Monomer conversion, microhardness, internal marginal adaptation, and shrinkage stress of bulk-fill resin composites

Effect of butylated hydroxytoluene (BHT) concentrations on polymerization shrinkage stress and other physicochemical properties of experimental resin composites

The present study examined different concentrations of the butylated hydroxytoluene (BHT) inhibitor on the kinetics of conversion, polymerization shrinkage stress, and other correlated physicochemical properties of experimental resin composites (ERC). A model composite was formulated with 75 wt% filler containing 0.5 wt% camphorquinone and 1 wt% amine with BHT concentrations of 0.01 wt% (BHT-0.01); 0.1 wt% (BHT-0.1); 0.25 wt% (BHT-0.25); 0.5 wt% (BHT-0.5); 1 wt% (BHT-1), and control (no BHT). They were tested on polymerization shrinkage stress (PSS; n = 5), degree of conversion (DC; n = 3), maximum polymerization rate (RpMAX; n = 5), water sorption (Wsp; n = 0), and solubility (Wsl; n = 10), flexural strength (FS; n = 10), flexural modulus (FM; n = 10), Knoop microhardness (KH; n = 10), and microhardness reduction (HR; n = 10). Data concerning these tests were submitted to one-way ANOVA and Tukey's test (α = 0.05; β = 0.2). BHT-0.25, BHT-0.5, and BHT-1 showed a gradually significant decrease in PSS (p = 0.037); however, BHT-1 demonstrated a decrease in the physicochemical properties tested. Thus, within the limitations of this study, it was possible to conclude that BHT concentrations between 0.25 and 0.5 wt% are optimal for reducing shrinkage stress without affecting other physicochemical properties of ERCs.

Novel matrix formulation for resin composite: Chemical and biomechanical characterization - Part 1

OBJECTIVE

This study aimed to investigate the effects of adding cholesteryl methacrylate (CM) monomer to experimental composite resins and evaluate its impact on polymerization shrinkage force (PSF), Knoop microhardness (KHN), sorption and solubility (SS), vulnerability to spontaneous oxidation (VOE), porosity (BES), viscosity (V), and cross-link density (CLD). CM was synthesized, mixed with varying proportions of Bis-GMA, 70 wt% filler particles, and 40 % TEGDMA. The groups tested were: CM0 (60 % Bis-GMA), CM6 (54 % Bis-GMA/6 % CM), CM12 (48 % Bis-GMA/12 % CM), CM18 (42 % Bis-GMA/18 % CM) and CM24 (36 % Bis-GMA/24 % CM). The PSF was evaluated using a universal testing machine. KHN was measured with a 50 g load for 30 s. SS was determined according to ISO 4049:2009. VOE was measured with a three-electrode system in an electrochemical cell. BES images were obtained using an electron microscope to assess porosity. Viscosity was measured through rheological analysis. CLD was estimated from hardness readings before and after ethanol storage.

RESULTS

CM6 (0.34 N) and CM12 (0.34 N) exhibited the lowest PSF values compared to CM0 (0.91 N). For KHN, CM6 (32.03) and CM12 (31.03) had higher values than CM0 (25.83) and were similar to CM18 (29.39) and CM24 (28.64). SS showed no significant differences among the groups. VOE indicated low vulnerability across all groups. CM12 had greater porosity compared to CM0 in BES images. CM0 had the lowest viscosity among the groups. No differences in CLD were observed among CM0, CM12, CM18, and CM24 regarding softening effects.

SIGNIFICANCE

Adding CM to Bis-GMA/TEGDMA composite resins can reduce polymerization shrinkage force and increase the initial Knoop microhardness without affecting the other properties studied.

Effects of Printing Angle and Post-Curing Time on the Color and Translucency of 3D-Printed Temporary Restoration

In resins produced with a 3D printer, the printing parameters affect the properties of the restoration produced. This study examined the effect of the printing angle and post-curing time on the optical properties of temporary restorations. A total of 135 disk-shaped Formlabs temporary resins (10 × 2 mm) were produced at three different printing angles (0, 45, and 90 degrees) and post-cured for three different times (20, 40, and 60 min) (n = 15). Color and translucency measurements were taken for each group with a spectrophotometer (VITA Easyshade V). The ΔE values between printing angles and curing times influence each other. The highest color change was observed in the groups produced with a 90° printing angle. Considering the post-curing times, the highest color change was observed in the groups cured for 40 min. Increasing the curing time from 20 to 40 min decreases the translucency, whereas further increasing the curing time does not significantly affect the translucency. In terms of the impact on the translucency caused by the printing angles, 0° exhibited a lower translucency compared to other printing angles. During the 3D printing of temporary prostheses, both printing angles and post-curing times can affect their optical properties.

Marginal integrity in minimally invasive molar resin composite restorations: Impact of polymerization shrinkage

OBJECTIVES

This study utilized non-linear finite element (FE) models to explore polymerization shrinkage and its impact on marginal integrity in molars following both selective caries removal (SCR) and conventional treatment. Specifically, we performed 2D in silico simulations to study residual stresses post-resin polymerization shrinkage and their influence on the marginal integrity of various restoration types.

METHODS

Initially, FE models were developed based on a cohesive zone framework to simulate crack propagation along the bonded interfaces between restoration and tooth structure in SCR-treated molars with class I and class II restorations. The modeled resin composite restorations first underwent polymerization shrinkage and were then subjected to various occlusal loading conditions. Stress magnitudes and distributions were identified to evaluate the margin integrity and predict the mechanism and location of interfacial failure.

RESULTS AND DISCUSSION

The FE models computed polymerization shrinkage stresses of less than 1 MPa, exerting a minor influence on the composite/tooth interface. Occlusal loading, however, significantly impacted the load-bearing capacity of the composite/tooth (c/t) interface, potentially jeopardizing the restoration integrity. Especially under bi-axial occlusal loading, interfacial debonding occurred in the vertical cavity walls of the class I restorations, increasing the risk of failure. Notably, SCR-treated teeth exhibited better margin integrity than restored teeth after complete caries removal (NCR). These findings provide valuable insights into the mechanical behavior of SCR-treated teeth under different loading conditions and highlight the importance of considering the load scenarios that may lead to failure at the c/t interface. By investigating the factors influencing crack initiation and delamination, this novel research contributes to the optimization of restorative treatments and aids in the design of more resilient dental restorations.

Performance of low shrinkage Bis-EFMA based bulk-fill dental resin composites

OBJECTIVES

The purpose of this study was evaluating the performance of new Bis-EFMA based bulk-fill composites with common methacrylate based composites and commercial dental composites.

METHODS

The Bis-EFMA monomer was synthesized and the novel Bis-EFMA based bulk-fill composites were prepared. The resin composite samples were co-cultured with human gingival epithelial cells and human dental pulp stem cells to test the biocompatibility. The edge adaptation was observed under a combination of stereoscope and scanning electron microscope. The internal hardness was measured using a Vickers microhardness tester after one-time filling of cavities prepared in extracted teeth. After friction and wear test on the surface of the resin composites, the surface morphology and volume wear of each group were measured by the optical profilometer. The color stability was measured by a colorimeter.

RESULTS

Direct contact with human gingival epithelial cells and human dental pulp stem cells did not cause significant changes in their growth density and morphology, indicating good biocompatibility of Bis-EFMA group (p > 0.05). The continuous margin proportion of the Bis-EFMA group was as good as commercial bulk-fill composites (p > 0.05). The sectional microhardness results showed that the Bis-EFMA group had the highest microhardness. After the friction and wear test, the volume wear of the Bis-EFMA group was minimal, indicating its good wear resistance and mechanical strength. Color changes in all resin groups after 28 days of immersion were within the clinically acceptable range.

SIGNIFICANCE

The addition of Bis-EFMA demonstrated excellent biocompatibility, edge adaptation and color stability comparable to commonly used clinical bulk-fill composites, along with preferable mechanical strength, friction and wear resistance. Bis-EFMA based bulk-fill composites have the potential to be employed as a bulk filling material in commercial dental composite applications.

Evaluation of surface microhardness and gingival marginal adaptation of three different bulk-fill flowable resin composites: A comparative study

OBJECTIVES

To evaluate surface microhardness and gingival marginal adaptation of three different bulk-fill flowable resin composites (FB-RBCs) in Class V cavities with enamel or dentin margins before and after thermocycling (TMC).

