Polymerization shrinkage, microhardness and depth of cure of bulk fill resin composites

Comparative analysis of conversion and crosslinking degree in bulk-fill, monochromatic, and ORMOCER composites

Bulk-fill, monochromatic, and ORMOCER composites were introduced in restorative dentistry with the aim of reducing clinical time and/or alleviating contraction stresses at the interface between the tooth and restoration. While the conversion and immediate properties of these materials are comparable to conventional composites, studies evaluating their long-term properties and the structure of the polymer matrix are lacking. The objective of this study was to evaluate the degree of conversion and, indirectly, the crosslink density of conventional, bulk-fill, monochromatic, and ORMOCER resin composites. The degree of conversion was measured using Fourier-transform infrared spectroscopy (FTIR). Flexural strength, elastic modulus, and hardness were measured both dry (24 h) and after ethanol storage (24 h) using three-point bending and Knoop microhardness testing, respectively. Sorption and solubility were determined by changes in mass before and after immersion in water and drying. Data were analyzed using one-way or two-way ANOVA (material or material/storage conditions). The degree of conversion was statistically similar across all materials. For composites from the same manufacturer, no significant differences were observed in the reduction of mechanical properties after ethanol storage between bulk-fill and monochromatic composites, although differences were noted for the ORMOCER material. Sorption and solubility varied among most composites from the same manufacturer, suggesting subtle differences in composition. Therefore, it can be concluded that, for composites from the same manufacturer, the degree of crosslinking was similar between bulk-fill and monochromatic composites, indicating comparable polymeric structures. The same was not observed for the ORMOCER material, although it exhibits properties similar to other conventional composites.

Effects of pre-heating on physical-mechanical-chemical properties of contemporary resin composites

This research assessed the effects of pre-heating on the physical-mechanical-chemical properties of different resin composites. For this, resin composites were evaluated in 6 levels: Admira/ADM, Vitra/VIT, Filtek Supreme/FS, Filtek Supreme Flowable/FSF, Filtek One/FO, and Filtek Bulk Fill Flowable/FBF; temperature was evaluated in 4 levels using a composite heater: room temperature/22 ºC, 37 ºC, 54 ºC, and 68 ºC. Response variables were: degree of conversion/DC, flexural strength/FS and color stability/ΔE (immediately after light curing/LC, after 7 days of dark-dry-storage, and after 24 h and 3 days of artificial aging in water at 60 ºC). Data were subjected to 2-way ANOVA (DC and FR) and 3-way repeated measurements ANOVA (ΔE), all followed by Tukey's test (α = 5%). DC were similar (FBF, FS, and FSF) or increased (ADM, FO, and VIT) as the temperature increased. Results of FR were unchanged or increased for all composites except VIT and ADM. High-viscosity composites (VIT and FS) showed higher FR values than low-viscosity composite (FSF). For bulk-fill composites, FBF and FO showed similar results, but lower than high-viscosity composites. Results of color stability showed acceptable values up to 3 days aging except for ADM and FSF. ΔE was not influenced by pre-heating and, overall, ΔE: FS < VIT < FO < FSF < ADM < FBF. Only VIT and FS showed ΔE ≤ 3.3 (clinical threshold). Therefore, the effects of pre-heating depend on the material. The tested materials generally showed similar or enhanced properties after pre-heating (except ADM and VIT).

The Effects of Intensity, Exposure Time, and Distance of Polymerization Light on Vickers Microhardness and Temperature Rise of Conventional Resin-Based Composite

(1) Background: This study investigates the effects of curing light intensity, exposure time, and distance on the Vickers microhardness (VMH), hardness bottom-to-top ratio (HR), and temperature rise (TR) of conventional dental resin-based composite (RBC). (2) Materials and Methods: Specimens of one conventional RBC (Tetric EvoCeram, Ivoclar Vivadent) were cured with 12 different curing protocols (CPs), created with three different light intensities (Quartz Tungsten Halogen 300 mW/cm2, LED 650 mW/cm2, LED 1100 mW/cm2), two exposure times (20 and 40 s), and two distances of curing tip (0 and 8 mm). The VMH of top (VMH-T) and bottom (VMH-B) surfaces was measured. The hardness bottom-to-top ratio (HR) was calculated from VMH-B and VMH-T. The HR below 80% was rated as inadequate polymerization. The TR at the depth of 2 mm within the RBC was measured using a K-type thermocouple. Data were analyzed using Levene's test and the multivariate analysis of variance (MANOVA). The level of significance was set at p < 0.05. (3) Results: Exposure time and distance significantly influenced VMH-B and HR. Increased distance significantly reduced VMH-B, HR, and TR. CPs 300 mW/cm2/8 mm/20 s and 650 mW/cm2/8 mm/20 s produced inadequate polymerization (HR < 80%). Prolonged exposure time produced higher values of VMH-B and HR. The TR was significantly influenced by light intensity and distance. (4) Conclusions: Suboptimal light intensity (<800 mW/cm2) can produce inadequate polymerization at the lower side of the composite layer when used from a distance. Prolonged irradiation can improve the polymerization to a certain extent. Clinicians are advised to monitor the intensity of the LCUs in order to optimize the photopolymerization process. Caution is required when polymerizing with high-intensity curing light in direct contact with the RBC with longer exposure times than recommended.

Light curing infection control barriers: do some types jeopardize the concept of conventional bulk-fill composites?

BACKGROUND

Using infection control barriers (ICBs) on light curing units (LCUs) became mandatory to achieve proper infection control measures without jeopardizing the integrity of the restorations, especially at deeper layers. This study explored the effect of two ICBs on the irradiance of the LCU, as well as the degree of conversion (DC) and flexural strength (FS) of two types of bulk-fill composites. Water vapor permeability (WVP) of both barriers was also assessed to evaluate the capability of such barriers to prevent transmission of blood and saliva droplets and aerosols.

METHODS

Two bulk-fill composites (X-tra fil and Tetric N- ceram) and two ICBs (Pinnacle Cure sleeve and Sanita wrapping film) were used in this study. Light irradiance was recorded per experimental condition using spectroradiometer. For DC and FS, specimens of 4 mm thickness were prepared. Each specimen was composed of two separable upper and lower layers of thickness 2 mm. DC and FS were measured using Infra-red spectroscopy and three-point loading test respectively. WVP was investigated using the cup method. Means and standard deviations were calculated, and the data were statistically analyzed using factorial analysis of variance test (α = 0.05).

RESULTS

Light irradiance showed highest values using no ICBs and lowest values using Pinnacle curing sleeve. Both bulk-fill composites showed higher DC mean values without ICBs and when using Sanita wrapping film for both upper and lower layers of the specimens compared to Pinnacle curing sleeve. The upper layers of composite specimens showed higher DC compared to lower layers for all experimental conditions. Both ICBs had no adverse effect on FS of both composites' upper layers. Pinnacle sleeve significantly reduced FS of both composites' lower layers. X-tra fil showed higher DC and FS compared to Tetric N-Ceram for all experimental conditions. Regarding WVP; the wrapping film showed higher WVP compared to the curing sleeve.

CONCLUSIONS

Sanita wrapping film can be used as a successful ICB, without jeopardizing the concept of bulk-fill composites. Pinnacle cure sleeve can be considered an effective ICB, however its influence on properties and serviceability of bulk-fill composites remains questionable.

