ACTIVA BioACTIVE-Restorative vs ACTIVA Presto vs Predicta Bioactive Bulk

Introduction and background

Modern bioactive restoratives encompass a diverse spectrum of material classes, including high-viscosity glass ionomer cements (GICs), resin-modified glass ionomers (RMGICs), giomers (surface pre-reacted glass ionomers), and newer categories such as alkasites (e.g. Cention N) and bioactive ionic resin composites (e.g. ACTIVA BioACTIVE) [1,5]. Recent advancements in nanotechnology have expanded this field, introducing materials doped with bioactive glass, silver nanoparticles, or zinc oxide to enhance antimicrobial efficacy and physicochemical durability [3,7]. These smart materials are designed to respond to environmental stimuli, such as pH drops, by increasing ion release on demand to prevent demineralization [5,6].

Clinical Efficacy of Bioactive and Smart Restorative Materials in Preventing Secondary Caries: A Systematic Review and Meta-Analysis. Copyright © 2026, Zailai et al. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Abstract

Forty RCTs involving 5,506 restorations were included. The meta-analysis revealed that bioactive materials significantly reduced the risk of secondary caries by 45% compared with conventional materials (risk ratio (RR) = 0.55; 95% CI: 0.46 to 0.65; p < 0.001), with no statistical heterogeneity (I2 = 0%). Subgroup analysis showed that GICs provided the strongest protective effect (RR = 0.36; p = 0.002), while giomers did not show a significant benefit (RR = 1.09; p = 0.87). TSA confirmed that the required information size was met and that the evidence for the benefit of bioactive materials is conclusive. The certainty of evidence was graded as moderate due to risk of bias in a subset of studies. Bioactive restorative materials demonstrate a superior ability to prevent secondary caries compared with conventional passive materials. The evidence is robust and conclusive, supporting the use of these materials, particularly GICs and bioactive resins, as a first-line therapeutic choice for patients at high risk of caries. Future research should focus on the long-term mechanical longevity of newer bioactive resin formulations.

Clinical Efficacy of Bioactive and Smart Restorative Materials in Preventing Secondary Caries: A Systematic Review and Meta-Analysis. Copyright © 2026, Zailai et al. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Review

Clinical Implications For clinicians, these findings advocate for a shift in material selection for high-risk patients, such as those with Class V cervical lesions and conservative Class I/II restorations, where mechanical stress is moderate. Bioactive materials should be considered the first line of defense against secondary caries. For large stress-bearing restorations, the trade-off between biological protection and mechanical fracture resistance is a clinical judgment call, favouring the use of bioactive materials as liners or bases under high-strength composites (e.g., sandwich technique). Future Directions Future research should focus on the long-term clinical performance (>5 years) of newer bioactive resin composites and alkasites to determine whether they successfully combine the cariostatic power of GICs with the fracture resistance of traditional composites. In addition, the standardization of bioactivity in clinical reporting is necessary to prevent marketing claims from outpacing clinical evidence.

Clinical Efficacy of Bioactive and Smart Restorative Materials in Preventing Secondary Caries: A Systematic Review and Meta-Analysis. Copyright © 2026, Zailai et al. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).