Do nanofilled/nanohybrid composites allow for better clinical performance of direct restorations than traditional microhybrid composites? a systematic review

This systematic review was carried out to assess the clinical effectiveness of nanofilled and nanohybrid composites used for direct restorations in comparison with microhybrid composites. The guidelines for the preferred reporting items for systematic reviews and meta-analyses were followed. A search of articles published from July 1996 to February 2017 was performed in PubMed, SciVerse Scopus, Latin American and Caribbean Health Sciences, the Scientific Electronic Library Online, and the Cochrane Library. The present review selected only randomized controlled trials comparing the clinical performance of a nanofilled or nanohybrid composite for direct restorations with that of a microhybrid composite. The research found 201 studies. Twenty-one articles fulfilled the criteria of the present review. However, the included studies were characterized by great methodological diversities. As a general trend, nanofilled and nanohybrid composites were found to be capable of clinical performance, marginal quality, and resistance to wear similar to that of traditional composites without showing improved surface characteristics. The risk of bias of included studies was judged unclear or high. The clinical performance of nanofilled/nanohybrid composites was found to be comparable to that of traditional composites in the posterior area. The data concerning anterior and cervical restorations were insufficient. With regard to the esthetic properties, there is a compelling need for studies on anterior teeth in which the operators are kept unaware of the restorative material. Nanofilled/nanohybrid composites seem to be a valid alternative to traditional microhybrid composites, and at the moment, there is low-level evidence attesting a lack of their superiority.