Three-year Randomized Clinical Study of a One-step

Universal Adhesive and a Two-step Self-etch Adhesive

in Class II Composite Restorations
Jan WV van Dijkena / Ulla Pallesenb

Purpose: To evaluate in a randomized clinical evaluation the 3-year clinical durability of a one-step universal adhe-
sive and compare it intraindividually with a 2-step self-etch adhesive in Class II restorations.
Materials and Methods: Each of 57 participants (mean age 58.3 years) received at least two extended Class II
restorations that were as similar as possible. The cavities in each of the 60 individual pairs of cavities were ran-
domly distributed to the 1-step universal adhesive (All-Bond Universal: AU) and the control 2-step self-etch adhe-
sive (Optibond XTR: OX). A low shrinkage composite (Aelite LS) was used for all restorations, which were evaluated
using slightly modified USPHS criteria at baseline and 1, 2, and 3 years.
Results: 114 Class II restorations were evaluated at three years. Eight restorations, 3 AU and 5 OX, failed during
the follow-up, resulting in 94.7% (AU) and 91.2% (OX) success rates (p > 0.05). Annual failure rates were 1.8% and
2.9%, respectively.The main reason for failure was composite fracture.
Conclusion: Class II composite restorations placed with a 1-step universal adhesive showed good short-term effi-
cacy.
Keywords: adhesive, clinical, posterior, composite, self etch, universal.

J Adhes Dent 2017; 19: 287–294. Submitted for publication: 21.02.17; accepted for publication: 24.07.17
doi: 10.3290/j.jad.a38867

D ental adhesives are generally classified as etch-and-

rinse (E&R) or self-etch (SE) systems. E&R adhesives
have been acknowledged as the most effective approach,
but they are also very technique sensitive, with a risk of col-
lagen fiber collapse and incomplete impregnation of the
entire depth of demineralized dentin.44 Self-etch adhesives
contain acidic monomers, which simultaneously demineral-
ize and infiltrate the dental tissues. In both type of adhe-
sives, the primer and bonding agent can be used separately
or combined, depending on the system. The mild SE adhe-
sives partially demineralize dentin, leaving a substantial
amount of hydroxyapatite crystals around the collagen fi-
brils.47 Due to the relatively low acidity of most SE adhe-
sives, enamel etching is less effective and does not pro-
duce the same deep, retentive etching pattern as is the
case with phosphoric acid. Clinically, this results in greater
marginal discoloration and inferior marginal adaptation.5,6
a
Professor, Department of Odontology, Faculty of Medicine, Umeå University,
Umeå, Sweden. Idea, placed the restorations, wrote the manuscript.
b Assistant Professor, Institute of Odontology, Faculty of Health Science, Univer-
sity of Copenhagen, Denmark. Co-wrote the manuscript.
Correspondence: Professor Jan WV van Dijken, Department of Odontology,
Dental School Umeå, Umeå University, 901 87 Umeå, Sweden. Tel: +46-70-
6116077; e-mail: Jan.van.Dijken@odont.umu.se
Stronger self-etch adhesives have been introduced with bet-
ter etching performance on enamel, but with inferior bond-
ing to dentin and higher clinical failure rates.22,45 To ensure
a durable bond to both enamel and dentin, etching of
enamel margins with phosphoric acid combined with appli-
cation of a mild self-etch adhesive on both enamel and den-
tin (the so-called selective etching approach) has been sug-
gested.45 A recent meta-analysis showed that the retention
of restorations placed in NCCLs (non-carious cervical le-
sions) were improved by the selective enamel etching ap-
proach, confirming the higher enamel bond strength re-
ported in vitro after selective etching.4,10,15,27
A novel adhesive approach was the introduction of the
first multi-mode universal adhesives in 2012. These are
single-step ultra-mild to mild self-etch adhesives that in-
clude functional monomers, which – besides providing mi-
cromechanical interlocking – also are able to chemically
bond to the tissues. They offer clinicians the choice of
using the etch-and-rinse or self-etch approach, or the selec-
tive enamel etch technique.7 There are several in vitro re-
ports of bond durability of universal adhesives, but there is
no clinical evidence for their use in posterior restorations.
The aim of this randomized clinical study in extensive Class
II restorations was to evaluate a new single-step universal
adhesive recommended for use with selective enamel etch-

