Silver modified atraumatic restorative treatment: a paradigm shift in dental caries management.

Silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) are treatment modalities that are minimally invasive and used for the prevention and control of dental caries. The amalgamation of these two techniques has led to the development of silver modified atraumatic restorative treatment (SMART). In this approach the carious lesion is restored with glass-ionomer cement (GIC) after SDF application. SMART effectively arrests caries without removing additional tooth structure, making it a promising option for caries management in children who lack cooperative ability.This article reviews the literature on SMART, the evidence regarding its applications in dental practice, its advantages, drawbacks, the scope for research, and clinical use.

Effect of erosive conditions on different sealant materials used in paediatric dentistry.

To evaluate the effect of acidic challenge on erosion depth and topographic characteristics of different materials used as occlusal sealants. Two hundred specimens of five sealant materials (Fuji IX, Ketac Molar, Fuji II, Equia and Clinpro) and forty bovine teeth enamel samples (control) were prepared and exposed to acidic challenge. The specimens were immersed in four different solutions (orange juice, coke drink, citric acid or distilled water) under mildly shaken conditions for 3 days. The erosion depth profiles were measured using a profilometer and Scanning Electron Microscope (SEM). Two-way ANOVA with Tukey post-hoc test was performed to evaluate the interactions. Sealant material and acidic challenge had significant effects on erosion depth. Among the materials, Fuji II presented the highest mean of erosion depth after immersion in orange juice, coke drink, and citric acid. All materials groups presented higher erosion depth values after immersion in the citric acid solution, except Clinpro. Bovine enamel presented higher erosion depth values compared to all materials when submitted to erosive challenge. Sealant materials submitted to the acidic challenge presented different degrees of erosion and topographic modification; however, they are less susceptible to erosion than bovine teeth enamel.

Comparison of remineralization ability of tricalcium silicate and of glass ionomer cement on residual dentin: an in vitro study.

OBJECTIVE: This study aimed to compare the remineralization effects of a calcium silicate-based cement (Biodentine) and of a glass ionomer cement (GIC: Fuji IX) on artificially demineralized dentin. METHODS: Four standard cavities were prepared in dentin discs prepared from 34 extracted sound human third molars. In each disc, one cavity was covered with an acid-resistant varnish before demineralization (Group 1). The specimens were soaked in a chemical demineralization solution for 96 h to induce artificial carious lesions. Thereafter, one cavity each was filled with Biodentine (Group 2) and GIC (Group 3), respectively, and one carious lesion was left unrestored as a negative control (Group 4). Next, specimens were immersed in simulated body fluid (SBF) for 21 days. After cross-sectioning the specimens, the Ca/P ratio was calculated in each specimen by using scanning electron microscopy-energy-dispersive X-ray spectroscopy (SEM-EDX). Finally, data were analyzed using repeated-measures ANOVA with post-hoc Bonferroni correction. RESULTS: Both cement types induced dentin remineralization as compared to Group 4. The Ca/P ratio was significantly higher in Group 2 than in Group 3 (p < 0.05). CONCLUSION: The dentin lesion remineralization capability of Biodentine is higher than that of GIC, suggesting the usefulness of the former as a bioactive dentin replacement material. CLINICAL RELEVANCE: Biodentine has a higher remineralization ability than that of GIC for carious dentin, and its interfacial properties make it a promising bioactive dentin restorative material.

2-year survival and cost analysis of occlusoproximal ART restorations using encapsulated glass ionomer cement in primary molars: a randomized controlled trial.

BACKGROUND: The survival of ART restorations can be influenced by the choice of the restorative material. The aim of this randomized non-inferiority controlled trial was to compare the 2-year survival rate and cost analysis of two encapsulated glass ionomer cements (GIC) as occlusoproximal restorative materials in primary molars. METHODS: Children from public schools in Tietê (Brazil), aged 4-8 years with occlusoproximal dentine carious lesions in primary molars were selected and randomly assigned to receive either Equia Forte (EF) or Riva Self Cure (RSC) as restorative materials. Treatment was carried out by two trained final-year dental students in schools following ART premises. Restorations were assessed by a trained and calibrated examiner after 2, 6, 12, 18, and 24 months. The primary outcome was restoration survival after 2 years, analyzed using Kaplan-Meier survival and Cox regression analysis (α = 5%). Professional and materials costs for each group were collected in Brazilian Reais (R$) and converted into US dollars (US$) and analyzed using Monte-Carlo simulation. RESULTS: A total of 152 children (76 per group) were included in the study, and 121 (79%) were evaluated after 2 years. The overall 2-year restoration survival rate was 39% (EF = 45%; RSC = 32%) with no difference between the groups. The baseline and 2-year total cost of restorations using RSC was lower when compared to EF (incremental cost: US$ 6.18). CONCLUSION: After two years of follow-up, Riva Self Cure shows comparable restoration survival rates to Equia Forte, being more cost-effective in the Brazilian perspective. TRIAL REGISTRATION: This randomized clinical trial was registered on ClinicalTrials.Gov - NCT02730000.