MATERIALS AND METHODS

Three available FB-RBCs were used; Palfique Bulk Flow (PaBF) (Tokuyama Dental), SDR Flow+ Bulk Fill Flowable (Dentsply Sirona), and I-Flow Bulk Fill (I-Dental). Thirty discs were prepared from each type of FB-RBCs. The discs were subjected to Vickers microhardness tester machine. Class V cavities were prepared on 180 molars. Gingival margins of half the specimens were prepared above CEJ and the other half below CEJ. Cavities were restored with FB-RBCs for gingival marginal adaptation test. Two-way ANOVA was used in microhardness, while three-way ANOVA was used for marginal adaptation.

RESULTS

The used materials showed statistically significant differences in microhardness and marginal adaptation.

CONCLUSIONS

Regarding microhardness, PaBF showed the highest value before TMC and SDR was the highest after TMC. Regarding marginal adaptation, SDR revealed the best marginal adaptation than PaBF and I-flow, either subjected to TMC or not.

CLINICAL SIGNIFICANCE

The longevity of cervical restorations depend on both the location of the cavity margin and the material used. The microfractures in resin composite surface due to low surface microhardness as well as marginal gaps seen in laboratory studies could be considered as an indicative parameter for clinical problem associated with marginal differences.

Comparison of Blue and Infrared Light Transmission Through Dental Tissues and Restorative Materials

OBJECTIVES

The depth of cure using blue-light photocuring units (BL) is limited by tooth structure and qualities of the restorative material through which the activating wavelength must pass. Recent developments incorporate an infrared (IR) activated upconversion (UC) fluorescence of a lining agent filled with nanocrystals of NaYF4 and doped with YB+3 and Tm+3 that emit both blue and violet light locally at the interface of the liner and restorative resin. The purpose of this study was to evaluate the BL and 975 nm infrared (IR) light power transmission through dental tissues and restorative materials.

METHODS AND MATERIALS

Power transmissions of the IR laser (975 nm) and a monowave blue-only light-curing unit (Bluephase 16i) through dental tissues (enamel, dentin, and enamel/dentin junction, or DEJ), eight (8) various dental resin composites, and eight (8) dental ceramics, each at four thicknesses (1, 2, 3 and 4 mm) were evaluated (n=5) using a thermopile sensor (PM10, Coherent Inc) connected to a laser power meter (Fieldmate, Coherent Inc). Power transmission values of each light source and restorative material were subjected to analysis of variance and Tukey test at a pre-set alpha of 0.05.

RESULTS

A linear correlation (r=0.9884) between the supplied current and emitted IR power of the laser diode was found, showing no statistical power reduction with increased distances (collimated beam). For tooth tissues, the highest power transmissions for both light sources were observed using 1.0 mm enamel while the lowest values were found for 2.0 mm dentin and an association of 2.0 mm DEJ and 1.0 mm dentin. The only group where IR demonstrated significantly higher transmission when compared to BL was 1.0 mm enamel. For all resin composites and dental ceramics, increased thickness resulted in a reduction of IR power transmission (except for EverX Posterior fiber-reinforced composite and e.max HT ceramic). IR resulted in higher transmission through all resin composites, except for Tetric EvoCeram White. The highest BL transmission was observed for SDR Flow, at all thicknesses. Higher IR/BL ratios were observed for EverX Posterior, Herculite Ultra, and Lava Ultimate, while the lowest ratio was observed for Tetric EvoCeram White. Reduced translucency shades within the same material resulted in lower power ratio values, especially for BL transmission. Higher IR/BL ratios were observed for e.Max LT, VitaVM7 Base Dentin, and e.max CAD HT, while the lowest values were found for VitaVM7 Enamel and Paradigm C.

CONCLUSION

IR power transmission through enamel was higher when compared to blue light, while no difference was observed for dentin. The power transmission of IR was higher than BL for resin composites, except for a high value and low chroma shade. Fiber-reinforced resin composite demonstrated the highest IR/BL power transmission ratio. A greater IR/BL ratio was observed for lower translucency ceramics when compared to high translucency.

The Evaluation of the Cervical Marginal Sealing of Direct vs. Indirect Composite Resin Restorations in MOD Cavities

INTRODUCTION

The aim of this in vitro study was to compare the quality of marginal sealing at the cervical margins of indirect and direct composite resin restorations in mesio-occluso-distal (MOD) cavities.

MATERIAL AND METHOD

MOD preparations were performed on 30 extracted teeth. The mesial cervical margin of each tooth was relocated using a flow composite resin (Enamel Plus HRi Flow, Micerium, Avegno, GE, Italy), then the samples were divided into three groups. In group A, the cavities were directly restored using a nanohybrid composite resin (Miris 2 Coltène Whaledent, Altstaetten, Switzerland) and a universal adhesive (ScotchBond Universal, 3M ESPE, St. Paul, MN, USA) by the etch-and-rinse strategy, for group B, the restoration procedure was similar but the self-etch strategy was used, and the samples in group C were filled using the inlay technique. Each sample was stored for 48 h in a 2% methylene blue solution, then it was cut in a mesio-distal direction using a Struers Secotom 50 device (Cleveland, OH, USA). The marginal sealing and adhesive interface were assessed for each sample at the cervical margin by optical microscopy (OM) and scanning electron microscopy (SEM). One-way ANOVA and Bonferroni post-hoc tests were used with a significance level of 0.05.

RESULTS

Significant differences were recorded within groups A and C, between mesial and distal margins (p = 0.02 in group A and p = 0.043 in group C).

CONCLUSIONS

The marginal sealing is more effective in MOD inlay restoration compared to direct restorations. Relocation of the cervical margin with flow composite resin and the use of different adhesive strategies do not improve the marginal sealing.

Relation between internal adaptation and degree of conversion of short-fiber reinforced resin composites applied in bulk or layered technique in deep MOD cavities

OBJECTIVE

The purpose was to evaluate the degree of conversion (DC), internal adaptation (IA) and closed porosity (CP) of short-fiber reinforced resin composites (SFRC) associated with layered or bulk restorative procedures in deep MOD cavities.

METHODS

Eighty third molars with standardized MOD cavities (5-mm-depth, 2.5-mm-width) were randomly divided into four groups and restored as follows: 1) bulk SFRC; 2) layered SFRC; 3) flowable bulk-fill resin-based composites (RBC); 4) layered conventional RBC. After one-month wet storage the samples were subjected to micro-computed tomography measurements and scanning electron microscopy to assess the IA and CP. Micro-Raman spectroscopy was used to determine the DC in different depths. Data were subjected to ANOVA and Tukey's post-hoc test, multivariate analysis and partial eta-squared statistics (p < 0.05). Pearson correlation coefficient was determined to assess the relationship among the parameters of interest.

RESULTS

Gap/total interface volume ratio ranged between 0.22-0.47%. RBCs applied in bulk revealed significantly lower gap volume (p < 0.001) and CP (p < 0.05). Each group showed complete detachment on the pulpal and partial on the lateral walls, except for group3. While the highest DC% was achieved by the conventional RBC (87.2%), followed by the flowable bulk-fill (81.2%), SFRC provided the best bottom to top DC ratio (bulk: 96.4%, layered: 98.7%). The effect of factors studied (RBC type, filling technique) on IA and DC was significant (p < 0.001).

SIGNIFICANCE

Bulk placement of RBCs exhibited lower interfacial gap volume and achieved satisfactory DC without significant correlation between these parameters. Incremental insertion of SFRC had no advantage over bulk placement in terms of IA and DC.

Influence of light exposure techniques on in vitro pulp temperature rise during bulk fill composite Class I restorations

This in vitro study assessed peak temperature and temperature increase (ΔT) within the pulp chamber during different extended photoactivation techniques (EPT-applying similar radiant exposure values) to resin-based composites (RBCs) placed in a Class I cavity preparation in an extracted human lower third molar. A T-type thermocouple was placed in the pulp chamber and connected to a temperature analysis device (Thermes, Physitemp). The tooth was attached to an assembly simulating the in vivo environment (controlled baseline pulp chamber temperature and fluid flow). The real-time pulp chamber temperature was evaluated throughout the photoactivation (Bluephase N, Ivoclar Vivadent) of two bulk-fill RBCs: Tetric N Ceram Bulk Fill (TBF; shade: IVA; Ivoclar Vivadent); Surefill SDR flow + (SDR, shade: Universal; Dentsply Sirona), which were exposed to different curing techniques: 40 s-occlusal surface; 20 s-occlusal + 10 s-buccal + 10 s-lingual surfaces; 10 s-buccal + 10 s + lingual + 20 s-occlusal surfaces. Each EPT delivered 42.4 J/cm2. Vickers hardness (VHN) was measured on the removed, sectioned RBC restorations at the top and bottom middle areas after curing. ΔT and VHN data were analyzed using 2-way ANOVA followed by Bonferroni post-hoc test (α = 0.05). Peak temperature data were analyzed using one-way ANOVA and Dunnett's post-hoc test (α = 0.05). SDR showed higher ΔT values than TBF (p = 0.008) in some EPTs. Neither technique resulted in ΔT values greater than 5.5 °C. Both composites had acceptable bottom/top hardness ratios (greater than 80%), regardless of the photoactivation technique. The evaluated EPTs may be considered safe as a low-temperature increase was noticed within the pulp chamber.

