Thirty-six month clinical evaluation of a highly filled flowable composite for direct posterior restorations

The mechanical, wear, antibacterial properties and biocompatibility of injectable restorative materials under wet challenge

OBJECTIVES

To evaluate the mechanical, wear, antibacterial properties, and biocompatibility of injectable composite materials.

METHODS

Two injectable composite resins (GU and BI), one flowable composite resin (FS), and one flowable compomer (DF), in A2 shade, were tested. Mechanical properties were tested via three-point bending test immediately after preparation and after 1-day, 7-day, 14-day, and 30-day water storage. Under water-PMMA slurry immersion, specimens were subjected to a 3-body wear test (10,000 cycles) against stainless steel balls, while the roughness, wear depth, and volume loss were recorded. After 1-day and 3-day MC3T3-E1 cell culture, cell viability was evaluated with CCK-8 test kits, while the cell morphology was observed under CLSM and SEM. Antibacterial properties on S. mutans were assessed via CFU counting, CLSM, and SEM observation. SPSS 26.0 was used for statistical analysis (α = 0.05).

RESULTS

The mechanical properties were material-dependent and sensitive to water storage. Flexural strength ranked GU > FS > BI > DF at all testing levels. Three nanocomposites had better wear properties than DF. No significant difference on 1-day cell viability was found, but DF showed significantly lower cell proliferation than nanocomposites on 3-day assessment. GU and FS had more favourable cell adhesion and morphology. CFU counting revealed no significant difference, while FS presented a slightly thicker biofilm and BI showed relatively lower bacteria density.

CONCLUSIONS

Injectable nanocomposites outperformed the compomer regarding mechanical properties, wear resistance, and biocompatibility. The tested materials presented comparable antibacterial behaviours. Flowable resin-based composites' performances are affected by multiple factors, and their compositions can be attributed.

CLINICAL SIGNIFICANCE

A profound understanding of the mechanical, wear, and biological properties of the restorative material is imperative for the clinical success of dental restorations. The current study demonstrated superior properties of highly filled injectable composite resins, which imply their wider indications and better long-term clinical performances.

Restoration of a Microdont Using the Resin Composite Injection Technique With a Fully Digital Workflow: A Flexible 3D-printed Index With a Stabilization Holder

Direct composite restorations are accepted as a treatment option for microdontia, which is a relatively prevalent condition that poses esthetic concerns. While free-hand composite placement is technique-sensitive and time-consuming, the resin composite injection technique is more straightforward and predictable. A fully digital workflow has been recently introduced, but the 3D-printed resin index is rigid and challenged by undercuts, as opposed to the silicone index. This case report presents a flexible 3D-printed resin index, which can accurately transfer the digitally simulated functional and esthetic form to the final restoration. In addition, a rigid stabilization holder was designed to stabilize the flexible index.

[Flexural strength of conventional flowable, bulk fill flowable and highly filled flowable resin composites: in vitro study.]

Objective

To evaluate and compare the flexural strength of conventional flowable, bulk fill flowable and highly filled flowable resins.

Materials and methods

Thirty 2mm x 2mm x 25mm specimens of Tetric N-Flow (TNF), Filtek Bulk Fill Flowable Restorative (FBF) and Beautifil Flow Plus F00 (BFP) flowable resins were made up; they were distributed into three groups according to brand (n=10) and stored in distilled water for 24 hours at 37ºC. The 3-point bending test according to ISO 4049 was performed on a universal testing machine at a speed of 0.5 mm/min until fracture. The results were evaluated with Anova and Tukey tests. P<0.05.

Results

Statistically significant differences were found between the groups with a value of p=0.011. According to the statistical analysis, the groups that showed statistically significant differences were the BFP and TNF groups (p=0.015) and the BFP and FBF groups (p=0.035), while no statistically significant difference was found in the TNF and FBF groups.

Conclusion

The high-filled flowable resin presents better flexural strength compared to the conventional flowable and bulk fill flowable resins, while the conventional and bulk fill flowable resins have no statistically significant difference.

