Polymerization contraction stress in light-cured compomer restorative materials

Effect of thickness on shrinkage stress and bottom-to-top hardness ratio of conventional and bulk-fill composites

This study evaluated the effect of the material thickness on shrinkage stress and bottom-to-top hardness ratio of conventional and bulk-fill composites. Six commercial composites were selected based on their different technologies: Two conventional (C1, C2), two high-viscosity bulk-fill (HVB1, HVB2), and two low-viscosity bulk-fill (LVB1, LVB2). Shrinkage stress was analyzed for five specimens with 2 mm thickness (C-factor 0.75 and volume 24 mm³ ) and five specimens with 4 mm thickness (C-factor 0.375 and volume 48 mm³ ) for 300 s in a universal testing machine. Bottom-to-top hardness ratio values were obtained from Knoop microhardness measurements in specimens with 2- and 4-mm thickness (n = 5). Thickness increase resulted in significantly higher shrinkage stress for all materials with the exception of HVB2 and LVB1. C1, C2, HVB2, and LVB1 showed lower bottom-to-top hardness ratios at 4 mm than at 2 mm. Only LVB2 presented a bottom-to-top hardness ratio lower than 80% at 2 mm, while HVB1 surpassed this threshold at 4 mm of depth. The results suggest that the increase of composite thickness affected the shrinkage stress values. Also, thickness increase resulted in lower bottom-to-top hardness ratio. HVB1 showed better behavior than other bulk-fill materials, with low stress and adequate bottom-to-top hardness ratio at 4 mm thickness.

Contraction and Hydroscopic Expansion Stress of Dental Ion-Releasing Polymeric Materials

Ion-releasing polymeric restorative materials seem to be promising solutions, due to their possible anticaries effect. However, acid functional groups (monomers) and glass filler increase hydrophilicity and, supposedly, water sorption. The purpose of the study was to evaluate the influence of water sorption of polymeric materials on the stress state at the restoration-tooth interface. Beautifil Bulk Fill Flow, Beautifil Flow Plus F00, Beautifil Flow F02, Dyract eXtra, Compoglass Flow, Ionosit, Glasiosite, TwinkiStar, Ionolux and Fuji II LC were used for the study. The stress state was measured using photoelastic analysis after: 0.5, 24, 72, 96, 168, 240, 336, 504, 672, 1344 and 2016 h. Moreover, water sorption, solubility and absorption dynamic were assessed. The water sorption, solubility and absorption dynamic of ion-releasing restorative materials are material dependent properties. The overall results indicated that the tested restorative materials showed significant stress decrease. The total reduction in contraction stress and water expansion stress was not observed for materials with low value of water sorption (Beautifil Bulk Fill, Dyract eXtra, Glasionosit and Twinky Star). The photoelastic method turned out to be inadequate to evaluate stress changes of resin modified glass-ionomer cement (RMGI, Fuji II LC and Ionolux).

Effect of fiber incorporation on the contraction stress of composite materials

OBJECTIVES

This study aimed to assess the effects of fiber incorporation on the contraction stress (CS), time to gelation (TG), and temperature rise (TR) features of two experimental resin-based composites (RBCs) in comparison to those of bulk-fill RBCs and conventional RBCs in simulated, clinically relevant cavities.

MATERIALS AND METHODS

CS over 300 s, TG and TR were assessed by a stress-strain analyzer (SSA T80) in two cavity configurations (2 × 4 × 4 mm³/4 × 4 × 4 mm³/configuration value [Formula: see text] and [Formula: see text]) for two experimental RBCs, eight bulk-fill RBCs (EverX Posterior, Filtek Bulk Fill, SDR, SonicFill, Tetric EvoCeram Bulk Fill, Venus Bulk Fill, X-tra base, and X-tra Fill) and one RBC (Filtek Supreme XTE) by light curing (1200 mW/cm²) (n = 10). The experimental materials used were based on EverX Posterior with modifications made to the fiber and filler content. Statistical analyses were performed via ANOVA; multiple pair-wise comparisons were performed via Tukey's test, and homogeneous subsets were identified ("multcomp" package, R).