Efficiency of bulk-fill versus conventional resin-based composite in class II restorations: A dental student perspective

Purpose/objectives

The aim of the study was to evaluate the effect of two distinct light-polymerization protocols, used by dental students, on the placement time and polymerization efficiency of bulk-fill (BF) and conventional (CRC) resin-based composites (RBCs).

Methods

Thirty dental students participated in this study. Each student was asked to complete four Class II RBC restorations using two different types of RBCs (BF and CRC) paired with two distinct light-polymerization protocols: one using 1200 mW/cm2 irradiance (P1200) and one using 800 mW/cm2 irradiance (P800). Manufacturer instructions for curing times relative to these irradiance levels were adhered to. The restorations were retrieved, sectioned and Vickers microhardness (VMH) was measured at specific reading points. The placement time was recorded for each procedure. Multivariate analysis of variance and Bonferroni post hoc test were used for data analysis.

Results

Bulk-fill RBCs were associated with significantly shortened placement times (P < 0.001). VMH values of CRC-P800 were significantly higher compared to all other groups (P < 0.02). Across all groups tested, the VMH values at the deepest reading points exceeded those at the occlusal surfaces by over 80 %.

Conclusions

The use of BF RBCs with a P1200 light-polymerization protocol reduced students' procedural times while maintaining effective polymerization of the restorations.

Maximizing dental composite performance: Strength and hardness enhanced by innovative polymer-coated MgO nanoparticles

INTRODUCTION

Zein-incorporated magnesium oxide nanoparticles (zMgO NPs) can influence the mechanical properties of dental materials. However, the effect of this addition on the mechanical properties of resin composite has yet to be investigated. The objective of this study was to add various concentrations of zMgO NPs to conventional, flowable, and bulk-fill composite and assess the effect on the compressive strength, flexural strength, and microhardness.

METHODOLOGY

150 samples each of conventional composite, flowable composite, and bulk-fill composite (n = 450) were enhanced with concentrations of zMgO NPs at 0 %, 0.3 %, 0.5 %, 1 %, and 2 % (n = 30). 10 samples of each group were randomly allotted to the compressive strength, flexural strength, or hardness test. Characterization of the specimens was performed by X-ray diffraction, Fourier transform infrared spectroscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and transmission electron microscopy. Two-way ANOVA test was used to compare between groups, and one-way ANOVA followed by Tukey's test was done at p = 0.05 to determine significance.

RESULTS

Characterization yielded a uniform distribution of nanoparticles in the matrix and the formation of a new hybrid composite that maintained its properties. Composite of all types enhanced with 0.3 % and 0.5 % zMgO NPs demonstrated a statistically significant increase in compressive strength, flexural strength, and hardness when compared to the control (p < 0.05). The bulk-fill composite with zMgO NPs concentrations of all groups demonstrated a statistically significant increase (p < 0.05) in hardness when compared to the control.

CONCLUSION

The modified composites' compressive strength, flexural strength, and hardness improved or remained consistent.

CLINICAL SIGNIFICANCE

An improved dental resin composite will enhance the quality of care and patient experience. The augmented strength and hardness of resin composite is desirable in prolonging the durability of the restoration.

Five-year survival of class II restorations with and without base bulk-fill composite: a retrospective cohort study

OBJECTIVE

This study aimed to determine the survival of class II composite restorations in premolars and molars with and without base bulk-fill composite in general dental practice.

MATERIALS AND METHODS

We collected data from the electronic patient files of the Public Dental Services in the City of Oulu, Finland. The timespan of data collection was from August 15th, 2002, to August 9th, 2018. The data consisted of class II composite restorations both with and without base bulk-fill composite. We compared the survival of these restorations using Kaplan-Meier survival curves, the log-rank test, survival rates, and the Wilcoxon signed ranks test.

RESULTS

We observed 297 restorations in 96 patients. The five-year survival rates for restorations with and without base bulk-fill composite were comparable in premolars (77.5% and 77.4%, respectively) but different in molars (69.9% and 57.8%, respectively, p = 0.069). In molars, the restorations with base bulk-fill composite exhibited a higher survival rate in 14 patients, whereas in 11 patients the restorations without base bulk-fill composites exhibited a higher survival rate. In 24 patients the survival rates were similar for restorations with and without the base bulk-fill composite (p = 0.246).

CONCLUSIONS

The restorations with and without base bulk-fill composite had similar longevity.

CLINICAL RELEVANCE

Base bulk-fill composites are safe to use in general practice due to their similar survival rates compared to conventional composites.

Flowable bulk-fill versus layering restorative material on Class II restorations: A randomized clinical trial

OBJECTIVE

This study evaluated the clinical performance of Class II restorations made with flowable bulk-fill base versus conventional layering ORMOCER-based restorative material in a split-mouth randomized clinical trial.

METHODS

Thirty patients received two class II restorations (n = 60) performed with different strategies. All preparations received the application of the universal self-etching adhesive system according to the manufacturer's recommendation, followed by the placement of a sectional matrix, wooden wedge, and separation ring. The first restoration was performed using 4 mm of flowable bulk-fill material covered by 2 mm of conventional viscosity restorative material (Bulk-fill technique). The second restoration was performed only with the conventional viscosity material, with a maximum of 2 mm thick increments, up to fill the cavity (Layering technique). After occlusal adjustment, the same polishing system was used for all restorations. Evaluations using the FDI criteria were conducted after 7 days, 12, and 24 months. Data were analyzed with the Fisher's Exact test (α=0.05).

RESULTS

From 30 participants, 24 attended the 24-month recall, and 48 restorations were evaluated. All restorations received acceptable overall scores for esthetic and biological properties after this period, while only 6.66 % of the restorations exhibited unacceptable overall scores for the functional properties in both groups. No significant differences between the tested restorative materials and techniques were found for each FDI criterion assessed. The success rate after 2 years was 93.33 % for both groups.

CONCLUSION

Both restorative materials exhibited good clinical performance for the parameters analyzed with no differences between them after 24-month follow-up.

CLINICAL RELEVANCE

Flowable bulk-fill ORMOCER-based material is a suitable alternative for direct Class II restorations, providing good clinical outcomes and simplifying the restorative procedure.

CLINICAL TRIAL REGISTRATION NUMBER

RBR-6mvp9w.

Clinical performance of different bulk-fill composite resin systems in class II cavities: A 2-year randomized clinical trial

OBJECTIVES

This study evaluated the clinical performance of bulk-fill resin composite systems with different viscosities in class II cavities.

MATERIALS AND METHODS

A total of 80 class II restorations were performed with a single operator in 50 patients using four different bulk-fill resin composite materials: Filtek™ Bulk Fill, Heated Filtek™ Bulk Fill, G-ænial™ BULK Injectable, and SonicFill3. A double-blinded randomized clinical trial was designed to evaluate the two-year clinical performance of the four bulk-fill composite resins using modified FDI criteria. Data were analyzed descriptively. Level of significance was set at 0.05. Differences between groups were tested using Wilcoxon-signed-rank and Mann-Whitney-U test as nonparametric tests.

RESULTS

Data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests (p < 0.05). Eighty restorations were available for evaluation, with a survival function of 100%. No statistically significant differences were observed between the four groups regarding assessing esthetic, functional, and biological properties during different follow-up periods.

