Four-year clinical evaluation of posterior resin-based composite restorations placed using the total-etch technique

To report the 4-year clinical performance of posterior resin-based composite restorations placed using the total-etch technique.

Over a period of 1 year, 726 restorations (248 molars, 478 premolars; 260 Class I, 466 Class II; 540 replacements, 186 primary decay) were placed on conservative preparations, using the incremental placement technique in a clinical environment. Baseline data were collected, and the restorations were evaluated after 4 years. Z100 and Scotchbond Multi-Purpose (SBMP) (3M Dental Products, St. Paul, Minnesota) were used as the restorative system. The criteria evaluated were color match, marginal adaptation, anatomic form, cavosurface marginal discoloration, axial contour, interproximal contact, secondary caries, postoperative sensitivity, and tooth vitality.

At baseline, 24% of the teeth restored presented postoperative sensitivity; 86% of the sensitive teeth were from the replacement group. At 4 years, all teeth were vital to cold test. Eighteen restorations (2.5%) presented clinically detectable marginal fracture. The shade was acceptable in all restorations. Cavosurface marginal discoloration was observed in 47 restorations (6.5% bravo scores). Axial contour, interproximal contact, and marginal adaptation received 100% alfa scores. No secondary caries was diagnosed in any of the teeth examined. None of the examined restorations required replacement.

Under controlled clinical conditions, posterior resin-based composite restorations placed with the total-etch technique and restorative Z100/SBMP have the potential to present a high success rate at 4 years. None of the examined restorations required replacement, and there was no clinically detectable wear in any of the restorations. Simultaneous etching of enamel and dentin followed by the application of a resin adhesive can be considered an adequate modality of pulp protection in nonexposed tooth preparations.