Long-Term Stability of a RAFT-Modified Bulk-Fill Resin-Composite under Clinically Relevant Versus ISO-Curing Conditions

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

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

Proposition of New Testing Procedure for the Mechanical Properties of Bulk-Fill Materials

This study analysed flexural properties, microhardness, and the degree of conversion (DC) of five bulk-fill composites under clinically relevant conditions (4 mm thick specimens) in comparison to 2 mm specimens according to ISO 4049. Additionally, the effect of rapid polymerisation on 4 mm specimens was evaluated after accelerated aging. DC was measured using Fourier transform infrared spectrometry at 2 and 4 mm thick layers, while flexural properties and Vickers microhardness were tested using 16 × 2 × 2 mm or 16 × 2 × 4 mm specimens. Three polymerisation protocols were used: (I) "ISO": 2 mm thickness, 1000 mW/cm², double-sided; (II) "10 s": 4 mm thickness, 1000 mW/cm², one-sided; and (III) "3 s": 4 mm thickness, 2600 mW/cm², one-sided. Mechanical properties were tested after 1 day, after 10,000 thermocycles, and after 10,000 thermocycles followed by a 7-day immersion in absolute ethanol. The "ISO" protocol produced a higher DC and microhardness of all materials. Elastic modulus was significantly higher for the "ISO" protocol compared to the 4 mm specimens. The differences in flexural strength for all polymerisation protocols were equalised after thermocycling and immersion in absolute ethanol. All tested materials met the ISO 4049 flexural strength requirement (80 MPa) for all polymerisation methods and all aging conditions. Rapid polymerisation achieved nearly optimal properties (ISO), except for elastic modulus, which was significantly reduced in 4 mm samples.

The effect of high-irradiance rapid polymerization on degree of conversion, monomer elution, polymerization shrinkage and porosity of bulk-fill resin composites

OBJECTIVE

The purpose was to compare the degree of conversion (DC), monomer elution (ME), polymerization shrinkage (PS) and porosity of two addition-fragmentation chain transfer (AFCT) modified resin-based composites (RBC) light-cured with rapid- (RP), turbo- (TP) or conventional polymerization (CP) settings.

METHODS

Cylindrical samples (6-mm wide, 4-mm thick) were prepared from Tetric PowerFill (TPF) and Filtek One Bulk (FOB). Four groups were established according to the polymerization settings: 3s-RP, 5s-TP, 10s-CP and 20s-CP. Samples in 1 mm thickness with 20s-CP settings served as controls. The DC at the top and bottom surfaces was measured with micro-Raman spectroscopy. ME was detected with high-performance liquid chromatography. PS and porosity were analyzed by micro-computed tomography. ANOVA and Tukey's post-hoc test, multivariate analysis and partial eta-squared statistics were used to analyze the data (p < 0.05).

RESULTS

FOB showed higher DC values (61.5-77.5 %) at the top compared to TPF (43.5-67.8 %). At the bottom TPF samples achieved higher DCs (39.9-58.5 %) than FOB (18.21-66.18 %). Extending the curing time increased DC (except the top of FOB) and decreased ME. BisGMA release was the highest among the detected monomers from both RBCs. The amount was three-fold more from TPF. The factor Material and Exposure significantly influenced DC and ME. PS (1.8-2.5 %) did not differ among the groups and RBCs except for the lowest value of TPF cured with the 3s_RP setting (p = 0.03). FOB showed 4.5-fold lower porosity (p < 0.001). Significantly higher pore volume was detected after polymerization in 3s_RP (p < 0.001).

SIGNIFICANCE

High-irradiance rapid 3-s curing of AFCT modified RBCs resulted in inferior results for some important material properties. A longer exposure time is recommended in a clinical situation.

Polymerization Kinetics and Development of Polymerization Shrinkage Stress in Rapid High-Intensity Light-Curing

