In vitro comparison of mechanical properties and degree of cure of bulk fill composites

Comparison of degree of conversion performance of bulk-fill resin composites: A systematic review and network meta-analysis of in vitro studies

OBJECTIVES

To systematically compile data on the degree of conversion (DC) for bulk-fill composites using a network meta-analysis.

METHODS

A systematic search for in vitro studies of DC of bulk-fill composites was performed in PubMed, Web of Science, Scopus, and Open Grey. Risk of bias within studies and due to missing evidence was assessed using the Joanna Briggs Institute scoring system and ROB-MEN tool, respectively. The primary outcome was the DC of bulk-fill composites. Surface Under the Cumulative Ranking curve (SUCRA) was used to rank relative performance. Inconsistencies in the model were investigated to ensure its validity and the level of confidence in the network meta-analysis (CINeMA) was assessed.

RESULTS

A total of 28 studies were included in the quantitative analysis. The average DC values (%) for 0-h/top, 0-h/bottom, 24-h/top, and 24-h/bottom were 59.09, 57.14, 66.73, and 63.87, respectively. According to their SUCRA ranking, the best-performing composites were: SonicFill, Venus Bulk Fill, and SDR (0-h/top), Reveal HD, i-Flow Bulk Fill, and Venus Bulk- Fill (0-h/bottom), Venus Bulk Fill, SDR, and QuiXfil (24-h/top), and Venus Bulk Fill, Aura Bulk Fill, and i-Flow Bulk Fill (24-h/bottom). Incoherence between direct and indirect evidence was identified as the most significant factor affecting confidence.

CONCLUSIONS

DC values of bulk-fill composites were within the range commonly reported for previous generations of "conventional" composites, with flowable composites tending to perform better than sculptable composites. High variability in DC data was observed, which may be attributed to incompletely understood methodological differences.

CLINICAL SIGNIFICANCE

DC is a fundamental parameter that influences multiple mechanical and biological properties of resin composites and is particularly relevant for the group of bulk-fill composites that are designed for use in thick layers.

Five-year clinical follow-up of bulk-fill restorative materials in class II restorations

This study evaluates the 5-year clinical performance of Class II restorations performed with different bulk-fill restorative materials. In the study, Class II restorations performed with Tetric Bulk-Fill (TBF), Filtek Bulk-Fill (FBF), and Equia Forte Fil (EF) were evaluated. One hundred-nineteen restorations were included in the study. Restorations were assessed during the 6th month, 1st, 2nd, and 5th year. Cochran Q, Pearson chi-square, and Fisher-Freeman-Halton tests were used for statistical analysis. In the 5th year, significant differences were observed in terms of retention, color match, marginal adaptation, marginal discoloration, surface texture, and anatomical form in all materials. There was a significant difference between EF and bulk-fill composites only in terms of retention and anatomical form. EF was significantly less successful than bulk-fill composites with regard to retention and anatomical form, but bulk-fill composites have shown similar clinical performance. EF cannot be an alternative to bulk-fill composites for Class II restorations.

Comparison of Water Sorption and Water Solubility Properties of Current Restorative Materials with Different Contents

OBJECTIVES

 This study aimed to investigate and compare water sorption and solubility properties of current restorative materials with different contents.

MATERIALS AND METHODS

 Alkasite, self-adhesive restorative material (Cention N, Ivoclar Vivadent AG, Schaan, Liechtenstein), bulk-fill glass hybrid restorative material (EQUIA Forte HT, GC Corp., Tokyo, Japan), nanohybrid universal composite material (OptiShade, Kerr Dental, United States), and bulk-fill composite material (Filtek One Bulk Fill Restorative, 3M ESPE, St. Paul, Minnesota, United States) were used. Samples (n = 6) were prepared (2 × 10 mm) according to the ISO 4049 standards. Water sorption and solubility values were calculated according to the ISO 4049 standards.

STATISTICAL ANALYSIS

 One-way ANOVA, Tukey's post-hoc, Tamhane's T2 post-hoc, Pearson's correlation, and independent samples t-tests were used for statistical analysis (p < 0.05).

RESULTS

 Group EQUIA Forte HT significantly showed the highest water sorption values (57.278 ± 3.174), while Group Filtek One Bulk Fill Restorative exhibited the lowest (4.429 ± 0.174; p < 0.05). The water sorption values for Group Cention N were 5.000 ± 0.542. Group EQUIA Forte HT significantly had the lowest water solubility values (-99.799 ± 1.909), while Group Cention N (-2.966 ± 0.402) significantly exhibited the highest (p < 0.05). There was no significant correlation between water sorption and solubility values for each material (p > 0.05).

CONCLUSION

 The bulk-fill nano-filled composite resin material was successful in terms of water sorption while the bulk-fill glass hybrid restorative system in terms of water solubility. Alkasite can be recommended to be used as a base material due to its high solubility feature. Monomer, filler type, and amount had an impact on the water sorption and solubility properties of the tested materials.

Photoactivated riboflavin-doped hydroxy apatite nanospheres infiltered in orthodontic adhesives

To assess micro-tensile bond strength (μTBS), degree of conversion (DC), microleakage (ML) antibacterial efficacy, and adhesive remnant index (ARI) of orthodontic brackets to enamel with different concentrations of photoactivated riboflavin-doped hydroxyapatite (HA) nanospheres (NS) (0%,1%,5% and 10%) and 0.5 wt% RF alone in orthodontic adhesive. Samples were included on the predefined inclusion criteria and positioned up to the cementoenamel junction (CEJ). Hydroxy apatite nanospheres (HANS) commercially bought were doped with RF. Surface characterization of HANS and RF-doped HANS were assessed along with EDX analysis. Samples were grouped based on experimental orthodontic adhesive modification. Group 1: Transbond XT no modification, Group 2: experimental Transbond XT 0.5 wt% RF, Group 3: experimental Transbond XT 0.5 wt% RF-doped 1% HANS, Group 4: experimental Transbond XT 0.5 wt % RF-doped 5% HANS and Group 5: Experimental Transbond XT 0.5 wt% RF-doped 10% HANS. Brackets were placed based on different adhesive modifications and samples underwent thermocycling. Samples were evaluated for μTBS, DC, and ML. The type of failure was assessed using ARI. Adhesive modified and un-modified in four different concentrations (0%, 1%, 5%, and 10%) and 0.5 wt% RF only were used to test efficacy against Streptococcus mutans (S.mutans). The survival rate of S.mutans and ML was determined using the Kruskal-Wallis Test. For the analysis of μTBS, ANOVA was employed, followed by a post-hoc Tukey HSD multiple comparisons test. The highest μTBS and lowest ML were observed in Group 2 experimental Transbond XT 0.5 wt% RF only. The lowest μTBS, highest ML, and lowest DC was seen in Group 5 experimental Transbond XT 0.5 wt% RF-doped 10% HANS. Samples in Group 1 in which Transbond XT was used as adhesive demonstrated significantly the highest microbial count of S.mutans and DC. Photoactivated RF-doped HANS in 1% and 0.5 wt% Riboflavin alone in orthodontic adhesive for metallic bracket bonding improved micro tensile bond strength, ML, DC, and antibacterial scores. RESEARCH HIGHLIGHTS: The highest μTBS and lowest ML were observed in Group 2 experimental Transbond XT 0.5 wt% RF only. The lowest μTBS, highest ML, and lowest DC was seen in Group 5 experimental Transbond XT 0.5 wt% RF-doped 10% HA-NS. Samples in Group 1 in which Transbond XT was used as adhesive demonstrated significantly the highest microbial count of S.mutans and DC.

Aluminum zirconate nanoparticles in etch and rinse adhesive to caries affected dentine: An in-vitro scanning electron microscopy, elemental distribution, antibacterial, degree of conversion and micro-tensile bond strength assessment

To incorporate different concentrations of Al2O9Zr3 (1%, 5%, and 10%) nanoparticles (NP) into the ER adhesive and subsequently assess the impact of this addition on the degree of conversion, μTBS, and antimicrobial efficacy. The current research involved a wide-ranging examination that merged various investigative techniques, including the application of scanning electron microscopy (SEM) for surface characterization of NP coupled with energy-dispersive x-ray spectroscopy (EDX), Fourier-transform infrared (FTIR) spectroscopy, μTBS testing, and microbial analysis. Teeth were divided into four groups based on the application of modified and unmodified three-step ER adhesive primer. Group 1 (0% Al2O9Zr3 NPs) Control, Group 2 (1% Al2O9Zr3 NPs), Group 3 (5% Al2O9Zr3 NPs), and Group 4 (10% Al2O9Zr3 NPs). EDX analysis of Al2O9Zr3 NPs was performed showing elemental distribution in synthesized NPs. Zirconium (Zr), Aluminum (Al), and Oxides (O2). After primer application, an assessment of the survival rate of Streptococcus mutans was completed. The FTIR spectra were analyzed to observe the characteristic peaks indicating the conversion of double bonds, both before and after the curing process, for the adhesive Etch and rinse containing 1,5,10 wt% Al2O9Zr3 NPs. μTBS and failure mode assessment were performed using a Universal Testing Machine (UTM) and stereomicroscope respectively. The μTBS and S.mutans survival rates comparison among different groups was performed using one-way ANOVA and Tukey post hoc (p = .05). Group 4 (10 wt% Al2O9Zr3 NPs + ER adhesive) specimens exhibited the minimum survival of S.mutans (0.11 ± 0.02 CFU/mL). Nonetheless, Group 1 (0 wt% Al2O9Zr3 NPs + ER adhesive) displayed the maximum surviving S.mutans (0.52 ± 0.08 CFU/mL). Moreover, Group 2 (1 wt% Al2O9Zr3 NPs + ER adhesive) (21.22 ± 0.73 MPa) samples displayed highest μTBS. However, the bond strength was weakest in Group 1 (0 wt% Al2O9Zr3 NPs + ER adhesive) (14.13 ± 0.32 MPa) study samples. The etch-and-rinse adhesive exhibited enhanced antibacterial activity and micro-tensile bond strength (μTBS) when 1% Al2O9Zr3 NPs was incorporated, as opposed to the control group. Nevertheless, the incorporation of Al2O9Zr3 NPs led to a decrease in DC. RESEARCH HIGHLIGHTS: 10 wt% Al2O9Zr3 NPs + ER adhesive specimens exhibited the minimum survival of S.mutans. 1 wt% Al2O9Zr3 NPs + ER adhesive samples displayed the most strong composite/CAD bond. The highest DC was observed in Group 1: 0 wt% Al2O9Zr3 NPs + ER adhesive.

