Dental Literature Watch · Trial · Restorative
Cention N Holds Up Against Composite in Class II at Four Years
TL;DR
- Alkasite (Cention N) versus a posterior resin composite (G-ænial Posterior), both bonded with a universal adhesive in etch-and-rinse mode, in Class II cavities.
- No statistically significant differences at 48 months in marginal adaptation, marginal discolouration, surface texture, colour match, postoperative sensitivity, or secondary caries.
- Survival 83.6% (Cention N) vs 88.4% (composite), log-rank p = 0.49.
- Both materials deteriorated slightly over time in marginal adaptation, discolouration, and surface texture.
- The recall rate at 48 months was 58%, which the authors themselves call relatively low.
The study
| Design | Randomised, split-mouth, double-blind clinical trial |
| Sample | 31 patients, 100 Class II restorations (50 per group) |
| Materials | Cention N vs G-ænial Posterior, both with a universal adhesive in etch-and-rinse mode |
| Assessment | Modified USPHS criteria at baseline, 6, 12, 36, 48 months |
| Survival at 48 months | 83.6% vs 88.4%, log-rank p = 0.49 |
| Recall at 48 months | 58% |
💎 Insight — what this means chairside
The appeal is workflow, not performance
Alkasite materials are marketed on bulk placement and simplified handling, and this trial suggests you do not pay for that in four-year outcomes.
Nobody is claiming it is better — the finding is that it is not worse.
Alkasite materials are marketed on bulk placement and simplified handling, and this trial suggests you do not pay for that in four-year outcomes.
Nobody is claiming it is better — the finding is that it is not worse.
Note that it was bonded, not just packed
Cention N is sometimes described as usable without an adhesive.
Both arms here used a universal adhesive in etch-and-rinse mode, so these results apply to the bonded technique, not the self-adhesive shortcut.
Cention N is sometimes described as usable without an adhesive.
Both arms here used a universal adhesive in etch-and-rinse mode, so these results apply to the bonded technique, not the self-adhesive shortcut.
Class II is the honest test
Occlusal load plus a proximal box plus a cervical margin is where restorative materials actually fail.
A four-year Class II dataset is worth more than a longer occlusal-only one.
Occlusal load plus a proximal box plus a cervical margin is where restorative materials actually fail.
A four-year Class II dataset is worth more than a longer occlusal-only one.
⚠️ The catch
Fifty-eight percent recall is the finding that limits everything else
When four in ten restorations are unaccounted for at the endpoint, survival estimates become fragile.
Patients whose restorations fail are also the ones more likely to be seen elsewhere — that biases the estimate optimistically for both arms.
When four in ten restorations are unaccounted for at the endpoint, survival estimates become fragile.
Patients whose restorations fail are also the ones more likely to be seen elsewhere — that biases the estimate optimistically for both arms.
Thirty-one patients
A split-mouth design controls for patient-level factors well, which is its strength, but this is still a small sample.
A 5-point survival difference with p = 0.49 means "not detectably different", not "the same".
A split-mouth design controls for patient-level factors well, which is its strength, but this is still a small sample.
A 5-point survival difference with p = 0.49 means "not detectably different", not "the same".
One product versus one product
This is Cention N against G-ænial Posterior, not alkasites against composites as classes.
This is Cention N against G-ænial Posterior, not alkasites against composites as classes.
⚡ Bottom line
- Considering an alkasite for posterior Class II → four-year performance was comparable to a posterior composite.
- Planning to skip the adhesive → this trial bonded both materials. It does not support the self-adhesive route.
- Quoting survival → quote the 58% recall alongside it.
- Expecting a material upgrade → the result is equivalence, not superiority.
🧪 Questions
Tap an answer — instant grade, deciding line, and the trap.
A colleague proposes switching the practice's posterior Class II material to an alkasite, citing the 2026 48-month randomised trial, and adds that it can be placed without an adhesive to save time. Which response is most accurate?
Deciding line: the trial found no significant differences and comparable survival, but both groups were bonded with a universal adhesive in etch-and-rinse mode, so it says nothing about placement without an adhesive. Trap: the superiority option is the common misreading of an equivalence result and the engineered trap; the last option asserts exactly the technique the trial did not test, which is how a reasonable material choice turns into an unsupported shortcut.