Clinical evaluation of hybrid ionomer restoratives in Class V abrasion lesions: two-year results.

Eighty Class V abrasion cavities were selected, and 20 cavities were restored with one of three resin-modified glass-ionomer materials (Fuji II LC, Photac-Fil, and Vitremer) or a polyacid-modified resin composite (Dyract). The restorations were clinically evaluated after 1 and 2 years with the US Public Health Service criteria. The results revealed a statistically significant difference in the percentage of restorations rated Alfa for color match at 2 years. No statistically significant difference was found in the percentage of alfa rating for anatomic form. Restorations of all materials showed some marginal discrepancies that were not statistically significant.     

Effect of home-use bleaching gels on fluoride releasing restorative materials

To evaluate the effects of two home-use bleaching gels (Nite-White and Contrast PM) on the surface roughness of one high-viscosity glass ionomer cement (Fuji IX GP), four polyacid-modified resin-based composites (Dyract AP, F2000, Elan and Compoglass F), two resin-modified glass-ionomer cements (Vitremer and Fuji II LC), a microfilled fluoride-releasing resin-based composite (Tetric) and a microfilled non-fluoridated resin-based composite (Valux) were used as controls. The null hypotheses tested were: (1) the use of bleaching gels would not result in surface roughness values different from those obtained at baseline; (2) differences in the amount of carbamide peroxide present in the gels would not influence surface roughness. Thirty specimen disks (the first 10 used for controls and the balance divided randomly into two groups) were made for each material according to the manufacturers' instructions. Finishing and polishing of the test and control specimens was performed after 24 hours using a sequential series of three (medium, fine and superfine) Sof-Lex disks, keeping the restoration surface wet. For every sequence, 10 strokes were made in one direction using a low-speed handpiece. Ultrasonic cleaning of the polished specimens was performed for two minutes in distilled water to remove any surface debris. Prior to bleaching treatment, the specimens were stored in 37 degrees C deionized water for 24 hours. The specimens were exposed to the bleaching gels for a period that simulated the equivalent of 15 days (eight hours/day) under bleaching treatment. The average surface roughness (Ra) of the control and treated specimens was measured. Three separate Ra measurements along the direction of rotation of the finishing and perpendicular to the finishing direction and edge of the mold were made for each specimen surface. After treatment with bleaching gels, there was an increase in surface roughness for F2000, Dyract AP, Elan, Valux and Tetric, while Fuji IX, Fuji II LC, Vitremer and Compoglass F displayed decreased surface roughness values, suggesting that the effects of the gels appear to be material-dependent. Although Contrast PM contains 5% more carbamide peroxide as the active ingredient, the second null hypothesis was rejected for Fuji IX, Vitremer, Dyract AP, Compoglass F, Elan and Valux.     

Clinical performance of a resin-modified glass-ionomer and two polyacid-modified resin composites in cervical lesions restorations: 1-year follow-up

The aim of this study was to assess the clinical performance of a resin-modified glass-ionomer cement (Vitremer) and two polyacid-modified resin composites (F2000 and Freedom) over 1 year. Nineteen patients with at least three cervical lesions were selected, providing an initial sample size of 87 restorations (29 per material), being 78 to non-carious and nine to carious lesions. Restorations were evaluated at baseline, 6 months and 1 year after placement, using modified US Public Health Service criteria: colour match, marginal discoloration, caries, anatomical form, marginal integrity and surface texture. At baseline, restorations were considered as acceptable for all criteria. At 1-year recall, 21 restorations per material were re-examined. Freedom was rated Bravo or Charlie for all the examined criteria and Vitremer earned an Alfa rating solely for the criterion caries. On the contrary, F2000 showed the best overall results, although presenting significant alteration in colour match. Statistical analysis of data was performed using chi-square and Mc Nemar tests. As to the evaluated periods, significant difference was observed solely between baseline and 1-year recall. Freedom and Vitremer were statistically different (P < 0.01) as to anatomical form and surface texture. For F2000, significant difference (P < 0.05) was noticed as to colour match and anatomical form. After 1-year follow-up, F2000 showed the most acceptable results as to the analysed criteria.     

