Clinical performance of a packable resin composite for posterior teeth after 3 years

There is a wide range of materials suitable for posterior resin-composite restorations. The objective of this clinical study was to evaluate the clinical performance of a packable resin composite (Solitaire, Heraeus-Kulzer, Hanau, Germany) in stress-bearing posterior cavities according to the Ryge criteria every 6 months over a 3-year period. A total of 250 class I (28%) and II (72%) restorations were placed in 120 patients using adhesive-bonding techniques without the use of rubber dam. After 3 years, 165 restorations (66%) were still in place during the follow-up investigation. Twelve restorations (4.8% out of the baseline number) had to be replaced due to postoperative sensitivity over the 3-year evaluation period. After 3 years, 65.5% of the restorations were scored Alpha for Marginal Adaptation, 18.2% Bravo, 2.4% Charlie, and 13.9% Delta. For the Ryge criteria Anatomic Form 70.9% of the restorations were scored Alpha, 15.2% Bravo, and 13.9% Charlie. Secondary caries was documented in 3.5% of the restorations. A Bravo score for Marginal Discoloration was determined in 26.1% of the restorations; 2.1% were scored Charlie. After 3 years, only 79.0% (summation effect of negative scores) of the restorations were still performing at clinically acceptable levels. Therefore, the packable resin composite Solitaire failed the criteria of the American Dental Association for resin restoratives. Bulk fractures (14 molar and 9 premolar restorations = 9.2% of the baseline number) due to poor physical properties of the material were the main reason for clinical failure.     

Clinical performance of resin composite restorations after 2 years

The objective of this study was to evaluate the clinical performance of a packable restorative material, after 2 years in stress-bearing posterior cavities, according to the Ryge criteria. At least two Class 2 restorations (occluso-mesial, mesial-occlusal-distal, occlusal-distal) were placed in 46 patients (36.7 +/- 16 years). In each of the restorations (lot 221, metal matrix band system, glass ionomer-cement-base in 53% of the cavities, mostly no rubber dam) an adhesive system was used. Additionally, in each patient a flowable composite was used in one of the two fillings. After 2 years, 70% of the patients were available for reevaluation. Two restorations needed to be replaced as a result of postoperative sensitivities within the observation period, and one tooth received root canal treatment. All other restored teeth remained vital. One restoration with marginal discoloration received a score of Charlie; another with secondary caries received a score of Bravo. All the others revealed excellent and clinically acceptable results. No statistically significant difference (Chi-square-test) was observed between the two groups, with and without an additional flowable composite. After 2 years, the restorative material performed clinically well, with no observable fractures in the restoration.     

Clinical performance evaluation of a packable posterior composite in bulk-cured restorations

BACKGROUND: The authors evaluated the clinical performance of Prodigy Condensable (Kerr, Orange, Calif.) composite placed and cured in increments up to 5 millimeters thick. METHODS: The authors placed 57 Class II restorations in 32 patients in composite increments up to 5 mm thick. Using this technique, they placed the majority of restorations in one increment and then carved the occlusal and proximal anatomy before light curing. The authors evaluated the restorations at three, six, 12, 24 and 36 months. RESULTS: No restorations required replacement; however, 11 developed a defect requiring repair or continued observation. Of these 11, nine restorations developed defects on the margins of the restorations and two developed secondary caries. The Kaplan-Meier estimate of probability that a restoration would develop a defect during 36 months that would require immediate repair was 0.13. Postoperative sensitivity was not significantly different from preoperative sensitivity. CONCLUSIONS: The authors found that no restorations required replacement and no increased postoperative sensitivity occurred. CLINICAL IMPLICATIONS: The authors suggest that this composite material can be placed in a single increment up to 5 mm thick for Class II restorations.     