CONCLUSIONS

After 2 years of clinical follow-up, the bulk-fill composite systems with different viscosities seem to be esthetically, functionally, and biologically acceptable, with a promising clinical performance in class II cavities.

Assessments of polymerization shrinkage by optical coherence tomography-based digital image correlation analysis-Part II: Effects of restorative composites

OBJECTIVES

To examine the polymerization shrinkage of different resin-based composite (RBC) restorations using optical coherence tomography (OCT) image-based digital image correlation (DIC) analysis.

METHODS

The refractive index (RI) of three RBCs, Filtek Z350XT (Z350), Z350Flowable (Z350F), and BulkFill Posterior (Bulkfill), was measured before and after polymerization to calibrate their axial dimensions under OCT. Class I cavities were prepared in bovine incisors and individually filled with these RBCs under nonbonded and bonded conditions. A series of OCT images of these restorations were captured during 20-s light polymerization and then input into DIC software to analyze their shrinkage behaviors. The interfacial adaptation was also examined using these OCT images.

RESULTS

The RI of the three composites ranged from 1.52 to 1.53, and photopolymerization caused neglectable increases in the RI values. For nonbonded restorations, Z350F showed maximal vertical displacements on the top surfaces (-16.75 µm), followed by Bulkfill (-8.81 µm) and Z350 (-5.97 µm). In their bonded conditions, all showed increased displacements. High variations were observed in displacement measurements on the bottom surfaces. In the temporal analysis, the shrinkage of nonbonded Z350F and Bulkfill decelerated after 6-10 s. However, Z350 showed a rebounding upward displacement after 8.2 s. Significant interfacial gaps were found in nonbonded Z350 and Z350F restorations.

SIGNIFICANCE

The novel OCT image-based DIC analysis provided a comprehensive examination of the shrinkage behaviors and debonding of the composite restorations throughout the polymerization process. The flowable composite showed the highest shrinkage displacements. Changes in the shrinkage direction may occur in nonbonded conventional composite restorations.

Comparative analysis of self-cure and dual cure-dental composites on their physico-mechanical behaviour

BACKGROUND

Clinical practitioners may have become familiar with the rapid transformation of dental composites. However, they may not scientifically understand the factors influencing the mechanical and physical properties. Scientific knowledge of filler-resin interaction can significantly improve clinical understanding of resin composites. Several independent studies have examined the mechanical and physico-mechanical properties of dental resin composites; however, no comprehensive study has examined the influence of fillers and resin materials on the physico-mechanical properties of both self-cure and dual-cure composites.

METHODS

This study performed investigations on the physico-mechanical behaviour of four commercially available dual-cure dental composites (Bioactive, Fill Up!, Surefil One, Cention N) and two commercially available self-cure dental composites (Stela Capsule and Stela Automix). Test specimens for flexural and compressive strength, microhardness, fracture toughness, and hydrolytic behaviour were prepared and tested as per respective standards. The data sets were statistically analysed using one-way ANOVA and Tukey's post-hoc comparison.

RESULTS

There was a substantial variation in flexural strength and modulus values in this study, ranging from 32.0 to 113.4 MPa and 2.36 to 12.07 GPa, respectively. Similarly, there were significant differences in compressive strength between the materials in this study, ranging from 119.3 to 223.5 MPa. The highest fracture toughness value was found to be 1.41 MPa.m0.5, while the lowest value was 0.43 MPa.m0.5. Variations in surface microhardness were significant (24.11-68.0 N/mm2), which correlated with the filler content. Water sorption and solubility demonstrated high variations among materials, with Surefil One exceeding ISO 4049 thresholds significantly.

CONCLUSIONS

A linear correlation can be established between surface microhardness (HV) and flexural and compressive moduli, as well as filler content (wt.%). However, both flexural and compressive strengths are impacted by the resin's constituent monomers and the resin-filler matrix's cross-linking capability. Additionally, factors such as filler size, shape, and the cross-linking ability of the resin-filler matrix play a crucial role in fracture toughness and the propagation of cracks within the restoration. Also, resin monomers and filler particle size affect the hydrolytic degradation characteristics of composites, which can also affect their mechanical properties. © 2023 Australian Dental Association.

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

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

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

Two-year evaluation of a nano-hybrid and a bulk-fill resin composite: a randomized, double-blind split-mouth clinical study

OBJECTIVES

The aim of this study was to compare the 2-year clinical performance of a bulk-fill composite resin and a nano-hybrid-filled composite resin in 6-12-year-old children in a split-mouth design.

MATERIALS AND METHODS

This randomized, split-mouth, and double-blind study was conducted on 89 patients aged 6-12 years with caries on bilateral mandibular first molars. In a split-mouth design, restorations of mandibular permanent molars were completed with nano-hybrid organically modified ceramic (ORMOCER)-based bulk-fill composite resin Admira Fusion x-tra (Voco GmbH, Cuxhaven, Germany) and nano-hybrid composite Grandio (Voco, Cuxhaven, Germany). Futurabond U single dose (Voco, Cuxhaven, Germany) was used with selective enamel etching. The clinical success of the restorations was evaluated using USPHS and FDI criteria at 6, 12, and 24-month follow-up controls.

RESULTS

In the 2-year follow-up, all restorations were clinically acceptable. Grandio was significantly worse than Admira Fusion x-tra in terms of surface luster and superficial change (p < 0.05). Surface staining and color match scores increased in Admira Fusion x-tra compared with Grandio significantly (p < 0.05).

CONCLUSIONS

Although both materials showed acceptable clinical performance over 2 years, a significant difference was observed between the surface luster, surface staining, marginal adaptation, and staining of the nano-hybrid composite placed with the incremental technique and the bulk-fill ORMOCER-based composite resin.

CLINICAL RELEVANCE

As an alternative to nano-hybrid composite resins, using bulk-fill restorative materials, which can be indicated in the proper case, may contribute to shortening treatment procedures and increasing patient and physician comfort, leading to clinical success.

Dentin adhesion of bulk-fill composites and universal adhesives in class I-cavities with high C-factor

OBJECTIVES

The aim of this study was to compare the dentin adhesion of bulk-fill composites in high C-factor class I-cavities before and after thermocycling to a control group using incremental layering technique.

METHODS

A standardized class I-cavity was prepared into 195 human molars, then different universal adhesives were applied either in self-etch or etch & rinse mode, and the cavity was filled according to each materials application protocol. The material combinations used were a conventional layered composite as control, the respective bulk-fill product, two other bulk-fill composites made by different manufacturers, with one of them being tested using two different polymerization times. Furthermore, one thermoviscous bulk-fill composite and one self-adhesive restorative were examined of which the latter can only be applied in self-etch mode. In each group the dentin adhesion to the cavity bottom was measured using microtensile bond strength test initially (24 h water storage) and after thermocycling. All results were statistically analyzed using STATA 17.0.

RESULTS

The statistical analysis showed significant differences between the control and the experimental groups (p < 0.001). The highest mean bond strength before (14.8 ± 10.7 MPa) and after aging (14.2 ± 11.5 MPa) was measured for the etch & rinse-control group. Among the bulk-fill groups, the etch & rinse technique consistently showed higher bond strengths. Bond strength of groups with shortened polymerization did not exceed 2.1 MPa. The bond strength of the self-adhesive restoration material was low before and after thermocycling (2.7 MPa/ 0.0 MPa). Groups with low bond strength values showed a high number of pre-testing-failures.