This study investigated polymerization kinetics, linear shrinkage, and shrinkage stress development for six contemporary composite materials of different viscosities cured using radiant exitances of 1100–2850 mW/cm². Real-time measurements of degree of conversion, linear shrinkage, and shrinkage stress were performed over 5 min using Fourier-transform infrared spectrometry, a custom-made linometer, and a custom-made stress analyzer, respectively. For most tested variables, the factor “material” had a higher effect size than the factor “curing protocol”. Maximum polymerization rate and maximum shrinkage stress rate were the most affected by changes in curing conditions. In contrast, no significant effects of curing conditions were identified within each material for shrinkage stress values measured at the end of the 5 min observation period. Linear shrinkage and shrinkage stress values measured after 5 min were closely correlated (R = 0.905–0.982). The analysis of polymerization kinetics suggested that the two composites specifically designed for rapid light-curing responded to higher radiant exitances differently than other composites. Polymerization kinetics and shrinkage stress behavior of contemporary restorative composite materials of different viscosities were overall more affected by material type than differences in curing conditions. Subtle differences in polymerization kinetics behavior shown by the two composites specifically designed for rapid high-intensity light-curing did not translate into significant differences in the development of polymerization shrinkage stress.

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

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

Impact of ultra-fast (3 s) light-cure on cell toxicity and viscoelastic behavior in a dental resin-based composite with RAFT-mediated polymerization

OBJECTIVE

The aim of the study was to determine the effects of ultra-fast (3 s) light-curing on the viscoelastic behaviour at clinically relevant frequencies, and cell toxicity, in a resin-based composite (RBC) with reversible addition-fragmentation-chain transfer (RAFT) mediated polymerization.

METHODS

Three different protocols were used to cure cylindrical samples (height = 4 mm, ϴ = 5 mm), including ultra-fast (3s) cure with high radiant emittance, 10 s and 20 s cure with moderate radiant emittance. The properties of the light curing device were evaluated in all curing protocols by spectrophotometry up to an exposure distance of 10 mm. The light transmission through the samples was determined in real-time with the same spectrophotometer. Absorbance was calculated as a function of wavelength. The quasi-static (indentation hardness/H_IT, indentation modulus/E_IT) and viscoelastic (storage modulus/E', loss modulus/E″, loss factor/tan δ) material behavior was determined in an instrumented indentation test with a DMA (Dynamic Mechanical Analysis) module for 10 frequencies (0.5-5 Hz) by profiling the center of the samples in 330 μm steps from top to bottom. Cellular toxicity on human gingival fibroblast (HGF-1) was assessed using a WST-1 colorimetric assay after incubation time of up to 3 months. One and multiple-way analysis of variance (ANOVA) with Tukey honestly significant difference (HSD) post-hoc tests (α = 0.05) were applied.

RESULTS

The irradiance transmitted through a 4 mm high sample was less than 7% of the incident irradiance, and the absorbance was similar for all curing protocols, showing a decrease with wavelength. Similar quasi-static and viscoelastic parameters were observed regardless of the curing protocol. H_IT increased slightly and E_IT, E', E″ and tan δ decreased with frequency. Occasionally, slightly higher confidence intervals were observed for the ultra-fast curing group, which were related to a potential accumulation of stress. The curing protocol had no effect on cell viability (p = 0.326) but the eluate age (p < 0.001, η_P² = 0.879) did. None of the groups showed cell toxicity at any point in time with respect to the corresponding negative control.

CONCLUSIONS

The ultra-fast curing with high irradiance induced no cell toxicity and an equivalent viscoelastic behavior as with conventional curing protocols in a RAFT-modified RBC.

Rapid 3 s Curing: What Happens in Deep Layers of New Bulk-Fill Composites?

This study assessed the influence of rapid 3 s light curing on the new generation of bulk-fill resin composites under the simulated aging challenge and depths up to 4 mm. Four bulk-fill materials were tested: two materials designed for rapid curing (Tetric PowerFill—PFILL; Tetric PowerFlow—PFLW) and two regular materials (Filtek One Bulk Fill Restorative—FIL; SDR Plus Bulk Fill Flowable—SDR). Three-point bending (n = 10) was used to measure flexural strength (FS) and flexural modulus (FM). In the 3 s group, two 2 mm thick specimens were stacked to obtain 4 mm thickness, while 2 mm-thick specimens were used for ISO group. Specimens were aged for 1, 30, or 30 + 3 days in ethanol. The degree of conversion (DC) up to 4 mm was measured by Raman spectroscopy. There was no difference between curing protocols in FS after 1 day for all materials except PFLW. FM was higher for all materials for ISO curing protocol. Mechanical properties deteriorated by increasing depth (2–4 mm) and aging. ISO curing induced higher DC for PFLW and FIL, while 3 s curing was sufficient for PFILL and SDR. The 3 s curing negatively affected FM of all tested materials, whereas its influence on FS and DC was highly material-specific.