3-Year clinical evaluation of posterior packable composite resin restorations

This study evaluated the clinical performance of four packable resin composite restorative materials in posterior teeth (Class I and II) compared with one hybrid composite after 3 years. Eighty-four restorations were placed in 16 patients. The tested materials were: (i) Solitaire + Solid Bond; (ii) ALERT + Bond-1; (iii) Surefil + Prime & Bond NT; (iv) Filtek P60 + Single Bond and (v) TPH Spectrum + Prime & Bond 2.1. All restorations were made using rubber dam isolation, and the cavity design was restricted to the elimination of carious tissue. Deeper cavities were covered with calcium hydroxide and/or glass-ionomer cement. Each adhesive system and composite resin was placed according to the manufacturer's instructions. One week later, the restorations were finished/polished and evaluated according USPHS modified criteria. Fourteen patients attended the 3-year recall and 75 restorations were evaluated at that time based on the same evaluation criteria. Friedman repeated measures analysis of variance by rank and Wilcoxon sign-ranked test for pair-wise comparison was used for data analysis (alpha = 0.05). The analysis was performed only for the baseline and for the 3-year period. Solitaire showed some fractures at marginal ridges in 25% of the cases. Solitaire and ALERT showed some concerns related to colour match (43 and 77%, respectively) and surface texture (86 and 77%, respectively). TPH Spectrum showed a great percentage of colour mismatch after 3 years, around 50%. Surefil and Filtek P60 showed an excellent clinical performance after 3 years, similar to the hybrid resin tested, TPH Spectrum. Solitaire did not fulfil the ADA acceptance criteria for restorative materials and, therefore, is not recommended for use in posterior restorations.     

One-year clinical evaluation of posterior packable resin composite restorations

This study evaluated the clinical performance of four packable resin composite restorative materials in posterior teeth (Class I and II) compared with one hybrid composite after one year. Eighty-four restorations were placed in 16 patients. Each patient received at least five restorations. The tested materials were: (1) Solitaire + Solid Bond; (2) ALERT + Bond-1; (3) Surefil + Prime & Bond NT (4) Filtek P60 + Single Bond and; (5) TPH Spectrum + Prime & Bond 2.1. All restorations were made using rubber dam isolation, and the cavity design was restricted to the elimination of carious tissue. Deeper cavities were covered with calcium hydroxide and/or glass ionomer cement. In shallow and medium cavities, no protection was performed except for the respective adhesive system used in each group. Each adhesive system and resin composite was placed according to the manufacturer's instructions. One week later, the restorations were finished/polished and evaluated according to the USPHS modified criteria. All patients attended the one-year recall, and the 84 restorations were evaluated at that time based on the same evaluation criteria. The scores were submitted to statistical analysis (Chi-square test, p<0.05). Solitaire and TPH showed some fractures at marginal ridges. Solitaire, ALERT and TPH showed some concerns related to color match and surface texture. Surefil and Filtek P60 showed an excellent clinical performance after one year.     

Clinical performance of posterior composite resin restorations.

Two formulations of posterior composite resin (P-30 and Bisfil-P) were evaluated and compared to a high-copper, dispersed-phase amalgam (Dispersalloy). One hundred twenty-eight restorations were placed in 27 patients so that each patient received at least one of each material. After 3 years of clinical service, all three restorative materials produced clinically acceptable restorations, according to US Public Health Service and Leinfelder criteria. The amalgam restorations, however, underwent less wear (44 microns) than did the posterior composite resin restorations (60 to 74 microns). Stratification of data by type of tooth, class of restoration, and size of restoration produced the same ranking of wear from lowest to highest: Dispersalloy, Bisfil-P, and P-30. Resin restorations showed 45% more wear in molars than in premolars, and more wear was associated with moderately sized restorations than with conservative restorations. The surface texture of restorations of composite resin with porous strontium glass filler was nearly as smooth as that of enamel and was significantly smoother than that of the restorations of composite resin with zinc glass filler or of unpolished amalgam.     

Clinical performance of posterior resin composite restorations after up to 33 years

ObjectivesThis retrospective study evaluated the performance of posterior composites after up to 33 years of clinical service and investigated factors associated with the risk of failures over time including patient- and tooth-related variables.MethodsPatients who received at least one Class I or Class II direct composite restoration in a private office in 1986–1992 and had follow-up appointments were included. Failures and interventions over time were investigated using the dental records. A follow-up clinical recall was carried out in 2020. Two scenarios were considered: restorations that did not require any intervention (success) or restorations that were repaired and still functional (survival). Multivariate Cox regression analyses and Kaplan-Meier curves were performed using success and survival rates (p < 0.05).ResultsOne hundred patient records and 683 restorations were included. A total of 353 failures were reported (success rate= 48%). Main reasons for failure were fracture and secondary caries. Most interventions after failures were repairs. Replacements were registered in 183 cases (survival rate= 73%). Annual failure rates were below 2.5% (success) and 1.1% (survival). Larger restorations and maxillary molars had higher failure risks. No significant differences in success rates among different resin composites was observed. A typical observation in this sample of restorations was the presence of moderate to advanced signs of aging, including marginal and surface staining, wear, chipping, changes in anatomical shape and translucency. Clearly aged restorations were still clinically satisfactory. Significance: This long-term, practice-based study indicates that resin composites can be used to restore posterior teeth with a long-lasting durability.     

