Objectives: This retrospective cohort study aimed to assess the survival time and factors associated with survival of anterior composite-resin restoration placed at the University of Iowa, College of Dentistry (UICOD). Methods: Patients at the UICOD who had anterior composite restorations placed between 1995-1997 and could be followed through 2013 were included in this study. Factors included: patient age and gender, tooth type (central or lateral incisor, or canine) and location (maxillary or mandibular), restoration size (1, 2, 3, 4 and more surfaces), provider type (dental student, graduate student, faculty), and clinic (operative, family, or other clinics) where the initial restoration placed. Survival time of a restoration was defined as how long a restoration lasted from the day of placement until the day of subsequent treatment. Subsequent treatment included: restorations, veneer and/or crowns, root canal therapy, and extraction. One restoration per patient was used for the study. Statistical analyses consisted of the Kaplan-Meier analysis and Cox regression (alpha=0.05). Results: Of the 668 subjects (mean±SD age=55±13 years and 60.8% females) who fulfilled the inclusion criteria, the mean±SD survival time of composite resin restoration was 11±7 years and an overall survival rate was 43.3%. Patients' gender, age, tooth location, and clinic type were not significantly associated with the survival time of composite resin restoration. Cox regression model indicated that significant differences in the restoration hazards were found on tooth type (p=0.002), provider type (p=0.003) and restoration sizes (p=0.0072). Central (HR=1.59; CI=1.23-2.07) and lateral (HR=1.36; CI=1.03-1.79) incisors had a significantly higher hazard ratio (HR) than canines, and faculty had significantly lower HR than undergraduate students (HR=0.68, CI=0.55-0.85). Restorations sizes one surface (HR=0.6; CI=0.44-0.81) and two surfaces (HR=0.65; CI=0.48-0.88) had significantly lower HR than four and more surfaces restorations. Conclusion: The mean and median survival time of anterior composite restoration at UICOD was 11 and 13 years, respectively. Tooth type, provider type, and restoration size were significant predictors for the survival time of anterior composite-resin restoration.