Polymerization shrinkage stress of contemporary dental composites: Comparison of two measurement methods

The aim of this study was to compare two testing methodologies employed for assessing the polymerization shrinkage stress of dental resin composites. Ten commercial resin composites were investigated (EverX Posterior & Flow; G-ænial Anterior, Posterior, A'CHORD & Universal Injectable; Filtek One Bulk Fill & Universal Restorative; SDR flow+ and Aura Bulk Fill). Photoelastic and contraction forces measurement methods were performed. The slope of the linear trendline and C-factor of specimens were calculated. The shrinkage stress values (range between: 6.4-13.4 MPa) obtained by the photoelastic method were higher for all resin composites than the values obtained by contraction forces measurements (range between 1.2-4.8 MPa). However, there was a strong linear correlation between these methods (r=0.8). The use of both investigated methods revealed important information about the shrinkage behavior of the restorative resin composites.

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.

Influence of surface sealants on the quality of posterior restorations with bulk-fill composites: A 4-year randomized clinical trial

OBJECTIVES

The aim of this study was to evaluate the clinical performance of surface sealants associated with a bulk-fill composite in posterior restorations after 4 years.

METHODS

A total of 174 posterior restorations were performed on 57 participants using a self-etch adhesive system and a bulk-fill composite. The groups were then divided into the following categories: 1) without surface sealant (NoS), 2) with surface sealant Biscover (Bisco, SBi), and 3) with surface sealant Permaseal (Ultradent, SPe). Restorations were evaluated using FDI criteria at baseline and after 1 and 4 years. Statistical analysis was conducted using Kaplan-Meier survival analysis and the Chi-square test (α = 0.05).

RESULTS

After 4 years, only one restoration was lost (1 in the NoS group). The fracture/retention rate (with 95% confidence interval) was 98% for NoS and 100% for both SBi and SPe (p = 0.76). The majority of secondary outcomes showed minor defects, with no significant differences among the groups (p > 0.05). However, significant differences were observed among the groups in terms of marginal staining and marginal adaptation (p = 0.03). In both items, twelve restorations (nine in NoS, one in SBi, and two in SPe) showed minor marginal discrepancies favoring the sealant groups (SBi and SPe).

SIGNIFICANCE

Regardless of the use of surface sealants, the bulk-fill composite restorations showed excellent clinical performance after 4 years. However, the groups that received sealants showed better marginal adaptation and less marginal discoloration compared to those that did not receive sealants.

Effect of Radiant Exposure on the Physical and Mechanical Properties of 10 Flowable and High-viscosity Bulk-fill Resin Composites

OBJECTIVES

To evaluate the effect of the different radiant exposures from a multipeak light curing unit on the physical and mechanical properties of flowable and high-viscosity bulk-fill resin-based composites (RBC).

METHODS

Five flowable bulk-fill RBCs (Tetric N-Flow Bulk-fill, Ivoclar Vivadent; Filtek Bulk Fill Flow, 3M Oral Care; Opus Bulk Fill Flow APS, FGM; Admira Fusion x-base, Voco and; and SDR Plus Bulk Fill Flowable, Dentsply Sirona) and five high-viscosity bulk-fill RBCs (Tetric N-Ceram Bulk-fill, Ivoclar Vivadent; Filtek One Bulk Fill, 3M Oral Care; Opus Bulk Fill APS, FGM; Admira Fusion x-tra, Voco; and SonicFill 2, Kerr) were photo-cured using a VALO Cordless light (Ultradent) for 10, 20, and 40 seconds at an irradiance of 1200, 800, or 400 mW/cm2, resulting in the delivery of 4, 8, 12, 16, 24, 32, or 48 J/cm2. Post-gel shrinkage (Shr) was calculated using strain-gauge test. The degree of conversion (DC, %) was calculated using FTIR. Knoop hardness (KH, N/mm2) and elastic modulus (E, MPa) were measured at the top and bottom surfaces. Logarithmic regressions between the radiant exposures and mechanical properties were calculated. Radiodensity was calculated using digital radiographs. Data of Shr and radiodensity were analyzed using two-way analysis of variance (ANOVA), and the DC, KH, and E data were analyzed with two-way ANOVA using split-plot repeated measurement tests followed by the Tukey test (a = 0.05).

RESULTS

Delivering higher radiant exposures produced higher Shr values (p<0.001) and higher DC values (R2=0.808-0.922; R2=0.648-0.914, p<0.001), KH (R2=0.707-0.952; R2=0.738-0.919; p<0.001), and E (R2=0.501-0.925; R2=0.823-0.919; p<0.001) values for the flowable and high-viscosity RBCs respectively. Lower KH, E and Shr were observed for the flowable bulk-fill RBCs. All bulk-fill RBCs had a radiopacity level greater than the 4-mm thick aluminum step wedge. The radiant exposure did not affect the radiopacity.

CONCLUSION

The Shr, DC, KH, and E values were highly correlated to the radiant exposure delivered to the RBCs. The combination of the higher irradiance for longer exposure time that resulted in radiant exposure between 24 J/cm2 to 48 J/cm2 produced better results than delivering 400 mW/cm2 for 40 s (16 J/cm2), and 800 mW/cm2 for 20 seconds (16 J/cm2) or 1200 mW/cm2 for 10 seconds (12 J/cm2). All the bulk-fill RBCs were sufficiently radiopaque compared to 4 mm of aluminum.

Comparison of two composite resin materials for splinting of dental luxation injuries: A double blind randomized controlled trial

BACKGROUND/AIM

Luxation is a common traumatic dental injury treated with a wire composite (WC) splint. However, bulk-fill flowable composite and conventional packable composite have not been compared for retaining these splints. Therefore, the objectives of this randomized controlled trial were (1) to compare retention of WC splints, and (2) to compare adhesive point dimension, application and removal time, and effect on tooth mobility between the two WC splints.

MATERIALS AND METHODS

In this parallel group, non-inferiority double blind randomized controlled trial, a total of 90 patients, aged 16-50 years participated. They were randomly allocated into two groups, the packable composite group (PC) n = 45 and the bulk-fill flowable composite group (BF-FC) n = 45 by lottery method. Following measurements were taken at the splint application appointment. Horizontal tooth mobility measured via Periotest, splint application time, and frontal images of splinted teeth to measure the percentage composite adhesive point area. After 2 weeks, splints were visually inspected for retention, whereas mobility and removal times were also recorded. Statistically, comparisons were made using independent samples sample T-test, Fisher's exact test, and Mann-Whitney U at p ≤ .05.

RESULTS

A total of 88 patients with 156 luxated teeth completed the trial, as two patients were lost to follow-up. Two patients in the PC group reported with completely de-bonded splints while none de-bonded in the BF-FC group. Both groups were similar in terms of splint retention (p = .352), reduction of mobility (p = .426), and splint removal times (p = .372). The BF-FC group performed significantly better in adhesive point dimension percentages (p < .001) and splint application time (p < .001).

CONCLUSION

Both groups were comparable in most parameters of the study. However, for BF-FC group application time and adhesive point dimension were significantly less.

Fatigue and failure analysis of restored endodontically treated maxillary incisors without a dowel or ferrule

STATEMENT OF PROBLEM

Information on the survival and mode of failure of endodontically treated incisors without a ferrule and restored without dowels is lacking.

PURPOSE

The purpose of this in vitro study was to compare the survival and failure mode of endodontically treated incisors without a ferrule and restored with bonded ceramic crowns and various composite resin foundation restorations without dowels with a control group with fiber dowels.

