Light Transmittance and Polymerization of Bulk-Fill Composite Materials Doped with Bioactive Micro-Fillers

Influence of Layer Thickness and Shade on the Transmission of Light through Contemporary Resin Composites

BACKGROUND

Material-dependent parameters have an important impact on the efficiency of light polymerization. The present in vitro study aimed to investigate the influence of the increment thickness and shade of nano- and nanohybrid resin composites on the transmission of curing light.

METHODS

Three contemporary resin composites were evaluated: Tetric EvoCeram® (TEC); Venus Diamond® (VD); and Filtek Supreme XTE® (FS XTE). Light transmission (LT) was recorded in accordance with the sample thickness (0.5 to 2.7 mm) and the shade. Polymerized samples were irradiated for 10 s each using the high-power LED curing light Celalux 2 (1900 mW/cm2). LT was simultaneously recorded using the MARC Patient Simulator (MARC-PS).

RESULTS

LT was strongly influenced by the composite layer thickness. For 0.5 mm-thick samples, a mean power density of 735 mW/cm2 was recorded at the bottom side. For the 2.7 mm samples, a mean power density of 107 mW/cm2 was measured. Only LT was markedly reduced in the case of darker shades. From A1 to A4, LT decreased by 39.3% for FS XTE and 50.8% for TEC. Dentin shades of FS XTE and TEC (A2, A4) showed the lowest LT.

CONCLUSIONS

The thickness and shade of resin composite increments strongly influences the transmission of curing light. More precise information about these parameters should be included in the manufacture manual.

Low and high viscosity bulk-fill composite resins stress distribution in primary molar tooth inlay cavity

The aim of this study is to evaluate the stress distributions of low and high viscosity bulk-fill composite resins at class II MOD inlay cavity in primary molar tooth using Finite Element Analysis (FEA). Original DICOM data of a primary molar tooth from a research archive was used to create a 3D model. Two models were prepared as Model 1: the tooth model without restoration (control group) and Model 2: the tooth model with class II MOD inlay restoration. Two different bulk-fill composite resins were tested in study: Model 2 A (class II MOD inlay cavity model restored with low viscosity bulk-fill composite resin) and Model 2B (class II MOD inlay cavity model restored with high viscosity bulk-fill composite resin). Occlusal vertical loading of 232 N was applied to the teeth in occlusal contact areas. Maximum Von Mises stress values in the models for enamel, dentin, and restorative material were evaluated as MPa. More intense stress accumulation is observed in enamel than in dentin. In addition, more stress values were determined in Model 2B (206.15 MPa, 32.76 MPa, 128.95 MPa) than in Model 2 A (203.39 MPa, 29.77 MPa, 120.61 MPa) for enamel, dentin and restorative material, respectively.

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.

A Narrative Review of Bioactive Glass-Loaded Dental Resin Composites

This review aims to provide a comprehensive analysis of the characterizations of bioactive glass (BAG)-loaded dental resin-based composite materials. Online databases (Web of Science, PubMed, and Science Direct) were used to collect data published from January 2011 to January 2022. Only BAG-containing resin adhesive and resin restorative composites are discussed in this narrative review. BAG-loaded resin composites exhibit excellent mineralization ability reflecting enhanced ion release, pH elevation, and apatite formation, especially regarding high BAG loading. This aids the anti-demineralization and remineralization of teeth. Furthermore, BAG-loaded resin composites demonstrated in vitro biocompatibility and antibacterial performance. It has been suggested that BAG fillers with small particle sizes and no more than 20 wt% in terms of loading amount should be used to guarantee the appropriate mechanical properties of resin composites. However, most of these studies focused on one or some aspects using different resin systems, BAG types, and BAG amounts. As such, this makes the comparison difficult, and it is essential to find an optimal balance between different properties. BAG-loaded resin composites can be regarded as bioactive materials, which present major benefits in dentistry, especially their capability in the bacterial inhibition, cell biocompatibility, anti-demineralization, and remineralization of teeth.

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.