CONCLUSIONS

Bulk-fill materials used in high C-factor class I-cavities showed lower bond strength during self-etch application. The same applies for a shortened polymerization regime, which cannot be recommended for high C-factor cavities.

CLINICAL SIGNIFICANCE

Today, a large variety of materials and application techniques can be used when placing an adhesive restoration. Whether new instead of established procedures should be applied in high C-factor cavities has to be critically assessed, as they are a demanding scenario for adhesive restorations.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Conventional-, bulk-fill- or flowable-resin composites as prosthetic core build-up: Influence on the load-bearing capacity under fatigue of bonded leucite-reinforced glass-ceramic

This study aimed to evaluate the fatigue performance of simplified ceramic restorations (leucite-reinforced glass ceramic) adhesively cemented onto substrates of different resin composites. Three options from the same commercial line were selected (Tetric N-Line, Ivoclar), classified as Conventional (CRC), Bulk-fill (BRC) and Flowable (FRC), which were used to make discs using a cylindrical metallic device (n = 19; Ø = 10 mm, thickness = 2.0 mm). A total of 57 discs (Ø = 10 mm, thickness = 1.0 mm) were made from CAD/CAM prefabricated blocks of a leucite reinforced glass-ceramic (Empress CAD, Ivoclar) to simulate a monolithic restoration, then were randomly distributed to be bonded on 19 discs of each three different resin composite substrates (CRC; BRC; or FRC) with a dual resin cement (Multilink N; Ivoclar). The samples were subjected to a compression test with a hemispherical stainless-steel piston (Ø = 40 mm) at a monotonic regimen (n = 4; 1 mm/min loading rate and 500 kgf loading cell until fracture). The cyclic fatigue test was performed underwater at a frequency of 20 Hz (n = 15). The first step was applied using 200N for 5000 cycles, followed by increments of 50N at each step of 10,000 until failure. The outcome considered for both tests was the occurrence of radial crack. Specific statistical tests (α = 0.05) were performed for monotonic (One-way ANOVA; Tukey's test) and fatigue data (Kaplan-Meier test; Log-rank test). Fractography of fractured samples were also performed. The FRC group had the lowest failure load in both test regimes (p < 0.05; monotonic: 726.64N; fatigue: 716.67N). There were no differences between the CRC and BRC groups (p > 0.05; monotonic: 989.30 and 990.11N; fatigue: 810.00 and 833.33N, respectively). The same result was obtained considering cycles for fatigue failure (FRC < CRC=BRC). Leucite glass-ceramic bonded to substrates made of flowable resin composite behaves worse mechanically than bonding to conventional or bulk-fill resin composite substrates.

Marginal adaptation of bulk-fill resin composites with different viscosities in class II restorations: a micro-CT evaluation

BACKGROUND

The purpose of this study is to evaluate the marginal adaptation of bulk-fill resin composites with different viscosities (paste-like and flowable) in Class II restorations using micro-CT imaging.

METHODS

Forty extracted human molars were used. Mesial and distal Class II box cavities (approximately 3 mm x 3 mm x 4 mm) were prepared for each tooth, with cavity floors located 1 mm below the enamel-cementum junction. Following adhesive application, teeth were restored using eight different groups: Group XB: X-tra Base Bulk-fill Flowable (VOCO), Group XF: X-tra Fill Bulk-fill (VOCO), Group FB: Filtek Bulk-fill Posterior (3 M ESPE), Group FF: Filtek Bulk-fill Flowable (3 M ESPE), Group BB: Beautifil-Bulk (SHOFU), Group BF: Beautifil-Bulk Flowable (SHOFU), and Group CO: "as a control group", Clearfil Majesty Posterior (KURARAY) and Group CF: "as a control group", Clearfil Majesty Flow + Clearfil Majesty Posterior (KURARAY). The restored teeth underwent an aging protocol involving 1000 cycles in a water bath fluctuating between 5 ± 1.0 °C and 55 ± 1.0 °C. Post-aging, teeth were immersed in 50% silver nitrate solution for 24 h and then in a film developer solution for 8 h. Microleakage analysis was performed using micro-CT, evaluated with 3D Slicer software. A two-way ANOVA was employed for statistical analysis.

RESULTS

Two-way ANOVA results indicated significant effects of both viscosity (p < 0.0001) and composite type (p < 0.0001) on marginal adaptation. Viscosity analysis (comparing flowable and paste-like) revealed no significant differences in the FB-FF, XB-XF and BB-BF groups but significant differences in the and CO-CF group, with flowable type exhibiting less microleakage than paste-like type.

CONCLUSIONS

The study suggests that while the viscosity of bulk-fill composites did not significantly affect marginal adaptation, the brand of bulk-fill composite did influence it.

The effect of depth of cure on microhardness between bulk-fill and hybrid composite resin material

Background

Functional properties should be considered when selecting composites for restorations. With bulk-fill resin composites, the disadvantages of conventional composites were overcome regarding the increments necessitating the application of a 2 mm thick layer of resin and the amount of polymerization. The most significant advantage of bulk-fill resin composite is the possibility of applying the material in 4 mm layers. Multiple studies have examined the polymerization, mechanical, and adhesive properties of bulk-fill resin composites and proven them successful.

Objective

This study aimed to compare the effect of the depth of cure on the microhardness between different bulk-fill composites and a hybrid composite material by following the manufacturer's instructions.

Methods

In this in vitro study, five composite types obtained from different companies were used: two high-viscosity bulk-fill composites, Filtek and OPUS bulk; two low-viscosity bulk-fill flowable composites, Any-com and OPUS flow; one light-cure hybrid composite, Cavex, totaling 25 samples. The composite was applied at a depth of 4 mm in the bulk-fill composite and 2 mm in the hybrid composite and light-cured. The microhardness was measured at three different times. The first time was performed immediately after light-curing, the second time was evaluated 24 h after polymerization, and the third time was after thermocycling.

Result

A total of 25 samples showed that the microhardness increased the first and second times and decreased the third time after thermocycling on the top and bottom sides of Filtek, OPUS bulk-fill, OPUS flow, and Any-com bulk. The Cavex microhardness at the bottom was equal at all three-time points. Two-way repeated measures ANOVA showed that the microhardness between all types of composite resin materials was significantly different at different times when p = 0.00.

