5-year clinical performance of posterior bulk-filled resin composite restorations: A double-blind randomized controlled trial

Alessandro D. Loguercio, Romina Ñaupari-Villasante, Mario F. Gutierrez, Maria Inés Gonzalez, Alessandra Reis, Siegward D. Heintze*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: The aim of this double-blind, and randomized controlled clinical trial was to evaluate the 5-year clinical performance of posterior resin composite restorations placed with the incremental filling technique [IF] or the bulk-fill technique [BF]. Two different adhesive systems were used: etch-&-rinse (ER) or self-etch (SE). Methods: Posterior dental teeth of 72 participants (n = 236), with a cavity depth of at least 3 mm, were randomly divided into four groups. Restorations were applied with either Tetric N-Bond or Tetric N-Bond SE. The composite resin Tetric N-Ceram Bulk-Fill was placed either with IF or BF. Restorations were evaluated using FDI criteria at baseline and after 1, 2, 3, 4, and 5 years. Statistical analysis was performed using the Wilcoxon Signed rank test (a=0.05). Results: Two hundred and four restorations were evaluated after 5 years. Eleven restorations were considered 'failed', ten due to fracture (4 IF and 6 BF) and one due to secondary caries (IF). The annual failure rate was 1.2% for BF and 1% for IF (p = 0.35). When comparing BF and IF, no significant differences were found for any of the parameters evaluated (p > 0.05). Regarding the adhesive systems, 44 and 51 restorations showed minor problems in terms of marginal adaptation and staining, with significantly more marginal discoloration when the self-etch adhesive was used (p = 0.002). Significance: The bulk-fill restorative technique showed good clinical behavior compared to the incremental filling technique, especially when using an etch-&-rinse adhesive, after 5 years of clinical evaluation.

Original languageEnglish
JournalDental Materials
StateAccepted/In press - 2023

Bibliographical note

Funding Information:
The authors would like to thank Ivoclar for the generous donation of the restorative products employed in this study. This study was partially supported by the National Council for Scientific and Technological Development (CNPq) under grant 308286/2019-7 and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.

Publisher Copyright:
© 2023 Elsevier Inc.


  • Bulk-fill
  • Etch-&-rinse
  • Incremental filling technique
  • Postoperative sensitivity
  • Randomized controlled trial
  • Resin composite
  • Self-etch


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