Modified Hybrid Hydroxyapatite-Silver Nanoparticles Activated via a Blue Light Source in Various Concentrations in Two-Step Self-Etch Adhesive to Caries-Affected Primary Dentin

Aims: To evaluate hydroxyapatite-silver (HA-Ag) hybrid nanoparticles (NPs), as an antibacterial agent when integrated in self-etch (SE) adhesive. Blue light activated HA-Ag hybrid NP incorporation on mechanical properties, degree of conversion (DC), and microtensile bond strength (μTBS). Method: Eighty primary molar teeth have carious lesions reaching the dentin but not involving the pulp. The infected dentin was removed and carious-affected dentin (CAD) was preserved. Forty samples were inoculated with Streptococcus mutans. All primary teeth (n = 80) were allocated into four groups based on the incorporation of HA-Ag hybrid NPs in different concentrations (0%, 1%, 5%, and 10%). Group 1: 0% HA-Ag hybrid NPs + Clearfil SE bond primer, group 2: 1% HA-Ag hybrid NPs + Clearfil SE bond primer, group 3: 5 wt% HA-Ag NPs + Clearfil SE bond primer, and group 4: 10 wt% HA-Ag NPs + Clearfil SE bond primer. The survival rate assessment of S. mutans was conducted on 40 inoculated samples. On the remaining primary teeth (n = 40), Clearfil SE bonding agent was applied uniformly via a blue light source. The composite buildup was performed on the samples and μTBS and failure analysis assessed. Fourier transform infrared spectroscopy was performed to assess DC. Survival rates of S. mutans and μTBS among the tested groups were compared using ANOVA and Tukey post hoc analysis. Results: 10 wt % HA-Ag NPs + Clearfil SE bond primer exhibited the highest level of antibacterial efficacy (0.14 ± 0.02 CFU/mL) against S. mutans. The highest μTBS (18.38 ± 0.78 MPa) at the composite/CAD interface was in group 2 (1 wt % HA-Ag NPs + Clearfil SE bond primer + Clearfil SE bonding agent + activation with a blue light source). The highest DC was observed in the control group with Clearfil SE bond primer + Clearfil SE bonding agent + activation with a blue light source. Conclusion: 1 wt% HA-Ag hybrid NPs showed enhanced antibacterial effectiveness, DC, and bond strength of the SE adhesive to the primary CAD.

Experimental and Chitosan-Infused Adhesive with Dentin Pretreated with Femtosecond Laser, Methylene Blue-Activated Low-Level Laser, and Phosphoric Acid

Aim: To prepare experimental adhesive (EA) with 1% and without chitosan nanoparticles on dentin conditioned with a conventional technique phosphoric acid (PA) compared with two different contemporary techniques: photodynamic therapy (PDT) and femtosecond laser (FSL). Method: The methodology consisted of synthesis of EA and 1% chitosan-modified adhesive (CMA). Scanning electron microscopy, dentin adhesive interface assessment, energy-dispersive spectroscopy, shear bond strength (SBS), degree of conversion (DC), and bond failure were assessed. Teeth were selected, disinfected, and mounted in acrylic up to the cementoenamel junction. Occlusal enamel was removed and teeth were randomly allocated into groups and conditioned. These included Group 1: samples treated with PA; Group 2: specimens conditioned with methylene blue photosensitizer (MBP) activated by PDT; and Group 3: samples conditioned with FSL. Following different conditioning regimes, specimens were bonded using 1% CMA and EA. The composite buildup was followed by SBS testing and a bond failure assessment. DC was assessed for both EA and CMA. Analysis of variance and Tukey's post hoc test were used to compare the mean and standard deviation of SBS and DC in different experimental groups, with a significance level of p < 0.05. Results: Dentin pretreated with etch and rinse demonstrated the highest bond strength with 1% CMA. Dentin conditioned with MBP activated by PDT and bonded to EA showed the lowest bond scores. Overall SBS values of 1% CMA were better than EA irrespective of the conditioning regime of dentin. The DC was higher in EA adhesive. This was followed by DC in 1% CMA. DC in EA was found to be comparable with 1% CMA. Conclusions: PA remains the gold standard for dentin conditioning. The incorporation of 1% chitosan in adhesive improves SBS and results in no change in DC. The use of FSL in dentin conditioning can be used as an alternative approach as it results in SBS within acceptable limits. The study was approved by the ethical board of King Saud University.

Real-time imaging and quantitative analysis of internal gap formation in bulk-fill and conventional resin composites: An OCT evaluation

BACKGROUND

This study used optical coherence tomography (OCT) to observe real-time internal gap formation in both bulk-fill and conventional resin composites. It aimed to provide a quantitative analysis of variations, addressing the inconclusive nature of microleakage assessment caused by differences in testing methods.

METHODS

Fifty extracted third molars prepared with Class I cavities, were divided into five groups (n = 10). Conventional resin Filtek Z350 XT (FZX) was applied with a double-layer filling of 2 mm per layer. Bulk-fill resins X-tra fil (XTF), Filtek Bulk Fill Posterior Restorative (FBP), Surefil SDR Flow + (SDR), and Filtek Flowable Restorative (FFR) were applied with a single-layer filling of 4 mm. Real-time OCT imaging was conducted during light curing. Post-curing, the entire sample was OCT-scanned. Following this, ImageJ software was used to measure the gap (G1 %). Subsequently, thermal cycling (TC) (5000 times, 5 °C-55 °C) was applied, followed by OCT scanning to calculate the gap (G2 %) and ΔG%. Data were analyzed using two-way repeated measures ANOVA, Kruskal-Wallis test, and Duncan's test (α=0.05).

RESULTS

There was no significant difference in G1 % among the groups (p > 0.05). Following TC, FZX exhibited the highest G2 %, succeeded by FFR, FBP, XTF, and SDR, with SDR demonstrating the lowest G2 % (p < 0.05). FZX showed the highest ΔG% (p < 0.05), while SDR exhibited the lowest ΔG% (p < 0.05).

CONCLUSION

OCT proves to be a promising tool for detecting microleakage. TC exerted a more significant negative impact on conventional resin. Surefil SDR Flow + displayed the least microleakage, both before and after TC.

One-Year Evaluation of High-Power Rapid Curing on Dentin Bond Strength

This study investigated the effect of 3 s light-curing with a high-power LED curing unit on the shear bond strength of bulk-fill composites. Four bulk-fill composites were bonded to dentin with a universal adhesive (Scotchbond Universal Plus): two materials designed for rapid curing (Tetric PowerFill and Tetric PowerFlow) and two controls (Filtek One Bulk Fill Restorative and SDR Plus Bulk Fill Flowable). The 4 mm composite layer was light-cured with Bluephase PowerCure for 20 s at 1000 mW/cm2 ("20 s") or for 3 s at 3000 mW/cm2 ("3 s"). The samples were stored at 37 °C in distilled water and tested after 1, 6 and 12 months. The samples polymerised in the "3 s" mode had statistically similar or higher bond strength than the samples cured in "20 s" mode, except for the Tetric PowerFlow (1 month) and SDR+ (6 month). The flowable materials Tetric PowerFlow and SDR Plus initially showed the highest values in the "3 s" and "20 s" groups, which decreased after 12 months. The bond strength was statistically similar for all materials and curing protocols after 12 months, except for Tetric PowerFill cured with the "3 s" protocol (21.22 ± 5.0 MPa), which showed the highest value. Tetric PowerFill showed the highest long-term bond strength. While "3 s" curing resulted in equal or better shear bond strength, its use can only be recommended for a material with an AFCT agent such as Tetric PowerFill.

Clinical evaluation of subgingival open sandwich restorations: 3-year results of a randomized double-blind trial

OBJECTIVES

To provide a 3-year follow-up of previously treated patients to assess and compare the periodontal responses and clinical performance of proximal subgingival open sandwich restorations.

MATERIALS AND METHODS

Ninety-five adults participated in the study, with a combined total of 120 compound Class II cavities. These cavities had gingival margins located below the CEJ. Four different restorative materials were used to elevate the dentin/cementum gingival margins of the cavities: resin-modified glass ionomer, glass hybrid, flowable bulk-fill composite, or ion-releasing material, which were then completed with the same overlaying composite. Different periodontal and clinical evaluations, based on the criteria set by the World Dental Federation (FDI) criteria, were performed at different time intervals, including baseline, 6 months, 1, 2, and 3 years.

RESULTS

The type of base material did not affect the periodontal evaluations. There were no statistically significant differences between different time intervals or base material groups in any of the evaluated FDI parameters. However, the ion-releasing material scored significantly worse in the radiographic evaluation than any of the other groups.

CONCLUSIONS

All tested materials are suitable for proximal subgingival open sandwich restorations, as long as the restoration/tooth margin is at least 2-mm away from the bone crest.