Effect of a demineralization model on the microhardness, surface roughness and topography of giomers: An in vitro study

The purpose of this study is to compare the effect of a demineralization model on the microhardness, surface roughness, and topography of giomers.Seventy-two discs of six different dental materials in three different presentations (pit and fissure sealant (PFS), flowable and restorative materials) were divided into six groups (n = 12 p/g). Three experimental groups (giomers) consisted of BeautiSealant, Beautifil Flow Plus, and Beautifil II, and three control groups (resin-based materials) were formed using ClinproTM, FiltekTM Z350 XT Flow, and Filtek™ Bulk Fill materials. Vickers microhardness, surface roughness, and topographic analysis with atomic force microscopy were measured at the beginning (0) after four (1) and 7 days (2) of immersion in a demineralizing model. Statistical analysis was performed using One-way and Repeated Measures ANOVA and Pearson's correlation coefficient (p ≤ .05). The microhardness values showed significant variations, except for the G_RM group. All the groups presented significant increases in roughness through the experiment stages, except for RB_PFS in the Ra parameter. The topographic analysis showed variations in the micromorphology, especially in the experimental group at the end of the demineralization model. Finally, there was no correlation between microhardness and surface roughness. The demineralization model decreased the microhardness, with the lowest reductions in the giomers groups. The effect of the demineralizing model on the surface roughness and topography showed an increase in specific patterns for the experimental and control groups. Therefore, their clinical use is recommended. RESEARCH HIGHLIGHTS: The demineralization model decreased the microhardness property of the evaluated materials, with better performance for the giomer groups. The effect of the demineralizing model on surface roughness showed an increase with specific patterns for the experimental and control groups. Although the materials presented changes in their microhardness, roughness, and topography, their clinical use is recommended.

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

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

Interfacial integrity of bulk-fill resin composite restorations in deep Class-II cavities

This study evaluated the interfacial integrity of deep (6 mm) Class-II (OM/OD) restorations placed using different bulk-fill resin composites [Filtek™ Bulk Fill Flowable Restorative (BF) and Filtek™ Bulk Fill Posterior Restorative (BP) (3M ESPE, St. Paul, MN, USA)] of different increment thicknesses (2 or 4 mm). BP was used for capping in all cases, while Filtek™ Z250 Universal Restorative (3M ESPE) was used as the control material. Interfacial debonding was measured during curing through acoustic emission (AE), followed by image analysis using micro-computed tomography and scanning electron microscopy. Microhardness testing was also conducted to assess degree of conversion. Depth of cure was adequate in all restorations. Specimens with 4-mm thick first increment of BF, which had a higher shrinkage strain, produced most AE events and debonding. Thus, bulk filling of deep cavities using bulk-fill resin composites with a high shrinkage strain should be avoided.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Pushout Bond Strength in Coronal Dentin: A Standardization Approach in Comparison to Shear Bond Strength

To find an alternative that is closer to clinical reality in terms of cavity geometry and configuration factor, this study investigated the pushout test on in vitro adhesive testing to coronal dentin when compared to the established shear test, both in a standardized approach. For a feasible comparison between both tests, the pushout specimen was adjusted in thickness (1.03 ± 0.05 mm) and cavity diameter (1.42 ± 0.03 mm) to receive a bonding area (4.63 ± 0.26 mm2) that matches that of the shear test (4.57 ± 0.13 mm2). Though, the configuration factor between both tests differs largely (pushout 1.5 ± 0.08; shear bond 0.20 ± 0.01). The bond strength of five different adhesives (n = 20) was investigated for both tests. The pushout test registered a high number of invalid measurements (30%) due to concomitant dentin fracture during testing. In contrast to the shear test, the pushout test failed to discriminate between different adhesives (p = 0.367). Both tests differed largely from each other when comparing adhesive groups. When solely looking at the valid specimens, Weibull modulus reached higher values in the pushout approach. Conclusively, the pushout test in this specific setup does not distinguish as precisely as the shear bond test between different adhesives and needs adaption to be routinely applied in adhesive dentistry.

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.

Polymerization shrinkage of light-cured conventional and bulk-fill composites -The effect of cavity depth and post-curing

Volumetric shrinkage (VS) of conventional, bulk-fill, and core build-up resin-based composites (RBCs) of various thickness (1-5 mm) was measured using the modified bonded-disk method with confocal laser scanning microscopy. Additionally, the bottom-to-top ratio of Vickers hardness (%VH) was measured. Conventional RBCs exhibited significantly higher VS than bulk-fill and core build-up RBCs (p<0.05). As specimen thickness increased, VS relative to volume (%VS) and difference in VS at each depth (VS_depth) decreased. For conventional RBCs, there was a significant drop in VS_depth between 1 mm and 2 mm (p<0.05), and another drop was observed between 3 mm and 4 mm (p<0.05) where %VH decreased below 90%. For bulk-fill and core build-up RBCs, VS_depth decreased significantly between 2 mm and 3 mm (p<0.05), but %VH exceeded 90% even in 5 mm deep cavities. These results indicated that post-curing contributed to lower shrinkage in deeper layers, and that conventional RBCs were not adequately polymerized at the depth of over 3 mm.

Ability of short exposures from laser and quad-wave curing lights to photo-cure bulk-fill resin-based composites

OBJECTIVE

This study investigated the ability of a laser, and a 'quad-wave' LCU, to photo-cure paste and flowable bulk-fill resin-based composites (RBCs).

METHODS

Five LCUs and nine exposure conditions were used. The laser LCU (Monet) used for 1 s and 3 s, the quad-wave LCU (PinkWave) used for 3 s in the Boost and 20 s in the Standard modes, the the multi-peak LCU (Valo X) used for 5 s in the Xtra and 20 s in the Standard modes, were compared to the polywave PowerCure used in the 3 s mode and for 20 s in the Standard mode, and to the mono-peak SmartLite Pro used for 20 s. Two paste consistency bulk-fill RBCs: Filtek One Bulk Fill Shade A2 (3 M), Tetric PowerFill Shade IVA (Ivoclar Vivadent), and two flowable RBCs: Filtek Bulk Fill Flowable Shade A2 (3 M), Tetric PowerFlow Shade IVA (Ivoclar Vivadent) were photo-cured in 4-mm deep x 4-mm diameter metal molds. The light received by these specimens was measured using a spectrometer (Flame-T, Ocean Insight), and the radiant exposure delivered to the top surface of the RBCs was mapped. The immediate degree of conversion (DC) at the bottom, and the 24-hour Vickers Hardness (VH) at the top and bottom of the RBCs were measured and compared.

RESULTS

The irradiance received by the 4-mm diameter specimens ranged from 1035 mW/cm² (SmartLite Pro) to 5303 mW/cm² (Monet). The radiant exposures between 350 and 500 nm delivered to the top surface of the RBCs ranged from 5.3 J/cm² (Monet in 1 s) to 26.4 J/cm² (Valo X), although the PinkWave delivered 32.1 J/cm² in 20 s 350 to 900 nm. All four RBCs achieved their maximum DC and VH values at the bottom when photo-cured for 20 s. The Monet used for 1 s and the PinkWave used for 3 s on the Boost setting delivered the lowest radiant exposures between 420 and 500 nm (5.3 J/cm² and 3.5 J/cm² respectively), and they produced the lowest DC and VH values.

CONCLUSIONS

Despite delivering a high irradiance, the short 1 or 3-s exposures delivered less energy to the RBC than 20-s exposures from LCUs that deliver> 1000 mW/cm². There was an excellent linear correlation (r > 0.98) between the DC and the VH at the bottom. There was a logarithmic relationship between the DC and the radiant exposure (Pearson's r = 0.87-97) and between the VH and the radiant exposure (Pearson's r = 0.92-0.96) delivered in the 420-500 nm range.

