European Journal of Cardiovascular Medicine

Composite resins have become the preferred material for direct restorations because of their superior esthetics, conservative preparation requirements, and favorable mechanical performance [1]. Advances in filler technology and adhesive systems have further enhanced their application in both anterior and posterior teeth, providing predictable outcomes in terms of function and durability [2].

Nevertheless, the long-term clinical success of composites is influenced by factors such as marginal integrity and resistance to discoloration. Deficiencies in marginal adaptation may lead to microleakage, postoperative sensitivity, and secondary caries, while discoloration adversely affects esthetics and patient satisfaction [3]. Both parameters are regarded as essential indicators of restoration performance and are commonly evaluated using standardized methods, including the United States Public Health Service (USPHS) criteria [4].

Clinical trials have shown varying rates of success, with outcomes often affected by patient-related variables such as age, cavity type, tooth location, and oral hygiene practices [5]. These variations highlight the importance of systematic follow-up to monitor restoration performance in real-world settings.

The present study was undertaken to assess marginal integrity and marginal discoloration of direct composite restorations placed in anterior and posterior teeth over a one-year follow-up period. The findings provide practical insight into the short-term clinical performance of composites and contribute to evidence-based restorative decision-making.

Study Design and Setting:
This prospective observational study was conducted in the Department of Conservative Dentistry and Endodontics, Government Medical College (GMC), Kanker, Chhattisgarh, over a period of one year, from March 2022 to February 2023.

Study Population:
A total of 100 patients who reported to the outpatient dental clinic and required direct composite restorations in anterior or posterior teeth were enrolled. Patients aged between 18 and 60 years were included, provided they were willing to participate and return for follow-up assessments. Exclusion criteria included patients with parafunctional habits (e.g., bruxism), grossly decayed or non-restorable teeth, poor oral hygiene, and those unwilling to comply with follow-up visits.

Restorative Procedure:
Standardized cavity preparations were performed for each patient under rubber dam isolation wherever feasible. A universal adhesive system was applied following manufacturer’s instructions, and direct composite resin restorations were placed using incremental technique and light curing. Finishing and polishing were performed with abrasive discs to ensure smooth margins.

Evaluation Criteria:
Restorations were evaluated at baseline (immediately after placement), 6 months, and 12 months using modified United States Public Health Service (USPHS) criteria. The primary parameters assessed were:

Marginal integrity (intact, minor defect, major breakdown/replacement)

Marginal discoloration (none, mild polishable, moderate requiring replacement)

Data Collection and Analysis:
All clinical evaluations were performed by two calibrated examiners blinded to each other’s assessment. Data were recorded in predesigned proformas, entered into Microsoft Excel, and analyzed using descriptive statistics (frequency and percentage).

Ethical Considerations:
Ethical clearance for the study was obtained from the Institutional Ethics Committee of GMC Kanker prior to commencement. Written informed consent was obtained from all participants before enrollment.

A total of 100 patients with direct composite restorations were enrolled and followed for one year between March 2022 and February 2023. The baseline demographic and clinical characteristics are presented in Table 1. The majority of participants belonged to the 31–45 year age group (42%), with nearly equal gender distribution (52% males and 48% females). Posterior teeth (62%) and Class II cavities (60%) were more frequently restored than anterior teeth and Class I cavities.

Table 1. Baseline Characteristics of Study Participants (N = 100)

Marginal Integrity:
At baseline, all restorations demonstrated intact margins. By six months, 94% maintained excellent marginal adaptation, while 6% showed minor marginal discrepancies. At 12 months, 88% retained intact margins, 10% developed minor defects, and 2% showed major breakdown necessitating replacement (Table 2).

Table 2. Marginal Integrity of Composite Restorations Over 12 Months

Figure 1. Marginal Integrity of Composite Restorations Over 12 Months

Marginal Discoloration:
No discoloration was observed at baseline or at six months. At 12 months, 10% of restorations developed marginal discoloration, of which 8% were mild and polishable, while 2% required replacement due to moderate discoloration (Table 3).

Table 3. Marginl Discoloration of Composite Restorations Over 12 Months

Figure 2. Marginl Discoloration of Composite Restorations Over 12 Months

Overall Clinical Acceptability:
At the end of the one-year follow-up, 96% of restorations were clinically acceptable, while 4% required replacement due to either major marginal breakdown or moderate discoloration (Table 4).

Table 4. Overall Clinical Acceptability of Restorations at 12 Months

Figure 3. Overall Clinical Acceptability of Restorations at 12 Months

The present study evaluated marginal integrity and marginal discoloration of direct composite restorations over a one-year period and demonstrated high clinical acceptability, with 96% of restorations remaining satisfactory at follow-up. Only 4% required replacement, primarily due to major marginal breakdown or moderate discoloration.

Marginal Integrity:
In this study, 88% of restorations maintained intact margins after one year, 10% developed minor defects, and 2% required replacement. These findings are comparable to the one-year clinical results reported by Sundfeld et al., who emphasized the influence of adhesive systems on marginal adaptation of posterior composites [6]. Similarly, Cetin and Unlu found that both direct nanofilled and indirect composites performed acceptably in posterior restorations after one year [7]. Earlier evidence also suggests that marginal deterioration is an important predictor of restoration failure, particularly in high-stress occlusal areas [8]. The small proportion of breakdown observed in our cohort may therefore be attributed to cavity class, occlusal loading, and operator technique.

Marginal Discoloration:
At 12 months, 10% of restorations showed marginal discoloration, although most cases were mild and clinically acceptable. Comparable levels of early discoloration have been documented in clinical studies of posterior composites, with factors such as dietary staining, insufficient finishing, and marginal microleakage contributing to these outcomes [9,10]. The very low replacement rate due to discoloration in our study underlines the importance of proper finishing and polishing protocols, which have been shown to improve esthetic longevity.

Overall Clinical Performance:
The overall one-year survival rate of 96% in this study aligns with international findings, where one-year survival typically exceeds 90% [11,12]. Longitudinal studies demonstrate that while short-term performance is excellent, failure rates gradually increase over time due to marginal degradation, secondary caries, and surface wear [11]. Celik et al. similarly reported that most posterior composite restorations remain clinically acceptable at one year, but extended monitoring is necessary to identify late failures [12]. These observations highlight the importance of continuous follow-up to evaluate long-term durability beyond the first year.

Strengths and Limitations:
A key strength of this study is the prospective design and complete follow-up of all participants. However, the relatively short one-year duration limits conclusions about long-term performance. Additionally, factors such as occlusal load, oral hygiene practices, and operator variability were not controlled, which may have influenced outcomes.

Clinical Implications:
The study reinforces the suitability of composite resins as reliable restorative materials for anterior and posterior teeth. Regular follow-up, patient education on oral hygiene, and meticulous restorative techniques remain critical to minimizing marginal defects and discoloration.

This prospective observational study demonstrated that direct composite restorations provide highly satisfactory clinical outcomes within a one-year follow-up period. The majority of restorations exhibited intact margins with minimal discoloration, and only a small proportion required replacement due to major marginal breakdown or moderate staining. The overall survival rate of 96% reflects the effectiveness of contemporary composite resins when placed under standardized protocols with proper finishing and polishing. Although short-term performance was favorable, the study emphasizes the need for longer follow-up to assess durability and detect late failures. Composite resins remain a dependable and esthetic restorative option for routine clinical practice.

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