market has led to a lack of consensus regarding the optimal
choice for each specic clinical case. This lack of clarity poses a signicant
challenge in the decision-making process for dental professionals, as they
must determine the most appropriate material to ensure clinical efcacy.
Therefore, the eld of modern dentistry has greatly beneted from the
advancement and implementation of novel technologies, including a
range of dental resins that offer diverse options for restorations. Among
these alternatives, bulk-ll resins and ber-reinforced resins have gained
prominence due to their ability to simplify procedures and increase
the longevity of restorations. However, choosing between these two
technologies remains a difcult task for dentists.
The absence of a comprehensive systematic review analyzing
the clinical performance of bulk-ll composites and ber-reinforced
composites has created a knowledge gap. This gap hampers dentists’
ability to make decisions based on sound scientic evidence, potentially
leading to suboptimal outcomes in terms of stability, longevity, and patient
satisfaction with restorations. Clarity is needed for dentists when selecting
the appropriate material for each case; this will signicantly contribute to
improving standards in restorative dentistry practice, thereby promoting
the quality of patient care and the effectiveness of dental procedures.
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
468-491
Therefore, the primary objective of this study is to conduct a comprehensive
and comparative systematic review of the clinical performance of bulk-
ll composites and ber-reinforced composites in restorative dentistry,
enabling dentists and oral health professionals to have a comprehensive
understanding of the clinical benets and limitations of both technologies.
Materials and methods
This research is descriptive with a quantitative approach, carried
out through a Systematic Review of the Literature (RSL), for which the
PRISMA statement for RSL was strictly followed (13–16) for example in
a matrix converter, the maximum voltage transfer ratio will be limited
if one or more input lines is at a reduced voltage. Control techniques to
compensate the effect of unbalanced voltage supply for matrix converters
allow for a limited output voltage and power capabilities, which depends
on the level of unbalance. This paper proposes the utilization of the clamp
capacitor, which is normally needed to protect a Direct Power Converter
(DPC).
Research question
What is the clinical effectiveness associated with dental restorations
using bulk ll resins compared to ber-reinforced resins in patients
requiring restorative dentistry procedures?
PICO Question
• P (Population): Adult patients requiring dental restorations on
permanent teeth.
• I (Intervention): Bulk Fill resins used in dental restorations.
• C (Comparison): Fiber- reinforced resins in dental restorations.
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
469-491
• O (Outcomes): Clinical effectiveness of restorations , measured
by success rate, clinical performance and application difculties.
Inclusion/exclusion criteria
The inclusion and exclusion criteria that documents must meet to
be included in the systematic review are set out below.
• Only articles that are controlled studies, prospective studies
and randomized clinical trials will be considered, excluding
systematic reviews.
• Documents published in the last ve years (2018 to 2022) will be
included, with the possibility of considering the year 2023 even
if it is not a fully completed year.
• Articles that do not deal with composite resins or are not
relevant to the subject matter will be excluded.
• Papers that do not address restorative dentistry will be excluded.
• Articles in languages other than Spanish, English, or Portuguese
are not considered for the study.
• Articles that are not empirical studies will be excluded.
Search strategies
The research was conducted in scientic databases such as Scopus,
Web of Science, PubMed, and Scielo, between October 1 and 4, 2023. Table
1 shows the categorized key terms for the study (dental resin, restorative
dentistry, comparison, and clinical efcacy), which will be used for
systematic exploration. Table 2 presents the search strings, emphasizing
that the keyword combination was carefully chosen to obtain non-zero
results.
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
470-491
Table 1. Search string according to each category
Search terms
“Bulk Fill”, “ Fibre -reinforced”, “Restorative Dentistry”, “Dental
restorations”, “Long-term restorations”, “Dental restorative
techniques”, “Dental restorative materials”, “Comparison”,
“Evaluation”, “Comparison”, “Differences*”, “Vs*”, “Clinical
effectiveness”, “Durability”, “Success rate”, “Restorative failure”,
“Failure”, “Postoperative complications”, “Complications”.