Marginal adaptation of direct composite and sandwich restorations in Class II cavities with cervical margins in dentine

OBJECTIVES: The aim of this study was to evaluate the marginal adaptation of direct Class II sandwich restorations with resin-modified glass-ionomer cements and compomers in comparison to base and total bond restorations. For sandwich restorations with a triple cure resin-modified glass-ionomer cement the influence of different light curing techniques was also evaluated. METHODS: Large butt-joint class II cavities with cervical margins 1 mm below the cemento-enamel junction were cut into 120 extracted human molars. The cavities (15 groups, n = 8) were filled using a sandwich, base or total bond technique with materials from five different manufacturers. A three-sited light curing technique was used in 13 groups. For the material combination Vitremer/Z100 two additional groups with a different wand positioning and a metal matrix were evaluated. After water storage for 21 days and thermocycling (2000x, 5-55 degrees C), replicas were quantitatively analysed in the SEM. Statistical analysis was performed with the Kruskal-Wallis test and the Bonferroni test at p < 0.05. RESULTS: The marginal adaptation of vertical enamel margins was not dependent on the restorative technique. For margins in dentine, marginal adaptation was significantly better with the sandwich technique than with a base or total bond technique for all materials. There were no significant differences between the base and total bond technique. Overall, resin-modified glass-ionomer cements showed somewhat better results than compomers in sandwich restorations, though differences were not significant for some criteria. Vitremer/Z100 sandwich restorations applied with a metal matrix showed the highest mean percentage of excellent margins of all experimental groups. CONCLUSIONS: Both resin-modified glass-ionomer cements and compomers can improve the marginal quality when used in a sandwich technique. Further research is necessary to determine the ideal material combination for sandwich restorations.     

Inhibition of artificial secondary caries in root by fluoride-releasing restorative materials

This investigation evaluated the fluoride-releasing properties of various fluoride-releasing restorative materials, including resin-modified glass-ionomer cements (Fuji ionomer TypeII LC, Photac-Fil Aplicap, Vitremer), compomers (Ionosit FIL, Compoglass, Dyract) and fluoride-releasing resin composites (Heliomolar radiopaque, Degufill mineral). The study also estimated the effects of those materials on the inhibition of artificial secondary caries around restorations using a bacterial caries-inducing system. The amount of fluoride released from the materials in deionized water was measured every one week for 10 weeks. Class V cavities with the gingival margin located in the root were prepared in extracted human premolars and restored with each of the materials. The restored teeth were incubated in the bacterial artificial caries chamber, and the artificial lesion created around the restoration was observed microradiographically. The resin-modified glass-ionomer cements released the largest amount of fluoride and created a thick radio-opaque zone in the artificial lesion along the restoration-dentin interface. These results indicated that the fluoride-releasing restorative materials have the potential to inhibit secondary caries formation around restorations. Resin-modified glass-ionomer cements presented a particularly strong effect, compared with compomers and fluoride-releasing resin composites.     