MATERIAL AND METHODS

Forty-five decoronated endodontically treated bovine incisors without ferrule were divided into 3 experimental groups and restored with different adhesive foundation restorations without dowel: nanohybrid composite resin (Nd), bulk-fill composite resin foundation restoration (NdB), and fiber-reinforced bulk-fill composite resin (NdFR). A control group with conventional foundation restorations (glass-fiber dowel with nanohybrid composite resin foundation restoration without ferrule) (D) was included for comparison. All teeth were prepared to receive bonded lithium disilicate ceramic crowns luted with dual-polymerizing composite resin cement and were subjected to accelerated fatigue testing. Cyclic isometric loading was applied to the incisal edge at an angle of 30 degrees and a frequency of 5 Hz, beginning with a load of 100 N (5000 cycles). A 100-N load increase was applied each 15 000 cycles. Specimens were loaded until failure or to a maximum for cycles endured of 1000 N (140 000 cycles). Groups were compared by using the Kaplan-Meier survival analysis (log rank test at α=.05 and pairwise post hoc comparisons) and life table analysis for load-at-failure (followed by Wilcoxon pairwise comparison α=.05).

RESULTS

All the specimens failed before 140 000 load cycles. Even though no statistically significant differences were found between the experimental groups without dowel (P>.127), the fiber-reinforced foundation restoration yielded the highest mean ±standard deviation cycles to failure (46 023 ±4326) compared with Nd (38 899 ±2975) and NdB (39 751 ±2998). NdFR, however, outperformed the foundation restoration with glass-fiber dowel (35 026 ±2687) (P<.05). Most failure in groups without dowel were restorable, while 100% of catastrophic failure (unrestorable) were found in the group with dowels.

CONCLUSIONS

Based on the present in vitro study, dowels did not improve the performance of the adhesive restoration of endodontically treated incisors without a ferrule. The use of a short fiber-reinforced composite resin foundation restoration without a dowel was able to not only improve the resistance of the restorations compared with adhesive foundation restorations with dowels but also minimize catastrophic failures.

Contemporary flowable bulk-fill resin-based composites: a systematic review

Flowable bulk-fill resin-based composites (BF-RBCs) represent a new and interesting alternative for the bulk-fill restorative techniques in the posterior region. However, they comprise a heterogeneous group of materials, with important differences in composition and design. Therefore, the aim of the present systematic review was to compare the main properties of flowable BF-RBCs, including their composition, degree of monomer conversion (DC), polymerization shrinkage and shrinkage stress, as well as flexural strength. The search was conducted following PRISMA guidelines in the Medline (PubMed), Scopus and Web of Science databases. In vitro articles reporting on the DC, polymerization shrinkage/shrinkage stress, and flexural strength of flowable BF-RBCs strength were included. The QUIN risk-of-bias (RoB) tool was used for assessing the study quality. From initially 684 found articles, 53 were included. Values for DC ranged between 19.41 and 93.71%, whereas polymerization shrinkage varied between 1.26 and 10.45%. Polymerization shrinkage stresses reported by most studies ranged between 2 and 3 MPa. Flexural strength was above 80 MPa for most materials. A moderate RoB was observed in most studies. Flowable BF-RBCs meet the requirements to be indicated for bulk fill restoration technique in the posterior region. However, important variations among composition and properties hinder extrapolation of the results to materials different from those reported here. Clinical studies are urgently required to assess their performance under a real working scenario.

Ethyl-2-(tosylmethyl)acrylate: A promising chain transfer agent for the development of low-shrinkage dental composites

OBJECTIVE

To evaluate the potential of ethyl-2-(tosylmethyl)acrylate (ASEE) as chain transfer agent for the development of low-shrinkage photopolymerizable dental composites.

METHODS

Composites containing 10, 20 and 30 mol% of ASEE in their organic matrix were formulated. Camphorquinone (CQ)/ethyl 4-(dimethylamino)benzoate (EDAB) (0.33 wt%/0.60 wt%), CQ/EDAB/Ivocerin® (0.33 wt%/0.60 wt%/0.10, 0.25 or 0.50 wt%), CQ/EDAB/SpeedCure 938 (SC-938) (0.33 wt%/0.60 wt%/0.30, 0.50 or 1.00 wt%) and Ivocerin® (0.50 wt%) were used as photoinitiator systems. The glass transition temperature (Tg) and the crosslink density were determined by DMTA measurements. The flexural strength/modulus and ambient light working time were assessed according to ISO 4049. The shrinkage force was evaluated using a universal testing machine. The double bond conversion (DBC) was determined by NIR spectroscopy. DBC, flexural strength and modulus were measured after the storage of the specimens in deionized water at 37 °C for 24 h. The DBC, flexural strength and modulus data were analyzed by one-way ANOVA with p = 0.05 as significance level.

RESULTS

ASEE-based composites containing the classical initiator system CQ/EDAB exhibited low mechanical properties (flexural strength/modulus) and DBC. The screening of various photoinitiator systems showed that composites based on CQ/EDAB/Ivocerin® (0.33 wt%/0.60 wt%/0.50 wt%), Ivocerin® (0.50 wt%) or CQ/EDAB/SC-938 (0.33 wt%/0.60 wt%/1.00 wt%) were particularly attractive. Indeed, the use of these photoinitiator systems enabled the formulation of composites containing up to 30 mol% ASEE exhibiting excellent mechanical properties, high DBC, good network homogeneity and low shrinkage force values. Interestingly, the addition of SC-938 did not impair the ambient light working time of the uncured composites, whereas the incorporation of 0.50 wt% Ivocerin® resulted in a strong decrease of this value.

SIGNIFICANCE

The addition of the allyl sulfone ASEE in combination with the initiator system CQ/EDAB/SC-938 (0.33 wt%/ 0.60 wt%/ 1.00 wt%) is a promising strategy to develop low-shrinkage dental composites which exhibit excellent mechanical properties, low shrinkage force, high DBC and suitable ambient light working time.

Fatigue and marginal adaptation of bulk fill restoratives: Effect of the layering technique and cavity dimension of extensively damaged teeth

OBJECTIVES

To evaluate the effect of layering technique and cavity dimension on the fatigue behavior and marginal adaptation of bulk fill (BF) restorations in extensively damaged teeth.

METHODS

Seventy-two premolars received class II cavities (MOD) followed by endodontic treatment. Half sample had 1/3 of their palatal cusp removed. Teeth were restored using three techniques: (I) incremental, with conventional resin composite (RC); (C) combined, using BF flow and RC, (B) bulk fill, with regular BF. Specimens were subjected to fatigue (80 N, 2 Hz, 37° C water) for 1 million cycles (n = 12). The test was interrupted every 250,000 cycles to evaluate tooth integrity, restoration fracture and adaptation using FDI criteria. Images of the proximal surfaces were obtained before and after the cycling to measure the gap. Restoration fatigue survival and success were analyzed using Weibull distribution and Maximum Likelihood Estimation. Gap thickness was analyzed with Kruskal-Wallis and Student-Newman-Keuls tests (α = 0.05).

RESULTS

For the survival analysis, Weibull modulus (β) and characteristic lifetime (η) were similar among groups. Yet, for the success analysis, in which only restorations that were free of technical complications were ranked as success, the bulk-fill technique resulted in higher β, while the combined technique produced restorations with higher η, for teeth that had their cusp removed. C-technique also resulted in smaller gaps than I and B.

SIGNIFICANCE

The effect of the layering technique on the success of restorations was dependent on the cavity extension. The combined technique favors the adaptation and the longevity of extensively damaged teeth.

Flexural Strength of Conventional or Bulk-fill Resin Composite Repaired with High- or Low-viscosity Restorative Materials

OBJECTIVE

To evaluate the flexural strength of two types of high-viscosity resin composites (conventional or bulk-fill) that were repaired with either high-viscosity composites (conventional or bulk-fill) or low-viscosity composites (conventional or bulk-fill) of the same manufacturer (3M Oral Care, St Paul, MN, USA).

METHODS AND MATERIALS

Specimens (25 mm × 2 mm × 2 mm) of both conventional nanofilled resin (Filtek Z350XT), and bulk-fill nanofilled resin (Filtek One Bulk Fill) were prepared. After fracture of the specimens in the 3-point bending test (initial), half of the specimens were repaired immediately afterwards (24 hours), and the other half were repaired after 6 months of storage in distilled water. Repairs were performed with (n=15) high-viscosity resin composites (Filtek Z350XT, Filtek One Bulk Fill), or their low-viscosity versions (Filtek Supreme XT Flow, Filtek Bulk Fill Flowable Restorative). The repair was performed by roughening the surface and applying phosphoric acid, silane, and adhesive. The bending test (results reported in MPa) was performed in a universal testing machine, and the fracture pattern was determined. Data were evaluated by generalized linear models, chi-square test and the Fisher exact test (α=0.05).