Giving the pulp another chance: a case report of vital pulp therapy retreatment.

Vital pulp therapy (VPT) has been increasingly advocated due to its advantages in preserving tooth vitality. While VPT is often successful, failures can occur, and traditional root canal therapy is often recommended following VPT failure. This case report provides an example of successful preservation of tooth vitality using coronal pulpotomy (CP), a more invasive type of VPT, after failure of partial pulpotomy (PP) that had been performed in a healthy 10-year-old boy. A mandibular right first molar with a diagnosis of reversible pulpitis was initially treated with PP, which included the use of tricalcium silicate cement as a pulp dressing and a resin-modified glass ionomer cement base, followed by placement of a composite resin restoration. The restoration dislodged after 34 months without complaints from the patient or radiographically detectable lesions. A stainless steel crown was placed on the tooth; however, 15 months after crown placement, the patient returned with symptoms in the treated tooth. The tooth was diagnosed with irreversible pulpitis and asymptomatic apical periodontitis but responded positively to cold testing, and the pulp appeared clinically vital upon direct inspection. The tooth was re-treated with CP, including the use of mineral trioxide aggregate as a dressing material, and examination 21 months posttreatment revealed successful resolution of the periapical lesion. When a tooth remains vital, a more invasive type of VPT may be an alternative to root canal therapy for treating failures in more conservatively treated teeth. Moreover, regular periodic recalls are essential for ensuring tooth survival and early detection of problems (ie, restoration failure) that may worsen treatment outcomes.

[Total rehabilitation in case of amelogenesis imperfecta].

The aim of the treatment of this case was to restore the form, function and aesthetics of all teeth in a patient with amelogenesis imperfecta within the age limit of the disability insurance (IV). Single-tooth zirconia crowns were selected as the treatment of choice and cemented with a conventional glass ionomer cement. For the maintenance of the oral rehabilitation and the protection of the reconstructions a michigan splint was produced and instructed to be carried over night.

Survival Analysis of Glass Ionomer Cement and Resin-Based Sealant Retention: A 10-Year Follow-Up Study.

Background and Objective: Sealant application is a proven method to prevent occlusal caries; however, long-term studies on this topic are scarce. This study aimed to assess the survival rate and clinical effectiveness of glass ionomer cement (GIC) and resin-based sealants (RBSs) on second permanent molars over a long-term follow-up period. Materials and methods: Sixteen patients aged 11-13 years with all four completely erupted permanent second molars were enrolled in the study. All patients attended 1-year and 3-year follow-ups; however, one participant did not respond after 10 years and was excluded from the final analyses. The oral health status evaluation was based on WHO criteria. A total of 32 teeth received an RBS (Clinpro), and a further 32 teeth were sealed with GIC (Fuji IX). The sealant retention was determined according to the Kilpatrick criteria after 1 year, 3 years, and 10 years, respectively. Statistical analysis included a chi-square test, the Kaplan-Meier method, and the Cox proportional hazard model. Results: At baseline, seven boys and eight girls participated in the study, with a mean age of 12.3 ± 0.9 years. The 1-year follow-up results revealed that 90% of the RBSs and 43.3% of the GIC sealants were completely retained, and no caries lesions were recorded (p = 0.01). The 3-year follow-up results showed that 23.3% of the RBSs and 0% of the GIC sealants demonstrated complete retention (p = 0.034). Moreover, 10.0% of the occlusal surfaces in the RBS group and 13.3% of the occlusal surfaces in the GIC group were filled (p > 0.05). A total of 6.7% of the RBSs showed complete retention. One-third of the sealed teeth (30.0% of the teeth sealed with RBSs and 36.7% of teeth applied with GIC) were filled after 10 years. The Kaplan-Meier analysis demonstrated a higher survival rate in the RBS group when compared with the GIC over the entire follow-up period (p = 0.001). Conclusions: Although the survival rate of RBSs was higher than GIC sealants, their effectiveness in preventing fissure caries in permanent second molars did not differ significantly over a 10-year follow-up.

