The evolution of restorative dentistry has progressed from the use of inert materials toward biologically interactive systems capable of modulating the oral environment and supporting tooth tissue repair. Bioactive restorative materials have emerged as a promising class of materials designed to release therapeutic ions, promote remineralization, inhibit bacterial activity, and potentially improve the longevity of restorations. This review aims to comprehensively analyze recent advancements in bioactive restorative materials and critically evaluate their clinical performance based on available in vitro and in vivo evidence. A systematic search of major electronic databases was conducted for studies published between 2019 and 2025. Glass ionomer cements, resin-modified glass ionomers, giomers, alkasite materials, and bioactive resin composites were included. Clinical performance parameters such as marginal integrity, retention, wear resistance, postoperative sensitivity, and secondary caries prevention were assessed. Current evidence indicates that bioactive restorative materials particularly glass ionomer–based systems exhibit favorable clinical outcomes in caries-prone patients, mainly due to sustained ion release and chemical bonding to tooth structure. However, limitations related to mechanical strength, material heterogeneity, and the paucity of long-term randomized clinical trials persist. Standardized evaluation methods and further clinical validation are required before widespread adoption of newer bioactive materials can be fully justified.

Keywords
Bioactive restorative materials; glass ionomer cement; ion-releasing restorations; secondary caries; remineralization; clinical performance.