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Aim: To evaluate the effect of hydro abrasion versus the conventional drill method of cavity preparation on the clinical performance of composite restoration over one year follow up period. Materials and methods:Twenty patients with occlusal carious lesions were selected and examined with DIAGNO cam and ICDAS visual criteria to select teeth having ICDAS Code 3 or 4. Forty lesions were randomly divided into two groups (n=20) according to the method of caries removal. Cavities were prepared by the conventional drill method in group I and by hydro-abrasion in group II. Cavities of both groups were restored by self-etch adhesive (Adper Easy Bond) and nano-filled composite (Filtek Z350XT). All restorations were evaluated after 24 hours, after 9 and 12 months according to (USPHS) criteria for retention, marginal adaptation, postoperative sensitivity, marginal discoloration, and secondary caries.Results: Mild, moderate -severe and very severe pain was recorded in group I While in group II, only mild pain was recorded in (40%) of cases. The statistical analysis of the collected data related to the tested USPHS criteria revealed 100% Alpha scoring regarding retention, marginal adaptation and secondary caries in both groups throughout the study period. The gap width measured under SEM was found increased sig. by time in both groups. Marginal discoloration was observed in the two groups after nine and 12 months. Post-operative hypersensitivity was found only in group I in 100% of cases at the base line and was disappeared during the next follow up period. Conclusion:Hydro-abrasion could be recommended as a preferred method of cavity preparation in shallow to mild carious lesions compared to the conventional cavity preparation method.