Grouping
themes
A. Dental resin
B. Restorative odontalgia
C. Comparison
D. Clinical effectiveness
Search strings
A: (“Bulk Fill” OR “ Fiber -reinforced *)
B: (“Restorative Dentistry” OR “Dental restorations” OR “Long-
term restorations” OR “Dental restorative techniques” OR “Dental
restorative materials”)
C: (“Comparison” OR “Evaluation” OR “Differences*” OR “Vs*”)
D: (“Clinical effectiveness” OR “Durability” OR “Success rate” OR
“Restorative failure” OR “Failure” OR “Postoperative complications”
OR “Complications”)
Table 2. Search equation according to each scientic database
Database Search equation
Initial
search
SCOPUS
SCOPUS = A+B+D TITLE-ABS-KEY(“Bulk Fill” OR “ Fiber -reinforced”)
AND TITLE-ABS-KEY(“Restorative Dentistry” OR “Dental restorations”
OR “Long-term restorations” OR “Dental restorative techniques” OR
“Dental restorative materials”) AND TITLE-ABS-KEY(“Comparison” OR
“Evaluation” OR “Differences*” OR “Vs”) AND TITLE-ABS-KEY(“Clinical
effectiveness” OR “Durability” OR “Success rate” OR “Restorative failure”
OR “Failure” OR “Postoperative complications” OR “Complications”)
180
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
471-491
WoS
WoS = A+B+C
TS=(“Bulk Fill” OR “ Fiber -reinforced”) AND TS=(“Restorative Dentistry”
OR “Dental restorations” OR “Long-term restorations” OR “Dental restor-
ative techniques” OR “Dental restorative materials”) AND TS=(“Clinical
effectiveness” OR “Durability” OR “Success rate” OR “Restorative failure”
OR “Failure” OR “Postoperative complications” OR “Complications”)
8
PubMed
PubMed = A+B+C+D
(“Bulk Fill” OR “ Fibre -reinforced”) AND (“Restorative Dentistry” OR
“Dental restorations” OR “Long-term restorations” OR “Dental restorative
techniques” OR “Dental restorative materials”) AND (“Comparison” OR
“Evaluation” OR “Differences*” OR “Vs”) AND (“Clinical effectiveness” OR
“Durability” OR “Success rate” OR “Restorative failure” OR “Failure” OR
“Postoperative complications” OR “Complications”)
30
Scielo
SCIELO = A+B+C
(“Bulk Fill” OR “ Fibre -reinforced”) AND (“Restorative Dentistry” OR
“Dental restorations” OR “Long-term restorations” OR “Dental restorative
techniques” OR “Dental restorative materials”) and (“Comparison” OR
“Evaluation” OR “Differences*” OR “Vs”)
27
Source: Own elaboration
Publication selection process
The initial search yielded 245 documents. After eliminating
duplicates, inclusion and exclusion criteria were applied, yielding 59. After
reviewing the titles, abstracts, and keywords to ensure article relevance,
13 documents were selected for inclusion in the study. The manuscripts
were reviewed and discussed with a professor with expertise in the eld
and in the development of systematic reviews.
Results
Based on the analysis performed at each stage of the methodological
exploration, the nal count of approved scientic manuscripts was seven.
A graphic representation of the study’s complexities is shown in Figure 1.
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
472-491
Figure 1. Flowchart according to the PRISMA methodology. Source: The
authors.
Table 3 shows in detail the summarized information from each
article included in the study, distinguishing the success rate, times, clinical
performance and difculties in the application of restorative dentistry
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
473-491
procedures. Demonstrating that the success rate for Bulk Fill restorations
was greater than 95% in all the studies analyzed, which were carried out
over the course of 6 months (equivalent to 500 thermocycling cycles), up
to 5 years of analysis, among some of the most visible complications shown
in the studies were: lack of adaptation due to polymerization contraction,
presence of stains at the marginal level, as well as microleaks, deterioration
of the surface brightness due to wear and caries recurrence was found
after a few months of restoration. On the other hand, in restorations
with ber-reinforced resin, marked complications such as the presence
of non-restorable fractures were seen in a high percentage of analyzed
pieces; however, in another study, its similarity to dentin property was
highlighted, which is why the use of ber-reinforced resin was preferred
in the posterior sector.