RESULTS

CS values ranged from 1.00 to 4.07 MPa (2 × 4 × 4 mm³) and from 0.97 to 2.49 MPa (4 × 4 × 4 mm³); TG values ranged from 1.31 to 4.05 s (2 × 4 × 4 mm³) and from 1.39 to 3.84 s (4 × 4 × 4 mm³). SDR values showed lowest stress values in both cavity configurations. The experimental composite with fibers presented significantly higher stress values than did the experimental composite without fibers.

CONCLUSION

Bulk-fill RBCs showed lower levels of stress than did conventional RBCs. The incorporation of fibers had no positive impact on the CS and TG.

CLINICAL RELEVANCE

Appropriate material selection may be essential to clinical success because certain RBCs exhibit higher CS, TG, and TR values.

Characterization of fluoride releasing restorative dental materials

This study aimed to evaluate and compare certain mechanical properties, Vickers-hardness, water sorption, fluoride-release, shrinkage-stress and wear of five commercial fluoride-releasing restorative materials (Dyract, CompGlass, BEAUTIFIL II, ACTIVA-Restorative, and GC Fuji II LC), in relation to their microstructural characteristics. Mechanical properties were determined for each material following ISO standards. A wear test was conducted with 15,000 chewing cycles using a dual-axis chewing simulator. Daily fluoride-release was measured during the first 10 days by using a fluoride ion selective electrode. Scanning electron microscopy (SEM) was used to evaluate the microstructure of each material. Results were statistically analysed using ANOVA followed by post hoc Tukey's test. ACTIVA-Restorative exhibited the highest fracture toughness (1.1 MPa m^1/2) among the materials tested. BEAUTIFIL II presented the highest flexural strength (145 MPa) which was not significantly different (p>0.05) from CompGlass and Dyract. Highest fluoride-release measurement was located for GC Fuji II LC among other tested materials.

The bond strength of highly filled flowable composites placed in two different configuration factors

Objective:

The aim of this study was to evaluate the microtensile bond strength (μTBS) of different flowable composite resins placed in different configuration factors (C-factors) into Class I cavities.

Materials and Methods:

Fifty freshly extracted human molars were divided into 10 groups. Five different composite resins; a universal flowable composite (AeliteFlo, BISCO), two highly filled flowable composites (GrandioSO Flow, VOCO; GrandioSO Heavy Flow, VOCO), a bulk-fill flowable composite (smart dentin replacement [SDR], Dentsply), and a conventional paste-like composite (Filtek Supreme XT, 3M ESPE) were placed into Class I cavities (4 mm deep) with 1 mm or 2 mm layers. Restored teeth were sectioned vertically with a slow-speed diamond saw (Isomet 1000, Buehler) and four micro-specimens (1 mm × 1 mm) were obtained from each tooth (n = 20). Specimens were subjected to μTBS test. Data were recorded and statistically analyzed with two-way analysis of variance and Tukey's post-hoc test. Fractured surfaces were examined using a scanning electron microscope.

Results:

The μTBS in SDR-1 mm were higher than other groups, where Filtek Supreme XT-2 mm and GrandioSO Flow-2 mm were lower. No significant differences were found between C-factors for any composite resin (P > 0.05).

Conclusion:

Bulk-fill flowable composite provided more satisfactory μTBS than others. Different C-factors did not affect mean μTBS of the materials tested.

Investigations on a methacrylate-based flowable composite based on the SDR™ technology

OBJECTIVE

Monomer development for a reduced shrinkage of composite materials still challenges the modern research. The purpose of this study was to analyse the shrinkage behavior of an innovative composite material for dental restorations based on a resin system that is claimed to control polymerization kinetics having incorporated a photoactive group within the resin.

METHODS

Shrinkage stress development within the first 300s after photoinitiation, gel point as well as micro-mechanical properties (Vickers hardness HV, modulus of elasticity E, creep Cr and elastic-plastic indentation work W(e)/W(tot)) were evaluated (n = 10). The experimental flowable resin-based composite (RBC) was measured in comparison to regular methacrylate-based micro- (Esthet X Flow) and nano-hybrid flowable RBCs (Filtek Supreme Plus Flow). Additionally, the high viscosity counterparts of the two regular flowable methacryate-based composites (Esthet X Plus and Filtek Supreme Plus) as well as a low shrinkage silorane-based micro-hybrid composite (Filtek Silorane) were considered. The curing time was 20s (LED unit Freelight2, 3M-ESPE, 1226 mW/cm(2)).

