The objective of this study is to evaluate the clinical performance of direct resin composite restorations placed with different techniques (incremental or bulk) and different flowable linings (conventional or bulk-fill) in endodontically treated teeth. Forty-seven pair class II (mesio-occlusal or disto-occlusal) composite restorations were placed in 37 patients. In all cavities, Adper Single Bond 2 was used. In one of the cavities of each pair, a conventional flowable composite, Aelite Flo, was applied in approximately 2mm thick, and the remaining cavity was restored incrementally with GrandioSO. In the second cavity, a bulk-fill flowable composite, x-tra base, was applied in approximately 4mm thick in bulk increments and the remaining 2-mm occlusal part of the cavity was restored with GrandioSO. All cavities were restored with open-sandwich technique by the same operator. At baseline and after 6-month, 1-, 2-, and 3-year follow-up visits, restorations were evaluated by modified USPHS criteria. At 3-year recall, 33 restorations with Aelite Flo lining and 33 with x-tra base lining were available. Two restorations from each group (6.0%) were scored as Bravo in terms of surface texture. One restoration's color match from x-tra base group scored as Bravo (3.0%). All other evaluated criteria were scored as Alfa (100%) for all restorations. No statistically significant difference between the two groups was found in all evaluated criteria during 3-year period (p>0.05). Bulk-filling technique showed clinically acceptable performance comparable to the incremental technique. Restorations placed with bulk-filling technique with x-tra base lining and incremental technique with a conventional flowable lining showed highly clinical performance over 3-year period.