Management of severity lesions of hypomineralized molars (MIH) with different treatment alternatives: 9-month results of a clinical trial.

The aim of this study was to evaluate the 9-month clinical performance of different materials and treatment procedures in teeth with MIH in children, and to evaluate the effectiveness of Papacarie gel as a deproteinization agent. The study included 90 children (aged 8-15) who had 189 first permanent molars with MIH were restored randomly with 4 different materials/methods. Equia Forte HT (GC, Tokyo, Japan) was used in Group 1; In Group 2, G-eanial composite (GC, Tokyo, Japan) was used with a Fuji IX (GC, Tokyo, Japan) base; In Group 3 and Group 4, EverX Posterior (GC, Tokyo, Japan) base and G-eanial composite (GC, Tokyo, Japan) were used. In group 4, deproteinization was performed with Papacarie Duo gel (F&A, Sao Paulo, Brazil). The restorations were evaluated at 3-month intervals for 9 months using modified United States Public Health Service (USPHS) criteria. The overall recall rate was 94.1% for every 3-month clinical evaluation over 9 months. A total of 9 restorations were unsuccessful. Surface roughness of Group 1 was statistically different from all other groups in all control periods (p < 0.05). Marginal adaptation of Group 2 was found to be significantly different from Groups 3 and 4 at the both of 6th and 9th month controls. There was no significant difference between the groups in terms of retention, color match, marginal discoloration and secondary caries in all control months. Restoration of MIH with Equia Forte HT is almost as successful as composites. The use of dentin replacement materials instead of glass ionomer cements as a base in composite restorations shows better results. Papacarie deproteinization showed similar success with other composite groups. This study was the first clinical study in which Papacarie was used for deproteinization in teeth with MIH and will thus contribute to the literature.

Cost-effectiveness of restorative treatments for permanent molars with severe molar incisor hypomineralization: perspectives for the Brazilian public health system.

OBJECTIVES: To undertake a cost-effectiveness analysis of restorative treatments for a first permanent molar with severe molar incisor hypomineralization from the perspective of the Brazilian public system. MATERIALS AND METHODS: Two models were constructed: a one-year decision tree and a ten-year Markov model, each based on a hypothetical cohort of one thousand individuals through Monte Carlo simulation. Eight restorative strategies were evaluated: high viscosity glass ionomer cement (HVGIC); encapsulated GIC; etch and rinse adhesive + composite; self-etch adhesive + composite; preformed stainless steel crown; HVGIC + etch and rinse adhesive + composite; HVGIC + self-etch adhesive + composite, and encapsulated GIC + etch and rinse adhesive + composite. Effectiveness data were sourced from the literature. Micro-costing was applied using 2022 USD market averages with a 5% variation. Incremental cost-effectiveness ratio (ICER), net monetary benefit (%NMB), and the budgetary impact were obtained. RESULTS: Cost-effective treatments included HVGIC (%NMB = 0%/ 0%), encapsulated GIC (%NMB = 19.4%/ 19.7%), and encapsulated GIC + etch and rinse adhesive + composite (%NMB = 23.4%/ 24.5%) at 1 year and 10 years, respectively. The benefit gain of encapsulated GIC + etch and rinse adhesive + composite in relation to encapsulated GIC was small when compared to the cost increase at 1 year (gain of 3.28% and increase of USD 24.26) and 10 years (gain of 4% and increase of USD 15.54). CONCLUSION: Within the horizon and perspective analyzed, the most cost-effective treatment was encapsulated GIC restoration. CLINICAL RELEVANCE: This study can provide information for decision-making.

Enhancement of mineral density and mechanical properties in root caries treated with silver diammine fluoride and glass ionomer cement, with emphasis on silver ion distribution.

