Bioactive restorative materials represent a paradigm shift in modern dentistry, moving from passive restorations to functional materials that actively promote oral health. This review comprehensively explores the evolution, mechanisms of action, methods of assessment, and clinical applications of direct bioactive restorative materials, including glass ionomer cements (GICs), resin-based composites, and ion-releasing materials. This review critically analyzes their roles in remineralization, fluoride release, antimicrobial activity, and tissue regeneration, while also addressing their mechanical properties and limitations. A systematic literature search was conducted across major databases, including PubMed, Scopus, Web of Science, and ScienceDirect. Key findings reveal that bioactive GICs, resin-based composites, and ion-releasing materials exhibit varying degrees of bioactivity through ion release, apatite layer formation, and collagen interaction. Recent advances in calcium phosphate-based fillers, bioactive glass additives, and antimicrobial agents have significantly improved these materials’ therapeutic potential. However, challenges remain regarding mechanical strength, long-term stability, and standardization of bioactivity assessment. Future research should focus on developing standardized testing protocols, optimizing mechanical performance, and conducting rigorous long-term clinical trials to fully harness the potential of bioactive restorative materials in dental practice. Also identifying the key knowledge gaps and proposing future research directions to advance the field.

Denture base fabrication has advanced with the introduction of computer-aided design and manufacturing (CAD-CAM) techniques, such as subtractive milling and additive 3D printing. However, concerns persist regarding the mechanical performance of 3D-printed denture bases. This systematic review and meta-analysis aimed to evaluate and compare the flexural strength (FS), surface hardness, fracture toughness, and impact strength of 3D-printed denture bases with those produced by milling and conventional methods. A systematic search of PubMed, Scopus, Web of Science, and Cochrane Central was conducted up to March 2025 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In vitro studies comparing 3D-printed denture bases with milled or conventional heat-polymerized bases in terms of mechanical properties were included. The Joanna Briggs Institute (JBI) checklist for quasi-experimental studies was used. Data was extracted, and quantitative synthesis was performed where possible. Thirty-eight studies were included, comprising 562 specimens for FS and 231 for surface hardness. Meta-analysis revealed that milled denture bases demonstrated the highest flexural strength (MD = -1.11, 95% CI [-1.29, -0.93], p < 0.001) and surface hardness (MD = -26.49, 95% CI [-29.89, -23.10], p < 0.001) compared to 3D-printed bases. Conventional bases outperformed 3D-printed ones in most mechanical properties. Milled denture bases exhibited the highest FS (120–146 MPa), followed by conventional PMMA (95–119 MPa), while 3D-printed bases showed wider variability (28–128 MPa). Surface hardness (VHN), fracture toughness (MPa·m¹/²), and impact strength (kJ/m²) were also superior in milled bases. Statistical heterogeneity was present due to differences in materials, printing orientation, and post-curing protocols. Subgroup analysis based on printing orientation (0°, 45°, and 90°) partially explained this variability, showing higher FS in horizontally printed specimens. Although 3D-printed denture bases offer customization and production efficiency, their mechanical properties remain inferior to milled alternatives. Optimization of resin formulations, printing parameters, and post-processing protocols is essential to enhance their clinical performance. The main limitations were high heterogeneity among included studies, differences in material formulations, variability in testing standards, and the in vitro nature of most included studies. This review was registered in PROSPERO (CRD420250639092). There were no deviations from the registered protocol.

Dental composites are widely used restorative materials but secondary caries to the restored tooth, polymerization shrinkage, and mechanical failure, limiting their longevity. Incorporating nanoparticles synthesized via eco-friendly methods offers a promising strategy to enhance composite performance. This study introduces a novel, eco-friendly strategy to enhance dental composite resins by incorporating TiO₂-NPs synthesized using Vitis vinifera extract. This study uniquely employs Vitis vinifera, rich in flavonoids and phenolics, as a reducing and capping agent, and for the first time integrates molecular docking analysis to explore the mechanistic antimicrobial interaction between TiO₂-NPs and Streptococcus mutans glucosyltransferase. The research evaluates the impact of these green-synthesized nanoparticles on antimicrobial properties, mechanical performance, polymerization shrinkage, and their molecular interactions with Streptococcus mutans glucosyltransferase via molecular docking analysis. The green-synthesized TiO₂-NPs were thoroughly characterized and integrated into dental composites at 10% and 20% by weight (Groups II and III, respectively), while Group I (control) contained only fumed silica fillers. The antimicrobial activity was assessed against S. mutans, S. sanguinis, and L. acidophilus, and mechanical properties (flexural strength and microhardness) were evaluated according to ISO standards. Polymerization shrinkage was measured using a strain gauge. Additionally, molecular docking analysis was performed to investigate the interaction of TiO₂-NPs with S. mutans glucosyltransferase. The modified composites exhibited significantly improved antimicrobial activity against key oral pathogens and superior mechanical properties compared to the control. Molecular docking studies provided insights into the potential antimicrobial mechanisms of TiO₂-NPs. These findings suggest that green-synthesized TiO₂-NPs offer a promising, eco-friendly approach to improve the performance and longevity of dental restorative materials.

