journal article·2025-03-20Open access

Class-I and Class-II Restorations with the Application of a Flowable Composite as an Intermediate Layer—A Narrative Review of Clinical Trials

Anh Duc Nguyen, Kerstin Bitter, Christian Ralf Gernhardt

Abstract

The objective of this review is to investigate the effect of an additional layer of flowable composite for cavity lining on the clinical outcome of direct posterior composite restorations. The PICO question (patient, intervention, comparison, and outcome) was stated as follows: Does the additional application of a flowable composite as a cavity liner improve the clinical outcome of Class-I and Class-II restorations? The electronic databases MEDLINE, Web of Science, LILAS, and BBO were assessed for identifying relevant clinical studies. After removal of duplicate records, 309 records could be identified and, after a screening of the title and abstract, 20 articles were selected for full-text analysis. Finally, six studies met the eligibility criteria and were included in this review for further investigation. Four of the included studies have a follow-up period of two years, while the other two studies had an observation period of three and seven years, respectively. No significant differences in annual failure rates were observed between restorations with and without a flowable composite liner. Consequently, the additional usage of flowable composites as a cavity liner seems to have no effect on the clinical longevity of direct composite restorations in Class-I and Class-II cavities. Therefore, the application of a flowable composite is a possible option in everyday dental clinical practice.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Dental materials and restorations · Dental Research and COVID-19 · Dental Implant Techniques and Outcomes

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

University Outpatient Clinic for Conservative Dentistry and Periodontology, Department of Dental Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 16, 06112 Halle, Germany

References (64)

