Clinical Performance of Self-Adhesive and Conventional Flowable Resin Composite Restorations: A Systematic Review and Meta-Analysis

Background/Objectives: Self-adhesive flowable resins (SAFR) entered the market, eliminating the adhesive system application due to their self-adhesive technology. The aim was to conduct a systematic review of clinical studies to compare the clinical performance of Self Adhesive Flowable Resin (SAFRs) with conventional flowable resins used for direct restorations. Methods: The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (CRD42023394297) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. A search of the scientific literature was performed by two independent reviewers using PubMed, Embase, Web of Science, Scopus, and Cochrane databases from commencement until July 2025. Investigations evaluating the clinical performance of SAFRs as direct restorative materials were included. The RevMan 5.4 program was used for meta-analysis, calculating the risk difference and 95% confidence interval (CI) of the dichotomous outcome (marginal adaptation, retention, post-operative sensitivity, marginal staining, smoothness, secondary caries, anatomical form and color match) using a random-effects model. Results: Nine studies were selected, comprising 493 analyzed restorations. The results revealed a comparable SARFs performance to conventional resins in terms of marginal adaptation, retention, post-operative sensitivity, marginal staining, smoothness, secondary caries, anatomical form and color match. Conclusions: SAFRs restorations exhibited comparable clinical performance when compared to conventional resins, specifically in the outcomes studied.