Direct and Semi-Direct Composite Techniques in Posterior Teeth: A Two-Year Follow-Up Comparative Study

<b><i>Background:</i></b> Composite restorations are the standard of care for posterior teeth due to their aesthetic properties and conservative nature. However, the choice between direct and semi-direct techniques can influence clinical longevity and performance. <b><i>Objectives:</i></b> This study aimed to compare the clinical performance of two restorative approaches: a direct technique and the semi-direct onlay technique in terms of aesthetic quality, surface finish, wear resistance, marginal integrity, and overall clinical efficiency over a two-year period. <b><i>Methods:</i></b> A total of 348 composite restorations were placed in 192 patients. Each restoration was evaluated at four timepoints: baseline (T0), 6 months (T1), 1 year (T2), and 2 years (T3). Clinical performance was assessed using standardised 5-point rating scales across the five dimensions. Repeated-measures ANOVA assessed changes over time, while Wilcoxon signed-rank and Mann-Whitney U tests were used for intra- and inter-group comparisons. <b><i>Results</i></b>: Significant time effects were observed across all clinical parameters (<i>p</i> < 0.0001). The direct technique exhibited superior initial results in aesthetics and surface finish at T0 and T1 (<i>p</i> < 0.001), but differences diminished by T3. In contrast, the semi-direct technique demonstrated improved performance in wear resistance and marginal integrity at T2 and T3. Both techniques showed progressive deterioration, particularly in marginal adaptation. <b><i>Conclusions:</i></b> The direct technique offers enhanced short-term aesthetics and procedural efficiency, while the semi-direct approach provides superior long-term durability and marginal adaptation.