Pre-orthodontic restorative treatment of microdontia diastema teeth using composite injection technique with a digital workflow-Case report

Restorative treatment of microdontia teeth is often considered as the final step of post-orthodontic treatment. Based on digital workflow, this clinical report presents pre-orthodontic reshaping of anterior teeth in the smile disharmony of a young patient using bilayering composite injection technique. Transparent silicone indexes for dentin and enamel fillings were fabricated from three-dimensional-printed models of the digital wax-up. This noninvasive, simple and straightforward injection technique was able to provide semipermanent reversible aesthetic restorations while awaiting for adulthood and definitive prosthodontic solution. Closure of diastemas before orthodontic treatment were carried out to restore functional contact point and to guide future teeth movements.

Patients´ satisfaction concerning direct anterior dental restoration

The objective of this study was to observe patients' satisfaction with their in-service direct anterior dental restorations and to compare it with clinical evaluation using FDI (Federation Dental International) criteria. Patients scored their own anterior dental restorations regarding satisfaction (satisfactory /dissatisfactory). If dissatisfaction was mentioned, then, they would be interviewed about the complaint. In the same session, the dental restorations were clinically evaluated by two dentists using FDI criteria (1-5 score) concerning esthetic, functional, and biological domains. Descriptive statistics were used for frequencies of scores attributed by patients and clinicians. In order to compare patients' to clinicians' frequencies, the Chi-square test was applied (p ≤ 0.05). A total of 106 restorations were evaluated by patients and clinicians. Patients reported 52.8% of restorations satisfactory and 47.8% dissatisfactory. Overall, clinicians reported the same restorations as 82,3% satisfactory and 17,6% dissatisfactory. Patients' most frequent complaints referred to color, followed by anatomical form, fracture of material and retention, and approximal anatomical form. Comparing patients' satisfaction and dissatisfaction rates to clinicians' evaluation per criteria, there was no difference regarding esthetics. The frequency of dissatisfactory restorations by clinicians was significantly lower when functional and biological properties were compared with patients' opinions. Direct anterior dental restorations were more frequently reported as satisfactory by patients and clinicians, being the main complaints related to esthetic issues. When clinicians and patients' evaluations were compared, it was observed that the frequencies of satisfactory restoration by patients and clinicians were similar regarding esthetic properties, and significantly different regarding functional and biological properties.

Injectable Resin Technique as a Restorative Alternative in a Cleft Lip and Palate Patient: A Case Report

Objective: The objective of this study is to present a case report in which the injectable composite resin technique was used as a restorative alternative for dental re-anatomization in a patient with cleft lip and palate and aesthetic complaints. Materials and Methods: The treatment plan included the re-anatomization of the maxillary premolars and canines using a flowable composite resin. This resin was injected and cured through a transparent matrix, which was a copy of the diagnostic wax-up model. Some parameters such as application time and marginal adaptation were also observed when performing the restorations. Additionally, old composite resin restorations on the upper lateral incisors were replaced using the incremental technique with conventional resins, which helped to assess color stability and fracture/wear deterioration for both restorative techniques. Results: The clinical case report shows that the injectable technique was a simple and quick method for restoring the anatomy of teeth (shape and contour) in one session, since the injectable resin can be easily applied in interproximal areas without the need to manually sculpt the resin. In this case, no clinical, visual, or photographic differences were found in marginal discoloration, color stability, and fracture/wear deterioration for the two restorative techniques after one year of follow-up. Conclusions: The professional may have another clinical option for restorative treatment in the case of small re-anatomizations. In addition, the injectable technique seems to require less operator skill and chair time and better marginal adaptation in cases of small anatomical changes.

A Systematic Review and Meta-Analysis of the Success of Resin Composite Restorations

Aim:

This review examines the studies on resin composites within the past decade and evaluates the materials’ application methods and success through Fédération Dentaire Internationale (FDI) scores.

Materials and Methods:

Search results from three databases (a total of 3295 studies) were transferred to Mendeley Desktop (Mendeley, London, UK) software and deduplicated (2638 studies). Eight studies were included in this meta-analysis after scanning the title, abstract, and full-text screening. Risk of bias analysis was performed using the Cochrane Handbook tool. Shapiro–Wilk, Kolmogorov–Smirnov, Kruskal–Wallis, and post hoc Tamhane’s T2 were used for statistical analysis.