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van Dijken and Pallesen
Table 1 Composites and adhesives used
Material Composition (lot No.)
All-Bond MDP phosphate monomer, bis-GMA, HEMA,
Universal ethanol, water, initiators. pH: 3.1 (1300007563)
Select HV etch, 32% phosphoric acid,
benzalkonium chloride
Optibond Primer: Glycerol diphosphate monomer (GPDM),
XTR hydrophilic co-monomers and di-functional
methacrylate monomers, water, acetone, ethyl
alcohol, camphorquinone (5034982)
Adhesive: hydrophobic cross-linking monomers,
ethyl alcohol, camphorquinone, 0.4-μm barium
glass 15%, sodium hexafluorosilicate (5034983)
Aelite LS Filler: 0.04 μm to 3.5 μm; 88% by weight, 74%
Posterior by volume (A3: lot 1300008522; A3.5
1200013523)
ing, compared with a control 2-step self-etch adhesive. The
null hypothesis tested was that there are no differences in
clinical efficacy between restorations placed with the two
adhesive systems.
MATERIALS AND METHODS
From February to May 2014, all adult patients attending the
PDHS Clinic at the Dental School Umeå who were in need
of two or four similar Class II restorations (one or two pairs)
were asked to participate in the study. All except two, who
planned to move, were included. Inclusion criteria were
adult patients requiring two or four similar Class II restor-
ations and who could attend the recalls. Exclusion criteria
were sensitive teeth and abutment teeth for a removable
partial denture. Teeth showing pulp exposure during caries
excavation were also excluded. All patients were informed
about the background of the study and the follow-up evalu-
ations, according to the rules at the Dental School Umeå.
Concomitant treatment was given to the patients in confor-
mity with normal clinical routine at the Dental School. The
study was approved by the ethics committee of the Univer-
sity of Umeå (Dnr 07-152M). Informed consent was ob-
tained from all individual participants included in the study.
The Class II restorations were placed in 57 patients,
28 men and 29 women, with a mean age of 58.3 years
(range 33–89). Reasons for placement of the composite res-
torations were carious lesions, fracture of old amalgam or
composite fillings, or replacement for esthetic reasons. After
removal of the old restoration and/or caries excavation ac-
cording to the principles of adhesive dentistry, the operative
288
Type Application steps Manufac-
turer
1-step universal, Selective enamel etching 15 s. Bisco;
self-etch Rinse thoroughly with water. Apply Schaumberg,
adhesive two separate coats of adhesive by IL, USA
scrubbing 20 s per coat with a
microbrush. Air dry for at least 10 s.
There should be no visible
movement of the adhesive and the
surface should have a uniform
glossy appearance. Light cure 10 s.
2-step self-etch Apply primer by scrubbing for 20 s Kerr; Orange,
adhesive for each of two coats, air dry at CA, USA
least 5 s.
Apply adhesive for 15 s with light
brushing motion, air dry for 5 s with
moderate air pressure. Light cure
for at least 10 s.
Low-shrinkage Apply in 2 mm layers, obliquely Bisco
composite, when possible. Light cure 20-40 s
volumetric per layer.
shrinkage:
1.40%, linear
shrinkage 0.47%
field was carefully isolated with cotton rolls and a suction
device. For all cavities, a thin metallic matrix was used, and
careful wedging was performed with wooden wedges (Kerr/
Hawe Neos; Bioggio, Switzerland). The cavities were cleaned
by thoroughly rinsing with water. No base was used and no
bevel prepared. The cavities in each individual pair of cavi-
ties were randomly distributed to the test adhesives before
the operative procedure started by throwing dice: 1. a 1-step
universal adhesive, All-Bond Universal (AU, Bisco; Schaum-
burg, IL, USA); 2. as control, a 2-step self-etch adhesive,
Optibond XTR (OX, Kerr; Orange, CA, USA) (Table 1). In this
way, intraindividual comparison was possible between the
two adhesive systems. The distribution of the 120 Class II
restorations (60 pairs) is shown in Table 2.
The adhesives were applied according to the respective
manufacturer’s instructions (Table 1). After preparation of
the cavities, the cavities were washed thoroughly with water
spray and dried carefully. In the AU cavity, selective enamel
etching was performed. The adhesive was light cured with a
well-monitored light curing unit (Bluephase Style, Ivoclar
Vivadent; Schaan, Liechtenstein) for 10 s. In the other cav-
ity, the 2-step self-etch adhesive Optibond XTR was applied.
The low-shrinkage composite Aelite LS (Bisco) was used for
both restorations in the pair. The composite was applied in
2-mm layers (maximum), if possible using an oblique layer-
ing technique employing selected composite instruments
(Hu Friedy; Chicago, IL, USA). Each increment was light
cured for at least 20 s for shade A3 and 40 s for shade
A3.5 as well as the final increment of both shades. The res-
torations were placed by one experienced operator (JvD).
After checking the occlusion/articulation and contouring
with fine finishing diamond burs, the Shofu polishing sys-
The Journal of Adhesive Dentistry

