Objective: To compare the failure rate of posterior interproximal amalgam restorations to resin-based composite restorations in a random young adult population. Method and Materials: Bilateral bitewing radiographs of 459 young adults were screened. A total of 14,140 interproximal surfaces were examined, recorded, and statistically analyzed. Rate of failure was determined by the number of restorations with radiographic evidence of secondary caries and/or overhanging margins. Results: Of the 650 restored interproximal surfaces (5% of all clearly demarcated interproximal surfaces), 86 (13%) demonstrated distinct interproximal secondary caries and 22 (3%) had overhanging margins. Of the 557 amalgam and 93 resin-based composite interproximal restorations, secondary caries were shown in 46 (8%) and 40 (43%), respectively, and overhanging margins in 21 (4%) and only 1 (1%), respectively. Generally, when secondary caries and overhanging margins were considered, the failure rate of amalgam and resin-based composite interproximal restorations was 12% and 44%, respectively. Conclusions: Higher failure rates were observed in resin-based composite restorations than in amalgam restorations. Secondary caries was the main reason for failure. Overhanging margins were not a primary factor in restoration failure. The vast use of posterior interproximal resin-based composite restorations should be reconsidered, and their limited long-term performance should be kept in mind. Keywords: amalgam, bitewing radiograph, failure rate, interproximal posterior restorations, resin composite