Marginal Adaptation of Flowable vs Sonically Activated or Preheated Resin Composites in Cervical Lesions

PURPOSE

To investigate marginal integrity of restorations applied with preheated and non-preheated composite, flowable composite, sonically activated composite, and a new thermo-viscous bulk-fill composite using near-infrared technology for preheating, in class V cavities of human molars.

MATERIALS AND METHODS

Standardized cavities were prepared on the buccal surfaces of 60 human mandibular molars and restored with one of the following resin composite materials after application of an etch-and-rinse adhesive (OptiBond FL, Kerr): non-preheated or preheated conventional composite (Filtek Supreme XTE, 3M Oral Care), preheated thermo-viscous composite (VisCalor bulk, Voco), soncially activated composite (SonicFill 3, Kerr), or flowable composite (Filtek Supreme XTE Flowable, 3M Oral Care) applied in bulk or as a lining material using the snow-plow technique. After light curing and polishing, the percentage of continuous margins (PCM) of the restorations in enamel and dentin was assessed using SEM both before and after thermomechanical loading (TML). TML was carried out with 3000 thermal cycles (5°C-50°C) and a simultaneous mechanical stress application with 1.2 million load-cycles (1.7 Hz, 49 N) in a computer-controlled masticator. Non-parametric statistical analysis was performed using Wilcoxon, Kruskal-Wallis, and Mann-Whitney U-tests (α = 0.05).

RESULTS

All groups revealed a significant decline in marginal integrity after TML in both enamel and dentin. Although the flowable group in enamel and the snow-plow group in dentin showed the highest PCM before TML, the differences between the groups were compensated after TML.

CONCLUSION

All of the tested composites and application methods showed similar marginal integrities after thermomechanical loading and can be recommended for clinical implementation.

Depth-Related Curing Potential of Ormocer- and Dimethacrylate-Based Bulk-Fill Composites

The aim of this in vitro study was to investigate the degree of C=C double bond conversion of high-viscosity dimethacrylate- or ormocer-based bulk-fill composites as a function of measurement depth. Four bulk-fill composites (Tetric EvoCeram Bulk Fill, x-tra fil, SonicFill, and Bulk Ormocer) and the conventional nanohybrid composite Tetric EvoCeram were applied in standardized Class II cavities (n = 6 per group) and photoactivated for 20 s at 1350 mW/cm². The degree of conversion of the composites was assessed using Fourier-transform infrared spectroscopy at seven measurement depths (0.15, 1, 2, 3, 4, 5, 6 mm). Data were analyzed using repeated measures ANOVA and one-way ANOVA with Bonferroni post-hoc tests (α = 0.05). The investigated bulk-fill composites showed at least 80% of their maximum degree of conversion (80% DC_max) up to a measuring depth of at least 4 mm. Tetric EvoCeram Bulk Fill and Bulk Ormocer achieved more than 80% DC_max up to a measuring depth of 5 mm, x-tra fil up to 6 mm. The conventional nanohybrid composite Tetric EvoCeram achieved more than 80% DC_max up to 3 mm. In contrast to the conventional composite, the investigated ormocer- and dimethacrylate-based bulk-fill composites can be photo-polymerized in thick layers of up to at least 4 mm with regard to their degree of C=C double bond conversion.

Polymerization kinetics of experimental resin composites functionalized with conventional (45S5) and a customized low-sodium fluoride-containing bioactive glass

This study aimed to investigate polymerization kinetics and curing light transmittance of two series of experimental dental resin composites filled with 0–40 wt% of either 45S5 bioactive glass (BG) or a customized low-Na F-containing BG. Polymerization kinetics in 0.1-mm and 2-mm thick layers were investigated through real-time degree of conversion measurements using a Fourier transform infrared (FTIR) spectrometer. FTIR spectra were continuously collected at a rate of 2 s⁻¹ during light-curing (1340 mW/cm²). Light transmittance through 2-mm thick composite specimens was measured using a UV–Vis spectrometer at a rate of 20 s⁻¹. Unlike BG 45S5, which led to a dose-dependent reduction in the rate and extent of polymerization, the customized low-Na F-containing BG showed a negligible influence on polymerization. The reduction in light transmittance of experimental composites due to the addition of the low-Na F-containing BG did not translate into impaired polymerization kinetics. Additionally, the comparison of polymerization kinetics between 0.1-mm and 2-mm thick layers revealed that polymerization inhibition identified for BG 45S5 was not mediated by an impaired light transmittance, indicating a direct effect of BG 45S5 on polymerization reaction. A customized low-Na F-containing BG showed favourable behaviour for being used as a functional filler in light-curing dental resin composites.