CLINICAL SIGNIFICANCE

Clinicians can confidently choose any of the tested materials for proximal subgingival open sandwich restorations, as they have shown good outcomes from both periodontal and clinical perspectives.

Two-year evaluation of a nano-hybrid and a bulk-fill resin composite: a randomized, double-blind split-mouth clinical study

OBJECTIVES

The aim of this study was to compare the 2-year clinical performance of a bulk-fill composite resin and a nano-hybrid-filled composite resin in 6-12-year-old children in a split-mouth design.

MATERIALS AND METHODS

This randomized, split-mouth, and double-blind study was conducted on 89 patients aged 6-12 years with caries on bilateral mandibular first molars. In a split-mouth design, restorations of mandibular permanent molars were completed with nano-hybrid organically modified ceramic (ORMOCER)-based bulk-fill composite resin Admira Fusion x-tra (Voco GmbH, Cuxhaven, Germany) and nano-hybrid composite Grandio (Voco, Cuxhaven, Germany). Futurabond U single dose (Voco, Cuxhaven, Germany) was used with selective enamel etching. The clinical success of the restorations was evaluated using USPHS and FDI criteria at 6, 12, and 24-month follow-up controls.

RESULTS

In the 2-year follow-up, all restorations were clinically acceptable. Grandio was significantly worse than Admira Fusion x-tra in terms of surface luster and superficial change (p < 0.05). Surface staining and color match scores increased in Admira Fusion x-tra compared with Grandio significantly (p < 0.05).

CONCLUSIONS

Although both materials showed acceptable clinical performance over 2 years, a significant difference was observed between the surface luster, surface staining, marginal adaptation, and staining of the nano-hybrid composite placed with the incremental technique and the bulk-fill ORMOCER-based composite resin.

CLINICAL RELEVANCE

As an alternative to nano-hybrid composite resins, using bulk-fill restorative materials, which can be indicated in the proper case, may contribute to shortening treatment procedures and increasing patient and physician comfort, leading to clinical success.

Investigation of color and physicomechanical properties of peek and pekk after storage in a different medium

The aim of this study is to assess color stability, solubility, and water sorption on polyether ether ketone (PEEK) and polyether ketone ketone (PEKK) after immersion in different storage conditions. Material and Methods Ninety disc-shaped specimens (8 × 2) were obtained from CAD/CAM blocks [PEEK (n = 45) and PEKK (n = 45)]. Before immersion, baseline color value data were recorded with a spectrophotometer. The specimens were soaked in three solutions red wine, coffee, and distilled water at 37 °C for 28 days. Following immersion, color values were remeasured, and color-change values (ΔE) were calculated. Water sorption and solubility were assessed by mass gain or loss after storage in water for 28 days. The Kruskal-Wallis and the Mann-Whitney U test were used for analysis (P = 0.05). Results ΔE00 between PEEK and PEKK was significantly different statistically (P < 0.001). PEEK presented higher water sorption than PEKK (P = 0.005). The difference in solubility between PEEK and PEKK was not statistically significant (P = 0.163). The materials and storage medium types had a statistically significant impact (P = 0.100). In terms of staining potential, the solutions tested in this experiment were ranked as: coffee > red wine > distilled water. The results of this study demonstrated that PEKK was more successful in polymer-containing CAD/CAM materials as it exhibited less color change and water absorption.

Effect of different restorative systems and aging on marginal adaptation of resin composites to deep proximal margins

OBJECTIVES

To evaluate and compare the marginal integrity of different restorative systems bonded to proximal gingival dentin, and determine the consistency level of the results obtained by two in vitro methods.

MATERIALS AND METHODS

Thirty molars received occluso-mesial preparations with dentin/cementum gingival margins. They were divided into three groups and restored using different restorative systems with light-cured (Adhese Universal), self-cured (Palfique universal bond), and dual-cured (Futurabond U) adhesives. The restoration/gingival dentin interfaces were observed using scanning electron microscopy (SEM) and evaluated based on the World Dental Federation (FDI) criteria. After 10,000 thermal cycles, the marginal integrity was re-evaluated. Marginal integrity was evaluated by the percentage of continuous margin (% CM) at ×200 for SEM and as the frequency of each score within the FDI ranking.

RESULTS

No significant differences were found between the restorative systems immediately, however, the system with the light-cured adhesive had the lowest marginal integrity after aging. All tested restorative systems were adversely affected by aging. A moderate inverse correlation was identified between evaluation techniques.

CONCLUSION

The tested restorative systems utilizing self-cured and dual-cured adhesives may be preferable for achieving optimal marginal integrity when bonding to deep proximal margins, compared to the tested system with light-cured adhesive.

CLINICAL SIGNIFICANCE

When performing deep margin elevation, it is important to consider the adhesive system being used.

Marginal Adaptation of In Vitro Class II Restorations Made Out of Bulk or Conventional Composite Using Single- or Multi-Layered Techniques

Objective: Testing the influence of various restorative materials (conventional or bulkfill composites) and filling techniques (single- or multi-layered techniques) on the in vitro marginal adaptation of large class II direct composites with supra and sub-gingival margins subjected to thermomechanical loading (TML). Methods: A total of 40 prepared teeth were attributed randomly to five experimental groups. In Group 1, restorations were made of multi-layered high-viscosity conventional composite (Tetric EvoCeram); in Groups 2 and 3, restorations were made of a high viscosity bulkfill composite (Tetric EvoCeram Bulk Fill) applied in one (Group 2) or three layers (Group 3); in Groups 4 and 5, restorations were made of a flowable bulkfill composite (SDR flow) applied in one (Group 4) or two layers (Group 5), covered with a layer of high-viscosity conventional composite (Ceram-X Universal). A single adhesive (OptiBond FL) was used in all groups. All specimens were submitted to a staged TML comprising three phases (2 × 500,000 and 1,000,000 cycles) at 50 N with 3350 thermal cycles (5 to 55 °C) every 500,000 cycles. The tooth-restoration interfaces on proximal surfaces were evaluated quantitatively by scanning electron microscopy, before and after each TML phase, hence at three timepoints (T0, T1, T2 and T3). The following segments were considered for evaluation: proximal, vertical enamel margins (assessed individually on both restoration sides), cervical enamel (restoration side above CEJ) and cervical dentin margin (restoration side below the CEJ). Results: TML induced a significant reduction in continuous adaptation at both enamel and dentin margins in all groups, with percentages of continuous margins ranging from 75.2 to 91.8% at T0, and decreasing to values ranging from 21.3 to 73.9% at T3. Both composite systems and layering protocols had a significant influence on marginal adaptation of the restorations, with statistical associations depending on the restoration group and the timepoint considered. Defective margins in enamel were all of a cohesive nature with micro-fractures, while in dentin, interfacial gaps were the main defect observed. Conclusions/Clinical significance: The present results highlighted significant degradation of marginal adaption after long-term in vitro fatigue test using materials even with high-viscosity conventional resin composites, applied with a proper layering approach in medium-large sub-gingival cavities. While no significant differences were observed at the dentin cervical margins, there was a tendency for better adaptation at the enamel margin when using a higher modulus material with a multi-layered technique.

Effect of short fiber-reinforced composite combined with polyethylene fibers on fracture resistance of endodontically treated premolars

STATEMENT OF PROBLEM

Whether direct coronal restorations of endodontically treated teeth with short fiber-reinforced composite combined with polyethylene fibers provide adequate mechanical strength is unclear.

PURPOSE

The purpose of this in vitro study was to compare the fracture strength of endodontically treated premolars with standardized mesio-occluso-distal (MOD) preparations restored with short fiber-reinforced composite (SFRC) combined with polyethylene Ribbond fibers (PRFs).

MATERIAL AND METHODS

A total of 40 premolars were selected and distributed into 4 groups (n=10) as follows: group restored with SFRC (EverX Posterior), group restored with PRF (Ribbond fibers), and group restored with the combination PRF+SFRC, all followed by a conventional composite resin (IPS Empress Direct). MOD preparations and endodontic treatments were prepared except in the control group (intact teeth). MOD preparations and endodontic treatments were prepared except in the control group (intact teeth). Specimens were loaded using a universal testing machine until fracture occurred at a crosshead speed of 0.5 mm/min, and the failure type and fracture patterns was reported descriptively. The mean values of the groups were analyzed by using the Shapiro-Wilk test and 1-way ANOVA tests (α=.05).

RESULTS

Restoration with PRF+SFRC provided the highest mean ±standard deviation fracture resistance (288.2 ±73.5 N). Restoration with just PRF had the lowest values (192.4 ±25.4 N), which were statistically different from those of SFRC and PRF+SFRC (P<.05). The predominant mode of failure was mixed, and all fracture patterns were favorable.

CONCLUSIONS

Reinforcing endodontically treated premolars with MOD cavities with Ribbond fibers followed by a conventional composite resin enhanced fracture resistance and may be suitable for the direct coronal restoration of large posterior cavities in stress-bearing areas.

In vitro microleakage at the enamel and dentin margins of class II cavities of primary molars restored with a bulk-fill and a conventional composite

OBJECTIVES

This study assessed the enamel and dentin margin microleakage of class II cavities of primary molars restored with a bulk-fill and a conventional composite.

MATERIALS AND METHODS

In this in vitro, experimental study, standard class II cavities were created in the proximal surfaces of 60 extracted primary molars. The teeth were randomly divided into two groups, and restored with SonicFill bulk-fill and Filtek Z250 conventional composite along with Single Bond 2 adhesive. The teeth were coated with two layers of nail varnish to 1 mm around the restoration margins, and the apices were sealed with wax. The teeth underwent 1500 thermal cycles and incubated at 37°C for 24 h. They were then immersed in 1 M silver nitrate in the dark, rinsed with water, immersed in developing solution for 12 h, and exposed to fluorescent light. Next, they were mesiodistally sectioned, and digitally photographed under a stereomicroscope at ×10 magnification. The dye penetration depth was measured by a blind observer, and analyzed by the Mann-Whitney U test (α = .05).