RESULTS

There was no significant difference between the former pair of high-viscosity resins in terms of initial flexural strength (p=0.42). The repairs performed with low-viscosity resin composites after 24 hours or 6 months obtained higher MPa values compared with those using high-viscosity composites (p=0.0006). There was a significant decrease in MPa values when the repair was performed after 24 hours and an increase after 6 months, regardless of the material (p<0.0001). After 6 months, fractures involving the old (conventional) resin were more frequent in the repair performed with bulk-fill resin composites compared with the conventional composites (p=0.02).

CONCLUSIONS

Considering the tested products, the material to be repaired did not influence the flexural strength of the repair composite; however, the use of the low-viscosity resin composites resulted in greater flexural strength of the repaired material. The repair of the aged composite resulted in an increase in its flexural strength, regardless of the material repaired or used to perform the repair.

Comparison between Different Bulk-Fill and Incremental Composite Materials Used for Class II Restorations in Primary and Permanent Teeth: In Vitro Assessments

INTRODUCTION

Several advantages, including improved aesthetics and conservative cavity preparation, made resin-based composite (RBC) a popular restorative material. However, several limitations come with RBC restorations such as the necessity for proper isolation of the tooth and an incremental layering for the material due to the limitations of the depth of cure. Despite these advantages and limitations, the usage of these restorative materials is increasingly being expanded due to the advancement made since their introduction. To overcome some of the limitations, several types of RBC restorations were developed.

MATERIALS AND METHODS

Four different RBC materials used for class II restorations in primary and permanent teeth were compared: Z350 XT Filtek™ Universal Restorative (ZXT), Filtek™ Bulk Fill Flowable Restorative (FBF), Beautifil-Bulk Flowable (BBF) and Tetric™ N-Flow (TNF). Flexure strength, elastic modulus, surface roughness, microhardness and microleakage were assessed using standard methods or previously published protocols. The data and differences between the groups were analyzed using One-way analysis of variance (ANOVA), Tukey's multiple comparisons, Kruskal-Wallis and Wilcoxon rank-sum (Mann-Whitney) tests.

RESULTS

The study found that BBF (86.24 ± 7.41 MPa) and ZXT (64.45 ± 11.52 MPa) had higher flexural strength than FBF (50.89 ± 8.44 MPa) and TNF (50.67 ± 9.40 MPa), while both exhibited the highest values of surface roughness. Elastic modulus was the highest with BBF, which was not statistically significant from FBF or ZXT (p > 0.05). ZXT (109.7 ± 7.83 VH) exhibited the highest value of microhardness, which was statistically significant from the other three materials (p < 0.0001). Microleakage was assessed after thermocycling for 20,000 cycles to simulate two years in the mouth. FBF (70%) exhibited the most resistance to microleakage.

CONCLUSIONS

Different types of RBC restorations exhibit different characteristics. The clinician needs to choose the most appropriate restorative material based on different clinical scenarios.

A Blinded Comparative Study of Four Commercially Available LEDs and a Laser Light Curing Device

OBJECTIVE

 This study determined the effectiveness of five light-curing units (LCUs; four light-emitting diode [LED] and one laser) used on different settings to photo-activate four conventional resin-based composites (RBCs).

MATERIALS AND METHODS

 A total of 108 RBC specimens were photo-activated in a white Delrin mold representing a mesial-occlusal-distal (MOD) class II restoration in a molar tooth. The proximal boxes were 5 mm deep, and the mesial-distal length was 12 mm. Immediately after photo-curing, the RBC specimens were immersed in a solvent to remove the uncured materials, after which they were photographed and deidentified. A Research Electronic Data Capture survey was created using these images and sent to respondents who blindly assessed the ability of the various LCUs to photo-cure the MOD restorations.

RESULTS

 There were significant differences in how the five curing lights had cured RBCs. One-way analysis of variance (ANOVA), pairwise t-test, Welch's one-way ANOVA, and Kruskal-Wallis rank test in the blinded survey data showed significant differences between the LED curing lights used for two 10-second cures and the laser curing light used for 1 second, and LED lights at lower settings.

CONCLUSION

 There was a significant difference in how the curing lights could photo-cure the RBCs used in this study. The laser curing light used for 1 second produced the worst results in all four RBCs.

Physical Properties and Clinical Performance of Short Fiber Reinforced Resin-based Composite in Posterior Dentition: Systematic Review and Meta-analysis

OBJECTIVE

This study compares the physical properties and clinical performance of short fiber reinforced composites (SFRC) to those of particulate-filled resin-based composites (PFRC) for class I and II direct restorations in permanent dentition.

METHODS

Systematic review and meta-analysis was conducted using PubMed, Embase (Elsevier), and Dentistry and Oral Sciences Source (EBSCO) databases. The outcomes evaluated were physical properties including flexural strength, flexural modulus, elastic modulus, microhardness, shrinkage, fracture toughness, degree of conversion, and depth of cure. Clinical performance was evaluated with a systematic review.

RESULTS

The meta-analyses favored SFRC for flexural strength and fracture toughness compared to every PFRC subgroup, with a high quality of evidence. For all other properties, the meta-analyses favored SFRC to overall PFRC, with some non-significant differences with certain PFRC subgroups. The most recent clinical trial showed SFRC performed similarly to PFRC, however older studies suggest inferior surface texture and discoloration of SFRC compared to PFRC.

CONCLUSION

This study can aid dental professionals in clinical decision making, supporting that SFRC offers improved physical properties, especially fracture resistance and flexural strength, compared to PFRC.

Effect of polymerization mode on shrinkage kinetics and degree of conversion of dual-curing bulk-fill resin composites

OBJECTIVES

To assess the behavior of dual-cure and conventional bulk-fill composite materials on real-time linear shrinkage, shrinkage stress, and degree of conversion.

MATERIALS AND METHODS

Two dual-cure bulk-fill materials (Cention, Ivoclar Vivadent (with ion-releasing properties) and Fill-Up!, Coltene) and two conventional bulk-fill composites (Tetric PowerFill, Ivoclar Vivadent; SDR flow + , Dentsply Sirona) were compared to conventional reference materials (Ceram.x Spectra ST (HV), Dentsply Sirona; X-flow; Dentsply Sirona). Light curing was performed for 20 s, or specimens were left to self-cure only. Linear shrinkage, shrinkage stress, and degree of conversion were measured in real time for 4 h (n = 8 per group), and kinetic parameters were determined for shrinkage stress and degree of conversion. Data were statistically analyzed by ANOVA followed by post hoc tests (α = 0.05). Pearson's analysis was used for correlating linear shrinkage and shrinkage force.

RESULTS

Significantly higher linear shrinkage and shrinkage stress were found for the low-viscosity materials compared to the high-viscosity materials. No significant difference in degree of conversion was revealed between the polymerization modes of the dual-cure bulk-fill composite Fill-Up!, but the time to achieve maximum polymerization rate was significantly longer for the self-cure mode. Significant differences in degree of conversion were however found between the polymerization modes of the ion-releasing bulk-fill material Cention, which also exhibited the significantly slowest polymerization rate of all materials when chemically cured.

CONCLUSIONS

While some of the parameters tested were found to be consistent across all materials studied, heterogeneity increased for others.

CLINICAL RELEVANCE

With the introduction of new classes of composite materials, predicting the effects of individual parameters on final clinically relevant properties becomes more difficult.

Assessment of Microhardness of Conventional and Bulk-Fill Resin Composites Using Different Light-Curing Intensity

(1) Background: This study evaluates the effect of a conventional/low-voltage light-curing protocol (LV protocol) (10 s with 1340 mW/cm²) and high-voltage light-curing protocol (HV protocol) (3 s with 3440 mW/cm²) on the microhardness (MH) of dental resin-based composites (RBCs). Five resin composites were tested: conventional Evetric (EVT), Tetric Prime (TP), Tetric Evo Flow (TEF), bulk-fill Tetric Power Fill (PFL), and Tetric Power Flow (PFW). (2) Materials and Methods: Two tested composites (PFW and PFL) were designed for high-intensity light curing. The samples were made in the laboratory in specially designed cylindrical molds; diameter = 6 mm and height = 2 or 4 mm, depending on the type of composite. Initial MH was measured on the top and bottom surfaces of composite specimens 24 h after light curing using a digital microhardness tester (QNESS 60 M EVO, ATM Qness GmbH, Mammelzen, Germany). The correlation between the filler content (wt%, vol%) and the MH of the RBCs was tested. For the calculation of depth-dependent curing effectiveness, the bottom/top ratio for initial MH was used. (3) Conclusions: MH of RBCs is more dependent on material composition than on light-curing protocol. Filler wt% has a greater influence on MH values compared to filler vol%. The bottom/top ratio showed values over 80% for bulk composites, while for conventional sculptable composites, borderline or suboptimal values were measured for both curing protocols.