RESULTS

The experimental material achieved the significantly lowest contraction stress (1.1 ± .01 MPa) followed by the silorane-based composite (3.6 ± .03 MPa), whereas the highest stress values were induced in the regular methacrylate-based flowable composites EsthetX Flow (5.3 ± .3 MPa) and Filtek Supreme Flow (6.5 ± .3 MPa). In view of gel point, the best values were obtained for the experimental flowable composite (3.1 ± .1s) and Filtek Silorane (3.2 ± .3s), which did not differ significant from each others, whereas EsthetX Plus and Filtek Supreme Plus did also not differ significantly, inducing the shortest gel point. The experimental flowable material achieved also the lowest shrinkage-rate (maximum at 0.1 MPa/s). For all analysed materials, no significant difference in the micro-mechanical properties between top and bottom were found when measured on 2mm thick increments 24h after polymerization. The categories of flowable materials performed in the measured micro-mechanical properties significantly inferior when compared to the hybrid-composites, showing lower HV and E and predominantly higher creep and plastic deformation. Within the flowable RBCs, the experimental material achieved the lowest Vickers hardness, the highest modulus of elasticity, the highest creep and showed the significantly lowest elastic deformation.

SIGNIFICANCE

The experimental flowable composite revealed the lowest shrinkage stress and shrinkage-rate values in comparison to regular methacrylate composites but intermediate micro-mechanical properties. Being at the same time more rigid (higher modulus of elasticity) and more plastic (low W(e)/W(tot) and high creep values) as the regular flowable materials, its effect on interfacial stress build-up cannot be easily predicted.

Post-gel shrinkage strain and degree of conversion of preheated resin composite cured using different regimens

OBJECTIVES

This study investigated the influence of resin composite preheating temperature, light curing regimen (mode and duration) on post-gel shrinkage strain (PGSS) and degree of conversion (DC) of a restorative resin composite.

METHODS

A hybrid resin composite preheated to three different temperatures (37 degrees C, 54 degrees C and 68 degrees C) was cured using a high intensity light emitting diode (LED) curing unit. The light source was used in 40- and 20-second continuous mode as well as soft start mode. The resin composite was monitored for PGSS during curing and 10 minutes following light irradiation using strain gauges. DC was measured using FTIR spectrometer. The results were analyzed using two-way ANOVA followed by the Duncan's Multiple Range Test for pairwise comparisons. The significance level was set at p < or = 0.05.

RESULTS

Preheating of the resin composite significantly increased its PGSS and DC. The soft start groups revealed significantly lower PGSS values compared to the 20- and 40-second groups without altering the DC.

CONCLUSIONS

Preheating of resin composite prior to curing increased its DC but also increased its PGSS. The soft-start mode decreased the PGSS of resin composite without altering the DC.

Flowability of composites is no guarantee for contraction stress reduction

OBJECTIVES

The purpose of this study was to measure the contraction stress development of three flowable resin-composite materials (Grandio Flow, VOCO GmbH, Cuxhaven, Germany; Tetric Flow, Ivoclar Vivadent, Schaan, Liechtenstein; Filtek Supreme XT Flowable Restorative, 3M ESPE, ST. Paul, MN, USA) and an universal micro-hybrid composite resin (Filtek Z250, 3M ESPE, St. Paul, MN, USA) during photopolymerization with a halogen curing light, using a novel stress-measuring gauge.

METHODS

Curing shrinkage stress was measured using a stress-analyzer. Composites were polymerized with a halogen curing unit (VIP, Bisco Inc., Schaumburg, IL, USA) for 40s. The contraction force (N) generated during polymerization was continuously recorded for 180s after photo-initiation. Contraction stress (MPa) was calculated at 20s, 40s, 60s, 120s and 180s. Data were statistically analyzed.

RESULTS

Filtek Supreme XT Flowable Restorative exhibited the highest stress values compared to other materials (p<0.05), while the lowest values were recorded with Tetric Flow (p<0.05). Tetric Flow was also the only flowable composite showing stress values lower than the conventional composite Filtek Z250 (p<0.05).