RESULTS

No significant difference existed in microleakage between the two composite groups at the enamel (p = .76) or dentin (p = .16) margins. In both composite groups, microleakage at the dentin margins was significantly greater than that at the enamel margins (p = .000).

CONCLUSION

Considering the absence of a significant difference in microleakage, SonicFill bulk-fill composite can be used as an alternative to Filtek Z250 conventional composite for restoration of primary molars to benefit from its advantages such as simpler and faster application.

An In Vitro Staining Effect of Different Children's Health Drinks on Esthetic Restorative Materials

Aim

To evaluate the staining effect of different children's health drinks (Boost, Complan, and Pediasure) on esthetic restorative materials (giomer, nanohybrid composite, and ormocer).

Materials and methods

The specimens consist of giomer, nanohybrid composite, and ormocer. Before the discoloration process, 80 disks of each material were fabricated, each measuring 5 mm in diameter and 2 mm in thickness. These disks were then measured for lightness*red/green*blue/yellow (L*a*b*) values. Around 10 samples from each subgroup were then submerged in each of the four staining solutions. Analysis of discoloration levels was done at baseline and 48 hours after immersion in the staining solution. Each specimen's staining effect was evaluated using a spectrophotometer.Each specimen's L*a*b* values were measured three times by placing it on the measurement head. The internal energy (ΔE) unit, which expresses resistance to the staining effect, was derived using each specimen's L*a*b* values.

Results

All the tested materials showed a color change. However, giomer showed greater ΔE values compared to nanohybrid composite and ormocer. Of all the immersion media used, Boost samples resulted in the highest color change, followed by Complan, Pediasure, and milk.

Conclusion

Out of the three restorative materials used in the study, ormocer showed more resistance to color change than nanohybrid composite and giomer with all the tested media.

How to cite this article

Ponnala SL, Punithavathy R, Birapu UKC, et al. An In Vitro Staining Effect of Different Children's Health Drinks on Esthetic Restorative Materials. Int J Clin Pediatr Dent 2023;16(2):211-217.

Crack propensity of different direct restorative procedures in deep MOD cavities

OBJECTIVE

The purpose was to evaluate the crack formation associated with different direct restorative procedures of the utilized resin composites (RC) right after and 1 week later of the restoration.

MATERIALS AND METHODS

Eighty intact, crack-free third molars with standard MOD cavities were included in this in vitro study and randomly divided into four groups of 20 each. After adhesive treatment, the cavities were restored either with bulk (group 1) or layered (group 2) short-fiber-reinforced resin composites (SFRC); bulk-fill RC (group 3); and layered conventional RC (control). Right after the polymerization and a week later, crack evaluation on the outer surface of the remaining cavity walls was performed with a transillumination method utilizing the D-Light Pro (GC Europe) with the "detection mode." Between- and within-groups comparisons Kruskal-Wallis and Wilcoxon tests were used, respectively.

RESULTS

Post-polymerization crack evaluation showed significantly lower crack formation in SFRC groups compared to the control (p<0.001). There was no significant difference within SFRC groups and non-SFRC groups (p=1.00 and p=0.11, respectively). Within group comparison revealed significantly higher number of cracks in all groups after 1 week (p≤0.001), however, only the control group differed significantly from all the other groups (p≤0.003).

CONCLUSIONS

Post-polymerization shrinkage induced further crack formation in the tooth 1 week after the restoration. SFRC was less prone to shrinkage-related crack formation during the restorative procedure; however, after 1 week, besides SFRC, bulk-fill RC also showed less prone to polymerization shrinkage-related crack formation than layered composite fillings.

CLINICAL RELEVANCE

SRFC can decrease the shrinkage stress-induced crack formation in MOD cavities.

Periodontopathic bacterial adhesion to different restorative materials used to elevate proximal subgingival margins

This study compared the periodontopathic bacterial adhesion to four restorative materials used for deep margin elevation at 2, 24, and 48-h after incubation. Discs were produced from four restorative materials: resin modified glass ionomer, glass hybrid, flowable bulk fill resin composite, and bioactive ionic resin. Root dentin was used as control. Specimens were coated with saliva and used to culture a biofilm comprised of three strains of periodontopathic bacteria; Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans. Bacterial adherence was assessed by colony count assay, crystal violet staining, and visualized using confocal laser scanning microscopy. Data were analyzed by two-way ANOVA followed by Tukey's post hoc tests. The adhesion values for the control specimens were significantly higher than for other materials, while those for the flowable bulk fill were significantly lower than for any other material within all evaluation assays. The 2-h incubation period showed the lowest adhesion values regardless of the group. The 48-h adhesion values were higher than the 24-h results in all groups except the flowable bulk fill. Microscopic imaging partially supported the findings of the measurements. In terms of periodontopathic bacterial adhesion, the tested flowable bulk fill may be preferable for subgingival use over other tested materials.

The influence of different placement techniques on the clinical success of bulk-fill resin composites placed in Class II cavities: a 4-year randomized controlled clinical study

OBJECTIVE

The purpose of this double-blind and split-mouth randomized controlled clinical trial was to evaluate the clinical success of the placement technique (bulk-filling and incremental techniques) of a bulk-fill resin composite in Class II carious lesions.

MATERIALS AND METHODS

Two different bulk-fill resin composites, X-tra fil (Voco) and Filtek Bulk Fill (3M ESPE), were used in the bulk-filling and incremental techniques for 20 patients. The study was carried out in 4 groups, with 20 restorations in each group. Restorations were appraised at baseline, 6-month, 2-year, and 4-year recall. World Dental Federation (FDI) and the US Public Health Service (USPHS) criteria were used in the evaluations. The Friedman, Kruskal-Wallis, and Mann-Whitney U tests were used for the statistical analysis.

RESULTS

At the end of year 4, there was no loss of restoration in any group. According to the USPHS and FDI criteria, there was a difference in the baseline and 4-year in marginal adaptation and marginal discoloration of the restorations (P < 0.05). When Filtek-Bulk was placed as an incremental technique, there was a minor fracture in four restorations (P > 0.05). In addition, Filtek-Bulk showed a color change according to the results based on both the USPHS and FDI criteria (P < 0.05). The difference between the two placement techniques of each resin composite was not significant at the year 4 recall when all criteria were evaluated (P ˃ 0.05).

CONCLUSIONS

The 4-year clinical success of the evaluated bulk-fill composites is not dependent on the placement technique used.

CLINICAL RELEVANCE

This study can help clinicians choose which technique (bulk fill and incremental techniques) bulk-fill composites can be used.

TRIAL REGISTRATION

US National Library of Medicine, www.

CLINICALTRIALS

gov , ID: NCT04565860 Registered on 10/09/2020. Clinical Evaluation of Bulk-fill resin Composites in Class II Restorations.

The influence of horizontal glass fiber posts on fracture strength and fracture pattern of endodontically treated teeth: A systematic review and meta-analysis of in vitro studies

PURPOSE

This systematic review and meta-analysis aimed to summarize available evidence regarding the effect of horizontal glass fiber posts (HGFPs) on fracture strength and fracture pattern of endodontically treated teeth (ETT) compared to controls without HGFP. The review protocol was registered on the OSF registries.

METHODS

Literature searches were conducted in MEDLINE/PubMed, Scopus, Web of Science, Embase, Google Scholar, and ProQuest for all relevant studies published up to February 2022. All in vitro studies that assessed the influence of HGFPs on fracture strength and fracture pattern of ETT whether mesio-occluso-distal or mesio-occlusal or DO cavities were considered eligible. Review Manager (RevMan) was used for the meta-analysis. Subgroup and funnel plot analyses were also performed. Quality assessment was conducted by two independent reviewers.

RESULTS

A total of 12 articles met the inclusion criteria, and 10 studies underwent quantitative evaluation. The pooled effect showed that fracture resistance of molar teeth restored with HGFP was significantly higher than teeth without HGFP (standardized mean difference [SMD]: 1.61, 95% confidence interval [CI]: 0.14, 3.09, p = 0.03), whereas marginally significant for premolars (SMD: 1.36, 95% CI: -0.00, 2.73, p = 0.05). Regarding fracture patterns, the presence of an HGFP significantly increased the occurrence of restorable fracture patterns for premolars (odds ratios [OR]: 4.15, 95% CI: 1.60, 10.82, p = 0.004) compared to controls, whereas the difference was not significant for molars (OR: 1.09, 95% CI: 0.43, 2.77, p = 0.85). Moderate risk of bias was identified in 9/12 studies; one study showed a high risk of bias and two studies showed a low risk of bias.

CONCLUSIONS

Within the limitations of this study, there is evidence from in vitro studies that the use of HGFP increases the fracture resistance of the ETT when compared to teeth without HGFP and also reduces the occurrence of non-restorable fractures for premolars. However, well-conducted in vitro and prospective clinical studies are warranted to validate this finding.

Clinical evaluation of bulk-fill and universal nanocomposites in class II cavities: Five-year results of a randomized clinical split-mouth trial

AIM

Evaluating the clinical survival and quality parameters of class-II restorations using 3M™ Filtek^TM Bulk Fill Posterior Restorative compared to 3M™ Filtek^TM Supreme XTE Universal Restorative over a period of five years.

