Abstract

Objectives: To systematically evaluate the fracture resistance, failure patterns, and clinical performance of SFRC-based restorations in posterior teeth, based on evidence from in vitro and clinical studies. Materials and Methods: A systematic review was performed following PRISMA 2020 and registered in PROSPERO. Searches were conducted in five databases and gray literature sources up to July 2025. In vitro and clinical studies on SFRC restorations in posterior teeth were included. Risk of bias was assessed with RoBDEMAT and RoB 2.0/JBI tools. Due to heterogeneity, a narrative synthesis was undertaken. Results: Twenty-eight studies met the inclusion criteria (23 in vitro, 5 clinical). In vitro studies consistently showed that restorations incorporating short fiber-reinforced composites (SFRCs) achieved higher fracture resistance and a greater proportion of repairable failures compared with conventional composites, particularly in large MOD cavities and endodontically treated teeth. Clinical studies, with follow-up periods of up to 4 years, confirmed favorable survival rates and satisfactory marginal adaptation, although no clear superiority over conventional composites was demonstrated. Conclusions: Short fiber-reinforced composites (SFRCs) show promising improvements in fracture resistance and failure behavior, but current clinical evidence is limited and of low certainty. Their routine use should remain cautious until validated by long-term randomized trials. Clinical Relevance: Short fiber-reinforced composites (SFRCs) have shown potential to improve fracture resistance and promote more favorable failure patterns in posterior restorations. While current evidence is promising, further clinical validation is needed before their routine use can be widely recommended. © 2025 Wiley Periodicals LLC.