Table 2 Distribution and size of the experimental restorations
Surfaces Maxilla
Premolars Molars
2 surfaces 11 27
3 surfaces 8 9
>3 surfaces 2 4
Total 21 40
tem (Brownie, Shofu; Kyoto, Japan) was used for the final
polish.
Evaluation
The restorations were evaluated and scored directly after
finishing or within two weeks after finishing. Restoration ef-
ficacy was determined by assessing the following param-
eters using slightly modified US Public Health Service cri-
teria (Table 3):30 secondary caries, anatomic form, marginal
adaptation, marginal discoloration, surface roughness, and
color match. Postoperative sensitivity was determined upon
questioning the participants at all recalls. Participants were
also instructed to contact the clinic immediately should any
discomfort occur.
The yearly evaluations during the 3-year follow-up were
performed by the operator and at regular intervals by two
calibrated evaluators. During the evaluation sessions, the
evaluators did not know which restorative system they were
scoring. The caries risk for each participant and their para-
functional habit activity at baseline and during the follow-
ups was estimated by the treating clinician, based on the
clinical and sociodemographic information routinely avail-
able at the annual clinical examinations, eg, incipient caries
lesions, previous caries history, frequency and symptoms
related to bruxing activity.8,24
Statistical Analysis
The characteristics of the restorations are described by de-
scriptive statistics using cumulative frequency distributions
of the scores. The experimental and control restorative
techniques were compared intraindividually using non-para-
metric Friedman two-way ANOVA.25
RESULTS
At the 3-year recalls, 54 participants with 114 Class II res-
torations were evaluated. Two male participants with 4 res-
torations (1 premolar, 3 molars) were not evaluated at the
2-year recall. A third female drop-out participant with 2 res-
torations (2 premolars) was not evaluated at the 3-year re-
call. One participant moved abroad, a second died, and a
third received prosthetic treatment. None of the participants
reported postoperative sensitivity, either at baseline or dur-
ing the 3-year follow-up.
Vol 19, No 4, 2017
van Dijken and Pallesen
Mandible Total
Premolars Molars
14 31 83
2 7 26
0 5 11
16 43 120
Eight restorations, 3 AU and 5O X, failed during the follow-
up. The success rates for the Class II restorations were
94.7% for All-Bond Universal and 91.2% for Optibond XTR.
The annual failure rates during the follow-up were 1.8% for
the AU-adhesive and 2.9% for the OX-adhesive. Tooth type
and the reasons for failure are shown in Table 4, the chief of
which was composite fracture. Six of the eight failures oc-
curred in male participants. In all cases but one, fractures
were observed in bruxing participants and the two observed
caries lesions were found in caries-risk participants. The
modified USPHS scores for the evaluated clinical variables of
the restorations examined are given as relative frequencies
(%) in Table 5. The overall differences seen between the two
experimental restorations for the evaluated variables in the
posterior cavities were not statistically significant (p > 0.05).
DISCUSSION
The universal adhesive AU can be classified as a mild/ultra-
mild SE adhesive (pH 3.1). Adhesives within this pH range
partially demineralise dentin, leaving a substantial amount
of hydroxyapatite crystals around the collagen fibrils.29 The
good clinical bonding ability of these self-etch adhesives to
dentin has been explained by the elimination of the discrep-
ancies between etched and hybridized zones and the micro-
mechanical interlocking of collagen fibrils. However, com-
plete elimination of discrepancies is still being discussed,
as some systems still present them.
Several universal adhesives contain functional mono-
mers, which are able to chemically bond to hydroxyapatite.
The tested AU adhesive contains 10-methacryloyloxydecyl
dihydrogen phosphate monomer (10-MDP), which has been
shown to effectively chemically react with hydroxyapa-
tite.48,49 A stronger nanolayer interface with hydrolytically
stable MDP-Ca salt deposition resulted in a high bond stabil-
ity.49 The MDP monomer has been used for many years in
Clearfil SE Bond (Kuraray Noritake; Tokyo, Japan), the gold
standard of the self-etch adhesives, with good clinical dura-
bility.33,23 Besides 10-MDP, several universal adhesives also
contain HEMA or other monomers, which may compete with
MDP for interaction with the calcium of hydroxyapatite,
thereby decreasing the chemical bond of MDP.48
Large differences in composition have been reported be-
tween marketed universal adhesives, which probably ex-
289
van Dijken and Pallesen