SIGNIFICANCE

Flowable composites investigated with this experimental setup showed shrinkage stress comparable to conventional resin restorative materials, thus supporting the hypothesis that the use of flowable materials do not lead to marked stress reduction and the risk of debonding at the adhesive interface as a result of polymerization contraction is similar for both type of materials.

Degree of Conversion and Contraction Stress Development of a Resin Composite Irradiated Using Halogen and LED at Two C-factor Levels

Curing methods using lower irradiance levels were shown to be effective in reducing the rate of stress generation without compromising the conversion of the restorative composite. Higher C-factor was shown to enhance the stress rate and amount of stress generated.

Assessment of polymerization contraction stress of three composite resins

OBJECTIVES

The purpose of this study was to measure the development of contraction stress of three composite resin restorative materials during photo-polymerization: a micro-hybrid composite (Filtek Z250, 3M ESPE, St. Paul, MN, USA); a nano-filled composite (Filtek Supreme, 3M ESPE, St. Paul, MN, USA); and a low-shrinkage composite (AElite LS, Bisco Inc., Schaumburg, IL, USA).

METHODS

Curing shrinkage stress was measured using a stress-analyzer. Composites were polymerized with a halogen-curing unit (VIP, Bisco Inc., Schaumburg, IL, USA) for 40 s. The contraction force (N) generated during polymerization was continuously recorded for 150 s after photo-initiation. Contraction stress (MPa) was calculated at 20, 40, 60 and 150 s. Data were statistically analyzed.

RESULTS

The low-shrinkage composite AElite LS exhibited the lowest stress values compared to other materials (p<0.05). Statistical analysis did not show significant differences between Filtek Z250 and Filtek Supreme.

SIGNIFICANCE

The low-shrinkage composite showed lower contraction stress than micro-hybrid and nano-filled composite. Ideally, non-shrinking resins would represent the ultimate solution to overcome polymerization contraction and stress-related problems.

The longevity of amalgam versus compomer/composite restorations in posterior primary and permanent teeth

BACKGROUND

Limited information is available from randomized clinical trials comparing the longevity of amalgam and resin-based compomer/composite restorations. The authors compared replacement rates of these types of restorations in posterior teeth during the five-year follow-up of the New England Children's Amalgam Trial.

METHODS

The authors randomized children aged 6 to 10 years who had two or more posterior occlusal carious lesions into groups that received amalgam (n=267) or compomer (primary teeth)/composite (permanent teeth) (n=267) restorations and followed them up semiannually. They compared the longevity of restorations placed on all posterior surfaces using random effects survival analysis.

RESULTS

The average+/-standard deviation follow-up was 2.8+/-1.4 years for primary tooth restorations and 3.4+/-1.9 years for permanent tooth restorations. In primary teeth, the replacement rate was 5.8 percent of compomers versus 4.0 percent of amalgams (P=.10), with 3.0 percent versus 0.5 percent (P=.002), respectively, due to recurrent caries. In permanent teeth, the replacement rate was 14.9 percent of composites versus 10.8 percent of amalgams (P=.45), and the repair rate was 2.8 percent of composites versus 0.4 percent of amalgams (P=.02).

CONCLUSION

Although the overall difference in longevity was not statistically significant, compomer was replaced significantly more frequently owing to recurrent caries, and composite restorations required seven times as many repairs as did amalgam restorations.

CLINICAL IMPLICATIONS

Compomer/composite restorations on posterior tooth surfaces in children may require replacement or repair at higher rates than amalgam restorations, even within five years of placement.

Modulated photoactivation methods: Influence on contraction stress, degree of conversion and push-out bond strength of composite restoratives

OBJECTIVES

Verify the influence of curing methods on contraction stress, stress rate, and degree of conversion (DC) of a restorative composite and on bond strength of composite restoratives.

METHODS

For the stress test, composite (0.84 mm thick) was applied between two 5-mm diameter glass rods, mounted in a servohydraulic machine. Stress rate was taken by the value of stress/time at each second. DC was measured by micro-FTIR. Bond strength testing was performed using a push-out test. The C-factor in all tests was 3.0. Four curing methods were tested: continuous light (CL), soft-start (SS), and two pulse delay methods using different initial irradiances--150 mW/cm(2) (PD150) and 80 mW/cm(2) (PD80). Results were analyzed by ANOVA and Tukey's test (alpha=0.05).