Evaluation of depth-wise post-gel polymerisation shrinkage behaviour of flowable dental composites

Short fibre reinforced flowable dental composites are gaining acceptance over particulate filled composites due to their competence to impart improved physio-mechanical properties and capability to prevent crack propagation. However, limited research exists to assess their overall post-gel shrinkage behaviour, which is an important factor to determine marginal seal around restoration and hence its longevity. In this paper, depth-wise post-gel shrinkage strain and the resulting factors such as degree of conversion and rheological behaviour of flowable fibre reinforced composite (FRC) containing 5% weight fraction of 5 μm diameter, 350 μm length S-Glass fibres in UDMA/TEGDMA mixture along with 50% strontium filler particles were investigated. Post-gel shrinkage strain was measured using an array of optical fibre Bragg grating sensors (FBGs) of diameter 250 μm and length 1 mm each embedded at three different depths (depth 0 mm, depth 2.5 mm and depth 5 mm from curing light tip) within the flowable dental composite samples. The rheological behaviour during the polymerisation process was carried out using dynamic oscillatory tests. To evaluate the conversion of CC during polymerisation, degree of conversion tests were conducted by using FTIR spectroscopy. The results obtained for FRC samples were further compared with that of particulate filled composite (PFC) samples, with 55% strontium filler particles only within the same resin system. The relationship between post-gel shrinkage strain at different depths, rheological behaviour and degree of conversion was also explored. The experimental results from the sensor embedded materials suggested that the post-gel shrinkage strain was higher at the top surface (depth 0 mm) and was 50% more than at the bottom surface (depth of 5 mm) for dental FRC as well as PFC samples. Further, similar flow behaviour and not significant different (p<0.05) degree of conversion (DC), post-gel shrinkage strain for dental PFC and FRC composites was observed, establishing a convincing positive relationship between all the key factors and further implying that replacement of fibres with fillers did not affect the overall post-gel polymerisation shrinkage behaviour in dental composites. This investigation has also demonstrated that fibre optic sensors-based shrinkage measurements can be an ideal technique to evaluate post-gel shrinkage performance of dental resins with PFCs or FRCs.

Short- and Long-Term Dentin Bond Strength of Bioactive Glass-Modified Dental Adhesives

This study investigated the short- and long-term effects of dental adhesives doped with nano-sized bioactive glass 45S5 (BAG) on the resin-dentin interfacial bond strength. Two etch-and-rinse adhesives (Adper Scotchbond Multi-Purpose (ASB) and Solobond Plus (SB)) and one self-etch adhesive (Clearfil SE Bond (CF)) were doped with different concentrations of BAG (5, 10, and 20 wt%). The unmodified (0 wt% BAG) commercial adhesives served as control groups. Dentin of 120 molars (n = 10 per group) was treated with the different adhesives, followed by buildups with a conventional composite restorative material. From each tooth, 14 sticks were prepared for micro-tensile bond strength (µTBS) testing. The sticks were stored in simulated body fluid at 37 °C and tested after 24 h or six months for µTBS and failure mode. Data were analyzed using Kruskal-Wallis tests in combination with post-hoc Conover-tests and Wilcoxon signed-rank tests at a level of significance of α = 0.05. After 24 h and six months, both etch-and-rinse adhesives with a low BAG content (up to 10 wt% for ASB and 5 wt% for SB) showed similar µTBSs as their respective control groups (0 wt% BAG). CF showed a significant decrease in µTBS even after addition of 5 wt% BAG. At a high concentration of added BAG (20 wt%), all three adhesives showed a significant decrease in µTBS compared to the unmodified controls. The CF control group showed significantly lower µTBS after 6 months of storage than after 24 h. In contrast, the µTBS of all CF groups modified with BAG was unaffected by aging. In conclusion, the tested etch-and-rinse adhesives can be modified with up to 5 wt% (SB), or 10 wt% (ASB) of BAG without reducing their short- and long-term dentin bond strength. Moreover, the addition of nano-sized BAG may prevent long-term bond strength deterioration of a self-etch adhesive.