MATERIALS AND METHODS

A longitudinal, randomized, prospective split-mouth study with 60 patients (29 female, 31 male; mean age 44 y; range 20-77 y) and a total of 120 load-bearing class II restorations (TEST: n=60 Filtek Bulk Fill Posterior Restorative; CONTROL: n=60 Filtek Supreme XTE Universal Restorative) was conducted. Clinical evaluation was performed by blinded evaluators according to FDI criteria. Kaplan-Meier method was used for survival analysis and an intergroup comparison (Mann-Whitney-U-Test) was carried out. A basic significance level of 0.05 was corrected by the Bonferroni method to account for multiple testing (significance after correction: p<0.00067).

RESULTS

The mean overall survival of restorations was 92% after 56.98±1.51 months in the TEST group (95 CI= 54.02;59.94) and 92% after 57.25±1.46 months (95 CI= 54.39; 60.12) in the CONTROL group (log-rank p=0.995). In total, four failures occurred in both TEST and CONTROL group during the observation period (mean annual failure rate: 1.6%). The most common reasons for failure were chipping-fractures, debonding, cracked-tooth-syndrome and recurrent decay. With regard to the FDI criteria, no significant differences between TEST and CONTROL material occurred for any of the evaluated variables. In the TEST group two restorations had to be repaired and two had to be replaced, in the CONTROL group four restorations had to be replaced.

CONCLUSION

Both materials showed acceptable clinical performance and survival during the 5-year observation period.

CLINICAL SIGNIFICANCE

The use of a nanofilled bulk-fill composite proved to be an aesthetically, functionally and biologically satisfactory alternative in posterior dentition.

Damping Behaviour and Mechanical Properties of Restorative Materials for Primary Teeth

The energy dissipation capacity and damping ability of restorative materials used to restore deciduous teeth were assessed compared to common mechanical properties. Mechanical properties (flexural strength, modulus of elasticity, modulus of toughness) for Compoglass F, Dyract eXtra, SDR flow, Tetric Evo Ceram, Tetric Evo Ceram Bulk Fill, and Venus Diamond were determined using a 4-point bending test. Vickers hardness and Martens hardness, together with its plastic index (η_ITdis), were recorded using instrumented indentation testing. Leeb hardness (HLD) and its deduced energy dissipation data (HLD_dis) were likewise determined. The reliability of materials was assessed using Weibull analysis. For common mechanical properties, Venus Diamond always exhibited the significantly highest results and SDR flow the lowest, except for flexural strength. Independently determined damping parameters (modulus of toughness, HLD_dis, η_ITdis) invariably disclosed the highest values for SDR flow. Composite materials, including SDR flow, showed markedly higher reliabilities (Weibull modulus) than Compoglass F and Dyract eXtra. SDR flow showed pronounced energy dissipation and damping characteristics, making it the most promising material for a biomimetic restoration of viscoelastic dentin structures in deciduous teeth. Future developments in composite technology should implement improved resin structures that facilitate damping effects in artificial restorative materials.

A Study on the Photopolymerization Kinetics of Selected Dental Resins Using Fourier Infrared Spectroscopy (FTIR)

The aim of the presented study was a comparative analysis of the polymerization kinetics of dental resin-based composites currently used in dentistry in different environmental conditions (irradiance, activation time, layer thickness). The photopolymerization kinetics of eleven dental resins were investigated using a Woodpecker LED source. The DC was measured by FTIR in transmission mode and attenuated total reflection (ATR) from 5 s to 7 days. In the transmission mode, the spectra from parallel optical layers (about 0.2 mm thick) of samples placed between the KBr crystals were recorded. In the reflection mode, an ATR attachment with a diamond window was used. The DC calculation method was applied based on the application of a monomer absorption band at 1638 cm^-1 (stretching vibration double bond C=C of the vinyl group) without using a reference band. The data were analyzed by performing an ANOVA test comparison between sample groups at the significance level α = 0.05. For all tested materials, the polymerization kinetics consist of three stages. The fastest stage occurs during the irradiation, and the achieved DC value is 70-75% of the maximum value 5 s after the irradiation. Another 15-20% DC increase at a moderate speed takes about 15-20 min. There is also a very slow further increase in DC of 5-10% within 5 days after irradiation. For 8 out of the 11 tested fillings, the optimal photopolymerization conditions are as follows: a power density of 400 or 1000 mW/cm²; an exposure time of 10 s; and a thickness of the irradiated resin layer of up to 2 mm. The influence of various conditions and factors on the reaction kinetics is dominant only in the early, rapid phase of the conversion. After longer times, the DC values gradually level out under different light conditions. The DC of the dental resins are dependent on the irradiance, light source, filler type, time after irradiance, and monomer thickness.

Evaluation of Temperature Changes in the Pulp Chamber During Bulk-Fill Composite Polymerization: An In-Vitro Study

Aim:

To investigate the temperature changes occurring in the pulp chamber during the polymerization of bulk-fill resin materials cured with different light sources by using a pulpal microcirculation simulation device in vitro.

Materials and Methods:

Class I cavities of width 2 × 3 mm were prepared on 120 permanent noncarious teeth. All samples were adjusted to maintain 2 mm dentin thickness within the pulp chamber and the cavity base. Venus Bulk Fill, Tetric Evo Ceram Bulk Fill, Filtek Bulk Fill, and Filtek Z250 were used as restorative materials. Materials were polymerized with Valo Light Emitting Diode (LED), Elipar S10, and Elipar Deepcure-S devices. A j-type thermocouple with microcirculation assemblies was used for measuring the temperature increments inside the pulp chamber during the polymerization of bulk-fill composite resins. The obtained data were recorded.

Results:

Statistically significant difference was found between the light sources and the temperature changes occurring during the polymerization ( P <.05). The difference in temperature increases was found to be significant ( P <.05) between restorative materials. The highest temperature rise values were obtained from Venus Bulk Fill.

Conclusion:

All light devices used in the study caused an increase in temperature in the pulp chamber in all groups. For all resin materials used, it was observed that the temperature values arising during the polymerization via used light sources did not exceed 5.5°C, which is the critical value for pulp.

Determination of microhardness of bulk-fill resins at different depths

The aim of this study was to determine Vickers microhardness (HV) in bulk fill resins at different depths. Test specimens were prepared with different bulk fill resins: Filtek Bulk-Fill (3M ESPE) [FBF], Surefill SDR flow (Dentsply) [SDR], Fill-UP (COLTENE) [FU] and Surefill (Dentsply) [SF]. Semi-cylindrical test specimens were prepared in a mold 6 mm in diameter and 4 mm thick (n=5). A 1000 mW/cm2 light curing unit was applied (Coltolux LED - Coltene) for 20 seconds. HV was determined with three indentations (Vickers Future Tech FM300, 300 g, 8 s) at four depths: 1, 2, 3 and 4 mm from the top surface to the interior. Data were recorded immediately (t0) and 24 hours later (t24). Results were analyzed with two-way ANOVA (p<0.05), and multiple comparisons were performed using Tukey's test. Mean and SD of HV at t0 for each mm were: [FBF] t0: 49.23(4.65) / 48.32(3.36) / 44.38(2.06) / 40.59(2.58); [FBF] t24: 61.37(3.47) / 62.63(3.03) / 57.27(5.22) / 56.37(5.88);[SDR]t0:27.81(3.13) / 28.07(2.4) / 27.24(2.94) / 25.71(3.0); [SDR] t24: 35.11(2.16) / 35.17(1.96) / 35.53(1.81) / 33.18(2.08); [FU] t0: 41.43(1.41) / 39.87(0.88) / 38.11(1.81) / 39.09(1.92); [FU] t24: 49.27(1.54) / 48.77(1.77) / 48.65(1.88) / 46.76(4.93); [SF] t0: 71.35(7.09) / 67.39(9.76) / 68.95(6.21) / 64.1(8.35); [SF] t24: 76.06(6.61) / 75.31(9.37) / 75.2(11.57) / 69.81(12.14). ANOVA showed significant effect of material, depth and recording time (p<0.05), and Tukey's test showed that recording sites (depths) differed significantly, giving four homogeneous groups. Under the conditions of this study, it can be concluded that microhardness of bulk-fill resins can be affected by depth and post-curing time.

Influence of Manual and Ultrasonic Scaling on Surface Roughness of Four Different Base Materials Used to Elevate Proximal Dentin-Cementum Gingival Margins: An In Vitro Study

AIM

To evaluate and compare the effects of both manual and ultrasonic scaling on surface roughness of four different base materials, used for elevating dentin/cementum gingival margins of proximal cavities.

METHODS AND MATERIALS

Eighty human upper molars with compound Class II mesial cavities, with gingival margins 1 mm below the cemento-enamel junction (CEJ), were divided into four different groups according to the type of the base material used; resin-modified glass ionomer (RMGI), glass hybrid (HV-GIC), flowable bulk-fill resin composite (Bulk Flow) and bioactive ionic resin (Activa). This was followed by completing the restorations with the same resin composite. All materials were used according to the manufacturers' instructions. All groups were further subdivided into two subgroups according to the scaling technique: manual (hand) or ultrasonic. All restorative and scaling procedures were performed after fixation of specimens with acrylic beside neighboring teeth to simulate natural contact. The mean surface roughness (Ra, μm) of all specimens was measured quantitatively and qualitatively by a three-dimensional (3D) surface analyzer system at two stages; (1) after thermal cycling for 5000 cycles without scaling and (2) after scaling. Data were statistically analyzed using analysis of variance (ANOVA), Tukey post hoc tests, and paired sample t-tests (at α=0.05).

RESULTS

For baseline readings, the Bulk Flow group had the lowest Ra values, while HV-GIC group had the highest. RMGI and Activa groups had no statistical significant difference between their Ra values (p>0.05). For post scaling readings, hand scaling had significantly lower Ra values than ultrasonic scaling in all the material groups (p<0.05), except in the Bulk Flow group, where both scaling methods were not significantly different from each other (p>0.05).

