BackgroundTo evaluate the clinical performance of direct composite restorations using the snowplow technique with up to 4 years of follow-up.Material and MethodsIn this retrospective study, 101 class II composite restorations which were placed in permanent molars (n = 19) and premolars (n = 82) in 85 patients by the snowplow technique, were evaluated according to the modified USPHS criteria. A Kaplan-Meier analysis with a 95% confidence level was used to calculate the survival probability.ResultsOf the 101 teeth examined, tooth failure was identified in 8 teeth due to secondary caries (3%), marginal gap (2%), marginal discoloration (1%) and restoration breakdown (2%) which required replacement of the whole restoration. Sixteen teeth achieved a Bravo score and just needed to be repaired. The results of the Kaplan-Meier analysis regarding overall survival estimates of composite-treated teeth using the snowplow technique at 1-, 2-, 3- and 4- year follow-ups were 99%, 96.2%, 89.6% and 79% respectively. The median survival times of composite restorations using the snowplow technique were 46.49 ± 11.47 month.ConclusionsThis retrospective study showed that application of a flowable composite as a liner using the snowplow technique does not improve the clinical survival of posterior composite restorations. Key words:Snowplow, composite restoration, success rate.