Longevity of posterior composite restorations: not only a matter of materials

Resin composites have become the first choice for direct posterior restorations and are increasingly popular among clinicians and patients. Meanwhile, a number of clinical reports in the literature have discussed the durability of these restorations over long periods. In this review, we have searched the dental literature looking for clinical trials investigating posterior composite restorations over periods of at least 5 years of follow-up published between 1996 and 2011. The search resulted in 34 selected studies. 90% of the clinical studies indicated that annual failure rates between 1% and 3% can be achieved with Class I and II posterior composite restorations depending on several factors such as tooth type and location, operator, and socioeconomic, demographic, and behavioral elements. The material properties showed a minor effect on longevity. The main reasons for failure in the long term are secondary caries, related to the individual caries risk, and fracture, related to the presence of a lining or the strength of the material used as well as patient factors such as bruxism. Repair is a viable alternative to replacement, and it can increase significantly the lifetime of restorations. As observed in the literature reviewed, a long survival rate for posterior composite restorations can be expected provided that patient, operator and materials factors are taken into account when the restorations are performed.