Awareness of possible complications associated with direct composite restorations: a systematic review

Introduction: Resin-based composites (RBCs) are among the most widely used materials for direct dental restorations due to their aesthetics and conservative preparation requirements. However, their clinical application remains highly technique-sensitive, and long-term outcomes are frequently compromised by complications. This systematic review aimed to evaluate the most common clinical challenges associated with direct composite restorations and assess awareness of these complications among dentists, dental students, and patients. Evidence acquisition: A comprehensive search of PubMed, Scopus, Web of Science, and Embase was conducted for studies published between January 2010 and August 2025, following PRISMA guidelines. Twenty eligible studies were included, encompassing survey-based research, clinical follow-ups, and cross-sectional analyses across diverse populations. Quality assessment revealed methodological heterogeneity, with most studies rated as intermediate quality. Evidence synthesis: The most frequently reported complications included secondary caries, restoration fractures, marginal defects, postoperative hypersensitivity, and food impaction. Factors contributing to these failures were multifactorial, encompassing operator technique, material properties such as polymerization shrinkage and moisture sensitivity, patient-related behaviors including poor oral hygiene and parafunctional habits, and inadequate pre- and postgraduate training. Evidence further indicated that repair, rather than replacement, is often a conservative and effective management strategy. Conclusions: The success of composite restorations depends not only on material advancements but also on clinician skill, adherence to evidence-based protocols, and patient cooperation. Continuous professional education and preventive measures remain critical for reducing complications and improving restoration longevity.