Influence of Composite Placement Techniques on the Clinical Performance of Posterior Restorations in Vital Teeth

February 9, 2026 updated by: Mohammed Abd El Ghany Mohammed, Tanta University
The purpose of this 12-month randomized clinical investigation was to compare the clinical performance of posterior composite resin restorations implanted in vital teeth using various placement techniques.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Because of their conservative nature, aesthetic qualities, and consistently improved mechanical performance and handling features, resin-based composites have become the restorative material of choice for posterior teeth. Nevertheless, significant obstacles influencing the stability of the marginal area, sensitivity following the procedure, and the durability and effectiveness of composite restorations in the long run are polymerization shrinkage and stress associated with shrinkage.

To reduce polymerization stress and maximize adaptability to hollow walls, various placement procedures have been suggested. While older incremental layering methods sought to lessen the configuration factor (C-factor) and increase light penetration, more recent methods like the Stamp and Snowplow approaches sought to replicate the occlusal architecture and enhance marginal sealing. Conversely, bulk-fill techniques were first developed to streamline clinical processes by enabling the use of bigger composite layers with the promise of lower shrinkage stress.

Despite a plethora of in vitro studies, there is a dearth of high-quality clinical data that compares these placement methods under controlled settings. Due to the fact that laboratory studies cannot completely replicate the oral environment, clinical trials continue to be the best way to assess the real-world efficacy of restorative procedures.

Consequently, this randomized clinical trial set out to assess the clinical efficacy of posterior composite restorations placed in vital teeth utilizing four distinct procedures over the course of a year

Study Type

Interventional

Enrollment (Actual)

50

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
      • Tanta, Egypt
        • Faculty of Dentistry
    • Tanta
      • Tanta, Tanta, Egypt
        • Restorative Department, Faculty of Dentistry, Tanta University
      • Tanta, Tanta, Egypt, 31527
        • Restorative Department, Faculty of Dentistry, Tanta University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Good general and oral health
  • Vital posterior teeth with primary occlusal caries
  • Class I cavities with depth ranging from 3 to 4 mm

Exclusion Criteria:

  • Non-vital or restored teeth
  • Parafunctional habits (e.g., bruxism)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: incremental nanohybrid composite
Stamp technique
Other: nanohybrid composite resin
Fifty patients received a total of 200 Class I composite restorations, which were placed using the same nanohybrid composite resin and randomly allocated into four groups (n = 50) according to placement technique: Group I-Stamp technique; Group II-Snowplow technique; Group III-Modified incremental "Pizza" technique; and Group IV-Bulk-fill technique
Experimental: Flowable and nanohybrid composite
Snowplow technique
Other: nanohybrid composite resin
Fifty patients received a total of 200 Class I composite restorations, which were placed using the same nanohybrid composite resin and randomly allocated into four groups (n = 50) according to placement technique: Group I-Stamp technique; Group II-Snowplow technique; Group III-Modified incremental "Pizza" technique; and Group IV-Bulk-fill technique
Experimental: incremental layering technique
Modified incremental "Pizza" technique
Other: nanohybrid composite resin
Fifty patients received a total of 200 Class I composite restorations, which were placed using the same nanohybrid composite resin and randomly allocated into four groups (n = 50) according to placement technique: Group I-Stamp technique; Group II-Snowplow technique; Group III-Modified incremental "Pizza" technique; and Group IV-Bulk-fill technique
Experimental: bulk fill composite resin
Bulk-fill technique
Other: nanohybrid composite resin
Fifty patients received a total of 200 Class I composite restorations, which were placed using the same nanohybrid composite resin and randomly allocated into four groups (n = 50) according to placement technique: Group I-Stamp technique; Group II-Snowplow technique; Group III-Modified incremental "Pizza" technique; and Group IV-Bulk-fill technique

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
The primary outcome was marginal adaptation
Time Frame: 24 months

Clinical evaluation of marginal adaptation was performed according to the World Dental Federation (FDI) by two calibrated evaluators at baseline and at 6, 12, and 24 months. All of the restorations were ranked according to how well they met the criteria: score 1 (clinically excellent), score 2 (clinically satisfactory), score 3 (clinically satisfactory), or scores 4 and 5 (clinically inadequate). Clinical success was defined as a score of 1, 2, or 3, and failure was indicated by scores of 4 or 5. A powerful light source was used to conduct the visual inspection of the parameters. A magnifying dental loupe was utilized for this purpose. The Friedman test was conducted to evaluate intragroup comparisons of the same restoration outcomes through different follow-up periods. The Kruskal-Wallis test was utilized to assess intergroup comparisons between different restorations during the same follow-up period.

Time Frame: 24 months
24 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Tanta University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2024

Primary Completion (Actual)

January 6, 2026

Study Completion (Actual)

January 17, 2026

Study Registration Dates

First Submitted

January 18, 2026

First Submitted That Met QC Criteria

February 9, 2026

First Posted (Actual)

February 17, 2026

Study Record Updates

Last Update Posted (Actual)

February 17, 2026

Last Update Submitted That Met QC Criteria

February 9, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • Composite Placement Techniques

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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