Fracture resistance of weakened roots restored with relined or milled CAD-CAM glass fiber posts

This in vitro study compared the fracture resistance of weakened roots restored with milled or relined glass fiber post (GFP). Seventy bovine incisors were divided into seven groups, according to the weakening protocol (none: control; medium-weakened: MW; highly-weakened: HW) and post anatomization technique (non-relined, relined with Bulk Fill or Z350 resin; milled GFP: M). Roots were thermomechanical cycled and submitted to compression. Frequencies and groups were compared by the chi-square test and two-factor ANOVA, Tukey's, and t-test (α=5%). The HW-M obtained the lowest values, showing significant differences compared to all groups (p<0.001). The highest value was HW-Bulk fill, with significant difference compared to MW-M (p=0.037) and HW-M (p<0.001). The frequency of repairable fractures was 100% in the control, 87%, and 63% in the MW and HW, respectively. Relined or milled GFPs can be considered to rehabilitate weakened teeth since failure patterns were predominantly repairable in all groups.

Bond strength of bulk fill composite to teeth prepared with Er

Aim: The present in vitro study aimed to evaluate the bond strength of a bulk fill composite on dentin surfaces prepared with the Er: YAG laser. Methods: Twenty-four permanent third molars were selected and divided into 2 groups: CP - Conventional preparation with high-speed handpiece (control) and LA (laser) - Preparation with Er: YAG laser. The occlusal surface was removed to expose coronal dentin, which was subsequently prepared with a high-speed handpiece or Er: YAG laser (350mJ, 4Hz, 1.5 ml/min water flow). Both groups were restored with Filtek One Bulk Fill (3M ESPE) composite resin. After 24 hours, the samples were evaluated for microtensile bond strength (μTBS), fracture pattern, and scanning electron microscopy (SEM). Results: The data obtained in the μTBS test were submitted to t-test (α=0.05). The results showed no difference in μTBS when the different types of cavity preparation were compared (ρ=0.091). Fracture patterns revealed the prevalence of cohesive fracture in composite resin in CP (83.3%) and adhesive fracture in LA (92.1%). In the SEM analysis, the LA group demonstrated the presence of gaps between the composite resin and the irradiated dentin surface. The hybrid layer exhibited more regularity with the presence of longer and uniform resin tags in the CP group. Conclusion: The type of cavity preparation did not influence the values of bulk fill composite resin μTBS to dentin. Fracture patterns and scanning electron microscopy analyses suggested less interference at the adhesive interface in preparations performed using CP.

Influence of Factors in the Photopolymerization Process on Dental Composites Microhardness

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

Comparison of polymerization shrinkage of a new bulk-fill flowable composite with other composites: An in vitro study

OBJECTIVE

Since composites still face a critical problem called polymerization shrinkage and bulk-fill composites have reported acceptable results for this issue, this study aims to assess the polymerization shrinkage of a new bulk-fill flowable composite (G-aenial bulk injectable [GBI]) and compare it to other bulk-fill and conventional composites.

MATERIALS AND METHODS

In this in vitro study, 25 composite discs were fabricated using three bulk-fill and two conventional composites. They were bonded to a microscopic slide and were covered by a coverslip. This assembly was transferred to a linear variable differential transformer and composite samples were cured from underneath the slides. Dimensional changes formed in composite samples were recorded. Data were analyzed using analysis of variance followed by post hoc Tukey's and Dunnett's tests.

RESULTS

The groups were significantly different regarding polymerization shrinkage. G-aenial bulk injectable and G-aenial universal flo showed significantly higher polymerization shrinkage than other composites at 30, 60, and 1800 s after light irradiation, while X-tra fil and Filtek Z250 showed the lowest polymerization shrinkage at the aforementioned time points.

CONCLUSION

According to the results, the new composite had polymerization shrinkage similar to the conventional one. Bulk-fill composites reported similar or lower shrinkage to conventional composites.

Influence of the self-adhering strategy on microhardness, sorption, solubility, color stability, and cytotoxicity compared to bulk-fill and conventional resin composites

OBJECTIVES

To analyze and compare, in vitro, the microhardness, sorption, solubility, color stability, and cytotoxicity of three types of resin composites: self-adhesive (SARC) (Dyad Flow (DF)/Kerr), bulk-fill (Filtek Bulk Fill Flow (FBF)/3 M ESPE), and conventional (Filtek Z350XT Flow (Z350)/3 M ESPE).

MATERIALS AND METHODS

Thirty cylindrical specimens were prepared using a split metal mold (15 mm × 1 mm), divided into 3 groups (n = 10) according to the material used. Vickers hardness (VH) was calculated from three indentations (300gf/15 s) per specimen. The sorption and solubility were measured according to the ISO 4049:2009 specification after storing in distilled water for 7 days. The color of each resin composite was measured using a portable digital spectrophotometer according to the CIELAB system. After a 7-day immersion in coffee, the color variation (∆E) was calculated. Following the ISO 10993:2012, the cytotoxicity in Vero cells was evaluated through the MTT assay. The results were analyzed using the Kruskal-Wallis test to compare the studied groups. The Wilcoxon test was used to compare the assessments in each studied group. For cytotoxicity analysis, the data were compared by the ANOVA test (α = 0.05).

RESULTS

DF showed the lowest VH (28.67), highest sorption (0.543 µg/mm³) and solubility (1.700 µg/mm³), and higher ∆E after 7 days of coffee immersion (p = 0.008). The resin composites studied were considered non-cytotoxic.

CONCLUSIONS

The SARC presented inferior mechanical and physical-chemical properties than bulk-fill and conventional resin composites, with comparable cytotoxicity against Vero cells.

CLINICAL RELEVANCE

The simplification of the clinical protocol of SARC can minimize the number of possible failures during the restorative technique. However, considering their inferior physical and mechanical properties, their coverage with materials of higher mechanical properties and physical-chemical stability should be considered.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

In Vitro Study of Mechanical Properties of Teeth Restored with Bulk-fill and Universal Composites Using Different Dentin Adhesives

Background: The most common dental materials are resin composite direct restorative materials and dentin adhesives, which are marketed with different techniques, application recommendations, and compositions, making it difficult to choose the most suitable material and method for different cases.

The present study aimed to investigate mechanical properties of teeth restored with universal and bulk-fill composites, by using different dentin adhesives and techniques, under in vitro conditions.

Material and methods: The study was carried out on freshly extracted premolar and molar teeth. After cavity preparation, the teeth were restored with conventional and bulk-fill resin composites, using different adhesive techniques. To assess the effect of the cavity preparation, the direct restoration, and the adhesive protocol on the tooth structure, a transillumination method and Vickers’ microhardness measurements were carried out.

Results: The universal composite showed an average hardness of 55.35 HV at the occlusal level of the restoration, while the bulk-fill composite showed an average of 79.93 HV at the same level. A statistically significant difference was found between the hardness values of the two composites (p = 0.02). The transillumination test revealed micro-fissures in the tooth structure in the first phase after cavity preparation and also after polymerization.

Conclusions: The bulk-fill composite showed higher hardness values than the universal composite. The tested dentin adhesives did not significantly affect the hardness of the dentin at the level of the adhesive interface. Fissures can appear in any phase of the direct restoration, after cavity preparation and polymerization.