CONCLUSION

Bulk Flow had the smoothest surfaces when cured against a matrix band compared with the other tested base materials. When hand and ultrasonic scaling methods were compared, the latter technique had more detrimental effect on the surface texture of the four tested base materials.

Bond strength of bulk-fill resin composites

 Aim: Evaluating the resin-dentin bond strength of Class II conventional and bulk-fill composite restorations, using different cavity sizes before and after aging. Methods: Seventy-five human molars were distributed into groups according to the buccolingual width of the cavities, conservative (n=25) and extended (n=50). They were divided according to the restorative material: conventional (Z100/control group) or bulk-fill resin composites (Filtek Bulk Fill/FBF; Tetric N Ceram Bulk Fill/TNCBF; Filtek Bulk Fill Flow/FBFF; Surefill SDR flow/SDR). The restored teeth were sectioned on sticks (n=50 per restorative materials + width cavities group), half were stored in Water/Ethanol 75% for 30 days and the other half were submitted to the immediate microtensile bond strength (μTBS) test. Data were analyzed applying the Three-Way Analysis of Variance (ANOVA), Bonferroni test, test t, and Weibull analyses (p<0.05). Results: SDR and FBF presented lower μTBS values for extended preparation when compared to the conservative preparation, before aging. After aging, only for the FBFF, a decrease in the μTBS values was observed. Comparing the μTBS values, before and after aging, the SDR demonstrated lower μTBS values after aging when the conservative cavity was used. A decrease in the μTBS values was observed for the Z100, the FBF and, the FBFF, after aging, when the extended cavity was used. Conclusion: The effect of cavity preparation and aging on the resin-dentin of Class II is material dependent. Most of the bulk-fill resin composites evaluated presented a similar performance to the conventional resin composites for all the conditions of this study.

In vitro biocompatibility testing of different base materials used for elevation of proximal subgingival margins using human gingival epithelial cells

PURPOSE

To analyze the biological effects of four base materials used for elevation of proximal subgingival margins on gingival epithelial cells.

METHODS

Twenty-eight specimens for each of the four base materials (total 112 specimens) were used: resin-modified glass ionomer (RMGI), glass hybrid (HV-GIC), flowable bulk fill resin composite (Bulk Flow) and bioactive ionic resin (Activa). Proximal enamel and root dentin were used as controls. Gingival epithelial cell viability was calculated after direct incubation on all four types of material for either 24 h or 72 h using both the methyl tetrazolium and trypan blue dye exclusion assays. Data were analyzed statistically using one-way analysis of variance, Tukey post hoc test and independent sample t-test (P < 0.05).

RESULTS

Cell viability values in both assays showed significant differences among the study groups. Bulk Flow showed the highest values, followed in order by Activa and the control groups. Both HV-GIC and RMGI had the lowest values. Cell viability in all of the study groups was higher after incubation for 72 h than after 24 h.

CONCLUSION

In terms of biocompatibility with epithelial tissues, bulk fill resin composite appears to be most suitable, followed by bioactive composite, for subgingival placement than glass ionomer-based materials, especially that containing 2-hydroxy-ethyl methacrylate.

Effect of Light Curing Distance on Microhardness Profiles of Bulk-Fill Resin Composites

Bulk-fill (BF) dental resin composites are made to be polymerized in increments of up to 5 mm rather than the 2 mm increment recommended for conventional composites. This project aimed to determine microhardness (MH) profiles of BF resin composites at different depths and varying light cure (LC) distances from the light source in an attempt to mimic varying clinical situations. Forty-eight cylindrical specimens (4 mm diameter and 6 mm height) were prepared from 3 BF composites: Tetric N-Ceram Bulk-Fill (TBF), Filtek One Bulk-Fill (FBF), and Sonic-Fill 2 (SF2). Four different distances (0, 2, 4, and 6 mm) from the LC unit were investigated. Vickers MH was measured at the top and bottom of the samples and at every 1 mm, by creating 3 indentations at each depth. The bottom-top microhardness ratio (MHR) and percentage reduction in MHR were also measured. Data was analyzed using mixed-model repeated-measure ANOVA at 0.05 significance level. The main variables effects “material, LC distance, and depth” were significant (p < 0.001). Increasing LC distance and the depth of the tested BF significantly affected Vickers MH and MHR. None of the tested BF materials had sufficient MHR at the depths of 4–6 mm. SF2 showed the least MHR reduction.

Aging-Dependent Changes in Mechanical Properties of the New Generation of Bulk-Fill Composites

This study evaluated the behavior of a new generation of bulk-fill resin composites after prolonged exposure to an aqueous environment and accelerated aging in ethanol. Six bulk-fill materials were tested (Tetric PowerFill, Filtek One Bulk Fill Restorative, Tetric EvoCeram Bulk Fill, Fill-Up!, Tetric PowerFlow, SDR Plus Bulk Fill Flowable) and compared to two conventional reference materials (Tetric EvoCeram and Tetric EvoFlow). Flexural strength, modulus, and Weibull parameters were examined at three time points: 1 day, 30 days, and 30 days followed by ethanol immersion. Degree of conversion after 30 days, water sorption, and solubility up to 90 days were also investigated. Filtek One Bulk Fill had the highest flexural strength and modulus among the tested materials, followed by Tetric PowerFill and SDR plus. Flexural strength and modulus of high-viscosity bulk-fill materials showed higher stability after accelerated aging in ethanol compared to their low-viscosity counterparts and reference materials. After 30 days, the degree of conversion was above 80% for all tested materials. Dual-cure material Fill-Up! was the best-cured material. The water sorption was highest for Fill-Up!, Filtek One Bulk Fill Restorative, and Tetric EvoFlow, while solubility was highest for Tetric EvoCeram. After aging in water and ethanol, new generation high-viscosity bulk-fill materials showed better mechanical properties than low-viscosity bulk-fill and conventional composites under extended light curing conditions.

Laboratory methods to simulate the mechanical degradation of resin composite restorations

OBJECTIVES

This study reviewed the literature to identify in vitro approaches that have been used to simulate the mechanical degradation and fatigue of resin composite restorations.

METHODS

A search for articles was carried out in 4 databases and included studies in which composite restorations were bonded to teeth and subject to cyclic loading. Articles were assessed for eligibility, and the following items were the extracted from the included studies: authors, country, year, materials tested, simulation device and details including load magnitude and frequency, number of cycles, type of antagonist, test medium, and temperature. Data were analyzed descriptively.

RESULTS

The 49 studies included showed a high level of heterogeneity in methods, devices, and test parameters. Nineteen different simulation devices were used, applying loads varying between 30 and 2900 N, and frequencies varying between 0.4 and 12 Hz. The load and frequency used most often were ~ 50 N (63.3%) and 1.5-1.7 Hz (32.7%). The number of cycles varied between 10 K and 2.4 M, 1.2 M was the most prevalent (40.8%). The majority of studies combined cyclic loading with at least one additional aging method: static liquid storage, thermo-mechanical cycling applied simultaneously, and thermal cycling as a discrete aging step were the three most frequent methods. The overall evidence indicated reporting problems, and suggested a lack of clinical validation of the research methods used.

SIGNIFICANCE

Validation studies, underlying clinical supporting data, and better reporting practices are needed for further improving research on the topic. Specific suggestions for future studies are provided.

Impact of Resin Composite Viscosity and Fill-technique on Internal Gap in Class I Restorations: An OCT Evaluation

The aim of this in vitro study was to quantitatively evaluate the internal gap of resin composites of high-and low-viscosity used in single- and incremental-fill techniques in Class I cavities exposed to thermal cycling (TC) using optical coherence tomography (OCT). Cavities of 4-mm depth and 3-mm diameter were prepared in 36 third molars randomly distributed into four groups, according to viscosity of restorative resin-based composite (high or low viscosity, all from 3M Oral Care) and technique application (bulk or incremental fill) used (n=9): RC, high-viscosity, incremental-fill, resin-based composite (Filtek Z350 XT Universal Restorative); BF, high-viscosity, bulk-fill, resin-based composite (Filtek One Bulk Fill); LRC, low-viscosity, incremental-fill, resin-based composite (Filtek Z350 XT Flowable Universal Restorative); and LBF, low-viscosity, bulk-fill, resin-based composite (Filtek Flowable Restorative). Single Bond Universal Adhesive system (3M Oral Care) was used in all the experimental groups. The incremental-fill technique was used for RC and LRC groups (2-mm increments), and a single-layer technique was used for BF and LBF groups, as recommended by the manufacturer. The internal adaptation of the resin at all dentin walls was evaluated before and after TC (5000 cycles between 5°C and 55°C) using OCT images. Five images of each restored tooth were obtained. Images were analyzed using ImageJ software that measured the entire length of the gaps at the dentin-restoration interface. The length of gaps (μm) was analyzed using two-way repeated measures ANOVA and the Tukey tests (α=0.05). There was a significant interaction between material types and TC (p=0.006), and a significant difference among all material types (p<0.0001), before and after TC (p<0.0001). Increased internal gaps at the dentin-restoration interface were noticed after TC for all groups. RC presented the lowest value of internal gap before and after TC, while LBF showed the highest values of internal gap after TC. In conclusion, TC negatively affected the integrity of internal gap, whereas high-viscosity, incremental-fill, resin-based composite presented better performance in terms of internal adaptation than low-viscosity, bulk-fill materials in Class I cavities.

Comparison of three different bulk-filling techniques for restoring class II cavities: μCT, SEM-EDS combined analyses for margins and internal fit assessments

OBJECTIVE

Evaluation of the behavior of three different bulk-filling techniques in terms of internal adaptation and external marginal sealing for restoring class II cavities.