The influence of a packable resin composite,conventional resin composite and amalgam on molar cuspal stiffness

Packable resin composites may offer improved properties and clinical performance over conventional resin composites or dental amalgam. This in vitro study examined the cuspal stiffness of molars restored with a packable resin composite, a conventional posterior microfilled resin composite and amalgam. Forty-eight intact caries-free human third molars were distributed into four treatment groups (n=12) so that the mean cross-sectional areas of all groups were equal. Standardized MOD cavity preparations were made and specimens restored using one of four restorative materials: (1) a spherical particle amalgam (Tytin); (2) Tytin amalgam with a dentin adhesive liner (OptiBond Solo); (3) a conventional microfilled posterior resin composite (Heliomolar); (4) a packable posterior resin composite (Prodigy Posterior). Cuspal stiffness was measured using a Bionix 200 biomaterials testing machine (MTS). Specimens were loaded vertically to 300 N at a crosshead speed of 1.0 mm/minute. Stiffness was measured at 10 intervals: (1) prior to cavity preparation (intact); (2) following cavity preparation, but before restoration; (3) seven days after restoration; then (4) 1, 2, 3, 4, 5, 6 and 12 months after restoration. All specimens were stored at 37 degrees C in deionized water throughout the study and thermocycled (5 degrees/55 degrees C; 2000 cycles) monthly for 12 months. Repeated Measures ANOVA revealed significant differences among treatment groups over time (p<0.0001). Cavity preparation reduced cuspal stiffness by more than 60%. At 12 months, the cuspal stiffness of restored teeth was, on average, 58% that of intact specimens. Neither the packable nor the conventional resin composite increased cuspal stiffness over that of amalgam.     

Clinical placement and performance of composite resin restorations.

The most frequent complaints registered against composite restorations are stained margins and a rough surface. The stained margins have many causes such as (1) fracturing or crazing of enamel during preparation of the cavity, (2) using a composite having an excessive curing shrinkage, (3) manipulating too slowly, which permits a loss of plasticity during placement, (4) maintaining inadequate pressure during setting or curing of the composite, and (5) using finishing instruments which cause defects in the margin area of the tooth and/or composite. All of these the operator can control, and if not, the defect will be built into the restoration. The roughness of composites can be reduced by polishing with the finest grit available in disks and by coating with a glaze. Today's composite restorations placed with care will provide long lasting esthetic restorations providing they are not placed in areas subjected to load bearing abrasion.     

Factors affecting microleakage of a packable resin composite: an in vitro study

This study was designed to determine the effects of three factors on the microleakage of a packable resin composite: different adhesive systems (single-step self-etching adhesive or total-etch and one-bottle adhesive), the use of a flowable resin composite (as a liner) and the different techniques of cavity preparation. Sixty extracted non-carious human first and second molars were selected and randomly divided into six groups. Cervical cavities were prepared using the conventional technique on the distal sides and the air-abrasive technique was used on the mesial sides of the teeth. The experimental groups were restored with PQ1 + SureFil or Prompt L-Pop + SureFil with or without PermaFlo. In the control groups, only SureFil was used on 10 teeth and PermaFlo + SureFil was applied on the remaining 10 teeth. The restored teeth were stored in 100% humidity at 37 degrees C for 24 hours and thermocycled between 5 degrees C and 55 degrees C for 100 cycles. Each tooth was immersed in India ink for 48 hours, then sectioned. Dye penetration at the occlusal and gingival margins was scored by two independent operators. The data were statistically analyzed to assess the differences between the test and control groups. No significant differences among the adhesives in terms of the occlusal margins of the cavities were observed. However, PQ1 led to less microleakage compared to Prompt L-Pop at the gingival margins (p < 0.0062). When flowable resin composite was used with Prompt L-Pop, microleakage was reduced (p < 0.0125). However, no significant difference was observed between the two cavity preparation techniques (p > 0.0125).     

