Non-Cochrane · intervention · PM41429866
Clinical performance of short fiber-reinforced composite resin restoration in large posterior cavities: a systematic review and meta-analysis.
Hamdi Kareem, Elsebaai Ahmed, Harp Youniss Saleh, et al. · Scientific reports · 2025 · PubMed · doi:10.1038/s41598-025-31441-z
Findings
Population Participants with vital permanent posterior teeth with large cavities (Class II/MOD or deep) needing restoration
18 findings
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Adequate marginal adaptation/integrity (USPHS Alpha/Bravo) 12 to 18 months · Sensitivity analysis excluding ElAziz 2020 (indirect nanohybrid comparator) | RR 1.01 [0.92, 1.11] GRADE not reported 3 studies · 128 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Adequate marginal adaptation/integrity (USPHS Alpha/Bravo) 18 months · Follow-up subgroup: 18 months | RR 1.03 [0.88, 1.21] GRADE not reported 2 studies · 94 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Adequate color match (USPHS Alpha/Bravo) 12 to 18 months | RR 0.77 [0.57, 1.03] -230 [-430, 30] per 1,000 Low Downgraded: imprecision, inconsistency 3 studies · 161 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Absence of post-operative hypersensitivity (USPHS Alpha/Bravo) 12 to 18 months | RR 1.01 [0.96, 1.07] 10 [-39, 68] per 1,000 Low Downgraded: risk of bias, imprecision 3 studies · 166 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Absence of fracture of restoration (USPHS Alpha/Bravo) 12 to 18 months | RR 1.00 [0.96, 1.04] 0 [-40, 40] per 1,000 Low Downgraded: risk of bias, imprecision 4 studies · 195 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Adequate marginal adaptation/integrity (USPHS Alpha/Bravo) 12 months · Follow-up subgroup: 12 months | RR 1.25 [1.04, 1.49] GRADE not reported 2 studies · 101 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Absence of fracture of restoration (USPHS Alpha/Bravo) 18 months · Follow-up subgroup: 18 months | RR 1.00 [0.94, 1.06] GRADE not reported 2 studies · 94 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Absence of marginal discoloration (USPHS Alpha/Bravo) 12 months · Follow-up subgroup: 12 months | RR 1.07 [0.95, 1.20] GRADE not reported 2 studies · 101 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Absence of fracture of restoration (USPHS Alpha/Bravo) 12 months · Follow-up subgroup: 12 months | RR 1.00 [0.95, 1.05] GRADE not reported 2 studies · 101 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Absence of marginal discoloration (USPHS Alpha/Bravo) 18 months · Follow-up subgroup: 18 months | RR 1.00 [0.90, 1.11] GRADE not reported 2 studies · 94 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Adequate color match (USPHS Alpha/Bravo) 12 to 18 months · Sensitivity analysis excluding ElAziz 2024 (everX Flow) | RR 0.68 [0.55, 0.83] GRADE not reported 2 studies · 96 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Absence of recurrent (secondary) caries (USPHS Alpha/Bravo) 12 to 18 months | RR 1.00 [0.96, 1.04] 0 [-40, 40] per 1,000 Low Downgraded: risk of bias, imprecision 4 studies · 195 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Absence of recurrent (secondary) caries (USPHS Alpha/Bravo) 18 months · Follow-up subgroup: 18 months | RR 1.00 [0.94, 1.06] GRADE not reported 2 studies · 94 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Absence of marginal discoloration (USPHS Alpha/Bravo) 12 to 18 months | RR 1.03 [0.96, 1.12] 27 [-37, 110] per 1,000 Low Downgraded: risk of bias, imprecision 4 studies · 195 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Adequate surface texture (USPHS Alpha/Bravo) 12 to 18 months | RR 1.00 [0.96, 1.04] 0 [-40, 40] per 1,000 Moderate Downgraded: imprecision 3 studies · 166 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Absence of recurrent (secondary) caries (USPHS Alpha/Bravo) 12 months · Follow-up subgroup: 12 months | RR 1.00 [0.95, 1.05] GRADE not reported 2 studies · 101 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Adequate anatomical contact, absence of wear (USPHS Alpha/Bravo) 12 to 18 months | RR 0.99 [0.95, 1.04] -10 [-50, 40] per 1,000 Low Downgraded: risk of bias, imprecision 3 studies · 166 participants |
| Short fiber-reinforced composite (SFRC) restoration (everX Posterior or everX Flow) | Conventional resin-based composite (RBC) restoration (nanohybrid or particulate filler) | Adequate marginal adaptation/integrity (USPHS Alpha/Bravo) 12 to 18 months | RR 1.10 [0.91, 1.33] 79 [-71, 261] per 1,000 Very low Downgraded: risk of bias, imprecision, inconsistency 4 studies · 195 participants |
Included primary studies 5
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Candan 2013 Clinical performance of fiber-reinforced nanofilled resin composite in extensively carious posterior teeth of children: 30-month evaluation. PMID:24579274 | 2013 | this review only | not stated | not extracted yet |
| ElAziz 2020 Clinical Performance of Short-fiber-reinforced Resin Composite Restorations vs Resin Composite Onlay Restorations in Complex Cavities of… PMID:32434978 | 2020 | this review only | not stated | not extracted yet |
| ElAziz 2024 Clinical evaluation of posterior flowable short fiber-reinforced composite restorations without proximal surface coverage. PMID:38393515 | 2024 | this review only | not stated | not extracted yet |
| Mohamed 2025 (cited as Hamdy et al.) Clinical performance of class II MOD fiber reinforced resin composite restorations: an 18-month randomized controlled clinical trial. PMID:39881262 | 2025 | this review only | not stated | not extracted yet |
| Salem 2022 12-months Clinical Evaluation of Fiber Reinforced Bulk Fill Resin Composite versus Incremental Packing of Nanohybrid Resin Composite in… PMID:36382215 | 2022 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Participants with vital permanent posterior teeth (molars or premolars) requiring restoration for carious lesions or replacement of defective restorations | Participants with vital posterior teeth with large cavities, mostly Class II/MOD, ages 8-40 years; 274 patients and 298 restored teeth (n=5 studies; 4 in meta-analysis) |
| Intervention | Short fiber-reinforced composite (SFRC) in large posterior cavities (Class II or MOD involving two or more surfaces, or depth beyond half of dentin thickness) | SFRC: ever-X Posterior (3 studies), ever-X Flow (1 study), everStick NET fiber (1 study, not pooled); Ribbond-reinforced arm excluded from pooling |
| Comparison | Conventional direct or indirect resin-based composites (RBCs) | Conventional nanohybrid or nanofilled composite, incremental layering or indirect (cemented) composite |
| Outcomes | Durability of the restorations (modified USPHS criteria: hypersensitivity, marginal discoloration, fracture, recurrent caries, color match, marginal adaptation, surface texture, anatomical contact) | Eight USPHS clinical parameters pooled as risk ratios (3 to 4 studies each) |
| Study designs | Randomized clinical trials (parallel or split-mouth) | RCTs (n=5; 4 parallel arm, 1 mixed split-mouth and parallel) |
| Timing | At least 12 months follow-up | 12 to 30 months follow-up (pooled studies 12 and 18 months) |