Bioactive restorative materials in dentistry: a comprehensive review of mechanisms, clinical applications, and future directions

Abstract

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.