A novel filling technique for packable composite resin in Class II restorations

ABSTRACT: The use of composite resin restorations in posterior teeth has increased considerably in the past few years. Specific composite resins for posterior teeth, as well as new operative techniques, have been developed to overcome some clinical difficulties. The present article describes a new technique to reconstitute the interproximal contour and contact of Class II restorations using a pack-able composite resin. Two lower first molars from the same patient are reported in detail, illustrating the technique step by step. The technique indicates the use of a metallic matrix band and wood wedges to provide an interproximal contour and contact with the adjacent tooth as well as to provide an adequate cervical adaptation. The first increment of the packable composite resin is applied on the gingival wall of the proximal box, packed cervically near the axial wall and, automatically, the resin climbs up in contact with the inner surface of the matrix band. This increment is sculpted and light-cured and the metallic matrix band is removed. Thus, the Class II cavities are transformed into Class I, with free access for light-curing. Small incremental layers of composite fill the remaining cavities. This technique is faster than conventional techniques and permits appropriate embrasure, better contour, and contact points.     

Two-year clinical performance of a packable posterior composite with and without a flowable composite liner

The aim of the study was to evaluate the clinical performance of a packable fine hybrid dental composite (Prodigy Condensable) and the influence of the additional application of a flowable resin composite (Revolution, SDS Kerr) layer on marginal integrity after 2 years in stress-bearing posterior cavities according to the Ryge criteria. In 50 patients (40.5±17.5 years of age), 116 class II fillings (metal matrix system, glass ionomer-cement-base in 36%, rubberdam isolation in 70%) were placed, with at least two restorations per patient. The adhesive Optibond Solo Plus was used for all the restorations. In one of the two fillings in each patient, an additional layer of the flowable composite Revolution was applied in the entire cavity and separately light-cured. Baseline scores have been rated Alfa in 95% and Bravo in <5%. After 2 years, the results [%] of the Ryge evaluation for the two groups with/without the additional use of Revolution were: (1) Marginal Adaptation: Alfa:78/70, Bravo:16/27, Charlie:0/0, Delta:6/4; (2) Anatomic Form: Alfa:89/95, Bravo:6/2, Charlie:6/4; (3) Secondary Caries: Alfa:98/100, Bravo:2/0; (4) Marginal Discoloration: Alfa:76/68, Bravo:24/32, Charlie:0/0; (5) Surface: Alfa:90/91, Bravo:4/5, Charlie:0/0, Delta:6/4; (6) Color Match: Oscar:56/57, Alfa:44/39, Bravo:0/4, Charlie:0/0. Within the observation period (recall rate: 95%), three restorations out of 116 at baseline fractured, one restoration showed a secondary caries, one tooth received endodontic treatment, and all other restored teeth remained vital. After 2 years, no statistically significant difference (Chi-square test) in the overall survival rate between the group with the additional use of Revolution (92.8%) and that without Revolution (94.6%) was found. The combined survival rate for both groups together was 93.7% of clinically acceptable restorations.     

A clinical evaluation of packable and microhybrid resin composite restorations: one-year report.

OBJECTIVE: The objective of this study was to evaluate the clinical performance of two packable and one microhybrid resin composites placed in occlusal cavities of posterior permanent teeth after 1 year. METHOD AND MATERIALS: Sixty occlusal restorations were placed in 18 male or female patients aged 21 to 44 years. The restorations were divided into three groups according to the restorative material: G1 (Surefil + Prime&Bond NT); G2 (Filtek P60 + Singlebond), and G3 (Suprafill + Suprafill). They were placed by two previously calibrated operators. The restorations were directly evaluated for color matching, marginal discoloration, secondary caries, wear, marginal adaptation, and postoperative sensitivity. RESULTS: Of the total restorations, 66.7% were scored A (ideal) for color matching; 98.2% for marginal discoloration; 100% for secondary caries; 92.6% for wear; and 92.6% for marginal adaptation. Postoperative sensitivity was reported in 5% of the restorations. Fisher's exact, McNamara's, and chi-square tests did not indicate statistical difference between the groups, related to the evaluated criteria. CONCLUSIONS: The packable (Filtek P60 and Surefil) and the microhybrid (Suprafill) resin composites exhibited excellent clinical performance after 1 year and may be considered possible materials for the restoration of posterior teeth.     

