Secondary caries remains a major cause of failure for direct dental restorations and is responsible for a significant proportion of replacement procedures worldwide. Bioactive restorative materials have been developed to mitigate this problem through mechanisms such as ion release, antimicrobial effects, and promotion of remineralization at the tooth–restoration interface. However, the clinical superiority of bioactive materials over conventional resin composites in preventing secondary caries remains uncertain. This systematic review evaluates the existing clinical and laboratory evidence comparing bioactive restorative materials with conventional composites for secondary caries prevention outcomes, including lesion progression, antimicrobial effects, marginal integrity, and ion release profiles. The review synthesizes evidence from randomized clinical trials, in vitro studies, and meta‑analyses to provide comprehensive insight into the efficacy of these materials. Current evidence suggests that although bioactive materials demonstrate enhanced biological activity and remineralization potential in controlled environments, their clinical advantage in preventing secondary caries when compared to conventional composites is still equivocal. Overall, bioactive restorative materials show promise as adjunctive tools in caries management strategies, but further standardized long‑term clinical trials are needed.