Show source-provided references
1. Guidance on posterior resin composites: Academy of Operative Dentistry—European Section10.1016/j.jdent.2014.01.009 ↗
2. Clinical performance of bulk-fill and conventional resin composite restorations in posterior teeth: A systematic review and meta-analysis10.1007/s00784-018-2429-7 ↗
3. Longevity of posterior direct versus indirect composite restorations: A systematic review and meta-analysis10.1016/j.dental.2024.07.033 ↗
4. Comparison between published clinical success of direct resin composite restorations in vital posterior teeth in 1995–2005 and 2006–2016 periods10.1111/adj.12487 ↗
5. Baltacioğlu, İ.H., Demirel, G., Öztürk, B., Aydin, F., and Orhan, K. (2024). Marginal adaptation of bulk-fill resin composites with different viscosities in class II restorations: A micro-CT evaluation. BMC Oral Health, 24.10.1186/s12903-024-03975-7 ↗
6. Effect of flowable composite liner and glass ionomer liner on class II gingival marginal adaptation of direct composite restorations with different bonding strategies10.1016/j.jdent.2014.02.016 ↗
7. Evaluation of Microleakage in Class II Cavities using Packable Composite Restorations with and without use of Liners10.5005/jp-journals-10005-1162 ↗
8. Sealing ability of packable resin composites in class II restorations
9. Marginal and Internal Adaptation of Cervical Restorations Using Direct, Direct-indirect, and Indirect Techniques10.2341/21-071-L ↗
10. Retrospective evaluation of the clinical performance of direct composite restorations using the snow-plow technique: Up to 4 years follow-up
11. Evaluation of the efficacy of flowable composite as lining material on microleakage of composite resin restorations: A systematic review and meta-analysis
12. Evaluation of Class II Restoration Microleakage with Various Restorative Materials: A Comparative In vitro Study10.4103/jpbs.jpbs_359_21 ↗
13. Flowable Resin Composites: A Systematic Review and Clinical Considerations
14. Interrelation among the handling, mechanical, and wear properties of the newly developed flowable resin composites10.1016/j.jmbbm.2018.09.019 ↗
15. Is use of flowable resin composite an option for occluso-proximal restorations in primary teeth? A fracture strength analysis
16. The effect of flowable composite lining and dentin location on microtensile bond strength and internal fracture formation10.4012/dmj.2018-232 ↗
17. Filler Content, Surface Microhardness, and Rheological Properties of Various Flowable Resin Composites10.2341/16-031-L ↗
18. A model of the viscoelastic behavior of flowable resin composites prior to setting10.1016/j.dental.2013.06.005 ↗
19. Clinical evaluation of flowable resin composite versus conventional resin composite in carious and noncarious lesions: Systematic review and meta-analysis10.4103/JCD.JCD_226_17 ↗
20. Three-year clinical evaluation of a flowable and a hybrid resin composite in non-carious cervical lesions10.1016/j.jdent.2009.10.003 ↗
21. Behaviour of general dental practitioners in Germany regarding posterior restorations with flowable composites10.1111/j.1875-595X.2011.00068.x ↗
22. The effect of flowable materials on the microleakage of Class II composite restorations that extend apical to the cemento-enamel junction10.2341/08-91 ↗
23. Gernhardt, C.R., Nguyen, A.D., Michaelis, M., and Puetz, N. (2023). Clinical Outcome of Class I and II Restorations with and without an Intermediary Layer of a Flowable Composite after 24 Months: A Prospective, Randomized, Split-Mouth-Designed, Controlled and Single-Blinded Clinical Trial. Appl. Sci., 13.10.3390/app13074224 ↗
24. Five-year clinical performance of two fluoride-releasing giomer resin materials in occlusal restorations10.1111/jerd.12948 ↗
25. Three-year clinical evaluation of class II posterior composite restorations placed with different techniques and flowable composite linings in endodontically treated teeth10.1007/s00784-016-1940-y ↗
26. In vivo interfacial adaptation of class II resin composite restorations with and without a flowable resin composite liner10.1007/s00784-005-0311-x ↗
27. A 24-month follow-up of flowable resin composite as an intermediate layer in non-carious cervical lesions10.2341/05-116 ↗
28. Effects of flowable composite lining and operator experience on microleakage and internal voids in class II composite restorations10.1067/mpr.2001.113780 ↗
29. Microleakage of posterior packable resin composites with and without flowable liners
30. Selective enamel etching in cervical lesions for self-etch adhesives: A systematic review and meta-analysis10.1016/j.jdent.2016.05.009 ↗
31. Effect of layer thickness on the elution of bulk-fill composite components10.1016/j.dental.2016.10.006 ↗
32. Mechanical properties of bulk-fill resin composites with single increment up to 4 mm: A novel mechanical strength test
33. To evaluate and compare the effect of different light-curing modes and different liners on cuspal deflection in premolar teeth restored with bulk filled or incrementally filled composite measured at different time intervals10.4103/JCD.JCD_328_16 ↗
34. Marginal Adaptation of Flowable vs Sonically Activated or Preheated Resin Composites in Cervical Lesions
35. Color stability of bulk-fill compared to conventional resin-based composites: A scoping review10.1111/jerd.13017 ↗
36. A prospective, double-blind, randomized clinical trial of a one-step, self-etch adhesive with and without an intermediary layer of a flowable composite: A 2-year evaluation
37. Two-year clinical evaluation of ormocer and nanofill composite with and without a flowable liner
38. Two-year clinical performance of a packable posterior composite with and without a flowable composite liner10.1007/s00784-003-0220-9 ↗
39. Clinical performance of a nanofilled resin composite with and without an intermediary layer of flowable composite: A 2-year evaluation10.1007/s00784-010-0485-8 ↗
40. Nguyen, A.D., Pütz, N., Michaelis, M., Bitter, K., and Gernhardt, C.R. (2024). Influence of Cavity Lining on the 3-Year Clinical Outcome of Posterior Composite Restorations: A Randomized Controlled Clinical Trial. Dent. J., 12.10.3390/dj12050128 ↗
41. Clinical performance of a hybrid resin composite with and without an intermediate layer of flowable resin composite: A 7-year evaluation10.1016/j.dental.2010.09.010 ↗
42. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews10.1136/bmj.n71 ↗
43. Reprint of Criteria for the clinical evaluation of dental restorative materials10.1007/s00784-005-0018-z ↗
44. Randomized Controlled Trials10.1016/j.chest.2020.03.013 ↗
45. In Vitro comparison of the physical and mechanical properties of an ormocer with an ormocer-based composite and a nanocomposite restorative material10.1002/cre2.756 ↗
46. Mechanical and hydrolytic degradation of an Ormocer®-based Bis-GMA-free resin composite10.1007/s00784-018-2651-3 ↗
47. Flexural properties of resin composites with different viscosities10.1016/j.identj.2024.07.1002 ↗
48. Investigations on mechanical behaviour of dental composites10.1007/s00784-009-0258-4 ↗
49. Influence of different viscosity and chemical composition of flowable composite resins: A 48-month split-mouth double-blind randomized clinical trial10.1016/j.dental.2024.07.034 ↗
50. A split-mouth randomized clinical trial of conventional and heavy flowable composites in class II restorations10.1016/j.jdent.2014.04.009 ↗
51. Chowdhury, A., Islam, R., Alam, A., Matsumoto, M., Yamauti, M., Carvalho, R.M., and Sano, H. (2019). Variable Smear Layer and Adhesive Application: The Pursuit of Clinical Relevance in Bond Strength Testing. Int. J. Mol. Sci., 20.10.3390/ijms20215381 ↗
52. Comparison of different etch-and-rinse adhesive systems based on shear fatigue dentin bond strength and morphological features the interface10.1016/j.dental.2020.11.006 ↗
53. Self-etch adhesive systems: A literature review10.1590/0103-6440201302442 ↗
54. Bond strength of self-etch adhesives to pre-etched enamel10.1016/j.dental.2009.04.004 ↗
55. El Gedaily, M., Attin, T., Wiedemeier, D.B., and Tauböck, T.T. (2020). Impact of Different Etching Strategies on Margin Integrity of Conservative Composite Restorations in Demineralized Enamel. Materials, 13.10.3390/ma13204500 ↗
56. Clinical performance of a self-etching and a total-etch adhesive system—2-year results10.1111/j.1365-2842.2007.01745.x ↗
57. A prospective, randomized clinical trial of a two-step self-etching vs two-step etch-and-rinse adhesive and SEM margin analysis: Four-year results
58. Clinical in-situ evaluation of the effect of rubber dam isolation on bond strength to enamel10.1111/jerd.12979 ↗
59. Influence of the operatory field isolation technique on tooth-colored direct dental restorations
60. Clinical and Radiographic Outcomes of Calcium Hydroxide vs Other Agents in Indirect Pulp Capping of Primary Teeth: A Systematic Review10.5005/jp-journals-10005-1672 ↗
61. Comparative evaluation of clinical outcome of indirect pulp treatment with calcium hydroxide, calcium silicate and Er,Cr:YSGG laser in permanent molars10.5978/islsm.28_19-OR-09 ↗
62. Influence of flowable composite lining thickness on Class II composite restorations
63. The effect of flowable composite lining thickness with various curing techniques on microleakage in class II composite restorations: An in vitro study10.5005/jp-journals-10024-1270 ↗
64. Use of flowable resin composite as an intermediate layer in class II restorations: A systematic review and meta-analysis10.1007/s00784-021-04090-5 ↗