Failure Risk of Composite Resin and Amalgam Restorations: A Systematic Review and Meta-Analysis

Objective: This systematic review and meta-analysis were conducted to compare the failure risk between amalgam and composite resin materials in permanent posterior teeth. Material and methods: Study eligibility requirements included clinical trials and observational studies with at least 12 months o...

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Main Authors: Woroud Al-Sulimmani, Asmaa Al-Rasheed, Hebah Al-Daraan, Muna Al-Mutairi, Yash Brahmbhatt, Hesham Al-Hazmi, Hend Al-Qaderi
Format: Article
Language:English
Published: Elsevier 2025-08-01
Series:International Dental Journal
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Online Access:http://www.sciencedirect.com/science/article/pii/S0020653925001601
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author Woroud Al-Sulimmani
Asmaa Al-Rasheed
Hebah Al-Daraan
Muna Al-Mutairi
Yash Brahmbhatt
Hesham Al-Hazmi
Hend Al-Qaderi
author_facet Woroud Al-Sulimmani
Asmaa Al-Rasheed
Hebah Al-Daraan
Muna Al-Mutairi
Yash Brahmbhatt
Hesham Al-Hazmi
Hend Al-Qaderi
author_sort Woroud Al-Sulimmani
collection DOAJ
description Objective: This systematic review and meta-analysis were conducted to compare the failure risk between amalgam and composite resin materials in permanent posterior teeth. Material and methods: Study eligibility requirements included clinical trials and observational studies with at least 12 months of follow-up. English-language studies from 1990 onwards were the only studies included. This review follows the Cochrane Handbook for Systematic Reviews of Interventions and the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Our search strategy included using the following databases: PubMed, Cochrane, and Google Scholar. The primary outcome was restoration failures, defined as restoration replacements, tooth and restoration fractures, secondary caries, postoperative sensitivity, and toothaches. We conducted a random-effects meta-analysis to determine the risk ratio (RR) of the included studies, and publication bias was assessed. The Cochrane Risk of Bias tool was employed to evaluate the quality of the clinical trials, while the Newcastle–Ottawa scale was used to assess the quality of other studies. Results: The results were derived from 13 studies. The failure proportion for amalgam ranged from 0% to 50.0%, while that of composite resin restorations ranged from 0% to 62.7%. The meta-analysis did not find any statistically significant difference in failure risk between amalgam and composite resin restorations (RR: 0.96, 95% confidence intervals: 0.68-1.34). The Egger’s test results did not show any significant evidence of publication bias in the meta-analysis (P > .05). Conclusion: This review did not reveal any statistically significant difference in the RR between composite resin and amalgam restorations. However, in their analyses, the 13 studies used varying definitions of failure and did not account for some important factors that might have influenced restoration failures. Future reviews need to account for other influential variables that contributed to restoration failures.
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spelling doaj-art-0eff162cdbe14f06bf314dc7ab24c73a2025-08-20T03:50:31ZengElsevierInternational Dental Journal0020-65392025-08-0175410087110.1016/j.identj.2025.100871Failure Risk of Composite Resin and Amalgam Restorations: A Systematic Review and Meta-AnalysisWoroud Al-Sulimmani0Asmaa Al-Rasheed1Hebah Al-Daraan2Muna Al-Mutairi3Yash Brahmbhatt4Hesham Al-Hazmi5Hend Al-Qaderi6Department of Oral and Maxillofacial Surgery, Al-Jahra Speciality Dental Center, Al-Jahra Medical Area, Ministry of Health, Al Jahra, Kuwait; Corresponding author. Block No. 3, Street No. 38, Building No. 12, Kaifan, Al Jahra 78103, Kuwait.Department of Endodontics, Al-Farwaniyah Speciality Dental Center, Al-Farwaniyah Medical Area, Ministry of Health, Al Jahra, KuwaitSchool Oral Health Program, Al-Jahra Speciality Dental Center, Al-Jahra Medical Area, Ministry of Health, Al Jahra, KuwaitSchool Oral Health Program, Al-Jahra Speciality Dental Center, Al-Jahra Medical Area, Ministry of Health, Al Jahra, KuwaitTufts University School of Dental Medicine, Boston, Massachusetts, USAPreventive Dentistry Department, Collage of Dental Medicine, Umm Al-Qura University, Makkah, Saudi ArabiaDepartment of Public Health and Community Service, Tufts University School of Dental Medicine, Boston, Massachusetts, USAObjective: This systematic review and meta-analysis were conducted to compare the failure risk between amalgam and composite resin materials in permanent posterior teeth. Material and methods: Study eligibility requirements included clinical trials and observational studies with at least 12 months of follow-up. English-language studies from 1990 onwards were the only studies included. This review follows the Cochrane Handbook for Systematic Reviews of Interventions and the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Our search strategy included using the following databases: PubMed, Cochrane, and Google Scholar. The primary outcome was restoration failures, defined as restoration replacements, tooth and restoration fractures, secondary caries, postoperative sensitivity, and toothaches. We conducted a random-effects meta-analysis to determine the risk ratio (RR) of the included studies, and publication bias was assessed. The Cochrane Risk of Bias tool was employed to evaluate the quality of the clinical trials, while the Newcastle–Ottawa scale was used to assess the quality of other studies. Results: The results were derived from 13 studies. The failure proportion for amalgam ranged from 0% to 50.0%, while that of composite resin restorations ranged from 0% to 62.7%. The meta-analysis did not find any statistically significant difference in failure risk between amalgam and composite resin restorations (RR: 0.96, 95% confidence intervals: 0.68-1.34). The Egger’s test results did not show any significant evidence of publication bias in the meta-analysis (P > .05). Conclusion: This review did not reveal any statistically significant difference in the RR between composite resin and amalgam restorations. However, in their analyses, the 13 studies used varying definitions of failure and did not account for some important factors that might have influenced restoration failures. Future reviews need to account for other influential variables that contributed to restoration failures.http://www.sciencedirect.com/science/article/pii/S0020653925001601Restorative dentistryComposite resinAmalgamFailure riskMeta-analysis
spellingShingle Woroud Al-Sulimmani
Asmaa Al-Rasheed
Hebah Al-Daraan
Muna Al-Mutairi
Yash Brahmbhatt
Hesham Al-Hazmi
Hend Al-Qaderi
Failure Risk of Composite Resin and Amalgam Restorations: A Systematic Review and Meta-Analysis
International Dental Journal
Restorative dentistry
Composite resin
Amalgam
Failure risk
Meta-analysis
title Failure Risk of Composite Resin and Amalgam Restorations: A Systematic Review and Meta-Analysis
title_full Failure Risk of Composite Resin and Amalgam Restorations: A Systematic Review and Meta-Analysis
title_fullStr Failure Risk of Composite Resin and Amalgam Restorations: A Systematic Review and Meta-Analysis
title_full_unstemmed Failure Risk of Composite Resin and Amalgam Restorations: A Systematic Review and Meta-Analysis
title_short Failure Risk of Composite Resin and Amalgam Restorations: A Systematic Review and Meta-Analysis
title_sort failure risk of composite resin and amalgam restorations a systematic review and meta analysis
topic Restorative dentistry
Composite resin
Amalgam
Failure risk
Meta-analysis
url http://www.sciencedirect.com/science/article/pii/S0020653925001601
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