Objective: Aim of the present study was to clinically evaluate the performance of IPS Empress inlays and onlays with cuspal replacements and margins below the amelocemental junction. Methods: Ninety six IPS Empress restorations (73 Class-II-inlays, 23 onlays / 39 premolars, 57 molars) were placed in 34 patients by six clinicians. The restorations were luted with four different composite systems (Syntac Classic with Tetric, Dual Cement, Variolink low, and Variolink ultra, all Ivoclar-Vivadent, Schaan, Liechtenstein). At baseline and after six months, one, two, four, six and eight years the restorations were assessed using modified USPHS criteria. Results: From 96 investigated restorations eight had to be replaced (failure rate 8%; survival analysis by Kaplan-Meier algorithm). Two teeth required endodontic treatment, six inlays revealed bulk fractures. Three inlays had to be replaced due to prosthodontic reasons and nine patients missed the six years recall (“dropout”). Fifty-seven of the fillings were in good condition. Between the recall assessments (A 6 months, B 1 year, C 2 years, D 4 years, E 6 years, F 8 years) significant differences (Friedman test; p<0.05) were detected for the following criteria ["excellent", "good" (="alpha"); "sufficient" (="bravo" in %]: marginal adaptation A 40/60/0 B 35/60/5 C 17/65/18 D 4/68/27 E 5/76/19 F 2/38/60; integrity inlay A 96/3/1 B 93/5/2 C 92/3/4 D 82/12/5 E 60/21/19 F 67/7/26; and integrity tooth A 84/16/0 B 90/9/1 C 78/21/1 D 53/41/6 E 34/64/2 F 18/70/12. Neither the absence of enamel margins, nor cuspal replacement significantly affected the adhesion or marginal quality of the restorations. No difference was evaluated for the following criteria [last recall, %]: surface roughness 81/19/0, colour 97/3/0, proximal contact 95/5/0, and hypersensitivity 100/0/0. Conclusion: IPS Empress® inlays and onlays bonded with Syntac® Classic were found to have a 92% survival rate after eight years of clinical service. Supported by Vivadent, Schaan, Liechtenstein.

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