Effect of 1.23 percent APF gel on fluoride-releasing restorative materials

This study evaluated the effect of a 1.23 percent APF gel on the surface morphological characteristics and surface roughness of one high-viscosity (Fuji IX GP), three polyacid-modified resin-based composites (Dyract AP, F2000 and Compoglass F) (PMRC), and two resin-modified glass-ionomer cements (Vitremer and Fuji II LC). A microfilled nonfluoridated resin-based composite (Silux Plus) was used as a control. All materials were handled according to the manufacturers' instructions. The fluoride gel used in the study was a 1.23 percent acidulated phosphate fluoride gel (APF) (Nupro APF). The specimens were repeatedly exposed to the APF gel with cotton applicators for a period that simulated the equivalent of 4 yrs (1 min/6 mo) under prophylactic fluoride treatment. Average surface roughness (Ra) of the control and treated specimens was measured. Three separate Ra measurements along the direction of rotation of the finishing and perpendicular to the finishing direction and edge of the mold were made for each specimen surface. In each group, specimens with Ra closest to the mean were removed from the molds, sputter-coated with gold and examined using a scanning electron microscope. The results showed that all tested materials, except Vitremer, displayed increased surface roughness values following APF treatment. However, this was not statistically significant for Compoglass F, Vitremer and Fuji II LC. Among PMRC materials, F2000 displayed the highest Ra average value, although the differences between F2000 and Dyract AP and of Compoglass F and Dyract AP was not statistically significant. Comparisons of the Ra values between Silux Plus and the other test materials revealed statistically significant differences except for Dyract AP and Compoglass F. No statistically significant difference was found between the Ra values of Vitremer and Fuji II LC following APF treatment. Among all groups, Fuji IX GP displayed the highest surface roughness.     

Clinical evaluation of direct esthetic restorations in cervical abrasion/erosion lesions: one-year results.

One hundred sixteen cervical abrasion/erosion lesions were restored with one of the following techniques: (1) glass-ionomer cement, (2) composite resin with a dentinal bonding agent, or (3) composite resin with a glass-ionomer cement liner and a dentinal bonding agent. The restorations were assessed at baseline and at 6 months and 1 year postrestoration for retention, caries, color match, marginal staining, and surface texture. No statistically significant differences were found in retention, caries, color match, or marginal staining. A statistically significant difference was found with regard to surface texture: glass-ionomer cement restorations demonstrated a rougher surface than did the composite resin restorations. A substantial number of restorations composed of composite resin with a dentinal bonding agent demonstrated a color shift towards mismatch when evaluated at 6 months. This difference was not significant at the 1-year followup.     

Longevity of extensive class II open-sandwich restorations with a resin-modified glass-ionomer cement.

Several new techniques have been introduced for use in the esthetic restoration of posterior cavities to substitute for the presumed toxicity of amalgam. Composite-laminated glass-ionomer cement restorations, the sandwich technique, have been recommended for caries-risk patients. Clinical evaluation of the use of conventional glass-ionomer cements in the open-sandwich restoration has shown a high failure rate. The aim of this study was to evaluate the durability and cariostatic effect of a modified open-sandwich restoration utilizing a resin-modified glass-ionomer cement (RMGIC) in large cavities. The materials consisted of 274 mostly extensive Class II Vitremer/Z100 restorations performed by four dentists in 168 adults. Six experimental groups were investigated. In four groups a thick and in two groups a thin layer of cement was placed. Cavity conditioning before application of the RMGIC self-etching primer was done in 3 groups with polyacrylic acid and in one group with maleic acid; in two groups, only water rinsing was performed. The restorations were evaluated at baseline and after 6, 12, 24, and 36 months according to modified USPHS criteria (van Dijken, 1986). After 3 years, 239 restorations were evaluated. Twelve (5%) were estimated as non-acceptable. Two were replaced, and seven were repaired with resin composite. Tooth fractures were observed in 2.5%. Slight erosion of the RMGIC part was seen in 4%, and in one case operative treatment was indicated. Post-operative sensitivity was reported for 9 teeth. Forty-three percent of the patients were considered as caries-risk patients. Only one restoration showed secondary caries. The three-year results indicated that the modified open-sandwich restoration is an appropriate alternative to amalgam including extensive restorations.     

Two-year clinical performance of a polyacid-modified resin composite and a resin-modified glass-ionomer restorative material

This study compared the clinical performance of a polyacid-modified resin composite and a resin-modified glass-ionomer restorative material over two years. Thirty-four pairs of restorations of Compoglass and Fuji II LC were placed in caries-free cervical erosion/abfraction lesions without tooth preparation. Restorations were clinically evaluated at baseline, 6, 12, 18 and 24 months using modified Ryge/USPHS criteria. A significantly higher incidence of failed restorations was found with the polyacid-modified resin composite (p < 0.05).     

