Fuel and restoration treatments seeking to mitigate the likelihood of uncharacteristic high-severity wildfires in forests with historically frequent, low-severity fire regimes are increasingly common, but long-term treatment effects on fuels, aboveground carbon, plant community structure, ecosystem resilience, and other ecosystem attributes are understudied. We present 20-year responses to thinning and prescribed burning treatments commonly used in dry, low-elevation forests of the western United States from a long-term study site in the Northern Rockies that is part of the National Fire and Fire Surrogate Study. We provide a comprehensive synthesis of short-term (<4 years) and mid-term (<14 years) results from previous findings. We then place these results in the context of a mountain pine beetle (MPB; Dendroctonus ponderosae) outbreak that impacted the site 5–10 years post-treatment and describe 20-year responses to assess the longevity of restoration and fuel reduction treatments in light of the MPB outbreak. Thinning treatments had persistently lower forest density and higher tree growth, but effects were more pronounced when thinning was combined with prescribed fire. The thinning +prescribed fire treatment had the additional benefit of maintaining the highest proportion of ponderosa pine (Pinus ponderosa) for overstory and regeneration. No differences in understory native plant cover and richness or exotic species cover remained after 20 years, but exotic species richness, while low relative to native species, was still higher in the thinning+prescribed fire treatment than the control. Aboveground live carbon stocks in thinning treatments recovered to near control and prescribed fire treatment levels by 20 years. The prescribed fire treatment and control had higher fuel loads than thinning treatments due to interactions with the MPB outbreak. The MPB-induced changes to forest structure and fuels increased the fire hazard 20 years post-treatment in the control and prescribed fire treatment. Should a wildfire occur now, the thinning+prescribed fire treatment would likely have the lowest intensity fire and highest tree survival and stable carbon stocks. Our findings show broad support that thinning and prescribed fire increase ponderosa pine forest resilience to both wildfire and bark beetles for up to 20 years, but efficacy is waning and additional fuel treatments are needed to maintain resilience.