OBJECTIVES: This study aimed to measure the distribution of silver ion (Ag+), mineral recovery, and nanohardness in carious lesions and comprehensively evaluate the degree of dentin restoration. METHODS: Sixty human teeth with root caries were randomly assigned to the control, silver diammine fluoride (SDF) [Safo], and SDF+Glass ionomer cement (GIC) treatment [Safo+Fuji] groups. Micro-computed tomography (micro-CT) was performed at five time points for each sample before/after treatment to evaluate mineral density within and around carious lesions. Three months following treatment, 12 samples were selected for synchrotron radiation X-ray fluorescence analysis to evaluate Ag+ distribution, while 15 samples were selected for nanoindentation. Data were analyzed using Dunnett's T3 test for micro-CT and Wilcoxon rank sum test with Bonferroni correction (p = 0.017) for nanoindentation. The correlation between hardness and mineral change was analyzed using the Spearman rank correlation coefficient. RESULTS: The Safo and Safo+Fuji groups showed significantly higher mineral recovery rates than did the control group (p < 0.001). In the Safo group, Ag+ accumulated in the deeper layers rather than the superficial layer of caries. In the Safo+Fuji group, Ag+ was found evenly distributed throughout caries, with only a few Ag+ detected in the GIC layer. Hardness in the Safo+Fuji group was significantly higher compared with the Safo group at depths in the range of 10-50 µm. CONCLUSION: In the presence of GICs, SDF exhibited high remineralization capacity when diffusing throughout carious lesions over time. Combined treatment with SDF and GIC could strengthen root dentin even in the presence of caries. CLINICAL SIGNIFICANCE: We found that combination treatment with SDF and GIC could increase mineral density in caries and improve the hardness of the tooth structure compared with fluoride-based agents alone. These findings might pave the way for future clinical trials to determine the therapeutic potential of nanotechnology-based restorative materials.

A quantitative and qualitative investigation into the management of carious primary molars by foundation dentists in primary care in the South East of England.

Introduction Dental caries is the most common reason for hospital admission of children aged 5-9 in the UK. Better management of caries in primary molars would reduce the number of children requiring treatment in hospitals; however, little research has been done into why primary care clinicians do not use an evidence-based approach to caries management for deciduous molars.Aims The aim of this paper is to identify the rationale behind caries management techniques used in primary care, as well as the choice of materials and long-term success of restorations placed.Materials and methods Use of a retrospective audit and a focus group with primary care clinicians to provide an insight into the management of carious primary molars and the barriers to achieving gold standard care.Results Glass ionomer cements (GICs) were the restoration of choice in primary care. Lack of time, equipment availability and clinician inexperience were cited as to why Hall crowns were not commonly placed.Conclusions The barriers to gold standard management of carious primary molars in practice are wide-ranging but tend to focus on the limitations of NHS care under the units of dental activity system. Lack of time and cost of materials encouraged clinicians to adopt a 'quick fix' approach in GIC.

Exploring Recent Decreases in First Molar Sealants among US Children.

Analyses of National Health and Nutrition Examination Survey (NHANES) data suggested a significant decrease in sealant prevalence among children between 2011 to 2014 and 2015 to 2018. We explore whether this decrease could be associated with possible changes in 1) clinical sealant delivery, 2) dental materials (i.e., increased use of glass ionomer [GI] sealants resulting in an inability to detect sealant fragments that still provide preventive benefits or increased use of composite restorations leading to misclassifying sealants as restorations), and 3) examination sensitivity and specificity. We used NHANES data to estimate the prevalences of sealants, untreated caries, and restorations in ≥1 first permanent molar among children aged 7 to 10 y and used Medical Expenditure Panel Survey data to estimate the annual clinical delivery of sealants and fluoride treatments. We examined changes in outcomes between 2 periods (P < 0.05) controlling for selected sociodemographic characteristics. NHANES sealant examination quality was based on the reference examiner's replicate examinations. The adjusted prevalence of sealants decreased relatively by 27.5% (46.6% vs. 33.8%). Overall, untreated caries decreased. Untreated caries and restoration decreased among children without sealants. Annual clinical sealant delivery did not change, whereas fluoride treatment delivery increased. The decrease in sealant prevalence held when assessed for various age ranges and NHANES cycle combinations. While sealant examination specificity remained similar between the periods, sensitivity (weighted by the proportion of exams by each examiner) decreased relatively by 17.4% (0.92 vs. 0.76). These findings suggest that decreased sealant prevalence was not supported by decreased clinical sealant delivery nor increased use of composite restorations. Decreased examination sensitivity, which could be due to an increased use of GI sealants, could contribute to the decrease in sealant prevalence. The decrease in caries among children without sealants could suggest the increased use of GI sealants. However, we could not rule out that the decrease in caries could be attributable to increased fluoride treatment delivery.

Clinical Performance of Glass Ionomer Cement in Load-Bearing Restorations: A Systematic Review.