Effect of preheating on mechanical properties of a resin-based composite containing elastomeric urethane monomer

This study investigated the effect of preheating an elastomeric urethane monomer (Exothane-24) experimental resin composite on its physicochemical properties. Two resin matrices were formulated: (a) 50 wt% Bisphenol-glycidyl methacrylate (Bis-GMA) and 50 wt% triethylene glycol dimethacrylate (TEGDMA); and (b) 20 wt% Exothane-24, 40 wt% Bis-GMA and 40 wt% TEGDMA. A photoinitiator system (0.25 wt% camphorquinone and 0.50 wt% ethyl-4-dimethylamino benzoate) and 65 wt% of the inorganic filler (20 wt% 0.05 μm silica and 80 wt% 0.7 μm BaBSiO₂ glass) were added to both matrices. These formulations were then assigned to four groups: Exothane-24 (E); Exothane-24 plus preheating (EH); no Exothane-24 (NE); and no Exothane-24 plus preheating (NEH). NEH and EH were preheated at 69 °C. The dependent variables were as follows: film thickness (FT); polymerization shrinkage stress (PSS); gap width (GW); maximum rate of polymerization (Rp_max); and degree of conversion (DC). Data were statistically analyzed by two-way ANOVA and Tukey's test (α = 0.05). Preheating reduced FT for both composites. PSS and GW were significantly lower for EH, when compared with E. The DC for EH and NEH and the Rp_max for EH increased significantly. Preheating improved most of the physicochemical properties (FT, PSS, GW, and DC) of the experimental resin composite containing Exothane-24.

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.

Curing profile and marginal gap formation using a liner containing long-wavelength-absorbing photoinitiator: an in vitro study

The aim was to evaluate the marginal-gap formation and curing profile of a new restorative technique using a liner with long-wavelength-absorbing photoinitiator (LWAP). Box-shaped preparations (6 mm × 4 mm × 4 mm) were made in third molars. All samples were treated with Clearfill SE Bond and divided into 4 groups (n = 5), according to restorative technique used: (1) incremental technique (INC-Technique); (2) camphorquinone-based liner (CQ-Liner) + bulk-fill resin composite; (3) LWAP-based liner (LWAP-Liner) + bulk-fill resin composite; and (4) bulk-fill technique without liner (BF-Technique). The marginal gaps (%) for all the samples were measured using micro-computed tomography. The restorations were cross-sectioned, and the degree of conversion (DC) and Knoop microhardness were evaluated at different depths (0.3, 1, 2, 3, and 4 mm). INC-Technique, CQ-Liner, and LWAP-Liner groups showed significantly fewer marginal gaps than those from the BF-Technique group. The BF-Technique specimens had the lowest DC and microhardness in depth. All the other techniques presented similar degree of conversion and microhardness at all the depths. The use of liners, regardless of the photoinitiator system, decreased the marginal-gap formation and improved the curing profile of bulk-filling restoration technique.

Effects of lesion size on the 30-month clinical performance of restorations with bulk fill and a regular nanofilled resin composite in noncarious cervical lesions

OBJECTIVE

The aim of this double-blind, randomized trial was to evaluate the influence of the occlusogingival distance (OGD) in noncarious cervical lesions (NCCLs) on the clinical performance of a regular bulk-fill resin composite and a regular nanofilled resin composite.

MATERIALS AND METHODS

One hundred and forty NCCLs in 77 participants were randomly divided into four groups (n = 35), according to OGD (1.5 mm ± 10% or 3 mm ± 10%) and resin composites (Filtek Bulk Fill Posterior [B] or Filtek Z350 XT [C]), namely: 1.5 mm-B, 1.5 mm-C, 3 mm-B, and 3 mm-C. The restorations were bonded using a two-step self-etch adhesive (Clearfil SE Bond), applied following the manufacturer's instructions. Restorations were polished 1 week after placement. Two experienced and calibrated examiners evaluated the restorations using modified US Public Health Service criteria at baseline (7 days) and after 6, 12, 18, 24, and 30 months. Statistical analyses were carried out using Kruskal-Wallis, Friedman's repeated measures analysis of variance, and the Wilcoxon signed rank test (α = 0.05).

RESULTS

After 30 months, the recall rate was 94.2%. Eight restorations were lost (3 for 1.5 mm-C, 2 for 1.5 mm-B, 1 for 3 mm-C, and 2 for 3 mm-B). All groups resulted in a significantly worse marginal discoloration and surface texture at 30 months in comparison with the baseline (1 week). No significant difference was found for the other parameters.

CONCLUSION

The restorations performed with both resin composites produced clinically acceptable restorations. The OGD of NCCLs did not influence the clinical performance of restorations.

CLINICAL SIGNIFICANCE

The OGD of NCCLs did not have a significant effect on the clinical performance of a regular bulk-fill and nanofilled restorations. Both materials showed a very good performance on 30-month evaluation.

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.

Effect of Type of Resin Composite Material on Porosity, Interfacial Gaps and Microhardness of Small Class I Restorations

AIM

This study aimed to compare the best restorative approach for the conservative class I cavity by comparing flowable and nanohybrid composites versus the placement technique regarding surface microhardness, porosity, and presence of interface gaps.

MATERIALS AND METHODS

Forty human molars were divided into four groups (n = 10). Standardized class I cavities were prepared and restored using one of the following materials: Group I - Flowable composite placed by incremental technique; group II - Flowable composite placed in one increment; group III - Nanohybrid composite placed by incremental technique; and group IV - Nano-hybrid composite placed in one increment. After finishing and polishing, specimens were sectioned into two halves. One section was chosen randomly for the Vickers microhardness (HV) evaluation and the other section was used for the assessment of porosities and interfacial adaptation (IA).

RESULTS

The surface microhardness range was 28.5-76.2 (p < 0.05), mean pulpal microhardness range was 27.6-74.4 (p < 0.05). Flowable composites had lower HV than conventional counterparts. The mean pulpal HV of all materials exceeded 80% of occlusal HV. Restorative approaches did not statistically differ in porosities. However, IA percentages were higher in flowable materials compared to nanocomposites.

CONCLUSION

Flowable resin composite materials have lower microhardness than Nanohybrid composites. In small class I cavities, the number of porosities was similar between the different placement techniques and the interfacial gaps were highest in the flowable composites.

CLINICAL SIGNIFICANCE

The use of nanohybrid resin composite to restore class I cavities will result in better hardness and less interfacial gaps compared to flowable composites.

In vitro surface and color changes of tooth-colored restorative materials after sport and energy drink cyclic immersions

BACKGROUND

There has not been any research conducted on surface properties and color changes from sport and energy drinks on bulk-fill resin composite, nanohybrid resin composite and glass ionomer restorative material. The aim of this in vitro study was to investigate the effect of sport and energy drinks on surface hardness, roughness and color changes of bulk-fill resin composite, nanohybrid resin composite and glass ionomer restorative material, and to also evaluate the acidity and titratable acidity of the drinks.

METHODS

One hundred and forty-seven specimens of each tooth-colored restorative material were prepared in a polytetrafluoroethylene mold (10 mm. in diameter and 2 mm. in thickness). Before immersion, baseline data of hardness, roughness, and color value were recorded. Each material was divided into 3 groups for sport drink, energy drink, and deionized water (serving as a control). The specimens were immersed in a storage agent for 5 s, then in artificial saliva for 5 s alternately for 24 cycles, and then stored in artificial saliva for 24 h. The immersion cycle was repeated for 14 days and hardness, roughness and color values were measured at 7 and 14 days.

RESULTS

After immersion, the glass ionomer restorative material had statistically less hardness, more roughness and more color changes than the others (P < 0.05). Energy drink groups statistically caused more surface and color changes than sport drink groups (P < 0.05).

CONCLUSION

Sport and energy drinks affected hardness, roughness, and color changes in all the tooth-colored restorative materials evaluated.

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.

