Aim and objectives: To evaluate the clinical performance (marginal discoloration, surface texture, and retention) of bioactive restorative material (ACTIVA) and resin-modified glass ionomer cement (RMGIC) in carious primary molar restorations at 6 and 12-month intervals. Materials and methods: The split-mouth randomized controlled trial comprised 31 children aged 5–8 years having contralateral matched pair of carious primary molars with an International Caries Detection and Assessment System (ICDAS) II score 5. Sixty-two teeth were randomly allocated into two groups: group I—ACTIVA (n = 31) and group II—RMGIC (n = 31). After caries excavation, the teeth were restored with the respective materials and evaluated the marginal discoloration, surface texture, and retention after 6 and 12 months using modified USPHS (United States Public Health Service) criteria under the dental operating microscope. Statistical analysis: Mann–Whitney “U” test was used for intragroup comparison and the Wilcoxon signed-rank test for intergroup comparison. Results: A statistically significant difference was found in the surface texture of ACTIVA and RMGIC restorations at both 6-month (p = 0.002) and 12-month (p = 0.001) intervals, whereas the difference in the marginal discoloration and retention were not significant at both 6-month (p = 0.267 and 0.161, respectively) and 12-month intervals (p = 0.339 and 0.064, respectively). Conclusion: The surface texture of ACTIVA is found to be superior to RMGIC, whereas marginal discoloration and retention are similar to RMGIC at both 6 and 12-month intervals. Clinical significance: ACTIVA bioactive restorative material and RMGIC both enhance tooth remineralization with improved adhesion and fluoride release properties, making them valuable choices in various clinical scenarios.