Results:

Conventional composite’s surface staining FDI score was higher than flowable and silorane composites (no difference between these two). Also, conventional composite has the highest score in terms of staining. Conventional composite + two-step self-etch adhesive and bulk fill composite + two-step self-etch adhesive have lower FDI scores in marginal staining. In noncarious cervical lesions (NCCL), conventional composite + two-step total-etch adhesive has a higher score than flowable composite + two-step self-etch adhesive. Flowable composite + two-step self-etch adhesive and conventional composite + single-step self-etch adhesive have the highest FDI scores for marginal adaptation (no statistical difference between them). Conventional composite + two-step self-etch adhesive and bulk fill composite + two-step self-etch have the lowest scores (no statistical difference between them). For recurrence of caries, all groups have Score 1, the best score, and there is no significant difference between them.

Conclusions:

Each restorative material and adhesive system has different advantages, and the practitioner must choose the most appropriate.

Compliance of randomized controlled trials in posterior restorations with the CONSORT statement: a systematic review of methodology

OBJECTIVES

This study aims to investigate the compliance of randomized controlled trials (RCTs) in posterior restorations with the Consolidated Standards of Reporting Trials Statement (CONSORT) statement and to analyze the risk of bias (RoB) of these studies.

METHODS

A systematic search was performed in PubMed, Scopus, Web of Science, LILACS/BBO, and Cochrane Library. Only RCTs published in peer-reviewed journals were included. The compliance with the CONSORT was evaluated in a 0-2 scale where 0 = no description, 1 = poor description and 2 = adequate description. Descriptive analyses of the CONSORT mean score by journal, country, and RoB were performed. The RoB in RCTs was evaluated by using the Cochrane Collaboration's tool version 1.0.

RESULTS

A total of 15,476 studies were identified after duplicates removal. O only 202 meet the eligibility criteria, among which 31 were follow-up studies. Concerning the overall RoB, only 29 out of 171 were classified as low risk of bias. The overall mean CONSORT score was 19 ± 5.4 points, which means compliance of approximately 59%. Significant differences among countries, publication period, and RoB were observed (p < 0.001). The journal's impact factor was not correlated with the overall CONSORT score (p = 0.36).

CONCLUSIONS

The adherence of RCTs conducted in posterior restorations to the CONSORT Statement is still low. In addition, most studies were classified as at unclear risk of bias. These results call up an urgent need for improvement.

CLINICAL RELEVANCE

Most RCTs conducted in posterior teeth have poor reporting and are mainly classified as having an unclear risk of bias.

Evaluation of the mechanical behavior of bulk-fill and conventional flowable resin composites using dynamic micro-indentation

The purpose of this research was to investigate the mechanical behavior of commercially available bulk-fill and conventional flowable resin composites using the dynamic micro-indentation method. The effect of inorganic filler content on mechanical properties was also assessed. Weight percentages of the inorganic filler in the resin composite were measured using the ashing technique. The results showed that dynamic hardness and elastic modulus tended to increase with inorganic filler content. Furthermore, the differences in mechanical properties between top and bottom surfaces were less pronounced in bulk-fill flowable resin composites compared with conventional flowable resin composites. In conclusion, the mechanical properties of bulk-fill flowable resin composites are affected by filler content. Moreover, bulk-fill flowable resin composites have a higher polymerization depth than conventional flowable resin composites when sample thickness is 4 mm.

Relationships between Flexural and Bonding Properties, Marginal Adaptation, and Polymerization Shrinkage in Flowable Composite Restorations for Dental Application

To evaluate the flexural and bonding properties, marginal adaptation, and polymerization shrinkage in flowable composite restorations and their relationships, four new generation flowable composites, one conventional, and one bulk-fill flowable composite were used in this study. Flexural properties of the composites and shear bond strength to enamel and dentin for flowable restorations were measured immediately and 24 h after polymerization. Marginal adaptation, polymerization shrinkage, and stress were also investigated immediately after polymerization. The flexural properties, and bond strength of the flowable composites to enamel and dentin were much lower immediately after polymerization than at 24 h, regardless of the type of the composite. Polymerization shrinkage and stress varied depending on the material, and bulk-fill flowable composite showed much lower values than the others. The marginal adaptation and polymerization shrinkage of the composites appeared to have a much stronger correlation with a shear bond strength to dentin than to enamel. The weak mechanical properties and bond strengths of flowable composites in the early stage after polymerization must be taken into account when using them in the clinic. In addition, clinicians should be aware that polymerization shrinkage of flowable composites can still lead to the formation of gaps and failure of adaptation to the cavity regardless of the type of composite.