METHODS

Fifteen extracted sound molar teeth were used. Two standardized class II mesio/disto-occlusal (MO/DO) slot cavities, 4 mm long, 4 mm wide and 3 mm deep were prepared in each tooth, obtaining n=30 cavity preparations. The cavities were randomly assigned into three groups (n=10 per group) according to three bulk filling techniques: Bulk Traditional (BT), Bulk&Go (BG) and Bulk&Flow (BF). The teeth were analyzed by scanning electron microscopy (SEM) to investigate the external marginal seal. Thereafter, the chemical composition of tooth-restoration interface was analyzed by energy-dispersive X-ray spectroscopy (EDS). Complementary information to the SEM and EDS were obtained by micro-computed tomography (μCT) to assess the internal fit.

RESULTS

SEM analysis showed a proper external marginal seal for all groups tested as confirmed by the EDS investigation, highlighting the presence of adhesive layer at the tooth-restoration interface. The internal marginal adaptation by means of μCT analysis revealed gaps formation at the tooth-restoration interface only for BT group, while an intimate contact free of gaps were found in the other two groups. Moreover, in BT and BF groups voids were present within the restoration.

SIGNIFICANCE

BG and BF techniques can be considered as reliable alternatives to BT technique, as they simplify the class II restoration without transforming it into class I, thus ensuring a successful result.

Effect of Stress Generated by Occlusal Cyclic Force on Class I Bulk-Fill Composite Restoration Microleakage

Objective  This study aimed to evaluate the effects of different types and restorative techniques of Class I composite restorations with a single loading force on stress distribution and cyclic loading force on microleakage formation.

Materials and Methods  Class I cavities were prepared in premolars with 4 mm depth and divided into six groups of different restorations with: (1) Filtek Z250; (2) a 3-mm-thick layer of Filtek Bulk Fill Flowable Restoration and covered with Z250; (3) a 1.5-mm-thick layer of flowable composite and covered with Z250; (4) lining all cavity with flowable composite and restored with Z250; (5) Filtek Bulk Fill Posterior Restoration; and (6) lining all cavity with flowable composite and restored with bulk-fill composite. The specimens with and without cyclic occlusal loading were subjected to microleakage observation. In addition, six different models of Class I restorations corresponding to the microleakage study were generated. Finite element analysis (FEA) was used to identify the stress distribution under a single loading force.

Statistical Analysis Data were statistically analyzed by two-way analysis of variance and multiple comparison. The significance level set at 0.05.

Results  Cavity lining or restoration with flowable composite underneath conventional composite reduced stress on composite resin based on FEA (groups 2 and 3). The cyclic stress on composite increased microleakage. Restoration with flowable composite underneath conventional composite reduced the microleakage in Class I restoration (groups 2, 3, and 4).

Conclusion  The most effective cavity lining with a flowable composite underneath conventional composite restoration was stress reduction under loading force resulting in microleakage reduction.

Physicochemical characterization of two bulk fill composites at different depths

Objectives

This study analyzed the physical-chemical behavior of 2 bulk fill resin composites (BFCs; Filtek Bulk Fill [FBF], and Tetric-N-Ceram Bulk Fill [TBF]) used in 2- and 4-mm increments and compared them with a conventional resin composite (Filtek Z250).

Materials and Methods

Flexural strength and elastic modulus were evaluated by using a 3-point bending test. Knoop hardness was measured at depth areas 0–1, 1–2, 2–3, and 3–4 mm. The translucency parameter was measured using an optical spectrophotometer. Real-time polymerization kinetics was analyzed using Fourier transform infrared spectroscopy.

Results

Flexural strength was similar among the materials, while TBF showed lower elastic modulus (Z250: 6.6 ± 1.3, FBF: 6.4 ± 0.9, TBF: 4.3 ± 1.3). The hardness of Z250 was similar only between 0–1 mm and 1–2 mm. Both BFCs had similar hardness until 2–3 mm, and showed significant decreases at 3–4 mm (FBF: 33.45 ± 1.95 at 0–1 mm to 23.19 ± 4.32 at 3–4 mm, TBF: 23.17 ± 2.51 at 0–1 mm to 15.11 ± 1.94 at 3–4 mm). The BFCs showed higher translucency than Z250. The polymerization kinetics of all the materials were similar at 2-mm increments. At 4-mm, only TBF had a similar degree of conversion compared with 2 mm.

Conclusions

The BFCs tested had similar performance compared to the conventional composite when used in up to 2-mm increments. When the increment was thicker, the BFCs were properly polymerized only up to 3 mm.

Influence of Curing Time on the Microbiological Behavior of Bulk-Fill Nanohybrid Resin Composites

This in vitro study aimed to evaluate the influence of curing time on surface characteristics and microbiological behavior of three bulk-fill resin-based composites (RBCs). Materials were light-cured for either 10 s or 80 s, then finished using a standard clinical procedure. They were characterized by surface morphology (SEM), surface elemental composition (EDS), surface roughness (SR), and surface free energy (SFE). Microbiological behavior was assessed as S. mutans adherence (2 h) and biofilm formation (24 h) using a continuous-flow bioreactor. Statistical analysis included a two-way ANOVA and Tukey’s test (p < 0.05). Materials differed substantially as filler shape, dimension, elemental composition and resin matrix composition. Significant differences between materials were found for SR, SFE, and microbiological behavior. Such differences were less pronounced or disappeared after prolonged photocuring. The latter yielded significantly lower adherence and biofilm formation on all tested materials, similar to conventional RBCs. Improved photoinitiators and UDMA-based resin matrix composition may explain these results. No correlation between surface characteristics and microbiological behavior can explain the similar microbiological behavior of bulk-fill materials after prolonged photocuring. This different performance of bulk-fill materials compared with conventional RBCs, where surface characteristics, especially surface chemistry, influence microbiological behavior, may have important implications for secondary caries occurrence and restoration longevity.

Evaluation of Efficiency of Polymerization, Surface Roughness, Porosity and Adaptation of Flowable and Sculptable Bulk Fill Composite Resins

A new category of commercial bulk fill composite resins (CRs) enables the placement of 4-mm-thick layers as an alternative to the traditional time-consuming incremental technique. The purpose of the present study was to compare the efficiency of the polymerization, adaptation and porosity of two high-viscosity ‘sculptable’ bulk fill CRs (Filtek™ Bulk Fill (3M™ ESPE, St. Paul, MN, USA) and Tetric EvoCeram^® Bulk Fill (Ivoclar Vivadent AG, Schwan, Liechtenstein)) and two low-viscosity ‘flowable’ bulk fill CRs (SureFil^® SDR™ flow (Dentsply Sirona, Charlotte, NC, USA) and Tetric EvoFlow^® Bulk Fill (Ivoclar Vivadent AG, Schaan, Liechtenstein)). Cylindrical samples of the bulk fill CRs (4 mm height × 10 mm diameter) were analyzed by Fourier-transform infrared spectroscopy (FTIR) and atomic force microscopy (AFM). Additionally, occlusal cavities were prepared in twelve extracted human molars and restored with the bulk fill CRs (n = 3 for each CR). The adaptation and porosity of the bulk fill CRs were evaluated by X-ray microcomputed tomography (µCT) with a 3D morphometric analysis, and the adaptation was also analyzed by scanning electron microscopy (SEM) on longitudinal vestibulo-oral sections of the restored teeth. The AFM analysis demonstrated that the surface roughness of the SureFil^® SDR™ flow was higher than that of the Tetric EvoFlow^® Bulk Fill and that the surface roughness of Filtek™ Bulk Fill was higher than that of Tetric EvoCeram^® Bulk Fill. µCT and SEM confirmed that the flowable bulk fill CRs had excellent adaptation to the cavity walls. The 3D morphometric analysis showed the highest and lowest degrees of porosity in Filtek™ Bulk Fill and Tetric EvoFlow^® Bulk Fill, respectively. In general, the flowable bulk fill CRs exhibited better adaptation, a higher efficiency of polymerization and lower porosity than the sculptable materials.

Comparison of depth of cure sonic-activated bulk-fill composite, low viscosity, and high viscosity in different thickness

Context

The polymerization quality of composite resin can be measured by measuring the cure depth. Vickers hardness ratio is an indirect method of measuring the depth of cure of the composite resin.

Aims

This study aimed to compare the effect of composite resin type and material thickness on the depth of cure of sonically activated bulk-fill composite resin (SonicFill, Kerr), low viscosity (Surefill SDR bulk-fill, Dentsply), and high viscosity (Tetric N Ceram bulk fill, Ivoclar Vivadent).

Settings and Design

The research is experimental laboratory.

Materials and Methods

The research samples were 36 cylindrical composite resin blocks with a thickness of 2 mm and 4 mm, which were divided into six groups (n = 6) based on sonically activated bulk-fill composite resin, low viscosity, and high viscosity. All samples were put in an incubator for 24 h. The microhardness ratio was performed using a Vickers microhardness tester with a weight of 100 g for 15 s, which calculated by the formula: Vickers hardness number bottom/top.

Statistical Analysis Used

The two-way ANOVA with Tukey post hoc test was used for statistical analysis (P < 0.05).

Results

The results of the two-way ANOVA test showed an effect of the type of composite resin on the depth of cure of the composite resin (P < 0.05); there was no effect of material thickness on the depth of cure of composite resin (P > 0.05). There was no interaction of composite resin type and material thickness to a resin composite depth (P > 0.05).

Conclusions

The depth of cure of sonic-activated and high-viscosity bulk-fill composite resin was greater than low-viscosity bulk-fill composite resin.