The influence of different cements on the fracture resistance and marginal adaptation of all-ceramic and fiber-reinforced crowns

PURPOSE: This in vitro study investigated the marginal adaptation and fracture resistance of heat-pressed glass-ceramic and fiber-reinforced composite molar crowns luted with resin, resin-modified glass-ionomer, or zinc-oxide-eugenol-free cements. MATERIALS AND METHODS: A total of 24 heat-pressed all-ceramic and 24 glass fiber-reinforced composite crowns were constructed and cemented using the above-mentioned luting agents (eight crowns per cement). The restorations were thermocycled and mechanically stressed, and fracture resistance was determined. Marginal adaptation was evaluated before and after stress application using semiquantitative analysis in a scanning electron microscope. RESULTS: All-ceramic and fiber-reinforced composite crowns reached the highest fracture resistance after stress application in combination with the resin cement. When luted with resin-modified glass-ionomer or zinc-oxide-eugenol-free cements, the fracture resistance of all-ceramics decreased significantly, while the fiber-reinforced composite crowns maintained their fracture resistance level; the lowest values were found for zinc-oxide-eugenol-free cements. The marginal adaptation remained unchanged after stress for all-ceramics and fiber-reinforced composite restorations if they were luted with resin cements. Luting with resin-modified glass-ionomers significantly deteriorated the marginal adaptation after stress application, with the exception of the crown-cement interface of all-ceramics. CONCLUSION: The highest fracture resistance and marginal adaptation were found for all-ceramic and glass fiber-reinforced composite molar crowns if they were luted with resin cement.     

Tooth-colored filling materials for the restoration of cervical lesions: a 24-month follow-up study

The recently developed resin-modified glass ionomer cements and the polyacid-modified composites are promising alternatives to conventional materials for restoring cervical defects. This clinical study evaluated the clinical condition of cervical fillings 24 months following placement. The study subjects were 197 cervical restorations placed on incisors, canines and premolars in 37 patients for restoration of erosion/non-carious lesions (69 cases), primary carious lesions (57 cases) and the replacement of deficient restorations (71 cases). The teeth were randomly divided into four groups for restoration with either Tetric (composite, Group A: n = 36), Dyract (compomer, Group B: n = 79), Fuji II LC (resin-modified glass ionomer cement, Group C: n = 51) or Photac-Fil (resin-modified glass ionomer cement, Group D: n = 31). The evaluation was done single-blind at baseline, 8 and 24 months after the placement of the fillings, according to a modified USPHS rating scale. The assessment criteria were color stability, anatomical form, surface texture, marginal integrity, marginal discoloration and loss of filling. Statistical analysis was completed using Pearson chi-square and Fisher's exact test at a significance level of 5% (p < 0.05). After the 24-month period, the composite restorations showed superior results. The compomer fillings demonstrated conditions that were only slightly worse. A substantial number of the resin-modified glass-ionomer fillings were evaluated with bravo or even charlie scores in respect to at least one of the criteria assessed.     

The two-year clinical performance of esthetic restorative materials in noncarious cervical lesions