Clinical Evaluation of Flowable Composite Materials in Permanent Molars Small Class I Restorations: 3-Year Double Blind Clinical Study

This study evaluated the 3-year clinical performance of four different flowable composite materials used in Small Class I restorations in permanent molars. This double-blinded, clinical study analyzed 229 Small Class I restorations/103 children at baseline, 12, 24, and 36 months with modified United States Public Health Services (USPHS) criteria. The tested flowable materials were Voco Grandio Flow + Voco Solobond M, Vivadent Tetric EvoFlow + Vivadent Excite, Dentsply X-Flow + Dentsply Prime&Bond NT, and 3M ESPE Filtek Supreme XT Flow + 3M ESPE Scotchbond Universal. The retention and marginal adaptation rates were highest for Grandio Flow and X Flow materials after 36 months, resulting in the highest score of clinical acceptability at 95.3% and 97.6%, respectively. The Tetric EvoFlow and Filtek Supreme XT Flow had the same retention rate after 36 months at 88.1%. Statistical significance was found in Grandio flow material in postoperative sensitivity criteria (p = 0.021). Tetric EvoFlow showed statistical differences in retention (p = 0.01), color match (p = 0.004), and marginal adaptation (p = 0.042). Filtek Supreme showed statistical differences in retention (p = 0.01) and marginal adaptation (p < 0.001). The flowable composite materials showed excellent clinical efficacy after 36 months of their clinical usage. There was no difference among the tested flowable composite materials quality in Small Class I restorations over time.

Aesthetic Management of Erosive Tooth Wear in a Young Egyptian Swimmer: A Case Report

Background

Tooth wear can have a multifactorial aetiology which requires thorough patient assessment and aesthetic management.

Purpose

This case report discusses the management of a young, Egyptian swimmer complaining of tooth sensitivity associated with erosive tooth wear. Anterior teeth were restored using the injection molding technique, also known as the injectable composite resin technique, to overcome the patient’s complaint and enhance the aesthetics of compromised anterior teeth.

Patients and Methods

Thorough patient assessment was followed by impression taking, a diagnostic wax-up and intraoral mock-up fabrication for aesthetic, functional and biological verification. Upon the patient’s agreement on the proposed treatment, an injection molding technique was carried out.

Conclusion

The tooth loss pattern associated with erosive tooth wear in competitive swimmers showed a very characteristic presentation. Detailed patient history is imperative for successful assessment of the risk factors contributing to the condition and treatment planning in such cases. The use of injection molding technique for restoration of anterior teeth is a simple, straightforward and aesthetically pleasing alternative for patients with erosive tooth wear requiring direct composite veneers.

The injectable resin composite restorative technique: A case report

OBJECTIVE

To describe the use of the injectable resin composite restorative technique with a flowable resin material, in a clinical case with esthetic problems associated with irregular tooth anatomies, allied with a finishing, and polishing protocol due to staining after 1 year of use.

CLINICAL CONSIDERATIONS

The presented case report helped to achieve an immediate highly esthetic restoration with appropriate width proportions based on a previous wax-up. After 1 year of use, restorations presented staining; therefore, finishing and polishing procedures were required to re-achieve acceptable esthetic results and thus increase restoration's survival.

CONCLUSIONS

The use of the presented technique allowed to obtain a simple and predictable workflow; however, care must be taken on the follow up of the restorations due to intrinsic characteristics of the flowable resin material.

CLINICAL SIGNIFICANCE

The use of the presented injectable technique helped on obtaining a precise anatomy replicating a diagnostic wax-up, thus improving marginal precision and achieving a highly esthetic and functional immediate outcome, with an easy workflow when appropriately planned and executed. However, it also presented low color stability after 1 year of use only, thus, requiring attention from clinicians in regard to its maintenance over time.