Dental Bulk-Fill Resin Composites Polymerization Efficiency: A Systematic Review and Meta-Analysis

Dental Bulk-Fill Composites (BFCs) and Bulk-Fill Flowables (BFFs) were introduced in the market to facilitate efficient bulk filling of cavities up to 5 mm. The aim of this study was to synthesize the literature investigating their polymerization efficiency. A comprehensive search of PubMed and the Cochrane Library from 2010 to January 2019 was performed using the medical subject headings. Screening of the titles, abstracts and full text was performed. Data extraction for relevant information was done on the included studies. Clinically relevant parameters were selected to present the study estimates (meta-analysis) using a random effects model for polymerization efficiency (Degree of Conversion (DC) and Depth of Cure (DoC)). Twenty one studies fulfilled the inclusion criteria and were included in the analysis reporting seven BFCs and nine BFFs. Ten materials reported acceptable DC values of above 55% and ten materials reported adequate DoC values. Most of the stated materials reported adequate DC and DoC values in at least one investigation with BFFs showing higher and more acceptable values compared to packable BFCs. It is suggested that future studies be carried out using a standard methodology following the ISO 4049 standard and manufacturer’s instructions to compare results.

Effects of different surface treatments and adhesive self-etch functional monomers on the repair of bulk fill composites: A randomised controlled study

OBJECTIVE

To evaluate the effect of different adhesive protocols on the microtensile bond strength (μTBS) and integrity of the repaired bulk fill composite interface.

METHODS

Two hundred and seventy composite blocks made of bulk fill composites of different viscosity were randomly assigned to 18 surface conditioning groups (n = 15/group). The universal adhesive systems used were Heliobond™, Tokuyama bond force II™ and Scotchbond Universal™. A nanohybrid resin composite was applied as the repair material. Negative and positive control groups were included. Stick shape specimens of each group were subjected to μTBS testing. Representative samples from all test groups were subjected to microscopic, profilometric and SEM examination to determine their mode of failure. The data were analysed statistically using two-way ANOVA test, Tukey's test and the independent t-test (α = 0.05).

RESULTS

The mean μTBS of all test groups ranged between 28.5 and 46.8 MPa and varied with the type of adhesive system employed. Significantly highest μTBS values were obtained when Tokuyama bond force II™ and Scotchbond Universal™ adhesives were used (p < 0.01) which were comparable to the coherent strength of the bulk fill resin composite in the positive control groups (p > 0.05). The viscosity of the bulk fill composite did not significantly influence repair bond strength. The microscopy and SEM examination of the failed interfaces revealed a mixture of adhesive and cohesive failures.

CONCLUSIONS

Under the tested conditions, significantly greater μTBS of repaired bulk fill composite was achieved when the substrate surface was treated with adhesive systems containing a functional monomer.

CLINICAL SIGNIFICANCE

Eff ;ecting a repair of a bulk fill resin composite restoration with the application of a functional monomer containing adhesive system, such as Tokuyama Bond Force II™ or Scotchbond Universal™, would seem to enhance the interfacial bond strength and integrity of the repaired resin composite interface.

Influence of material type, thickness and storage on fracture resistance of CAD/CAM occlusal veneers

OBJECTIVES

The present study aimed to evaluate the effect of restoration thickness, CAD/CAM material, and 6 months of artificial saliva storage on the fracture resistance of occlusal veneers.

MATERIALS AND METHODS

A total of 84 intact maxillary molars were sectioned 4.0 mm occlusal to the cementoenamel junction to expose the dentine. The teeth were assigned into 3 main groups according to the type of restorative material (e.max CAD, Vita Enamic, and Lava Ultimate). In each group, the teeth were allocated into 2 subgroups (n = 14) according to restoration thickness (1.0 and 1.5 mm). The veneers were adhesively bonded using dual-cure self-adhesive luting agent. A total of 42 specimens comprising half the tested subgroups were stored in distilled water for 24-h before the test. The remaining half was stored in artificial saliva at 37 ± 1 °C in an incubator for 6 months. All specimens (n = 84) were subjected to 5000 thermal cycles between 5 and 55 °C ± 2 before the fracture resistance test. The maximum force at fracture was recorded in Newton. Failure mode was analyzed using a stereomicroscope. The results were analyzed using a parametric Three-way ANOVA test.

RESULTS

The results of the Three-way ANOVA test revealed that material type and restoration thickness significantly affected fracture resistance values (p < 0.5), while 6 months of storage in artificial saliva had no significant effect on mean fracture resistance values (p˃0.5). The most common failure patterns in CAD/CAM resin composite and polymer-infiltrated ceramics were scores I and score II. For glass ceramic groups, score IV and III were more dominant.

CONCLUSIONS

All the tested CAD/CAM restorations in both thicknesses exhibited fracture resistance values exceeding normal and parafunctional bite forces. Polymer-infiltrated ceramics and CAD/CAM resin composite veneers showed more favorable fracture patterns.

Physical and mechanical characteristics of short fiber-reinforced resin composite in comparison with bulk-fill composites

PURPOSE

The objective of this study was to evaluate the physical and mechanical properties of a short fiber-reinforced resin composite: everX-Posterior and compare it with two bulk-fill composites, namely, Filtek Bulk-fill and Beautifil-Bulk, which are intended for large posterior restorations.

METHODS

Investigated properties were flexural strength, flexural modulus, surface roughness, volumetric shrinkage and depth of cure. Scanning electron microscopy images of each specimen after the flexural test were used for cross-sectional comparison. Results were analyzed using ANOVA following Tukey post-hoc test.

RESULTS

Flexural strength of everX-Posterior was comparable with two other resin composites, showing higher flexural modulus. EverX-Posterior showed the highest surface roughness after polishing and the lowest volumetric shrinkage (2.29%) among all composites used in this study. Data also showed that the everX-Posterior depth of cure was 4.24 mm, which was the highest among the three groups.

CONCLUSION

Based on the results of this study, it was concluded that everX-Posterior as a short fiber-reinforced composite showed improvements and satisfactory performance in mechanical and physical properties, which make it a reliable base material candidate for large posterior restorations.

Comparative Evaluation of Fracture Resistance of Endodontically Treated Teeth Restored with Different Core Build-up Materials: An In Vitro Study

The aim is to evaluate the fracture resistance of endodontically treated teeth restored with posterior direct composite (PRC) resin, bulk-fill composite resin, dual-cure composite (DCC) resin, and short fiber-reinforced composite (SFC) resin material.

Effect of food-simulating solvents on flexural properties of bulk-fill resin composites

PURPOSE

This study evaluated the flexural strength of bulk-fills after immersion in food-simulating solvents.

METHODS

Four overlapping segments along both sides of bar-shaped specimens (25 × 2 × 2 mm) made from bulk-fill composite were irradiated with an Elipar LED light-curing (1,200 mW/cm² for 20 s) device. The specimens were then divided into four groups (n = 20), according to storage media-namely, distilled water, 99% ethanol, heptane, and methyl ethyl ketone-at 37^oC for 4 weeks. Flexural testing was done with a universal testing machine at a crosshead speed of 1 mm/min.

RESULTS

Data were analyzed with the two-way and one-way ANOVA and post-hoc Tukey (HSD) tests (P < 0.05), along with the Weibull statistic. Flexural properties significantly differed in relation to the bulk-fill and solvent used. The flexural properties of bulk-fills decreased in solvents. SonicFill in distilled water had the highest values for flexural properties (σ_f = 165.77 MPa; E_f = 10.3 GPa), followed by the values for SonicFill in ethanol and those for X-tra base and everX Posterior in water. Venus Bulk Fill in methyl ethyl ketone yielded the lowest values (σ_f = 74.11 MPa; E_f = 3.06 GPa).

CONCLUSION

The flexural properties of bulk-fills are affected by the food-simulating solvent used and by the filler content, type, and resin component.

Could sonic delivery of bulk-fill resins improve the bond strength and cure depth in extended size class I cavities?

Background

The implementation of restorative procedures that guarantee success and optimize clinical time is the target of investigations in Restorative Dentistry. This study aimed to analyze the influence of sonic insertion of bulk-fill (BF) and conventional (C) resin composites on the microtensile bond-strength (µ-TBS) and cure depth (CD) of large and deep class I restorations.

Material and Methods

Fifty-six healthy human premolars were selected and occlusal cavities (4 x 4 x 3 mm; factor C = 5) were prepared. TC - Tetric N-Ceram (BF), SF - SonicFill (BF), and Z350 - Filtek Z350 XT (C) composite resins were used to restore the cavities, using sonic (S) and non-sonic (NS) insertion techniques. A group restored with conventional incremental insertion (I) using Z350 XT resin was performed serving as a control. Teeth were prepared for microtensile bond-strength test (µ-TBS). And also, restoration depths of 1 and 4 mm were measured with an automatic microhardness indenter (50 g -15 s) to determine the CD. Results were evaluated using ANOVA, Scheffe, and Games-Howel posthoc test (α = 0.05).

Results

Types of resins and insertion techniques present statistical differences for µ-TBS and CD (p ≤ 0.001). The µ-TBS was higher respectively for the groups SF > TC > Z350; however, the sonic insertion for SF and Z350 (I) did not present significant differences in µ-TBS. Higher microhardness values were observed on the surface (1mm). At a depth of 4 mm Z350 (I)> SF(S)> SF(NS)> TC(S/NS)> Z350(S/NS) (p< 0.001). Pearson's Correlation of bond strength and base micro-hardness was significant (p ≤ 0.001), strong, and positive (0.955).

Conclusions

The influence of sonic insertion is material dependent, influenced only the microhardness of the SonicFill resin and did not interfere with the bond strength and cure depth of other bulk fill and conventional resin composite. Key words:Composite resins, dentin, hardness tests, tensile strength, Bulk-fill resins, sonic insertion.