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
474-491
Revista multidisciplinaria
Investigación Contemporánea 07 - 2025 Vol. 3 - No. 2 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
Análisis comparativo del desempeño clínico de las resinas Bulk Fill y
reforzadas con Fibra: Una revisión sistemática en odontología restaurativa 474 - 491
Tabla 3. Determinantes para la aplicación de la resina Bulk Fill y reforzada
con bra.
Título Autores Año
Periodo
de eva-
luación
Tamaño
muestral
tasa de éxi-
to/fracaso
Desem-
peño
clínico
Dicul-
tades de
aplicación
Randomi-
zed clinical
split-mou-
th study
on a novel
self-adhesi-
ve bulk-ll
restorative
vs. a con-
ventional
bulk-ll
composite
for restora-
tion of class
II cavities –
results after
three years
Cieplik
et al.
(17)
2022 36 me-
ses
60 restau-
raciones TE=96,6%
Uso
clínico
reco-
menda-
do.
Deterioro
signi-
cativo en
la adap-
tación
marginal.
Aumentos
signica-
tivos en
la tinción
marginal
Thir-
ty-six-mon-
th clinical
evaluation
of posterior
high-visco-
sity bulk-ll
resin com-
posite resto-
rations in a
high caries
incidence
population:
interim
results of a
randomized
clinical trial
Almeida
et al.
(18)
2021 36 me-
ses
138 res-
tauracio-
nes
TF=1,26% No espe-
cica
No pre-
senta
Table 3. Determinants for the application of Bulk Fill and ber-reinforced
resin.
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
475-491
Revista multidisciplinaria
Investigación Contemporánea 07 - 2025 Vol. 3 - No. 2 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
Análisis comparativo del desempeño clínico de las resinas Bulk Fill y
reforzadas con Fibra: Una revisión sistemática en odontología restaurativa 475 - 491
12-months
Clinical Eva-
luation of
Fiber Rein-
forced Bulk
Fill Resin
Composi-
te versus
Incremental
Packing of
Nanohy-
brid Resin
Composite
in Restora-
tion of Deep
Proximal
Lesions of
Permanent
Molars: A
Randomized
Controlled
Trial
Menna-
tallah et
al. (19)
2022 12 meses 36 restau-
raciones TE= 95%
No exis-
te riesgo
de fra-
caso
No pre-
senta
A randomi-
zed, pros-
pective clini-
cal study
evaluating
effectiveness
of a bulk-ll
composite
resin, a con-
ventional
composite
resin and a
reinforced
glass iono-
mer in Class
II cavities:
one-year
results
Balkaya
et al.
(20)
2019 12 meses
109 res-
tauracio-
nes
TE= 100%
Marcada
super-
vivencia
de las
restau-
raciones
Cambios
de color
(2,8%).
Decolo-
ración
marginal
(5.5%).
Mala
adap-
tación
marginal
(5.5%).
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Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
Análisis comparativo del desempeño clínico de las resinas Bulk Fill y
reforzadas con Fibra: Una revisión sistemática en odontología restaurativa 476 - 491
Evaluation
of micro-
leakage
in Class II
composite
restorations:
Bonded base
and bulk ll
techniques
Feiz
et al.
(21)2021
6 meses
(500
ciclos de
termoci-
clado)
60 res-
taura-
ciones
No espe-
cica
Baja contrac-
ción de poli-
merización.
Alto
nivel de
micro-
ltra-
ción al
no utili-
zar una
base
cavita-
ria.
Optimiza-
tion of large
MOD res-
torations:
Composite
resin inlays
vs. short
ber-rein-
forced direct
restorations
Soares
et al (22) 2018 No espe-
cica
45 restau-
raciones TE= 87%
Resis-
tencia
a las
pruebas
de fati-
ga: 87%
Propenso
a agrietar-
se. Frac-
turas no
catastró-
cas.