RESULTS

Stress values ranged from 7.9 MPa (PD80) to 10.3 MPa (CL). No statistical difference was verified among CL, SS, and PD150. PD80 presented statistically lower stress values compared to CL and SS. CL presented the highest maximum stress rate, followed by SS, PD150 and PD80. Mean DC values ranged from 54.2% (PD150) to 55.9% (PD80), with no difference observed among the methods. For the bond strength test, values ranged from 26.4 MPa (CL) to 35.5 MPa (PD150). PD150 and PD80 were both statistically superior to SS and CL. SS presented statistically higher bond strength compared to CL.

CONCLUSIONS

Modulated curing methods were shown to be effective in reducing contraction stress rate and improving the strength of the bonded interface, and without compromising the DC of the restorative composite.

Nine-year evaluation of a polyacid-modified resin composite/resin composite open sandwich technique in Class II cavities

OBJECTIVES

The aim of this study was to evaluate in an intraindividual comparison the durability of a polyacid-modified resin composite/resin composite open sandwich restoration in a 9 years follow-up. A polyacid-modified resin composite (PMRC; compomer, Dyract) was placed as an intermediate layer and covered with resin composite (RC, Prisma TPH). A direct RC restoration was used as control.

METHODS

Each of 57 patients, received at least one pair of Class II restorations, one open sandwich and one resin composite control. In total 75 pairs of Class II restorations, 68 premolars and 82 molars, all in occlusion, were placed by two dentists. Most of the cavities were surrounded by enamel. The restorations were evaluated at baseline, 6, 12, 24, 36 months and 9 years by slightly modified USPHS criteria. Survival of restorations grouped on the two different techniques was determined using Kaplan-Meier survival curves.

RESULTS

After 9 years, 14 of 135 evaluated restorations were estimated as unacceptable, 6 in the sandwich group and 8 in the control group. Over all annual failure rate during the 9-year period was 1.1%. The survival rate was not significant different between the two techniques (p=0.604). Reasons of failure were: secondary caries (8), fracture of tooth (1), fracture of restoration (2), endodontic treatment (3).

CONCLUSIONS

Both restorative techniques showed good durability during the 9-year period. No clinical advantage was observed for the sandwich technique.

Study of shrinkage–strain and contraction rates of commercial and experimental compomers

OBJECTIVE

To asses the contraction rate and shrinkage-strain of a new experimental compomer in comparison with four commercial compomers and a flowable composite resin.

METHOD

Shrinkage-strain and contraction rate were calculated by measuring the deflection of a disc in a developed instrument using "bonded disk" method.

RESULTS

Both shrinkage-strain and contraction rate are reported. Total shrinkage-strain for compomer systems varies from 2.59 to 3.34%, whereas the flowable composite resin showed a value of 3.50%. The contraction rate for compomers varies from 81.60 to 109.80 microm/min, whereas the flowable composite resin obtained 141.6 microm/min. Commercial compomers show a lower contraction rate than the control group, whereas the experimental group only shows statistical differences with a commercial compomer (Dyract AP).

SIGNIFICANCE

The shrinkage-strain and contraction rate results for the experimental compomer are as good as those obtained for a commercial flowable compomer and a flowable composite resin. The contraction rates of all compomers could be directly related to polymerization rates. The method used to measure shrinkage-strain and contraction rate is adequate because it simulates conditions in situ. It can be inferred that the contraction rate is directly related to shrinkage-strain.

The Clinical Repair of Teeth Using Direct Filling Materials: Engineering Considerations

This paper reviews the way in which teeth damaged by caries may be repaired clinically. The mechanical effects of caries are described, as are the materials available to repair the damage caused by this disease. Studies are reported which have shown that caries reduces the compressive strength of the tooth to less than 50 per cent of its original value and that, by use of appropriate materials and placement techniques, this can be restored to some 80 per cent of this value. However, very few studies have been carried out which view tooth repair from an engineering perspective. Instead, emphasis is placed on determining clinical durability of repairs. This is related to repair strength but brings in other factors, such as the oral hygiene of the patient. Despite this complication, durability studies show that modern restorative materials perform well under clinical conditions, from which it may be concluded that the repair process allows a structure to be fabricated that is essentially sound from an engineering view-point, even if inferior to the original tooth structure provided by nature.

