Information about the long-term clinical survival of large amalgam and composite restorations is still lacking. This retrospective study compares the longevity of three- and four-/five-surface amalgam and composite restorations relative to patients' caries risk. Patient records from a general practice were used for data collection. We evaluated 1949 large class II restorations (1202 amalgam/747 composite). Dates of placement, replacement, and failure were recorded, and caries risk of patients was assessed. Survival was calculated from Kaplan-Meier statistics. After 12 years, 293 amalgam and 114 composite restorations had failed. Large composite restorations showed a higher survival in the combined population and in the low-risk group. For three-surface restorations in high-risk patients, amalgam showed better survival.

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The service life of defective direct or indirect restorations could be prolonged by repair or relayering actions where durable adhesion of resin-based composite materials is established for longevity of repairs. The advances in adhesive technologies have introduced several surface conditioning concepts to adhere resin composites onto different restorative materials. The purpose of this report is to summarize reasons for failure, survival of repaired reconstructions, elaborate upon types and mechanisms of available surface conditioning methods, and present operative dentists with practical guidelines for intraoral repair procedures.

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