One-year
clinical
evaluation
of bulk-ll
owable
vs. regular
nanolled
composite in
non-carious
cervical
lesions
Canali
et al.
(23)
2019 12 meses 89 restau-
raciones
TF= 3,3%
para la forma
anatómica
TF=2,2% para
la adapta-
ción margi-
nal
Desem-
peños
clínicos
acep-
tables
para la
restau-
ración
de NCCL
después
de 1 año.
Tinción
marginal,
sensi-
bilidad
postope-
ratoria y
presencia
de caries
recurren-
te
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Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
Análisis comparativo del desempeño clínico de las resinas Bulk Fill y
reforzadas con Fibra: Una revisión sistemática en odontología restaurativa 477 - 491
Clinical eva-
luation of
bulk-ll and
universal
nanocompo-
sites in class
II cavities:
Five-year
results of a
randomi-
zed clinical
split-mouth
trial
Schoi-
lew et al.
(24)
2023 5 años
120 res-
tauracio-
nes
Tasa me-
dia de fallo
anual: 1,6%
Rendi-
miento
clínico
y una
super-
vivencia
acep-
table
durante
el pe-
ríodo de
observa-
ción de
5 años
Restau-
raciones
mal adap-
tadas.
Recambio
de restau-
raciones
por fallas.
Bulk-ll
Composites
Compared
to a Nanohy-
brid Compo-
site in Class-
II Cavities
- A Two-year
Follow-Up
Study
Hoff-
mann et
al. (25)
2021 24 me-
ses
160 res-
tauracio-
nes
TE=92%
Estabi-
lidad
clínica.
Caries re-
currentes.
Fracturas
de las
restaura-
ciones
Clinical Per-
formance of
Bulk-Fill Re-
sin Compo-
site Restora-
tions Using
the United
States Pu-
blic Health
Service and
Federation
Dentaire In-
ternationale
Criteria: A
12-Month
Randomi-
zed Clinical
Trial
Almeida
et al.
(26)
2021 12 meses
138 res-
tauracio-
nes
TE=97.2%
TF=1%
Rendi-
miento
clínico
satisfac-
torio.
Mala
adap-
tación
marginal.
Rugosi-
dad su-
percial.
Recambio
de restau-
raciones
por fallas.
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Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
Análisis comparativo del desempeño clínico de las resinas Bulk Fill y
reforzadas con Fibra: Una revisión sistemática en odontología restaurativa 478 - 491
Flowable -
ber-reinfor-
ced versus
owable
bulk-ll
resin com-
posites:
Degree of
conversion
and micro-
tensile bond
strength to
dentin in
high C-fac-
tor cavities
Harp et
al. (27) 2022 No pre-
senta
30 restau-
raciones No especica
Prefe-
rencia
de la
resina
reforza-
da con
bra en
zonas
con alto
estrés.
No pre-
senta.
Clinical time
and posto-
perative
sensitivity
after use
of bulk-ll
(syringe and
capsule) vs.
incremental
lling com-
posites: A
randomized
clinical trial
Tardem
et al.
(28)
2019 No pre-
senta
295 res-
tauracio-
nes
No especica
Menor
tiempo
opera-
torio.
Dismi-
nuye la
sensi-
bilidad
posope-
ratoria
con la
técnica
incre-
mental
tradicio-
nal.
Sensibili-
dad poso-
peratoria
(4.6%)
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Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
Análisis comparativo del desempeño clínico de las resinas Bulk Fill y
reforzadas con Fibra: Una revisión sistemática en odontología restaurativa 479 - 491
Short-ber
Reinforced
ced MOD
Restorations
of Molars
with Severe-
ly Undermi-
ned Cusps
Pascal
et al.
(29)
2023 No pre-
senta
36 restau-
raciones TE= 100%
Restau-
raciones
de bajo
costo.
Resina
reforza-
da con
bra
como
comple-
men-
to de
incrus-
taciones
CAD/
CAM
Grietas
por con-
tracción
Nota: TE: Tasa de éxito. TF: Tasa de fracaso. Fuente. Elaborado a partir de los
resultados de la búsqueda sistemática de la literatura.