Glass ionomer cement (GIC) is a self-adhesive dental restorative material composed of a polyacrylic acid liquid and fluoro-aluminosilicate glass powder. It is commonly used for cementation during dental restoration. This study aimed to systematically review the existing literature regarding the clinical performance of GIC in load-bearing dental restorations. A comprehensive literature search was conducted in EBSCO, PubMed, Embrace, and Cochrane databases. Only randomized controlled trials (RCTs) were included in the search, and a broad search technique was used, where inclusion and exclusion criteria were applied. After a thorough evaluation, 12 RCTs were extensively reviewed, and whether GIC is suitable for load-bearing restorations was determined. Significant variations in staining surface or margin, color match, translucency, esthetic anatomical form, retention, material fracture, marginal adaptation, surface luster, occlusal contour, wear, and approximal anatomical form indicated the unsuitability of GIC. By contrast, significance differences in patient view and periodontal response indicated that GIC is suitable. No significant differences in postoperative sensitivity, recurrence of caries, or tooth integrity were observed. Nevertheless, the results of the review demonstrated that the clinical performance of GIC is comparable to that of traditional restorative materials with regard to the parameters analyzed. GIC is a suitable restorative material for load-bearing restorations regarding surface margin, esthetic anatomical form, material retention and fracture, marginal adaptation, occlusal contour, wear, and approximal anatomical form. It reduces other parameters, such as postoperative sensitivity, recurrence of caries, and tooth integrity.

Randomized clinical trial of pulpotomy using a premixed injectable calcium silicate cement on mature permanent teeth with reversible pulpitis.

The aim of this two-center randomized controlled trial was to assess the outcomes and relative factors associated with pulpotomies performed using a premixed injectable calcium silicate cement, as compared to mineral trioxide aggregate in mature permanent premolar and molar teeth with reversible pulpitis. Included teeth were randomly divided into two groups according to pulpotomy material (ProRoot MTA [PMTA] group, Endocem MTA Premixed [EPM] group). After pulp exposure, the superficial pulp was either removed to a depth of 2 mm (partial pulpotomy) or completely amputated to the level of the root canal orifice (full pulpotomy). A 3-mm layer of either material was randomly placed over the pulp wound, followed by the application of a thin layer of a light-cured glass ionomer composite liner. The restoration procedure was then carried out during the same visit. After one year of treatment, the pulpotomy success rate was 94.4% (67/71), with no significant difference between the PMTA and EPM groups. The success rate was 93.9% in the PMTA group and 97.1% in the EPM group. There were no significant factors related to the procedures. EPM is a viable alternative to PMTA for single-visit pulpotomies of permanent premolars and molars.

The stress distribution of a primary molar tooth restored with stainless steel crown using different luting cements.

BACKGROUND: The aim of this study is to evaluate the stress distributions of a primary molar tooth restored with a stainless steel crown (SSC) using resin and glass ionomer luting cements by Finite Element Analysis (FEA). METHODS: Original DICOM data of a primary molar was used to create a 3D model. One model was prepared as a tooth model with SSC. A 30 µm cement layer was used in model. Two different luting cements were tested in the study: self-cure adhesive resin cement, and glass ionomer cement. Vertical and oblique loads of 330 N were applied to simulate maximum bite force and lateral forces in the occlusal contact areas of the models. Maximum von Mises stress values in the models were evaluated as MPa. RESULTS: The maximum von Mises stress value was observed in the force application and general occlusal contact areas for all models. The maximum von Mises stress values were higher in the tooth model with SSC using self-cure adhesive resin cement (478.09 MPa and 214.62 MPa) than in the tooth model with SSC using glass ionomer cement (220.06 MPa and 198.72 MPa) in both vertical and oblique loading, respectively. CONCLUSIONS: Depending on the magnitude of the bite force on the SSC, fracture of the luting cement materials could occur if the stress exceeds the endurance limit of the luting cement. Cementation with glass ionomer cement may help to reduce stress levels in SSC restorations of primary molars in children.

Effect of silver diamine fluoride on the microleakage of flowable resin composite and glass ionomer cement restorations to carious primary dentin: an-in vitro study.