Bulk Fill Composites Have Similar Performance to Conventional Dental Composites

The aim of the study was to perform comprehensive characterization of two commonly used bulk fill composite materials (SDR Flow (SDR) and Filtek™ Bulk Fill Flowable Restorative (FBF) and one conventional composite material (Tetric EvoCeram; TEC). Eleven parameters were examined: flexural strength (FS), flexural modulus (FM), degree of conversion, depth of cure, polymerisation shrinkage (PS), filler particle morphology, filler mass fraction, Vickers hardness, surface roughness following simulated toothbrush abrasion, monomer elution, and cytotoxic reaction of human gingival fibroblasts, osteoblasts, and cancer cells. The degree of conversion and depth of cure were the highest for SDR, followed by FBF and TEC, but there was no difference in PS between them. FS was higher for bulk fill materials, while their FM and hardness were lower than those of TEC. Surface roughness decreased in the order TEC→SDR→FBF. Bisphenol A-glycidyl methacrylate (BisGMA) and urethane dimethacrylate were found in TEC and FBF eluates, while SDR released BisGMA and triethylene glycol dimethacrylate. Conditioned media accumulated for 24 h from FBF and TEC were cytotoxic to primary human osteoblasts. Compared to the conventional composite, the tested bulk fill materials performed equally or better in most of the tests, except for their hardness, elastic modulus, and biocompatibility with osteoblasts.

Post-orthodontic recontouring of anterior teeth using composite injection technique with a digital workflow

OBJECTIVE

Restorative treatment of anterior teeth is often required as the final step of orthodontic therapy to optimize the esthetics and function. This case report presents a direct minimally invasive approach for post-orthodontic recontouring of anterior teeth using the composite injection technique with a digital workflow.

CLINICAL CONSIDERATIONS

The extraction of central incisors with short roots was indicated to resolve maxillary anterior crowding. The gained space was closed with lateral incisors, and it was necessary to recontour them and canines to resemble central and lateral incisors, respectively. The restorations were digitally designed, and a transparent silicone index was fabricated from a 3D-printed cast of the digital wax-up. After lateral incisors and canines were bonded with a universal adhesive in the etch-and-rinse mode, a highly filled injectable composite resin was applied into the index. The restorative treatment was preceded by gingivectomy using an Er:YAG laser and home bleaching.

CONCLUSIONS

In cases where more complex recontouring of anterior teeth is necessary, the composite injection technique could be a suitable alternative to indirect restorations, because it is straightforward, cost-effective, and does not require any preparation. The digital workflow simplified and expedited the treatment while contributing to its precision.

CLINICAL SIGNIFICANCE

Post-orthodontic recontouring using direct composite restorations is well accepted by patients due to low cost and non-invasiveness. However, in complicated cases, the free-hand technique is time-consuming and technique-sensitive. The presented composite injection technique with a digital workflow significantly simplifies and expedites the composite placement while predictably enhancing the treatment outcome.

Clinical Evaluation of a Self-Adhering Flowable Resin Composite in Minimally Invasive Class I Cavities: 5-year Results of a Double Blind Randomized, Controlled Clinical Trial

OBJECTIVE

The aim of this study was to evaluate the long-term clinical performance of a self-adhering flowable resin composite compared to a conventional flowable resin composite used with an etch&rinse adhesive system in minimally invasive Class I cavities.

MATERIALS AND METHODS

Twenty-five patients received at least one pair of Class I restorations (n=65). After class I cavities had been prepared, they were randomly restored either with a self-adhering flowable resin composite (VertiseFlow/Kerr-VR) [Group-1 (n=33)], or with a flowable resin composite (Luxaflow/DMG-LX) in combination with an etch&rinse adhesive (Teco/DMG) [Group-2 (n=32)] according to the manufacturers' instructions. The restorations were evaluated at baseline and yearly during 5 years according to the FDI criteria by two evaluators. A statistical analysis was carried out using the Pearson Chi-Square test and the Cochran Q-test followed by the Mc Nemar's test (p=0.05).

RESULTS

After 5 years a total of 47 restorations were evaluated with a recall rate of 68%. At 4-year, 3 (11.5%) VR and 2 LX (7.6%) restorations exhibited a cumulative retention loss. Seventeen (73.9%) VR and 14 LX (58.3%) restorations exhibited clinically acceptable (2) scores for marginal adaptation. At 5-year evaluations VR and LX showed similar results regarding all evaluated criteria (p > 0.05). The cumulative retention loss rates of VR and LX were 15.3% and 7.6%, respectively. None of the restorations demonstrated a recurrence of caries and post operative sensitivity. Both materials showed significant changes at 4 and 5 years regarding marginal staining when compared to baseline (p<0.001). Furthermore, significant changes were observed for VR and LX at 1, 2, 3, 4 and 5 years for marginal adaptation according to baseline (p<0.001).