BACKGROUND: Materials used in restoration of cervical lesions include resin-modified glass ionomer cements, polyacid-modified resin-based composites and resin-based composites. In this study, the authors evaluated the clinical performance of these materials over a two-year period. METHODS: Thirty patients were enrolled in this study. The authors placed in these patients 130 restorations, 24 of which were Vitremer (3M Dental Products, St. Paul, Minn.), 38 were F2000 Compomer (3M Dental Products), 46 were Dyract AP (Dentsply DeTrey, Konstanz, Germany) and 22 were Valux Plus (3M Dental Products). Enamel margins were not beveled, and no mechanical retention was placed. Two independent, calibrated examiners evaluated the restorations baseline and at one and two years after placement using modified U.S. Public Health Service criteria. RESULTS: Retention rates at the end of two years were 100 percent for Vitremer, 67 percent for F2000 Compomer, 68 percent for Dyract AP and 70 percent for Valux Plus. The retention rate of Vitremer was significantly higher than that of the others (P < .05). In other categories, however, Valux Plus had the most favorable performance (P < .05). No secondary caries was detected around any restoration. CONCLUSION: Vitremer, with its high retention rate, seems to be the most appropriate material for restoration of noncarious cervical lesions, though it does not have the esthetic properties of resin-based composites. All materials used in this study were in need of improvements. CLINICAL IMPLICATIONS: Resin-modified glass ionomer cement, polyacid-modified resin-based composite and resin-based composite behaved differently in the restoration of noncarious cervical lesions. Therefore, clinicians should take factors such as esthetic needs and localization into account in selecting materials for such restorations.     

Three-year clinical evaluation of a resin modified glass-ionomer cement and a composite resin in non-carious class V lesions

The purpose of this study was a 3-year clinical evaluation of a resin modified glass-ionomer and a composite resin restorative material in non-carious class V lesions. In 24 patients 98 non-carious class V lesions were restored with either a resin modified glass-ionomer (Vitremer), or a composite resin restoration (Z100). The restorations were clinically evaluated after 6, 12, 24 and 36 months with the US Public Health Service criteria. At 3 years, 88 teeth of 21 patients were evaluated. All restorations were rated clinically acceptable for colour match, marginal discoloration, marginal adaptation and anatomical form. Restoration retention of both groups was high without any statistically significant difference. However, Vitremer restorations showed a lower incidence of Alfa scores for colour match and marginal discoloration than Z100 restorations (P < 0.05).     

A preliminary study on a resin-modified glass-ionomer cement for transitional restorations and subsequent core buildups

PURPOSE: The purpose of this study was to evaluate the serviceability of a resin-modified glass-ionomer cement for transitional restorations and subsequent core buildups in endodontically treated maxillary premolars. MATERIALS AND METHODS: Fifty Vitremer restorations were made in 42 patients by one operator during a period of 5 months. After 1 year of follow up, the quality of the restorations was assessed for the variables occlusal contacts, proximal contacts, marginal adaptation, and surface roughness. Survival was estimated at 2 years of service either as a transitional restoration or as a core buildup. RESULTS: The percentage survival of the transitional restorations was 85% +/- 6%. When the crowned Vitremer restorations were added to the transitional restorations, the 2-year survival was 98% +/- 2%. With respect to the quality assessment, the majority of the restorations showed either no or light occlusal contacts and no or light contacts on at least one of their proximal surfaces. Marginal integrity and surface roughness were considered to be suboptimal on average. CONCLUSION: The described restorations seem to perform adequately for a transitional period of 1 to 2 years. Their viability as substructures for permanent cast restorations remains to be tested in long-term clinical studies.     

Flowable resin composite as a class II restorative in primary molars: A two-year clinical evaluation

OBJECTIVE: To evaluate the clinical durability of flowable resin composite and resin-modified glass ionomer cement when used as class II restoratives in primary molars. MATERIAL AND METHODS: A total of 190 restorations were placed in 61 children, age in the range of 5-11 years. The restoratives, Tetric Flow, in combination with the adhesives, Excite or Prompt-L-Pop and Vitremer, were used in class II cavities in primary molars. An intra-individual study design was used and the restorations were evaluated by modified USPHS criteria over a 2-year period. RESULTS: 146 of the restorations could be evaluated at 2 years. The cumulative failure rate was 10.6% for Vitremer and 13.6% for Tetric Flow. No statistically significant differences were found in failure rates between different materials or between bonding systems. The main cause of failure for Tetric Flow was secondary caries and for Vitremer wear and dissolution. CONCLUSIONS: Vitremer and Tetric Flow showed no significant difference concerning clinical durability at 2 years when used as class II restoratives in primary molars. Both materials demonstrated acceptable clinical results.     

