Objective To evaluate the clinical efficacy of Class I and II composite resin restorations performed with a universal adhesive system using three different adhesive strategies after 7 years.Methods This is a prospective, randomized, double-blind, split-mouth clinical study conducted at the School of Dentistry of the Federal University of Goiás. Eighty-seven Class I and II composite resin restorations (3M™ Filtek™ Supreme) were evaluated in 20 participants, which were performed in association with the universal adhesive system (3M™ Scotchbond Universal) in three adhesive strategies: etch-and-rise (ER), selective etch enamel (SEE), and self-etch (SE). The restorations were evaluated at baseline and after 7 years using the FDI and adapted USPHS criteria. The data obtained were subjected to statistical analysis using the Friedman and Wilcoxon tests for comparison between groups and evaluation times, and survival rates were analysis using the Kaplan-Meier and long-rank tests (α < 0.05).Results The participant return rate was 57.1%. No significant differences were observed among the adhesive strategies at baseline or after 7 years (p > 0.05). Overall, the restorations showed excellent clinical performance according to the FDI and adapted USPHS criteria. Survival analysis was performed only for the fracture/retention outcome, as it presented the highest number of scores classified as clinically unsatisfactory. The overall survival rate was 97.7%, with no significant differences among the groups. The rates of repairable and irreparable failures (fracture/retention) were 10.4% for the ER group, 0% for the SEE group, and 3.5% for the SE group.Conclusion Class I and II composite resin restorations performed with universal adhesive using the ER, SEE, and SE strategies demonstrated excellent clinical performance. In addition, the FDI and adapted USPHS criteria generated similar results.