Clinical performance and SEM marginal quality of extended posterior resin composite restorations after 12 years

ObjectiveTo investigate the clinical behavior of two different resin-based restorative systems in extended Class II cavities in a controlled prospective split-mouth study over 12 years and to assess marginal quality under a SEM using epoxy replicas.MethodsThirty patients received 68 resin composite restorations (Solobond M + Grandio: n = 36; Syntac + Tetric Ceram: n = 32) by one dentist in a private practice. 35% of cavities revealed no enamel at the bottom of the proximal box, 48% of cavities provided <0.5 mm remaining proximal enamel. Restorations were examined according to modified USPHS criteria at baseline, and after six months, one, two, four, six, eight, 10, and 12 years. Expoxy replicas of 21 restoration pairs were analysed under a SEM at 200× magnification regarding marginal quality.ResultsAt the 12-years recall, 59 of the original 68 restorations in 27 of 30 patients were available (drop out 13%). Two restorations failed due to cusp fracture (Tetric Ceram) and marginal fracture (Grandio). The overall success rate of all restorations was 97.1% (Kaplan–Meier survival algorithm) with no differences between the two materials (p = 0.923). After 144 months of clinical service, restorations in molars performed worse than in premolars regarding the integrity of restoration and tooth (p < 0.05) being detected as wear, chippings, and cracks. Beyond the 4-year recall, marginal staining significantly increased. SEM evaluation of replicas revealed that perfect margin (49% baseline vs. 10% after 12 years), overhang (13% at baseline vs. 3% after 12 years), negative step formation (34% at baseline vs. 75% after 12 years), and marginal fractures (0% at baseline vs. 6% after 12 years) significantly changed during the evaluation period (p < 0.001).SignificanceExtended direct resin composite restorations performed satisfactorily over 12 years of clinical service. SEM analysis delivered qualitative data regarding marginal deterioration over time.     

Clinical evaluation of packable composite resins in Class-II restorations

This study investigated the clinical performance of two packable composite resins in Class-II restorations. One hundred and four Class-II restorations were placed in 52 patients by five dentists (four in dental practices and one in a university clinic) in a controlled prospective multicentre clinical trial. Each patient received one Definite/Etch & Prime 3.0 (D-EP) and one Solitaire/Solid Bond (S-SB) restoration, which were examined clinically according to modified USPHS-criteria after 1 week (baseline) and after 1 year. Statistical analysis was performed using the Wilcoxon rank sum test and the error rates method. The significance level was set to 0.05. At baseline both materials performed equally according to the evaluated criteria. After 1 year D-EP showed significantly worse marginal adaptation compared to S-SB. Both materials displayed significant deterioration for the criteria marginal adaptation, marginal discolouration, approximal contact, and fracture of restoration after 1 year compared to baseline. With a failure rate of 9.6% after 1 year, D-EP did not fulfill ADA acceptance criteria for restorative materials. It is proposed that at least 1-year data of clinical testing should be available before a new material is broadly marketed.     

The effect of an intermediate layer of flowable composite resin on microleakage in packable composite restorations

OBJECTIVES: The aim of the present study was to evaluate the effect of a thin layer of flowable composite on microleakage in Class II direct packable composite resin restorations on young permanent teeth in vitro. METHODS: Twenty sound human premolars and molars extracted for orthodontic reasons were selected for this study. The teeth were randomly assigned into two groups of 10 teeth each (groups A and B). Class II cavities were prepared as uniformly as possible in the mesial and distal aspects of each tooth. The gingival margin extended apically approximately 0.5 mm beyond the cemento-enamel junction, in the dentin. Cavities in group A were restored with packable composite and Alert/Flow-it flowable composite, while groups B cavities were restored with Pyramid/Aeliteflo. The control cavities in groups A1 and B1 were restored with only packable composite. The teeth were immersed in 2% methylene blue solution for 24 h to allow dye penetration into possible existing gaps between the tooth substance and the restorative material. All teeth were subjected to thermocycling. RESULTS: The dye penetration ranged between 6.6 and 7.2 mm. No significant difference was found between the control and the experimental groups. CONCLUSION: The use of flowable composite resin as intermediate material does not reduce microleakage.     

Effect of eccentric load cycling on microleakage of Class V flowable and packable composite resin restorations.

Class V composite restorations are subject to the stresses that induce non-carious cervical lesions. This study evaluated the effect of eccentric oblique load on microleakage of restorations. Class V cavities were randomly prepared on the buccal surfaces of 40 recently extracted premolars and restored with composite resin according to manufacturers' directions. Teeth were randomly assigned to one of four treatment groups with 10 teeth per group: (1) flowable resin (Revolution) without load cycling; (2) packable resin (Prodigy Condensable) without load cycling; (3) flowable resin with load cycling (200,000 cycles) and (4) packable resin with load cycling (200,000 cycles). All teeth were then immersed in 2% methylene blue solution for 24 hours after thermocycling (500 cycles). Dye penetration was measured (scores 0-3). The results indicated that adding load cycling significantly increased microleakage (p < 0.05). No significant differences in microleakage were observed for flowable resin vs packable resin. Gingival margins had significantly more microleakage (p < 0.05) than occlusal margins.     