The Effect of Two Different Light-Curing Units and Curing Times on Bulk-Fill Restorative Materials

This study aimed to evaluate the effect of two different light-curing units and curing times on the surface microhardness (SMH), compressive strength (CS), and volumetric shrinkage (VS) of four restorative materials (FiltekTM Z250, FiltekTM Bulk Fill Posterior, Beautifil® Bulk Restorative, ACTIVATM BioACTIVE). For all tests, each material was divided into two groups depending on the curing unit (Woodpecker LED-E and CarboLED), and each curing unit group was further divided into two subgroups according to curing time (10 s and 20 s). SMH was evaluated using a Vickers hardness tester, CS was tested using a universal testing machine, and VS was measured using video imaging. In all the restorative materials cured with Woodpecker LED-E, the 20 s subgroup demonstrated significantly higher SMH values than the 10 s subgroup. In both light-curing time subgroups, the CarboLED group showed significantly higher CS values than the Woodpecker LED-E group for all restorative materials except FiltekTM Bulk Fill Posterior cured for 20 s. ACTIVATM BioACTIVE showed significantly greater volumetric change than the other restorative materials. A higher curing light intensity and longer curing time had a positive effect on the SMH and CS of the restorative materials tested in this study. On the other hand, curing unit and time did not show a significant effect on the VS values of restorative materials.

Determination of microhardness of bulk-fill resins at different depths

The aim of this study was to determine Vickers microhardness (HV) in bulk fill resins at different depths. Test specimens were prepared with different bulk fill resins: Filtek Bulk-Fill (3M ESPE) [FBF], Surefill SDR flow (Dentsply) [SDR], Fill-UP (COLTENE) [FU] and Surefill (Dentsply) [SF]. Semi-cylindrical test specimens were prepared in a mold 6 mm in diameter and 4 mm thick (n=5). A 1000 mW/cm2 light curing unit was applied (Coltolux LED - Coltene) for 20 seconds. HV was determined with three indentations (Vickers Future Tech FM300, 300 g, 8 s) at four depths: 1, 2, 3 and 4 mm from the top surface to the interior. Data were recorded immediately (t0) and 24 hours later (t24). Results were analyzed with two-way ANOVA (p<0.05), and multiple comparisons were performed using Tukey's test. Mean and SD of HV at t0 for each mm were: [FBF] t0: 49.23(4.65) / 48.32(3.36) / 44.38(2.06) / 40.59(2.58); [FBF] t24: 61.37(3.47) / 62.63(3.03) / 57.27(5.22) / 56.37(5.88);[SDR]t0:27.81(3.13) / 28.07(2.4) / 27.24(2.94) / 25.71(3.0); [SDR] t24: 35.11(2.16) / 35.17(1.96) / 35.53(1.81) / 33.18(2.08); [FU] t0: 41.43(1.41) / 39.87(0.88) / 38.11(1.81) / 39.09(1.92); [FU] t24: 49.27(1.54) / 48.77(1.77) / 48.65(1.88) / 46.76(4.93); [SF] t0: 71.35(7.09) / 67.39(9.76) / 68.95(6.21) / 64.1(8.35); [SF] t24: 76.06(6.61) / 75.31(9.37) / 75.2(11.57) / 69.81(12.14). ANOVA showed significant effect of material, depth and recording time (p<0.05), and Tukey's test showed that recording sites (depths) differed significantly, giving four homogeneous groups. Under the conditions of this study, it can be concluded that microhardness of bulk-fill resins can be affected by depth and post-curing time.

Direct and semi-direct resin composite restoration in large cavity preparations: analysis of dentin bond strength stability and bottom/top microhardness ratio in a cavity model

To evaluate the influence of the restorative approach and aging time on dentin bond strength (BS), failure mode (FM), and bottom/top microhardness ratio (B/T) in a large dentin cavity model. A total of 102 bovine incisors were used to produce models of conical dentin cavities (4.0 mm thickness × 4.8 mm top diameter × 2.8 mm bottom diameter), which were restored using semi-direct filling (SDF) (Filtek™ Z250 XT + Scotchbond™ Universal/RelyX™ Ultimate luting system), direct bulk filling (DBF) (Filtek™ One Bulk Fill), and direct incremental filling (DIF) (Filtek™ Z250 XT) techniques. B/T, BS, and FM (n = 17) were analyzed in a microhardness tester, a universal testing machine, and a stereomicroscope, respectively, after 24 h and 6 months of water storage. BS and B/T data were analyzed using two-way ANOVA/Tukey post-hoc test (p < 0.05), while FM data were analyzed descriptively. There was a statistically significant difference in BS between the restorative techniques, and BS was influenced by aging time in the DBF and SDF groups. Mixed failure was predominant for the SDF technique in both aging times. There was no statistically significant difference in B/T among the restorative approaches regardless of the aging time (p > 0.05). Although all restorative approaches provided similar B/T, the semi-direct technique showed better performance on the material bond strength to dentine in large cavities.

Effect of Light Curing Distance on Microhardness Profiles of Bulk-Fill Resin Composites

Bulk-fill (BF) dental resin composites are made to be polymerized in increments of up to 5 mm rather than the 2 mm increment recommended for conventional composites. This project aimed to determine microhardness (MH) profiles of BF resin composites at different depths and varying light cure (LC) distances from the light source in an attempt to mimic varying clinical situations. Forty-eight cylindrical specimens (4 mm diameter and 6 mm height) were prepared from 3 BF composites: Tetric N-Ceram Bulk-Fill (TBF), Filtek One Bulk-Fill (FBF), and Sonic-Fill 2 (SF2). Four different distances (0, 2, 4, and 6 mm) from the LC unit were investigated. Vickers MH was measured at the top and bottom of the samples and at every 1 mm, by creating 3 indentations at each depth. The bottom-top microhardness ratio (MHR) and percentage reduction in MHR were also measured. Data was analyzed using mixed-model repeated-measure ANOVA at 0.05 significance level. The main variables effects “material, LC distance, and depth” were significant (p < 0.001). Increasing LC distance and the depth of the tested BF significantly affected Vickers MH and MHR. None of the tested BF materials had sufficient MHR at the depths of 4–6 mm. SF2 showed the least MHR reduction.

X-ray microtomography analysis of gaps and voids in the restoration of non-carious cervical lesions with different composite resins

Context (Background)

Resin composites are the most widely used material for restoring cervical defects. However, the high failure rate of these restorations is still a concern.

Aims

The aim of this in vitro study was to evaluate, using microtomography (μCT), the interfacial gap and voids formation in Class V cavities in premolars restored with materials with lower polymerization shrinkage combined with different restorative techniques.

Settings and Design

Cervical defects were created in 30 intact premolar and were randomly distributed to be restored by one of the following techniques (n = 6): Composite resin with two increments (CR), organic modified polymer (ORMOCER) with single (OR1) or two increments (OR2, or low viscosity bulk-fill composite resin with single (BF1) or two increments (BF2).

Methods and Material

Each tooth was scanned before filling to determine the volume of interest (VOI) to be applied in the second μCT after restoration and to control the cavity volume among the groups. In the μCT after filling, the volume of interfacial gaps and voids was calculated for each group.

Statistical Analysis

The groups were compared using one-way and Tukey HSD post hoc test (α = 0.05).

Results

It was possible to identify higher gap formation in the OR1 group and higher void formation in CR group (P < 0.05). OR2 group showed better results than the group with one increment. BF2 showed the best filling capacity.