A continuación se presenta un cuadro comparativo de las complicacio-
nes clínicas de la resina Bulk Fill a lo largo del tiempo en un intervalo de 6
meses (envejecimiento articial) a 5 años de estudio, en el que se puede evi-
denciar que entre las complicaciones más prevalentes son las microltracio-
nes, cambios de coloración, tinciones marginales, mal adaptación marginal,
desgaste supercial, caries recurrentes, y rugosidad supercial; cabe recalcar
que no se evidenció literatura que abarcará alguna complicación clínica res-
pecto a la resina reforzada con bra por ser un elemento nuevo y por escasez
de información (Tabla 4).
Note: TE: Success rate . TF: Failure rate . Source: Prepared from the results
of a systematic literature search.
The following table shows a comparison of clinical complications of
Bulk Fill resin over time, ranging from 6 months (articial aging) to 5 years
of study. It shows that the most prevalent complications are microleaks,
color changes, marginal staining, poor marginal adaptation, surface wear,
recurrent caries, and surface roughness. It should be noted that there is no
literature covering any clinical complications with ber-reinforced resin
because it is a new element and there is a lack of information (Table 4).
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reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
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Complicaciones clínicas en la aplicación de resina Bulk Fill
Título Intervalo de tiempo Complicaciones
Evaluation of microleaka-
ge in Class II composite
restorations: Bonded base
and bulk ll techniques
500 ciclos termociclado 6
meses de envejecimiento
articial
• Presencia de microl-
traciones al no emplear
bases cavitarias en cavi-
dades profundas antes de
la aplicación de la resina
Bulk Fill.
A randomized, prospec-
tive clinical study eva-
luating effectiveness of a
bulk-ll composite resin,
a conventional composite
resin and a reinforced
glass ionomer in Class II
cavities: one-year results
12 meses
•Se evidenció cambios de
color.
•Zonas de decoloración
marginal.
•Mal adaptación margi-
nal.
One-year clinical evalua-
tion of bulk-ll owable
vs. regular nanolled
composite in non-carious
cervical lesions
12 meses
•Tinciones marginales
•Desgaste supercial de
la resina.
•Sensibilidad postopera-
toria.
•Mal adaptación margi-
nal por lo tanto presencia
de caries recurrente.
Table 4. Complications in the application of Bulk Fill resins over a period
of 6 months to 5 years.
Revista multidisciplinaria
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Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
Análisis comparativo del desempeño clínico de las resinas Bulk Fill y
reforzadas con Fibra: Una revisión sistemática en odontología restaurativa 481 - 491
Clinical Performance of
Bulk-Fill Resin Compo-
site Restorations Using
the United States Pu-
blic Health Service and
Federation Dentaire
Internationale Criteria:
A 12-Month Randomized
Clinical Trial
12 meses
•Rugosidad supercial
por desgaste.
• Mal adaptación margi-
nal.
• Se tuvieron que hacer
recambio de restauracio-
nes por fallas presentes.
Bulk-ll Composites
Compared to a Nanohy-
brid Composite in Class-
II Cavities - A Two-year
Follow-Up Study
24 meses
• Fracturas de las restau-
raciones.
• Caries recurrentes por
microltraciones.
Randomized clinical
split-mouth study on
a novel self-adhesive
bulk-ll restorative vs.
a conventional bulk-ll
composite for restoration
of class II cavities – re-
sults after three years
36 meses
• Adaptación marginal
con deterioro signica-
tivo.
• Tinción marginal.
Clinical evaluation of
bulk-ll and universal
nanocomposites in class
II cavities: Five-year
results of a randomized
clinical split-mouth trial
5 años
• Mal adaptaciones en las
restauraciones.
• Necesidad de recambio
de restauraciones por
fallas.
Fuente. Elaborado a partir de los resultados de la búsqueda sistemática de la lite-
ratura.