CONCLUSION

The use of both materials for the restoration of Class-I cavities demonstrated clinically acceptable performance at the end of 5-year. The self-adhering flowable composite exhibited a clinical performance similar to the conventional flowable applied with an etch&rinse adhesive.

Influence of attachment bonding protocol on precision of the attachment in aligner treatments

AIM

Precise bonding of attachments in aligner treatment is crucial to achieve the intended tooth movement. Thus, we evaluated five different bonding protocols for attachments used in aligner treatments with the goal of identifying the most precise protocol.

METHODS

One ellipsoid and one rectangular attachment were exemplarily chosen and examined. All attachments were bonded using the same template aligner, which was produced by thermoforming. The bonding process was repeated 30 times with each protocol for statistical analysis. The protocols differed in the type of composite used (high viscous, low viscous), the additional application of a perforation in the attachment reservoir, and the use of a two-phase procedure with high viscous composite. All bonded attachments were laser scanned and compared to the attachments of a master model using a surface/surface matching algorithm to determine the precision, i.e., highest aberrations (maximum vertical distance) between the attachment of the master and results obtained from the various bonding protocols. Furthermore, the excessive amounts of composite bonded around the attachments were measured and compared.

RESULTS

The two-phase procedure had a median aberration of 0.13 mm and a median amount of excessive composite of 7.40 mm² (ellipsoid attachment). With the low viscous composite without a perforation in the template reservoir, similar results were achieved (median 0.13 mm) regarding the maximum vertical distance, but had an excess area of 33.50 mm².

CONCLUSION

In this in vitro study, the bonding protocol influenced the precision of bonded attachments. The bonding protocol with high viscous composite without a perforation in the attachment reservoir was the most inaccurate. The use of a low viscous composite or attachments made by a two-phase procedure with high viscous composite revealed more precise results.

Effect of Different Surface Treatments and Roughness on the Repair Bond Strength of Aged Nanohybrid Composite

Objective and background: Different surface treatments have been tested in composite repair studies. However, there is still no consensus on the most effective repair protocol. The aim of this study is to measure the roughness values of eight different surface treatments for the repair procedure, to examine the effect of each surface treatment and three different composites on the repair bond strength with and without silane, and to evaluate whether there is a correlation between bond strength and roughness. Methods: The blocks were prepared with Filtek Z550 (3M ESPE) for the roughness measurements and divided into eight groups according to surface treatments. The roughness values of the surface treatments were measured by a 3D scanning contact profilometer (Nanomap LS). For the shear test, further samples were prepared, aged, and divided into three subgroups for the repair procedure with Filtek Z550 (3M ESPE), Vertise Flow (Kerr, USA), and G-aenial Flo (GC, Japan) after the surface treatments. Then, the shear test was performed. The Kruskal-Wallis and Spearman's Correlation tests were used for statistical evaluation of the data. Results: Significant differences were found between surface treatments and composite resins in terms of bond strength (p < 0.05). There is no correlation between the roughness and bond strength values. Conclusions: In bond strength, surface topography is more important than the numerical value of roughness. In the repair of composite restorations, methods that are already in clinical practice and more practical can be used instead of methods that require additional costs and devices.

Clinical evaluation of flowable resin composite versus conventional resin composite in carious and noncarious lesions: Systematic review and meta-analysis

The purpose of this systematic review was to evaluate clinical performance of flowable composite in carious and noncarious lesions. An electronic search was conducted using specific databases (PubMed, Embase, Cochrane Library, and LILACS) through March 2017. Clinical trials for restoration of carious and noncarious lesions were included with no date restrictions; follow-up was 6 months at least and dental restorations were evaluated using the United States Public Health Service criteria. The systematic search generated 908 papers, of which 35 papers were included for full-text review. Inclusion criteria were met by eight papers, six papers were for noncarious lesions and two papers were for restoration of carious lesions. The results of this review have shown no statistical or clinical difference between flowable and conventional composites for all tested outcomes in both carious and noncarious lesions. Both materials have shown clinically acceptable scores for all criteria, with no evidence of clinically unacceptable scores except in retention, with a retention rate of 83% in both materials after 36 months. Flowable composites had clinical efficacy after 3 years of service similar to that of conventional composite in both carious and noncarious lesions, these results are based on low quality of evidence. Based on the available literature and the best available evidence, flowable composites can be used in restoration of noncarious cervical lesions and minimally invasive occlusal cavities.