Table 3 Criteria for direct clinical evaluation; modified USPHS criteria (van Dijken 1986)

Category Score Criteria

acceptable unacceptable
Anatomical 0 The restoration is contiguous with tooth anatomy
form

1 Slightly under- or over-contoured restoration; marginal ridges slightly undercontoured;

contact slightly open (may be self-correcting); occlusal height reduced locally

2 Restoration is undercontoured, dentin or base exposed; contact is faulty, not self-

correcting; occlusal height reduced; occlusion affected

3 Restoration is missing partially or totally; fracture of tooth structure; shows traumatic

occlusion; restoration causes pain in tooth or adjacent tissue

Marginal 0 Restoration is contiguous with existing anatomic form, explorer does not catch
adaptation

1 Explorer catches, no crevice is visible into which explorer will penetrate

2 Crevice at margin, enamel exposed

3 Obvious crevice at margin, dentin or base exposed

4 Restoration mobile, fractured or missing

Color match 0 Very good color match

1 Good color match

2 Slight mismatch in color, shade or translucency

3 Obvious mismatch, outside the normal range

4 Gross mismatch

Marginal 0 No discoloration evident

discoloration

1 Slight staining, can be polished away

2 Obvious staining can not be polished away

3 Gross staining

Surface 0 Smooth surface

roughness

1 Slightly rough or pitted

2 Rough, cannot be refinished

3 Surface deeply pitted, irregular grooves

Caries 0 No evidence of caries contiguous with the margin of the restoration

1 Caries is evident contiguous with the margin of the restoration

plain observed in vitro differences in bond strength and
sealing between different universal adhesives.14,16 Wagner
et al48 observed that none of the universal adhesives ap-
plied to dentin in the SE mode modified the smear layer or
penetrated into the dental tubules; they explained this by
the mild acidity of the adhesives. However, long tags in
dentin tubuli, observed after the use of the E&R technique,
are not mechanically retained in the dentin tubuli, except in
the tubuli orifices, and do not contribute to bond
strength.11 Several studies did not find significantly differ-
ent values for dentin shear bond strength and shear fatigue
strength of universal adhesives applied in the E&R mode
and self-etch mode, while very different infiltration behav-
iours were observed.2,28,46 Muñoz et al14 showed no sig-
nificant differences in dentin microtensile bond strength
between three universal adhesives applied in E&R mode.
Two of these universal adhesives showed no significant dif-
ference between E&R and SE mode, while the third (AU)
showed significantly lower dentin bond strength in the SE
mode. This was explained by the passive application of the

290 The Journal of Adhesive Dentistry

 van Dijken and Pallesen

Table 4 Failed restorations during the 3-year evaluation, tooth type, year and reason for failure

Tooth type (no surfaces) Year of failure Reason for failure

All-Bond Universal M (2) 2 Tooth fracture
M (2) 2 Composite fracture
M (4) 3
Optibond XTR M (2) 1 Composite fracture, total
M (2) 2 Secondary caries
M (2) 2 Composite fracture
M (3) 3 Composite fracture
M (2) 3 Secondary caries
M: molars.