En la Tabla 5, se pueden evidenciar las ventajas de emplear restauracio-
nes con resina reforzada con bra, tanto por sus aplicaciones y desventajas
en el punto de vista de costos.
Source: Prepared from the results of a systematic literature search.
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
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Table 5 shows the advantages of using ber-reinforced resin
restorations, both in terms of their applications and disadvantages from a
cost point of view.
Table 5. Fiber reinforced resin considerations.
Implications of ber-reinforced resin
Advantages
• Reconstruction of class IV cavities
• Replacement of amalgam restorations.
• Class I and II cavities with previous endodontic
treatment.
• Cavities where inlays are indicated.
Disadvantages
• High cost of resin.
• It is necessary to use a conventional resin for
the supercial portion of the restoration.
• High cost of restorations.
Source: Prepared from the results of a systematic literature search.
Discussion
The results of this systematic review facilitate the recognition that
restorations made with bulk-ll composites demonstrate acceptable
clinical efcacy, with success rates exceeding 95% in most studies,
reafrming their suitability for restorative interventions in Class I and
II cavities. However, recurrent complications, such as poor marginal
adaptation, microleakage, marginal discoloration, surface roughness,
and caries recurrence, were evident, especially in long-term evaluations.
In contrast, restorations with ber-reinforced composites, although less
frequently analyzed in the academic literature, showed favorable clinical
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Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
483-491
performance in terms of mechanical properties and strength, and showed
lower susceptibility to aesthetic or bond-related complications, although
accompanied by a risk of non-repairable fractures. This divergence may be
attributed to the structural similarity of ber-reinforced resin to dentin,
which could improve its functionality in regions subjected to high stress
levels.
In this context , the study by Cieplik et al. (17) tooth-colored, self-
adhesive bulk-ll restorative (SABF, 3Mindicates that the success rate of
Bulk Fill restorations was 96.06% in a period analyzed of 36 months, in
terms of biological properties the results were acceptable throughout the
study, additionally signicant deterioration in the surface brightness of
the restorations could be observed, demonstrating a signicant marginal
staining during the course of the study, which is consistent with the study
by Mennatallah et al. (19) in which it was observed that there was no risk of
failure with respect to fractures, marginal integrity, color changes, surface
texture, postoperative complications and recurrent caries, presenting a
success rate of 95%, limiting this study the evaluation time was carried
out in 12 months, so possible complications that may occur over time
cannot be evaluated. On the other hand , Tardem et al. (28)of posterior
restoration that used a universal adhesive, in a self-etch or selective
enamel-etching technique, along with incremental or bulk-ll composites
(presented in syringes or capsules In his study he evaluated postoperative
sensitivity after using Bulk Fill resins, giving a rate of 4.06% of presenting
this complication.
In the study by Balkaya et al. (20) a survival rate of restorations based
on Bulk Fill resins of 100% was determined after one year of analysis used
in class II cavities, the complications that occurred in the study were in
terms of marginal adaptation of the restorations (5.5%), color changes
(2.8%) and marginal coloration in (5.5%). This shows a relationship with
the study by Schoilew et al. (24) , in which they observed failures on the part
of the restorations, these had to be replaced and even thus they presented
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investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
484-491
poor adaptation in the restorations presenting an average annual failure
rate of 1.6% , because this study was carried out over 5 years. Additionally,
to these studies in class II cavities, Hoffmann et al. (25) add that, in their
study carried out over 24 months, a success rate of 92% was presented,
having as complications fractures of the restoration and recurrent caries
are added to the clinical defects. Complementing the studies in class II,
Feiz et al. (21) in his study used Bulk Fill resins subjected to thermocycling
500 cycles / 6 months of articial aging, study in which it was possible to
afrm that there is a high level of microltration when cavity bases are
not used prior to restoration with Bulk Fill material.
Almeida et al. (26) In his study carried out over 12 months, he presents
an overall success rate of 99.07% in which only a failed relationship of
0.93% based on Bulk Fill resin was detected. Among the difculties that
were observed were poor marginal adaptation and surface roughness,
which complements his second study by Almeida et al. (18) Tetric
EvoCeram BF (TBF; Ivoclar Vivadentdeveloped over a time interval of 36
months in which a failure rate of 1.26% was obtained, which is mainly
related to a poor adaptation of the restoration, which led to a recurrence
of caries .