BACKGROUND: This study aimed to evaluate the effect of Silver Diamine Fluoride (SDF) on the microleakage of flowable resin composite (FRC) and resin-modified glass ionomer cement (GIC) restorations bound to carious primary dentin. METHODS: Forty-four extracted carious primary molars were allocated into four groups as follows (n = 11 teeth/group): Group I, Flowable resin composite (FRCa): SDF38% treatment + FRC, Group II, Flowable resin composite (FRCb): FRC without SDF treatment, Group III, Resin-modified glass ionomer cement (GICa): SDF38% treatment + GIC, Group IV, Resin-modified glass ionomer cement (GICb): GIC without SDF treatment. Specimens were subjected to thermo cycling at 500 cycles between 5 to 55 °C (dwell time of 60 seconds) in baths before being immersed for 24 h in a 1% toluidine blue solution. Microleakage testing was conducted for each specimen in two areas; occlusal and gingival. Specimens were evaluated under stereomicroscope at 4x magnification. Results were analyzed using Kruskal-Wallis test followed by pairwise comparisons utilizing Dunn's post hoc test at p ≤ 0.05. RESULTS: Insignificant differences between different groups (p = 0.49) were observed at the gingival walls area readings. The highest value was found in GICb (2.33 ± 0.52), while the lowest value was found in FRCa (1.71 ± 0.76). Insignificant differences between different groups (p = 0.982) were observed at the occlusal walls area readings. The highest value was found in FRCa (1.43 ± 0.98), while the lowest value was found in GICb (1.17 ± 1.33). CONCLUSION: SDF does not adversely affect the microleakage of FRC and GIC restorations bound to carious primary dentin.

Shear bond strength of calcium silicate-based cements to glass ionomers.

BACKGROUND: A shear bond strength between the biomaterial and restorative material is crucial for minimizing bacterial microleakage and ensuring a favorable long-term prognosis for vital pulp therapy. This study aimed to conduct a comparative evaluation of the shear bond strength between calcium silicate-based biomaterials utilized in vital pulp treatment and various glass ionomer cement materials, both with and without the application of adhesive agents. METHODS: A total of 270 acrylic blocks, each featuring cavities measuring 4 mm in diameter and 2 mm in depth, were prepared. Calcium silicate-containing biomaterials (ProRoot MTA, Medcem Pure Portland Cement, and Medcem MTA), following manufacturers' instructions, were placed within the voids in the acrylic blocks and allowed to set for the recommended durations. The biomaterial samples were randomly categorized into three groups based on the restorative material to be applied: conventional glass ionomer cement, resin-modified glass ionomer cement, and bioactive restorative material. Using cylindrical molds with a diameter of 3.2 mm and a height of 3 mm, restorative materials were applied to the biomaterials in two different methods, contingent on whether adhesive was administered. After all samples were incubated in an oven at 37 °C for 24 h, shear bond strength values were measured utilizing a universal testing device. The obtained data were statistically evaluated using ANOVA and post-hoc Tukey tests. RESULTS: The highest shear bond strength value was noted in the Medcem MTA + ACTIVA bioactive restorative material group with adhesive application, while the lowest shear bond strength value was observed in the ProRoot MTA White + Equia Forte HT Fil group without adhesive application (P < 0.05). CONCLUSION: Activa Bioactive Restorative may be considered a suitable restorative material in combination with calcium silicate-based biomaterials for vital pulp treatment. The application of adhesives to calcium silicate-based biomaterials can effectively address the technical limitations.

Clinical performance of a glass-hybrid system in comparison with a resin composite in two-surface class II restorations: a 5-year randomised multi-centre study.

OBJECTIVE: To evaluate the 5-year clinical performance of a glass hybrid restorative system and a nano-hybrid resin composite in moderate to large two-surface class II cavities. MATERIALS AND METHODS: This study was carried out by dental schools in Zagreb, Croatia; Izmir, Turkey; Belgrade, Serbia; and Milan, Italy. A total of 180 patients requiring two class-II two-surface restorations in the molars of the same jaw were recruited. The teeth were randomly restored with either a nano-hybrid resin composite (Tetric EvoCeram, Ivoclar Vivadent) or a glass-hybrid material (EQUIA Forte, GC). During the 5-year follow-up, two calibrated evaluators at each centre scored the restorations annually using the FDI-2 scoring system. The survival rates were calculated using the Kaplan-Meier method and compared using non-parametric matched pair tests (p < 0.05). RESULTS: There were no statistically significant differences between the overall survival and success rates of the two types of restorations (p>0.05). The success rates (FDI-2 scores 1-3) for EQUIA Forte were 81.9% (average annual failure rate: 3.9%) and 90.7% for Tetric EvoCeram (average annual failure rate: 1.9%). The survival rates (FDI-2 scores 1-4) for EQUIA Forte and Tetric EvoCeram were 94.5% and 94.4%, respectively, with an average annual failure rate of 1.1%. CONCLUSIONS: In terms of success and survival rates, both the glass-hybrid restorative system and the nano-hybrid resin composite have been shown to perform satisfactorily. CLINICAL RELEVANCE: The results of this study indicate that EQUIA Forte can be one of the therapeutic options for moderate to large two-surface class II restorations of posterior teeth.