Table 5 Scores* for the evaluated All-Bond Universal/Aelite LS, and Optibond XTR/Aelite LS

0 1 2 3 4
Anatomical AU Baseline 92.9 7.1 0 0
form OX Baseline 94.7 5.3 0 0
AU 1 year 94.9 5.4 0 0
OX 1 year 93.7 5.1 0 1.7
AU 2years 89.7 8.6 0 1.7
OX 2 years 87.9 8.6 0 3.5
AU 3 years 87.7 8.8 0 3.5
OX 3 years 85.9 8.8 0 5.3
Marginal AU Baseline 100 0 0 0 0
adaptation OX Baseline 100 0 0 0 0
AU 1 year 100 0 0 0 0
OX 1 year 98.3 1.7 0 0 0
AU 2 years 89.7 5.2 3.5 0 1.7
OX 2 years 93.0 3.5 0 0 3.5
AU 3 years 87.7 5.3 0 0 3.5
OX 3 years 89.4 5.3 0 0 5.3
Color AU Baseline 26.8 67.9 5.3 0 0
match OX Baseline 30.4 66.1 3.5 0 0
AU 1 year 27.1 62.7 10.2 0 0
OX 1 year 31.0 63.8 5.2 0 0
AU 2 years 26.3 57.9 15.8 0 0
OX 2 years 29.8 52.7 17.5 0 0
AU 3 years 17.9 66.1 16.0 0 0
OX 3 years 21.4 60.7 17.9 0 0
Marginal AU Baseline 100 0 0 0
discoloration OX Baseline 100 0 0 0
AU 1 year 100 0 0 0
OX 1 year 100 0 0 0
AU 2 years 94.7 1.8 3.5 0
OX 2 years 94.7 3.5 1.8 0
AU 3 years 92.8 3.6 3.6 0
OX 3 years 91.0 3.6 5.4 0
Surface roughness AU Baseline 100 0 0 0
OX Baseline 100 0 0 0
AU 1 year 100 0 0 0
OX 1 year 100 0 0 0
AU 2 years 66.6 31.6 1.8 0
OX 2 years 68.4 29.8 1.8 0
AU 3 years 66.1 32.1 1.8 0
OX 3 years 67.8 30.4 1.8 0
Caries AU Baseline 100 0
OX Baseline 100 0
AU 1 year 100 0
OX 1 year 100 0
AU 2 years 100 0
OX 2 years 98.3 1.7
AU 3 years 100 0
OX 3 years 96.5 3.5
*See Table 3 for scoring system. Class II restorations at baseline (60 pairs), one year (60 pairs), two years (58 pairs), and 3 years (57 pairs), given as relative
frequencies (%). AU: All-Bond Universal; OX: Optibond XTR.