Regarding innovative restorations, Soares et al. (22) in his study
determined the fatigue test survival of ber-reinforced restorations to
be 87%. A limitation of this study was the comparison of ber-reinforced
resins placed directly in cavities with inlay-type restorations. In contrast
to the study by Harp et al. (27), the great adhesion capacity and its
properties similar to dentin were exposed, which is why in this study the
use of this reinforced resin is preferred in high stress areas, specically
in the posterior sector where occlusal forces are greater, as a complement
to the study by Pascal et al. (29) leaving unsupported buccal and lingual
enamel cusps. A short-ber reinforced composite resin base (SFRC, everX
Flow, GCIt is stated that ber-reinforced resins are a good complement to
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Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
485-491
be placed together with CAD/CAM inlays, having a 100% success rate in
their restorations.
While the ndings underscore the advantageous clinical efcacy
of ber-reinforced composites in dental restorations, scrutiny of this
material category is limited due to the limited available evidence, which
can be attributed to its recent integration into restorative dentistry.
This limitation emphasizes the need for long -term clinical studies that
facilitate a more comprehensive evaluation of their performance in
relation to variables such as marginal adaptation, fracture resistance,
and caries recurrence, with the aim of establishing their efcacy and
improving their application in diverse clinical settings.
Conclusions
dentistry today is mainly based on providing long-lasting treatments
, therefore, the analysis of new restorative materials that are introduced
in the eld is essential, among one of the most used are Bulk Fill resins,
which in studies have shown that it has a success rate of more than 95%
in a study interval of 6 months to 5 years, although according to the
analysis, it can show long-term complications, among the most prevalent
are marginal maladjustments, supercial wear of the restorations and
marginal discolorations; Despite this, its use is still recommended in deep
cavities, more specically in Black I and II cavities, another demonstrated
benet is that it reduces clinical time in the dental ofce.
Innovation in restorative materials has driven the development
of composites that mimic the biomechanical properties of dental tissue,
including berglass-reinforced resins. These materials have demonstrated
a high clinical success rate and fatigue resistance close to 87%, justifying
their increasing use in complex restorative procedures. Their ability to
adequately distribute functional loads and occlusal stresses from dental
structures to the restorative material represents a signicant advantage in
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Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
486-491
the rehabilitation of Class I and II cavities in endodontically treated teeth,
reconstructions with cervical margin elevation, replacement of amalgam
restorations, and restorations in teeth with cusp destruction . However, as
this is an emerging technology in restorative dentistry, limitations persist
due to the limited clinical evidence available. Therefore, longitudinal
studies are required to rigorously evaluate their clinical behavior,
durability, and potential associated complications.
The innovation of restorative materials has seen the need to
implement a material that resembles the biological characteristics of teeth,
therefore , restorations with berglass reinforced resins are currently being
used, which allow the transmission of loads and tensions from the affected
teeth to the resinous material and as a result, the success of restorations
in which a margin elevation is necessary, reconstruction of cavities I and
II with endodontic treatments, cavities with amalgam replacement, and
cavities where a destruction of cusps is seen. Its success rate is relatively
high and they also have a fatigue resistance of 87%. However, being a new
element in the restorative eld , Further clinical studies are still needed
to better establish the qualities, clinical performance, and potential
complications that ber-reinforced resins may present.
Contribution of the authors
NH: Idea, introduction, methodology, data collection, analysis of results,
discussion, nal review of the article.
AG: Idea, introduction, data collection, analysis of results, discussion, nal
revision of the article.
CUU : Data analysis, results analysis, discussion, nal review of the article.
CUE: Data analysis, results analysis, discussion, nal review of the article.
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investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Comparative analysis of the clinical performance of Bulk Fill and Fiber-
reinforced resins: A systematic review in restorative dentistry
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a110
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