One-year clinical evaluation of class II bulk-fill restorations in primary molars: a randomized clinical trial

This double-blind, randomized clinical trial aimed to compare the clinical performance and clinical time to restore occluso-proximal cavities in primary molars withbulk-fillresin and conventional resin. A total of 140 class II restorations in primary molars of 65 participants (mean age of 6.7 + 1.5) were placed in two random groups:bulk-filland conventional resin. The restorations were evaluated using FDI criteria at the baseline, 6-month, and one year by a single calibrated examiner, and the clinical restorative time was measured with a digital timer. The success and survival of the restorations were evaluated with Kaplan-Meier graphs. The log-rank test compared the curves. Differences in restorative clinical time were compared using the Mann-Whitney U test. The level of significance was 5%. After one year, 115 restorations were evaluated. The success probability was 88.7% for Filtek Z350 XT and 85.9% for FiltekTM Bulk-fill, and for the survival probability, Filtek Z350 XT presented 90%, and FiltekTM Bulk-fill presented 93.7%. No significant difference was found between the success and survival curves (p=0.62), (p=0.51). The main reason for failure was marginal adaptation.Bulk-fillresin required 30% less time than the conventional resin (p<0.001).Bulk-fillresin presented similar clinical performance to the conventional resin and required less restorative clinical time. It is an option to restore class II lesions of primary molars.

Effect of Fast High-Irradiance Photo-Polymerization of Resin Composites on the Dentin Bond Strength

This study investigated the influence of conventional (10 s at 1160 mW/cm²) and fast high-irradiance (3 s at 2850 mW/cm²) light curing on the micro-tensile bond strength (μTBS) of bulk-fill resin composites bonded to human dentin. Sixty-four extracted human molars were ground to dentin and randomly assigned into eight groups (n = 8 per group). After application of a three-step adhesive system (Optibond FL), four different bulk-fill composites (two sculptable and two flowable composites) were placed. Of these, one sculptable (Tetric PowerFill) and one flowable (Tetric PowerFlow) composite were specifically developed for fast high-irradiance light curing. Each composite was polymerized with the conventional or the fast high-irradiance light-curing protocol. The specimens were cut into dentin-composite sticks, μTBS was determined and failure modes were analyzed. Statistical analysis was performed using t-test for independent observations and one-way ANOVA. A statistical difference between the curing protocols was only found for Tetric PowerFlow, where the conventional protocol (23.8 ± 4.2 MPa) led to significantly higher values than the fast high-irradiance light-curing protocol (18.7 ± 3.7 MPa). All other composite materials showed statistically similar values for both polymerization protocols. In conclusion, the use of fast high-irradiation light curing has no negative influence on the μTBS of the investigated high-viscosity bulk-fill composites. However, it may reduce the dentin bond strength of flowable bulk-fill composite.

Resin-Based Composites for Direct and Indirect Restorations: Clinical Applications, Recent Advances, and Future Trends

Continuous advancements in resin-based composites can make selection of the appropriate system a daunting task for the clinician. This review aims to simplify this process and clarify some new or controversial topics. Various types of composites for direct and indirect applications are discussed, including microfilled and microhybrid composites, nanocomposites, single shade, bulk fill, fiber-reinforced, high temperature/high pressure processed, CAD/CAM, and three-dimensional printable composites. Recent material advancements that lead to improved seal and toughness, degradation resistance, antimicrobial and self-healing capabilities are presented. Future directions are highlighted, such as the development of "smart" materials that are able to interact with the host environment.

Influence of Factors in the Photopolymerization Process on Dental Composites Microhardness

The aim of the present paper is to investigate the influence of factors in photopolymerization process that govern microhardness of three types of dental composites-universal (UC), bulk-fill (BC), and flowable (FC). Cylindrical specimens with different thicknesses are made and light cured. The significance of light intensity, irradiation time, and layer thickness on Vickers microhardness is evaluated by experimental design, analysis of variance, and regression analysis. It is found that the main factor influencing the microhardness on the top surface of the three composites is light intensity. The second factor is layer thickness for the UC and FC, while for BC, it is curing time. The third factor is curing time for the first two composites and layer thickness for bulk-fill. The significance of factors' influence on the microhardness of the bottom surface is the same for the UC and FC, but different for BC. The main factor for the first two composites is layer thickness, followed by curing time and light intensity. For bulk-fill, curing time is main factor, light intensity is second, and layer thickness is last. Different significance of factors influencing the microhardness on top and bottom surfaces of investigated composites is revealed for the first time in the present study.

Fracture Resistance and Microleakage around Direct Restorations in High C-Factor Cavities

The aim of this research was to evaluate the mechanical impact of different direct restorations in terms of fracture resistance, and subsequent fracture pattern, in occlusal high C-factor cavities. Furthermore, the adaptation of different direct restorations in the form of gap formation was also evaluated. Seventy-two intact mandibular molars were collected and randomly distributed into three groups (n = 24). Class I occlusal cavities with standardized dimensions were prepared in all specimens. After adhesive treatment, the cavities were restored with direct restorations utilizing three different materials. Group 1: layered conventional packable resin composite (Filtek Ultimate), Group 2: bulk-fill resin composite (SDR), Group 3: bulk-fill short fibre-reinforced composite (SFRC; everX Posterior) covered with packable composite occlusally. Half of the restored specimens underwent static load-to fracture testing (n = 12/group), while the rest underwent sectioning and staining for microleakage evaluation and gap formation analysis. Fracture patterns were evaluated visually among the mechanically tested specimens. The layered composite restoration (Group 1) showed significantly lower fracture resistance compared to the bulk fill groups (Group 2, p = 0.005, Group 3, p = 0.008), while there was no difference in fracture resistance between the other groups. In terms of gap formation values, the layered composite restoration (Group 1) produced significantly higher gap formation compared to the bulk-fill groups (Group 2, p = 0.000, Group 3, p = 0.000). Regarding the fracture pattern, SFRC (Group 3) produced the highest number, while SDR (Group 2) produced the lowest number of repairable fractures. The use of bulk-fill resin composite (fibre or non-fibre-reinforced) for occlusal direct restorations in high C-factor cavities showed promising achievements regarding both fracture resistance and microleakage. Furthermore, the use of short fibre-reinforced bulk-fill composite can also improve the fracture pattern of the restoration-tooth unit. Bulk-fill materials provide a simple and effective solution for restoring and reinforcing high C-factor occlusal cavities.

Comparative Evaluation of Bulk-Fill Composite Resins: Knoop Microhardness, Diametral Tensile Strength and Degree of Conversion

Purpose

Bulk-fill composite resins were developed to reduce time and facilitate the restorative procedure. However, considering their recent introduction on the market and the new formulations, their performance still requires evaluation. This study aimed to evaluate Knoop microhardness (KHN), diametral tensile strength (DTS) and degree of conversion (DC) of three Bulk-Fill composite resins and a conventional one.

Materials and Methods

Sixty samples (n = 15; 8 mm ø x 4 mm height) were confectioned using a mold. Filtek Bulk-Fill (FBF), Tetric N-Ceram Bulk-Fill (TNC) and SonicFill 2 (SF2) were placed in 4 mm increments, and Filtek Z350 (FZ350) was placed in 2 mm increments. The KHN of top and bottom surfaces were tested using Knoop Hardness tester at 10 gf/10s. The DTS was tested under compressive load at 1.0 mm/min. The DC was measured by Fourier Transform Infrared (FTIR) spectroscopy. Differences in DTS and DC were analyzed by ANOVA and Tukey post hoc test. For KHN, Kruskal–Wallis and Wilcoxon tests were performed at α = 0.05.

Results

Top surfaces of all composite resins had higher KHN than bottom surfaces. At top and bottom surfaces, FZ350 showed higher KHN than TNC and SF2. The highest DTS was obtained by FBF, followed by FZ350 and SF2. The highest DC was obtained by SF2, the lowest one was obtained by FBF.

Conclusion

From Bulk-Fill composite resins, FBF presented the best KHN and DTS results. The SF2 showed the best DC. Further studies are required to ensure whether these differences can negatively influence the behavior of in vivo restorations.

The effect of filling technique on the cuspal strain, polymerization shrinkage stress, enamel crack formation and depth of cure of restored molars

OBJECTIVE

Evaluate the effect of different restorative filling techniques on the residual shrinkage stress (ShrS), cuspal strain (CS), depth of cure (DC), and enamel crack formation (Ec) in molars with MOD restorations.