Recurrent caries remains a significant challenge in restorative dentistry. While various antimicrobial agents have been incorporated into restorative materials, their efficacy and impact on mechanical properties remain a concern. This study investigates the potential of incorporating Citrus aurantium L. seed extract into glass ionomer cement (GIC) to enhance its antimicrobial activity while maintaining mechanical integrity comparable to conventional GIC. Additionally, in silico molecular docking and bioactivity predictions were performed to elucidate the mechanistic basis of its antimicrobial effects and broader pharmacological potential. The aqueous extract of Citrus aurantium L. was incorporated into the liquid component of a commercially available conventional GIC at two concentrations (10% and 20% by weight), forming two modified groups. Antimicrobial activity against S. mutans was evaluated using the agar diffusion assay. Molecular docking was conducted to predict interactions between key phytocompounds and S. mutans glucosyltransferase B (GtfB). Mechanical properties, including flexural strength and microhardness, were evaluated according to ISO 9917-1 and ASTM E-384:1999, respectively. Modified GIC demonstrated significantly enhanced antimicrobial activity, with the 20% concentration showing the strongest effect (27.2 ± 0.6 mm inhibition zone) compared to the control (16.2 ± 0.6 mm). Molecular docking confirmed strong binding affinities between key bioactive compounds and GtfB. A minor but significant reduction in flexural strength was observed in modified GICs. Additionally, both modified GIC groups demonstrated improved surface microhardness (10% CA: 32.2 VHN; 20% CA: 42.4 ± 2.1 VHN) compared to the control (33.5 ± 2.0 VHN). The incorporation of C. aurantium L. extract into GIC significantly enhanced its antimicrobial properties against S. mutans while maintaining satisfactory mechanical performance. Molecular docking provided mechanistic insights into the antimicrobial effects, reinforcing the potential of integrating natural bioactive compounds with computational approaches in dental material development.

Glass ionomer cement (GIC) is valued in restorative dentistry for its chemical adhesion, fluoride release, and biocompatibility but has limitations in mechanical strength and long-term antibacterial activity. Propolis, a natural resin rich in flavonoids and phenolic acids, has shown antimicrobial, antioxidant, and anti-inflammatory effects, making it a potential bioactive additive to improve GIC performance. This systematic review evaluates the effects of propolis-modified GIC on antimicrobial activity and physico-mechanical properties, while identifying optimal formulations and concentrations for clinical use. Special emphasis is placed on methodological heterogeneity, chemical characterization gaps, and future research needs. Publications up to the end of 2024 were included from the Cochrane Library, Web of Science, PubMed, and Scopus. The review was registered on PROSPERO (CRD42024627498) and conducted according to PRISMA guidelines using the PICO framework. Propolis-modified GIC generally demonstrated enhanced antibacterial activity against Streptococcus mutans , Lactobacillus , and Candida albicans , particularly at concentrations of 25–50%. Mechanical outcomes varied with concentration, with 25% often balancing antimicrobial efficacy and mechanical stability, while higher concentrations improved hardness but sometimes reduced compressive and bond strength. Considerable heterogeneity was observed in GIC brands, propolis sources, extraction techniques, and incorporation methods, limiting direct comparability. Most studies lacked detailed chemical characterization, making it unclear which flavonoids or phenolic compounds drive the observed effects. Yellow discoloration was the main reported esthetic change, with no studies assessing long-term color stability or translucency. Propolis-modified GIC is a promising bioactive restorative material with potential antimicrobial benefits. However, methodological weaknesses, heterogeneity in preparation, and absence of chemical and long-term esthetic evaluation limit the direct clinical applicability of current evidence. Standardized protocols for material preparation, bioactive component identification, and comprehensive testing of mechanical and esthetic properties are recommended to advance this field.

Aim: This study aimed to compare the qualitative and radiographic outcomes of polyether-ether-ketone (PEEK) bars versus titanium bars fabricated using computer-aided design/computer-aided manufacturing (CAD/CAM) technique for use in mandibular hybrid prostheses. Materials and Methods: A total of 14 patients with completely edentulous mandibular arches opposing natural dentition were selected and divided into two groups; seven patients in each. All patients received implant-supported hybrid prostheses with a bar fabricated utilizing CAD/CAM milling technique on four dental implants. The bar was fabricated from titanium in Group I (control), while it was fabricated from PEEK in Group II. Furthermore, the study compared the two groups as follows: 1) Qualitatively, a questionnaire was used to evaluate patient satisfaction. 2) Radiographically, digital periapical imaging was used to measure marginal bone loss around implants. Finally, the results were statistically analyzed. Results: The patients in both study groups demonstrated increased levels of satisfaction, with no significant difference between them, except in terms of aesthetics, as the PEEK group exhibited superior aesthetic outcomes. In terms of marginal bone loss, a reduced marginal bone loss in the PEEK group was observed between the two groups during the 6- and 12-month assessments. Conclusion: PEEK material has proven to be a valuable alternative for bar fabrication in implant-supported hybrid prostheses for patients with a single edentulous mandible as the patients with PEEK bars demonstrated higher satisfaction and less marginal bone loss than those with titanium bars