Polyacid-modified composite resins ("compomers") and their use in clinical dentistry

OBJECTIVES

This paper describes the chemistry and properties of polyacid-modified composite resins ("compomers") designed for use in clinical dentistry, and reviews the literature in this area.

METHODS

Information has been obtained from over 50 published articles appearing in the dental and biomaterials literature, with studies being principally identified through MedLine.

RESULTS

Published work shows that polyacid-modified composite resins constitute a discrete class of polymeric repair material for use in dentistry. Their distinction is that they contain hydrophilic components, and these cause water to be drawn into the material following cure. This triggers an acid-base reaction, and gives the materials certain clinically-desirable properties (fluoride release, buffering capability) that are also associated with glass-ionomer cements. The water uptake leads to a decline in certain, though not all, physical properties. However, clinical studies have shown these materials to perform acceptably in a variety of applications (Class I, Class II and Class V cavities, as fissure sealants and as orthodontic band cements), especially in children's teeth.

CONCLUSIONS/SIGNIFICANCE

Polyacid-modified composite resins constitute a versatile class of dental repair material, whose bioactivity confers clinical advantages, and which are particularly useful in children's dentistry.

Flowable materials as an intermediate layer could improve the marginal and internal adaptation of composite restorations in Class-V-cavities

OBJECTIVES

The purpose of this in vitro study was to evaluate the marginal and internal adaptation of restorative systems in combination with flowable materials as an intermediate layer in Class-V-cavities.

METHODS

Thirty Class-V-cavities with occlusal margins in enamel and gingival margins in dentin/cementum were prepared and randomly assigned to five groups. The following five restorative systems were used: compomer, composite E, flowable compomer/composite E, composite RF and flowable composite/composite RF. The flowable materials were added between the restorative composites and the cervical margins of the cavities. Marginal and internal adaptation were quantitatively evaluated before and after thermal (2,500 times between 5 and 55 degrees C) and mechanical load cycling (25,000 times 100 N) using standard SEM procedures. Statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney U-Test. The morphology of the internal restorative interfaces was also evaluated.

RESULTS

The present study revealed that the best marginal adaptation in dentin was attained with the compomer restoration (95.8% perfect margin). The marginal adaptation of composite restorative systems was improved by the use of a flowable compomer (45.5% vs. 68.2% perfect margin in dentin) or a flowable composite (46.7% vs. 80.7% perfect margin in dentin, p<0.05) as an intermediate layer. No differences were observed between the used materials for the parameter internal adaptation.

SIGNIFICANCE

In Class-V-cavities compomers showed the best marginal adaptation and the marginal adaptation of composite fillings could be improved by the use of flowable materials as an intermediate layer.

Polymerization shrinkage and contraction stress of dental resin composites

OBJECTIVE

The aim of this study was to evaluate the shrinkage, contraction stress, tensile modulus, and the flow factor of 17 commercially available dental resin composites.

METHOD

The volumetric shrinkage measurements were performed by mercury dilatometry, and the contraction stress and tensile modulus were determined by means of stress-strain analysis. The statistical analysis was conducted by ANOVA and Tukey's post hoc test, and linear regression.

RESULTS

Strong linear correlation for most resin composites were found for (i) contraction stress and shrinkage (ii) contraction stress and tensile modulus, and (iii) shrinkage and tensile modules. For most of the materials the unpolymerized resin content determines the amount of shrinkage, contraction stress and tensile modules. The pre-polymerized clusters in Heliomolar results in improved shrinkage/contraction stress properties. The shrinkage/contraction stress for Filtek Z100, Aelite Flo, and Flow-it was too high for the amount of resin in the resin composite. This was rationalized by high polymerization rates, a flow factor, and the nature of the resin.

SIGNIFICANCE

High shrinkage and/or high contraction stress may lead to failure of the bond between the resin composites and the tooth structure. This study shows that the unpolymerized resin content determines the amount of shrinkage, contraction stress and tensile modules. Therefore, using pre-polymerized clusters will improve shrinkage/contraction stress properties, as was shown in Heliomolar, while high polymerization rates, and low flow factors have a deteriorative effect on the shrinkage/contraction stress properties.