Microleakage of various cementing agents for full cast crowns.

OBJECTIVES: To evaluate microleakage and marginal gaps in full cast crown restorations bonded with six different types of cementing agents. METHODS: Sixty non-carious human premolars and molars were prepared in a standardized manner for full cast crown restorations. The mesial and distal margins were located in dentin, while the vestibular and palatal/lingual margins were located in enamel. Crowns were made from a high-gold alloy using a standardized technique. The specimens were randomized to six groups of cementing agents: one zinc-phosphate cement (Harvard cement), one conventional glass-ionomer cement (Fuji I), one resin-modified glass-ionomer cement (Fuji Plus), two standard resin cements (RelyX ARC, Panavia F), and one self-adhesive universal resin cement (RelyX Unicem). After 4 weeks of storage in distilled water at 37 degrees C, the specimens were subjected to 5000 thermocycles ranging from 5 to 55 degrees C. Then, they were placed in a silver nitrate solution, embedded in resin blocks, and vertically cut in buccolingual and mesiodistal direction. Subsequently, the objects were evaluated for microleakage and marginal gap using a high-resolution digital microscope camera. RESULTS: A number of inter-group differences were statistically significant. RelyX Unicem showed the smallest degree of microleakage both in enamel and in dentin. Panavia F und RelyX Unicem were associated with significantly larger marginal gaps than all other cementing agents. No association was observed between microleakage and marginal gap other than a weak direct correlation when using Harvard cement on enamel. SIGNIFICANCE: The cementing agents investigated revealed different sealing abilities. These differences were not associated with specific types of materials.     

Mechanical properties of compomer restorative materials.

The purpose of this study was to measure the compressive strength, flexural strength, microhardness, and surface roughness of three compomers (Compoglass, Dyract, and Hytac) and compare the values to the ones obtained for a resin-modified glass-ionomer cement (Vitremer) and a resin composite (Z100). All materials were handled according to the manufacturers' instructions. There was a significant difference (P < 0.01) among Vitremer, Hytac and Z100 composite with regard to yield strength. Vitremer values were lower than for Hytac, which were lower than for Z100. The yield strength values for Compoglass and Dyract were significantly lower than for Hytac and Z100 composite and significantly higher than for Vitremer (P < 0.01). There was no significant difference in the strain at yield among Vitremer, Hytac, and Z100, but their values were significantly higher than for Compoglass and Dyract (P < 0.01). The flexural strength data displayed a significant difference between Vitremer and Hytac (P < 0.05). Z100 was significantly stronger than the other products tested. The values of strain at break for Vitremer, Hytac, and Z100 were significantly lower than for Compoglass and Dyract (P < 0.01). The compressive strength results showed significantly higher values for Dyract, Compoglass, and Hytac than for Vitremer (P < 0.01). Z100 displayed higher values than the other products tested (P < 0.01). Hytac strength was significantly higher than for Dyract (P < 0.01). The microhardness of Compoglass and Dyract was not significantly different (P < 0.05). Hytac displayed microhardness values higher than for Vitremer, Compoglass, and Dyract (P < 0.01). However, all products tested showed values significantly lower than for Z100 (P < 0.01). The surface roughness values for Compoglass, Dyract, Hytac, and Z100 were not significantly different. Vitremer displayed a significantly higher value than Dyract, Hytac, and Z100 (P < 0.05).     

Clinical and SEM evaluations of three compomer systems in Class V carious lesions

The aim of this study was to evaluate the clinical performance of three compomer systems: Compoglass F, Dyract AP and F2000 in Class V carious lesions. In addition, some restorations were placed in teeth scheduled for extractions in order to evaluate the compomer/dentin interface with the scanning electron microscope (SEM). A total of 175 Class V carious lesions having the gingival margins extending into cementum were restored with the tested materials. Each restoration was clinically evaluated immediately after placement, after 1 year and after 2 years using the USPHS criteria. After 1 year no loss of restoration was recorded. No significant difference between the materials was observed for any evaluation category. After 2 years, one Compoglass and two Dyract restorations were lost. No loss of F2000 was reported. No significant difference was reported between the tested materials and between the 2-year data and baseline ones. A well-defined hybrid layer as well as resin tags was seen at the interface between the tested materials and vital dentin.     