Clinical evaluation of two "packable" posterior composite resins

The purpose of this study was to evaluate the clinical performance of two "packable" posterior composites: Prodigy Condensable (P) (Kerr) and Definite (D) (Degussa). Thirty-six patients participated in the study. A total of 78 restorations were made, 40 with D and 38 with P. Each patient received at least two restorations, one of each studied material. The materials were handled according to the manufacturer's instructions. The restorations were finished and polished after 1 week. They were evaluated at baseline and after 1 year by two independent evaluators using the United States Public Health Service (USPHS) criteria. Colored slides were made of all the restorations. After 1 year, 35 patients and 76 restorations (39 with D and 37 with P) were available for evaluation. All restorations received A criteria except the following ones, which received B criteria: color P (one restoration) and D (one restoration), marginal staining P (three restorations) and D (two restorations), surface staining P (nine restorations) and D (three restorations), anatomic form P (one restoration) and D (three restorations), and marginal adaptation P (one restoration) and D (eight restorations). The obtained data were tabulated and statistically analyzed using the Fisher and McNemar tests. After 1 year, P showed a significant increase in superficial staining. For D, the marginal adaptation became significantly worse than baseline and P. The studied materials can be considered acceptable during this evaluation period. Further evaluations are necessary for a better clinical performance analysis.     

Clinical evaluation of indirect resin composite and ceramic onlays over a 24-month period

The purpose of this study was to compare the clinical performance of ceramic and indirect resin composite onlays over a 24-month period. A total of 94 onlay restorations in 47 patients were included in this study. Cavities were prepared, full-arch impressions were taken, and onlays were fabricated in the laboratory. All restorations were placed with a dual-cured luting resin composite system. Restorations were evaluated at baseline and at 6, 12, 18, and 24 months. Differences between Alpha scores were analyzed statistically. The recall rate of this study was 93.6%. At the six-month evaluation, one onlay failed due to pulpitis. Other than the color match, there was no significant difference between indirect resin composite and ceramic onlays (p > 0.05). For indirect resin composites, Alpha score differences pertaining to color match, marginal adaptation, and surface texture were found to be statistically significant (p < 0.05) between the baseline and the 24-month recall. For ceramic restorations, marginal adaptation criteria was the only significant difference over the 24-month period (p < 0.05). At the end of 24 months, both indirect resin composite and ceramic onlays were considered to be successful clinically.     

Two-year clinical evaluation of a packable resin-based composite

BACKGROUND: Packable resin-based composites were introduced in 1998, but few clinical studies have been conducted to evaluate them. The authors conducted a clinical study to determine the two-year performance of SureFil (Dentsply DeTrey GmbH, Konstanz, Germany) packable posterior resin-based composite in Class I and II restorations. METHODS: An operator (L.S.T.) restored 55 cavities in 36 patients (16 Class I restorations and 39 Class II restorations). After cavity preparation, she etched the enamel with 34 percent phosphoric acid, applied Prime & Bond NT (Dentsply DeTrey GmbH) to dentin and etched enamel for 20 seconds and then cured it for 20 seconds. She restored the cavity using 3- to 5-millimeter increments of SureFil. Independent examiners assessed the restorations after placement and at six months, one year and two years for color matching, marginal discoloration, marginal adaptation, secondary caries, surface texture, anatomical form and postoperative sensitivity, using the Ryge criteria. RESULTS: The authors assessed the changes in the parameters during the two-year period using a software program with Friedman test analysis with a Bonferroni adjustment at significant level of P = .05. At baseline, 31 restorations were graded as Bravo for color match. At the six-month and one-year recall periods (n = 55), 53 restorations remained unchanged. Two restorations from the same patient fell out after one month. After two years (n = 50), there were five Bravos for surface staining and three for marginal adaptation (P < .05). CONCLUSION: After two years of clinical service, SureFil packable resin-based composite had a success rate of 96 percent, and the authors considered it successful in Class I and II restorations. CLINICAL IMPLICATIONS: SureFil packable resin-based composite can be successful in clinical situations with limited-sized cavities and proper application of restorative techniques.