Polymerization shrinkage behaviour of resin composites functionalized with unsilanized bioactive glass fillers

Previous work has shown that partial replacement of reinforcing fillers with unsilanized silica particles can diminish polymerization shrinkage stress of dental resin composites. The aim of the present study was to investigate whether such an effect can be attained by using unsilanized bioactive glass (BG). Incorporating BG fillers into resin composites is interesting due to their potential for exerting caries-preventive effects. Experimental light-curable composites with a total filler load of 77 wt% were prepared. Reinforcing fillers were partially replaced with 0-60 wt% of BG 45S5 and an experimental low-sodium fluoride-containing BG. The following properties were investigated: linear shrinkage, degree of conversion, shrinkage stress, maximum shrinkage stress rate, and time to achieve maximum shrinkage stress rate. The diminishing effect of BG 45S5 on shrinkage stress was mediated by a decrease in degree of conversion caused by this BG type. In contrast, as the degree of conversion remained unaffected by the experimental BG, the resulting shrinkage behaviour was governed by the effect of varying amounts of silanized and unsilanized fillers on material's viscoelastic properties. The replacement of silanized reinforcing fillers with unsilanized BG did not reduce polymerization shrinkage stress unless the reduction was attained indirectly through a diminished degree of conversion.

Margin Integrity of Bulk-Fill Composite Restorations in Primary Teeth

This in vitro study examined the margin integrity of sculptable and flowable bulk-fill resin composites in Class II cavities of primary molars. Standardized Class II cavities were prepared in human primary molars and restored with the following resin composite materials after application of a universal adhesive: a sculptable bulk-fill composite (Tetric EvoCeram Bulk Fill (TEC) or Admira Fusion x-tra (AFX)), a flowable bulk-fill composite (Venus Bulk Fill (VBF) or SDR), or a conventional composite (Filtek Supreme XTE (FS)). The bulk-fill materials were applied in 4 mm layers, while the conventional composite was applied in either 2 mm (FS2, positive control) or 4 mm layers (FS4, negative control). The specimens were exposed to thermo-mechanical loading (TML) in a computer-controlled masticator. A quantitative margin analysis was performed both before and after TML using scanning electron microscopy, and the percentage of continuous margins (margin integrity) was statistically analyzed (α = 0.05). All composites showed a significant decline in margin integrity after TML. AFX exhibited the significantly highest margin integrity of all materials after TML (97.5 ± 2.3%), followed by FS2 (79.2 ± 10.8%), TEC (73.0 ± 9.1%), and FS4 (71.3 ± 14.6%). SDR (43.6 ± 22.3%) and VBF (25.0 ± 8.5%) revealed the lowest margin integrity. In conclusion, the tested sculptable bulk-fill materials show similar or better margin integrity in primary molars than the conventional resin composite placed in 2 mm increments.

