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Background  This study was carried out as a prospective clinical field study with the aim of evaluating the clinical performance of Equia Fil® with a nanofilled resin coating and the conventional Fuji IX GP® fast with an LC coating according to the World Dental Federation (FDI) restoration material evaluation criteria.    Methods  The clinical performance of Equia Fil® and Fuji IX GP® fast was evaluated on permanent posterior teeth of 643 adult patients aged between 20 to 80 years old in randomly selected clinics across Germany. Occlusal cavities in posterior permanent teeth were restored with Equia Fil® with a nanofilled, light-cured resin coating ( n  = 515) and Fuji IX GP® fast with an LC coating ( n  = 486). Direct clinical assessment as well as photographic assessment and assessment of stone casts of the restorations were made at 1 year, 2 years, 3 years, and 4 years.    Results  In 4 years, a total of 1001 fillings from both materials were placed by 111 dentists in 643 patients. Random slope models showed that the Equia filling system had overall lower odds of obtaining a delta event (material needs replacement) in comparison to Fuji IX GP® fast with an LC coating within all models. In both materials, filling size/surface was the most important component affecting the clinical performance of the materials. When measuring the odds of obtaining a delta event (material needs replacement), the odds ratios jumped to approximately 43 and 296 times for class II (two surfaces) and class II mesial-occlusal-distal (three surfaces) respectively in comparison to class I fillings.    Conclusion  Both materials showed similar good overall performance in class I cavities; however, when including numbers from both class I and II fillings, the Equia system with a nanofilled resin coating showed better overall performance with fewer failures in all the follow-up intervals. Nonetheless, the percentage of unsatisfactory to poor fillings according to the FDI criteria was relatively high in two-surface class II fillings and higher in three-surface class II fillings for both materials.    Trial registration  Deutsches Register Klinischer Studien (German Clinical Trials Register): DRKS00004220. ( www.germanctr.de ). Registration date: 6 Sept 2012.    Electronic supplementary material  The online version of this article (doi:10.1186/s13063-016-1339-8) contains supplementary material, which is available to authorized users.

Clinical performance during 48 months of two current glass ionomer restorative systems with coatings: a randomized clinical trial in the field