METHODS

Post-gel shrinkage, elastic modulus, compressive and diametral tensile strength of the Filtek One Bulk Fill composite were calculated. Sixty molars with MOD preparations were restored using four filling techniques: Bulk; Horizontal; Oblique; Natural enamel and dentin substitution (NEDS) technique. CS was measured using a strain gauge (n = 10). The DC (n = 5) was measured using Knoop hardness. Shrinkage stress/strain was analyzed using 3D finite element analysis. The Ec analysis was carried out by transillumination. Two-way ANOVA with repeated measures and Tukey's HSD test (α = 0.05) was performed for the CS data. Two-Way ANOVA and Tukey's HSD test was performed for the DC data (α = 0.05).

RESULTS

CS was higher at the lingual cusp for the horizontal and NEDS technique. No statistical difference was found between the buccal and lingual CS values for the Bulk (p = 0.367) or Oblique techniques (p = 0.192). CS values were lower for the Bulk. More enamel cracks were found for the Bulk. DC was lower at 4 mm regardless the filling technique. The Horizontal showed the highest ShrS values. The Bulk generated the lower ShrS values.

SIGNIFICANCE

A Bulk technique caused the lowest shrinkage stress/strain. An Oblique technique yielded the best balance between stress, strain and crack formation. NEDS technique is a good alternative to decrease the number of increments while maintaining the stress levels nearby the Oblique technique.

Color alterations, flexural strength, and microhardness of 3D printed resins for fixed provisional restoration using different post-curing times

OBJECTIVES

To evaluate the effect of post-curing times on the color change, flexural strength (FS), modulus (FM) and microhardness at different depths of four 3D printed resins.

MATERIALS AND METHODS

A characterization of the light emitted by 3D-resin post-curing unit (Wash and Cure 2.0, Anycubic) was performed. The tested 3D printed resins were Cosmos Temp3D (COS), SmartPrint BioTemp (SM) Resilab3D Temp (RES) and Prizma3D BioProv (PRI) were evaluated under five different post-curing conditions (no post-curing or 5-, 10-, 15, and 20 min of post-curing). For color change analysis, 10 mm diameter x 1 mm thick discs (n = 7) were printed, and the luminosity, color and translucency were measured before post-curing as control, and repeatedly after 5 min cycles of post-curing until a total of 20 min was reached for ΔE₀₀ [CIED2000 (1:1:1)] calculation. For FS and FM, 25 × 2×2 mm (n = 10, for each post-curing time) 3D printed bars were subjected to a 3-point being test. Knoop microhardness (KHN) was measured transversally on 5 × 5×5 mm blocks (n = 10, for each post-curing time). Color results were analyzed by one-way repeated measures ANOVA (factor: color change). FS and FM were analyzed by two-way ANOVA (factors: Material*Post-Curing Time). KHN was analyzed individually for each material by two-way ANOVA (factors: Depth*Post-Curing Time).

RESULTS

The post-curing time significantly influenced the ΔE_00, FS, FM and KHN of all the evaluated materials. COS and SMA presented ΔE₀₀ values above the acceptability threshold after 5 and 10 min of post-curing, respectively. The FS of RES reached a plateau after 5 min of post-curing, and for PRI and SMA, the FS stabilized after 10 min of post-curing. The post-curing process improved the KHN of the tested materials, and longer exposure periods were associated to higher KHN values at all the evaluated depths.

SIGNIFICANCE

A fine adjustment of the post-curing time is crucial to produce adequate mechanical properties in 3D-printed restorative resins, while minimizing the color alterations on the restorations. For the evaluated resins, 5-10 min of post-curing will result in adequate mechanical properties, without affecting the acceptability in the color of the material. However, the results are material-dependent, and evaluation of each specific resin is advised.

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.

Color stability of resin-based composites: Staining procedures with liquids-A narrative review

OBJECTIVE

The objective of this study was to review the experimental staining procedures performed in in-vitro studies for evaluating color stability of resin-based composites used for direct restorations.

OVERVIEW

A review was performed with the purpose to identify in vitro procedures carried out to establish staining and color stability of resin-based composites used for direct restorations. A literature search was performed on four online databases (PubMed, Scopus, Embase and Web of Science) for articles published from January 1st 2001 till March 20th 2021, using a combination of free words and Medical Subject Headings (MESH) terms: "Composite Resins" AND "Color Stability" OR "Staining." Two reviewers screened titles and/or abstracts of 1728 unique studies. In total, 208 studies were selected for full-text reading, from which 178 were included in the review. The assessed variables were specimen dimensions, shape, and surface finishing; time before immersion; staining media type, dwell time, temperature and renewal interval; type of composite; color and translucency assessment parameters and measuring system. One hundred and seventy-eight articles analyzed color stability with staining liquids. Coffee was the most used staining medium (n = 102), followed by tea (n = 61), and red wine (n = 55). A disc-shaped specimen was used in most studies (n = 170) with a 2 mm thickness (n = 116). Spectrophotometers were the most used color assessment devices (n = 154), followed by colorimeters (n = 17). Color differences were quantified with ΔE (n = 154), ΔE00 (n = 23). Acceptability and or perceptibility thresholds were also taken into consideration (n = 126).

CONCLUSIONS

The large variety of staining procedure suggests the need for standardization.

CLINICAL SIGNIFICANCE

Aesthetic failure due to discoloration is a relevant clinical problem. Evaluating benefits and drawbacks of resin based composites artificial staining procedures will improve to predict materials clinical performances.

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.

Flowable fiber-reinforced versus flowable bulk-fill resin composites: Degree of conversion and microtensile bond strength to dentin in high C-factor cavities

OBJECTIVES

To compare flowable fiber-reinforced and flowable bulk-fill resin composites regarding their degree of conversion (DC) and microtensile bond strength (μTBS) to dentin in high C-factor class I cavities.

MATERIALS AND METHODS

One flowable fiber-reinforced (EverX Flow, GC) and two flowable bulk-fill composites (SDR, Dentsply, and Tetric N-flow Bulk fill, Ivoclar Vivadent) were tested. Regarding DC, 10 cylindrical-shaped specimens were prepared from each material (N = 30), measured using Fourier-Transform Infrared Spectroscopy (FTIR). Regarding µ TBS , class I cavities (4.5 × 4.5 × 3) were prepared on flat dentin surfaces of 30 molars, divided into three equal groups, restored with the three restorative materials, thermocycled, sectioned to create 1 mm × 1 mm cross-sectional beams, then tested using a universal testing machine. Failure mode was assessed using a stereomicroscope. Two-way ANOVA and Tukey's HSD post-hoc tests were used in DC, while One-way ANOVA was used for µ TBS .

RESULTS

The used materials showed statistically significant differences in DC with the fiber-reinforced composite having the highest value. No statistically significant differences were found between the materials regarding their µ TBS .

CONCLUSIONS

Flowable fiber-reinforced composite provided the most DC performance compared to the flowable bulk-fill composites. The three used restorative materials provided comparable bonding ability to dentin in high C-factor cavities.

CLINICAL SIGNIFICANCE

Flowable fiber-reinforced resin composite is preferred as a dentin-replacement material in high-stress bearing areas. However, both flowable fiber-reinforced and bulk-fill resin composites are equally effective in bonding to dentin in high C-factor cavities.

Evaluation of color stability and microhardness of contemporary bulk-fill composite resins with different polymerization properties

OBJECTIVES

To determine the color stability and microhardness of three bulk-fill composites with different polymerization characteristics, after immersion in four different solutions.

MATERIALS AND METHODS

Color measurements of three bulk fill (Viscalor (VIS), Tetric PowerFill (TPF), Fill Up! (FUP)) and a microhyrid composite resin (G-aenial posterior [GCP]) were performed after polymerization. The specimens were immersed in coffee, cola, red wine and distilled water. Discolorations were recorded after 24 h (T1), 10 days (T2) and 30 days (T3) of immersion. ΔE (CIEDE2000) values were calculated. Vickers microhardness (VHN) was measured from top and bottom surfaces at T0 and T3. Data was analyzed with Two-way ANOVA, One-way ANOVA and Tukey post hoc tests.

RESULTS

The highest discoloration was seen in wine and the lowest in distilled water and cola. At T3, there was no difference in distilled water groups, while the statistically highest ΔE₀₀ were obtained in TPF and GCP in coffee, cola and wine. VIS groups had the highest VHN values at T0 and T3 in all solutions.

CONCLUSIONS

Samples immersed in coffee and wine showed discoloration beyond clinically acceptable limits. After 30 days, discoloration occurred in all materials immersed in all solutions. At T3, VIS microhardness generally decreased, while TPF did not.

CLINICAL SIGNIFICANCE

After 30 days, all bulk-fill composites immersed in distilled water, coffee and wine showed clinically unacceptable ΔE₀₀ .