The aim of the current study was to evaluate the clinical performance of the novel radio-opaque universal adhesive "Scotchbond™ Universal Adhesive Plus" compared to conventional universal adhesive "Single Bond Universal" over 24 months in cervical carious lesions. Fifty participants with cervical carious lesions were randomly allocated into two groups (n = 25)
either Scotchbond™ Universal Plus Adhesive (intervention) or Single Bond™ Universal Adhesive (control). Restorations were assessed at baseline, 12 and 24 months using the modified USPHS criteria. Data analysis was conducted using MedCalc software, version 22 for Windows. Intergroup comparisons at each follow-up were performed using the Chi-Square test (p ≤ 0.05). Intragroup comparisons within each intervention were conducted using Cochran's Q test (p ≤ 0.016). After 24 months, all restorations in Scotchbond™ Universal Plus scored alpha, while in Single Bond™ Universal group, three restorations scored bravo after 24 months in marginal adaptation and discoloration. There was no statistically significant difference between both adhesives (p >
0.05) at all follow-up periods. Intragroup comparison within both adhesives has shown no statistically significant change across follow-up periods regarding all tested outcomes (p >
0.016) except for marginal adaptation within Single Bond Universal, where there was statistically significant difference (p = 0.005). Both adhesives exhibited satisfactory clinical performance in cervical restorations after 24-months. The present study emphasizes the clinical significance of using a new radio-opaque universal adhesive for restoring carious cervical lesions, providing radio-opacity, low viscosity, excellent handling, eliminating misinterpretation of MDP-based adhesive layer and generating reliable bonding performance to support long-term success in restorative dentistry.