The effect of rapid high-intensity light-curing on micromechanical properties of bulk-fill and conventional resin composites

Rapid high-intensity light-curing of dental resin composites is attractive from a clinical standpoint due to the prospect of time-savings. This study compared the effect of high-intensity (3 s with 3,440 mW/cm²) and conventional (10 s with 1,340 mW/cm²) light-curing on micromechanical properties of conventional and bulk-fill resin composites, including two composites specifically designed for high-intensity curing. Composite specimens were prepared in clinically realistic layer thicknesses. Microhardness (MH) was measured on the top and bottom surfaces of composite specimens 24 h after light-curing (initial MH), and after subsequent immersion for 24 h in absolute ethanol (ethanol MH). Bottom/top ratio for initial MH was calculated as a measure of depth-dependent curing effectiveness, whereas ethanol/initial MH ratio was calculated as a measure of crosslinking density. High-intensity light-curing showed a complex material-dependent effect on micromechanical properties. Most of the sculptable composites showed no effect of the curing protocol on initial MH, whereas flowable composites showed 11–48% lower initial MH for high-intensity curing. Ethanol/initial MH ratios were improved by high-intensity curing in flowable composites (up to 30%) but diminished in sculptable composites (up to 15%). Due to its mixed effect on MH and crosslinking density in flowable composites, high-intensity curing should be used with caution in clinical work.

A New Customized Bioactive Glass Filler to Functionalize Resin Composites: Acid-Neutralizing Capability, Degree of Conversion, and Apatite Precipitation

This study introduced an experimental bioactive glass (BG) with a lower Na₂O content than conventional BG 45S5 (10.5 wt% vs. 24.5 wt%), additionally containing CaF₂ (12 wt%) and a network connectivity similar to that of BG 45S5. A series of experimental composites functionalized with 5-40 wt% of the novel BG was prepared and compared to a corresponding series of experimental composites functionalized with 5-40 wt% of BG 45S5. Commercial acidneutralizing materials (alkasite, giomer, and glass ionomer) were used as references. The capabilities of the materials to neutralize hydrochloric acid (pH = 2.6) and lactic acid (pH = 4.5) were evaluated by real-time pH measurements over 1 h. The degree of conversion and precipitation of calcium phosphate were also investigated. Data were analyzed using one-way and Welch ANOVA at an overall level of significance of 0.05. The acid-neutralizing potential of the experimental BG incorporated into resin composites was generally comparable to that of BG 45S5, and better than that of a giomer and glass ionomer. Fluorine was identified in the precipitate that developed on the composites functionalized with the experimental BG, suggesting a capability of forming fluorapatite. Unlike the 45S5 composition, the experimental BG did not impair the degree of conversion of resin composites. The novel BG filler is therefore an interesting candidate for future investigations of caries-preventive resin composites, and their potential clinical applicability for restorative, preventive, and orthodontic purposes.

Bioactivity and Physico-Chemical Properties of Dental Composites Functionalized with Nano- vs. Micro-Sized Bioactive Glass

Bioactive resin composites can contribute to the prevention of secondary caries, which is one of the main reasons for failure of contemporary dental restorations. This study investigated the effect of particle size of bioactive glass 45S5 on chemical and physical composite properties. Four experimental composites were prepared by admixing the following fillers into a commercial flowable composite: (1) 15 wt% of micro-sized bioactive glass, (2) 15 wt% of nano-sized bioactive glass, (3) a combination of micro- (7.5 wt%) and nano-sized (7.5 wt%) bioactive glass, and (4) 15 wt% of micro-sized inert barium glass. Hydroxyapatite precipitation and pH rise in phosphate-buffered saline were evaluated during 28 days. Degree of conversion and Knoop microhardness were measured 24 h after specimen preparation and after 28 days of phosphate-buffered saline immersion. Data were analyzed using non-parametric statistics (Kruskal-Wallis and Wilcoxon tests) at an overall level of significance of 5%. Downsizing the bioactive glass particles from micro- to nano-size considerably improved their capability to increase pH. The effect of nano-sized bioactive glass on degree of conversion and Knoop microhardness was similar to that of micro-sized bioactive glass. Composites containing nano-sized bioactive glass formed a more uniform hydroxyapatite layer after phosphate-buffered saline immersion than composites containing exclusively micro-sized particles. Partial replacement of nano- by micro-sized bioactive glass in the hybrid composite did not impair its reactivity, degree of conversion (p > 0.05), and Knoop microhardness (p > 0.05). It is concluded that downsizing bioactive glass particles to nano-size improves the alkalizing potential of experimental composites with no negative effects on their fundamental properties.