In vitro push-out strength of seven luting agents to dentin

PURPOSE: New luting agents, described as resin-modified glass-ionomer cements and compomers, have been developed during the last decade to improve the retention of cemented restorations. The aims of this study were to (1) compare the push-out strength of these new luting materials against both conventional cements and bonding luting agents, and (2) evaluate the influence of dentin surface treatment on both glass-ionomer cement and 4-META adhesive resin push-out strength. MATERIALS AND METHODS: Conical standardized cavities were drilled in the center of coronal dentin disks. Ninety sandblasted Ni-Cr inlays, divided into nine batches, were luted into the cavities according to the surface treatment and the nature of the following luting agents: zinc phosphate cement, zinc polycarboxylate cement, type 1 glass-ionomer +/- polyacrylic acid, resin-modified glass-ionomer, polyacid-modified composite resin, filled bis-GMA phosphate ester resin, and 4-META adhesive resin +/- application of activated monomer. Each specimen was placed in a holding device, and a steel rod was used to apply a force on the inlay until rupture occurred. The push-out strength was calculated, and the failure mode was controlled. RESULTS: There were significant differences between some of the groups. The highest push-out strength was achieved by the 4-META adhesive resin after application of activated monomer. The lowest value was attained with zinc phosphate and polycarboxylate cements. CONCLUSION: Both resin-modified glass-ionomer and polyacid-modified composite resin luting materials exhibited a push-out strength similar to resin-based materials. Specific dentin surface treatments significantly enhanced the push-out strengths of glass-ionomer cement and 4-META adhesive resin.     

Amalgam Substitutes: A Critical Analysis

Purpose: Quality standards for restorations recently have been defined in Switzerland. Amalgam substitutes must meet restoration Grade 2 requirements (i.e., pulp and dental hard substance must be preserved, and both form and function of the tooth have to be reconstituted). The pertinent operative technique has to be simple and amalgam‐like. A minimum service life of 8 years is required. This in vitro study investigated the clinical potential of several amalgam substitutes, taking into account the operative requirements, the defined restorative guidelines, and the required service life. Materials and Methods: Potential amalgam substitutes evaluated in this study included compomers (Compoglass, Dyract, Dyract AP, Elan, F 2000) and resin‐based composites (Alert, Ariston, Definite, Nulite, Solitaire, Surefil). The composites Adaptic and Tetric Cream, using a simplified placement technique, were tested as negative and positive controls, respectively. Marginal adaptation and wear properties were measured in vitro in mixed Class II cavities. Relative radiopacity was measured in terms of millimeters of equivalent aluminum. Results: All compomers showed a radiopacity of 2.5 mm or more aluminum. Only Dyract AP and Elan were more wear resistant than amalgam. After stressing, the percentage of continuous margin was at best 31% overall and 17% in dentin only. Among resin‐based composites, the minimum requirements of radiopacity were fulfilled only by Alert, Surefil, and Tetric. Only Definite, Surefil, Solitaire, and Tetric exhibited wear resistance greater than amalgam. After stressing, the best marginal qualities were 41% continuous margin overall, and 8% in dentin only. CLINICAL SIGNIFICANCE Based on the requirements set for amalgam substitutes, results for the materials tested in this study indicated poor marginal quality and potential risk of secondary caries. Currently, the use of amalgam substitutes for stress‐bearing restorations in permanent teeth cannot be recommended without serious cautions. This is particularly true if a dynamic performance quality of the restorations is demanded, which guarantees the achievement of the restorative targets for 8 years, according to recently adopted quality standards.