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van Dijken and Pallesen
adhesive.15 On the other hand, AU in the SE mode showed
the lowest nanoleakage of all adhesives. Hybrid layers in
the etch-and-rinse mode were approximately 5 μm com-
pared to < 0.5 μm for the self-etch approach.2 Marchesi et
al12 showed inferior sealing after 1-year water storage when
a universal adhesive was applied in SE mode to dentin. In
another study, Muñoz et al16 observed significantly lower
microtensile bond strength for AU compared to the 2-step
SE gold-standard adhesive (Clearfil SE Bond). They ex-
plained this by a lower content of MDP in the 1-step adhe-
sive compared to the gold standard, which has MDP incor-
porated into both the primer and the bonding agent. Based
on the above-mentioned bond strengths, Takamizawa et
al28 concluded that in clinical situations, universal adhe-
sives might be used for bonding to dentin with either the
etch-and-rinse or self-etch approach.
The clinical evaluations of universal adhesives published
to date are restricted to studies in Class V NCCLs. Over a
3-year period, one such study compared the etch-and-rinse,
selective enamel etch, and self-etch techniques before ap-
plying the universal adhesive Scotchbond Universal l (3M
ESPE; Seefeld, Germany), a universal adhesive which also
contains 10-MDP.9 The adhesive fulfilled the ADA criteria
for full approval of NCCL restorations with all three bonding
strategies. No control adhesive was evaluated and a highly
selected patient group was used, excluding subjects with
extremely poor oral hygiene, severe or chronic periodontitis,
and heavy bruxism. The ADA approval of this universal ad-
hesive was confirmed by an 18-month study on Class V
NCCL restorations.21
In the present study, the recommended use of selective
enamel etching before application of AU was based on evi-
dence obtained both in vitro and in vivo.13,14,23,27 Shear
bond strength of a mild and an ultra-mild universal adhesive
to enamel was improved using selective enamel etching
compared to the self-etch mode.13 However, the study
showed also that the 2-step gold standard, mild self-etch
adhesive, Clearfil SE Bond (pH 2.7) was capable of achiev-
ing strong bonds to enamel with or without a selective-etch
step. The adhesive showed significantly better bond
strength than did the universal adhesives.
A recently published systematic review and meta-analy-
sis of selective enamel etching of SE adhesives reported
less marginal discoloration and better marginal adapta-
tion.27 The 3-year meta-analysis of the Szesz et al study27
found that the retention of NCCL restorations was also im-
proved by selective etching. However, the 5-year meta-anal-
ysis27 did not confirm this. A long-term clinical study of
Clearfil SE Bond in NCCL restorations demonstrated only
minor benefits of selective etching of enamel margins.23 No
significant differences in retention rates were reported be-
tween the selective enamel etch and the self-etch ap-
proach. An increase in marginal staining was also recently
reported by Pena et al,20 who evaluated the effect of selec-
tive enamel etching before application of a 1-step SE vs the
2-step gold-standard SE adhesive (Clearfil SE Bond) in
Class V NCCLs. In a 3-year follow-up of Class V NCCL res-
torations bonded with Scotchbond Universal, Loguercio et
292
al9 recently observed a slight marginal degradation with the
self-etch mode but not with the selective enamel etch
mode.9 This clinical difference in marginal behavior be-
tween the two techniques was previously documented by
Peumans et al23 for a self-etch adhesive. The clinical im-
pact of the improved marginal enamel quality of the selec-
tive enamel etch mode on longevity of posterior restor-
ations is questionable. In the non-phosphoric-acid–etched
enamel margins, an increase in secondary caries and/or a
higher frequency of pulpal problems may be clinically ex-
pected as a result of greater marginal deterioration. How-
ever, no clinical evidence supports this. Marginal discolor-
ation may be an esthetic problem in anterior but hardly in
posterior restorations. These marginal discolorations are
often quite easily removed simply by polishing. A disadvan-
tage of the technique is that the selective etching step
adds one more step to the adhesive SE procedure, which
makes a simplified procedure more complicated. In the
present study, no significant difference in marginal discolor-
ation was found during the 3 years between the selectively
etched and the SE restorations. A lower absolute frequency
of inacceptable restorations was observed for the selec-
tively enamel-etched restorations, but the difference in over-
all clinical success rate was not statistically significant. The
null hypothesis was therefore accepted.
Class II restorations are the most stress-bearing type of
restoration. The present 3-year results were obtained for ex-
tensive Class II restorations. As opposed to many earlier
studies on posterior composite restorations, Class I restor-
ations were not included. Studies on clinical posterior restor-
ations including Class I restorations showed lower AFRs, de-
pending on the ratio of Class I:Class II restorations. Over the
years, rather large differences in longevity for Class II restor-
ations have been reported. The design of many published
clinical studies included a high selection of participants by
excluding risk patients, such as caries-risk and/or bruxing
participants. The majority of failures can be expected from
these participants. To avoid selection bias, all participants
attending the PDHS clinic who were in need of at least two
similar-sized Class II restorations, were asked to participate.
The best comparison of the success rate of the “universal
bond” composite system with those of other composite sys-
tems is by observing clinical studies with the same study
design and patient selection. Table 6 presents studies on
posterior composites performed by our research groups in
Umeå and Copenhagen and published in international re-
viewer-based dental journals, of which the majority was pub-
lished during the last 10 years.17,32,34-43 Short- and long-
term studies investigating Class II restorations and their
3-year as well as annual failure rates are shown. The 94.7%
success rate observed after 3 years with the “universal
bond“ composite in the present study is in line with those of
highly acceptable composite systems with traditional mono-
mers and bonded with clinically acceptable E&R or SE adhe-
sives.
Today, composites are the first choice of restorative ma-
terial for Class II restorations. Bonding of resinous materials
to dental tissues is a well-established technique and the
The Journal of Adhesive Dentistry
 van Dijken and Pallesen

