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

4 Scopus citations


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
Pages (from-to)1159-1168
Number of pages10
JournalDental Materials
Issue number12
StatePublished - Dec 2023

Bibliographical note

Publisher Copyright:
© 2023 The Academy of Dental Materials


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


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