Table 6 Published annual failure rates (AFR) at 3 years of restorative systems tested in Class II restorations in
Umeå and Copenhagen

Classification Restorative system Year of publication Failures at AFR at Manufacturer

(study’s total follow-up (reference no) 3 years (%) 3 years
years) (%)
Low-shrinkage composite All-Bond Universal/Aelite LS 5.3 1.8 Bisco; Schaumburg, IL,
Optibond XTR/Aelite LS 8.8 2.9 USA
(3 years) Kerr; Orange, CA, USA

Bulk-fill composite SDR/Ceram X Mono/Xeno V 2017 (40) 0 0 Dentsply DeTrey;

Nanofilled composite Ceram X Mono/Xeno V 5.3 1.8 Konstanz, Germany
(6 years)

Low-shrinkage composite els/cmf 2017 (41) 2.8% 0.9 Saremco; Rebstein,

Switzerland
HEMA and TEG-DMA free els/AdheSE (6 years) 7.7% 2.6% Ivoclar Vivadent; Schaan,
Liechtenstein

Bulk-fill composite SDR/Ceram X Mono/ 2016 (39) 6.6% 2.2 Dentsply DeTrey
Xeno V+
Nanofilled composite Ceram X Mono/Xeno V+ 4.8% 1.6
(5 years)

Low-shrinkage composite InTen-S/Excite 2015 (35) 8.2% 2.7% Ivoclar Vivadent

Microhybrid composite Point 4/Optibond Solo Plus 2.0% 0.7% Kerr
(15 years)

Nanofilled composite Ceram X / Xeno III 2015 (38) 5.5% 1.8% Dentsply DeTrey
Ceram X /Excite (8 years) 5.6% 1.9%

Nanofilled composite Tetric Evo Ceram 2014 (37) 9.8% 3.3% Ivoclar Vivadent
Highly filled hybrid Tetric Ceram (10 years) 3.3% 1.1%
composite

Hybrid composite Spectrum TPH/Prime&Bond 2014 (17) 7.2% 2.4% Dentsply DeTrey
(8 years)

Hybrid composite Gradia Direct Posterior/ 2013 (34) 3.4% 1.1% GC; Tokyo, Japan
G-Bond
Giomer composite Beautifil/Fl Bond 7.2% 2.4 Shofu; Kyoto, Japan
(6 years)

Highly filled hybrid Tetric Ceram/Excite 2011 (36) 5.2% 1.7% Ivoclar Vivadent
composite
Small-particle filled Tetric Ceram/Tetric flow/ 5.2% 1.7%
composite Excite (7 years)

Fiber-reinforced Alert/ Bond-1 2006 (43) 4.7% 1.6% Jeneric/Pentron;

composite Wallingford, CT, USA
Nulite/ NS Bond Universal 9.8% 3.3% Nulite Systems
Adhesive International PTY;
(6 years) Hornsby, Australia

Calcium-aluminate cement Doxadent (3 years) 2005 (42) 21% 7.0% Doxa; Uppsala, Sweden

Composite, smart material Ariston (3 years) 2002 (32) 26% 8.7% Ivoclar Vivadent

good durability of posterior composite restorations has been CONCLUSION

reported in several long-term evaluations.3,18,19,31 Thus, it is
sometimes claimed that the need for short-term follow-ups of
new or slightly modified restorative materials has decreased.
However, this is not the case for dental materials with new
formulations and/or properties, as shown in Table 6. Studies
showed that new restorative materials with a high rate of
catastrophic failures could already be detected during the
first 2 to 3 years, indicating that there is still a need for
shorter-term follow-up studies for new materials.4,31,32,43
Class II restorations placed with the universal adhesive
tested showed a good short-term performance with a 94.7%
success rate after 3 years.
ACKNOWLEDGMENTS
Support by the County Council of Västerbotten and Bisco Inc. is
gratefully acknowledged. The authors do not have any financial inter-
est in the companies whose materials were studied.

Vol 19, No 4, 2017 293

van Dijken and Pallesen
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short-term efficacy in extensive Class II restorations.
The Journal of Adhesive Dentistry