Conclusions

It was possible to conclude that the material and the number of increments directly influenced the internal adaptation and voids formation of Class V restorations.

O método de fotopolimerização é capaz de influenciar nos valores de microdureza das resinas compostas? Um estudo in vitro

Resumo Introdução a inovação dos métodos de fotopolimerização foi proposta na tentativa de diminuir o estresse de contração de polimerização das resinas compostas e proporcionar maior conforto ao paciente, reduzindo o tempo de atendimento odontológico. Objetivo avaliar a microdureza de duas resinas compostas nanoparticuladas submetidas a diferentes técnicas de polimerização. Material e método quarenta espécimes foram divididos em quatro grupos (n=10) da seguinte forma: Filtek Z350 XT® + técnica imediata (GI); Filtek One Bulkfill® + técnica imediata (GII); Filtek Z350 XT® + técnica de pulso tardio (GIII); Filtek One Bulkfill® + técnica de pulso tardio (GIV). Após o armazenamento em água destilada à temperatura ambiente, os corpos de prova foram direcionados para a medição de microdureza. Utilizou-se teste T para comparação de técnicas e teste Two-Way ANOVA para calcular os efeitos das resinas compostas, técnicas de polimerização e interações referentes à variável dependente (p ≤0,05). Resultado a resina Filtek Z350 XT® apresentou maior dureza na técnica imediata (GI - 312,45 ± 64,37) e pulso tardio (GIII - 244,50 ± 75,63) comparado à resina Filtek One Bulkfill®, em ambas as técnicas. Observaram-se maiores valores de dureza referentes à técnica imediata, com diferença estatística significativa em relação à resina testada (p = 0,04 - Filtek Z350 XT®; p = 0,03 - Filtek One Bulkfill®). Ambos os fatores isolados (resina e técnicas) apresentaram efeito nos valores de microdureza (p = 0,02 e p < 0,01, respectivamente). Conclusão a técnica convencional demonstrou atingir maiores valores de dureza quando comparada à técnica de polimerização alternativa.

Effect of Conventional Adhesive Application or Co-Curing Technique on Dentin Bond Strength

The aim of this in vitro study was to assess the effect of two different adhesive application methods on shear dentin bond strength (ISO 29022) using three various adhesive systems. A mid-coronal section of 77 intact third human molars with fully developed apices was made to create flat bonding substrates. The materials used in the study were Excite F (Ivoclar Vivadent), Prime&Bond Universal (Dentsply Sirona) and G-Premio Bond (GC). The application of each adhesion system was performed in two different ways. In the first group, the bonding agent was light cured immediately after the application (conventional method), while in the second group the adhesive and composite were cured concurrently (“co-curing” method). A total of 180 specimens were prepared (3 adhesives × 2 method of application × 30 specimens per experimental group), stored at 37 °C in distilled water and fractured in shear mode after 1 week. Statistical analysis was performed using ANOVA and Weibull statistics. The highest bond strength was obtained for Prime&Bond conventional (21.7 MPa), whilst the lowest bond strength was observed when co-curing was used (particularly, Excite F 12.2 MPa). The results showed a significant difference between conventional and co-curing methods in all materials. According to reliability analysis, the co-curing method diminished bond reliability. Different application techniques exhibit different bond strengths to dentin.

Comparative evaluation of different adhesive strategies of a universal adhesive in class II bulk-fill restorations: A 48-month randomized controlled trial

OBJECTIVES

To compare the clinical performance of the universal adhesive used in etch-and-rinse (ER) and self-etch (SE) adhesive strategies for 48-month in class II bulk-fill restorations.

METHODS

A total of 84 class II bulk-fill resin composite (Tetric EvoCeram Bulk Fill) restorations were placed in 35 participants by one operator using the universal adhesive's (Adhese Universal VivaPen) etch-and-rinse or self-etch mode randomly. The restorations were evaluated by two calibrated examiners at baseline and after 6-, 12-, 24-, 36- and 48-month using modified USPHS criteria. The comparison of the two adhesive strategies for each evaluation criteria was performed with the chi-square test. The baseline scores were compared with those at the recalls using the Friedman and Cochran's Q-test (p < .05).

RESULTS

At 48-month, 74 restorations were evaluated in 30 participants (recall rate: 85.7%). Marginal discoloration was statistically more frequent in SE approach (p < .05), whereas no significant difference was observed between the two strategies in terms of marginal adaptation (p > .05). There were statistically significant differences between the baseline and 48-month recall in the SE group in terms of marginal adaptation and discoloration (p < .05). In ER group, significant differences were found between baseline and 48-month only for marginal adaptation (p < .05). None of the restorations showed post-operative sensitivity. Secondary caries was observed in one restoration from SE group.

CONCLUSIONS

The tested bulk-fill restorative exhibited better clinical performance only in terms of marginal discoloration when the universal adhesive was used with ER strategy.

CLINICAL RELEVANCE

Though ER approach of the tested universal adhesive appears to be advantageous in terms of marginal discoloration, both adhesive strategies had similar impact on the clinical success of bulk-fill resin restorations.

Comparison of three different bulk-filling techniques for restoring class II cavities: μCT, SEM-EDS combined analyses for margins and internal fit assessments

OBJECTIVE

Evaluation of the behavior of three different bulk-filling techniques in terms of internal adaptation and external marginal sealing for restoring class II cavities.

METHODS

Fifteen extracted sound molar teeth were used. Two standardized class II mesio/disto-occlusal (MO/DO) slot cavities, 4 mm long, 4 mm wide and 3 mm deep were prepared in each tooth, obtaining n=30 cavity preparations. The cavities were randomly assigned into three groups (n=10 per group) according to three bulk filling techniques: Bulk Traditional (BT), Bulk&Go (BG) and Bulk&Flow (BF). The teeth were analyzed by scanning electron microscopy (SEM) to investigate the external marginal seal. Thereafter, the chemical composition of tooth-restoration interface was analyzed by energy-dispersive X-ray spectroscopy (EDS). Complementary information to the SEM and EDS were obtained by micro-computed tomography (μCT) to assess the internal fit.

RESULTS

SEM analysis showed a proper external marginal seal for all groups tested as confirmed by the EDS investigation, highlighting the presence of adhesive layer at the tooth-restoration interface. The internal marginal adaptation by means of μCT analysis revealed gaps formation at the tooth-restoration interface only for BT group, while an intimate contact free of gaps were found in the other two groups. Moreover, in BT and BF groups voids were present within the restoration.

SIGNIFICANCE

BG and BF techniques can be considered as reliable alternatives to BT technique, as they simplify the class II restoration without transforming it into class I, thus ensuring a successful result.

Bonding States of In Vitro Class 2 Direct Resin Composite Restoration Applied by Various Incremental Techniques

Incremental techniques are always required for clinical cases of deep and/or large cavities restored with resin composite materials. The purpose of this study was to examine the bonding states of class 2 direct resin composite restoration applied by various incremental techniques after cyclic loading to simulate the intra-oral environment to define the appropriate technique. Three types of resin composites, namely, bulk-fill (B), flowable (F), and conventional resin composite (C), were applied to standardized class 2 cavities by incremental techniques with single- or bi-resin restoratives. After cyclic loading, the micro-tensile bond strength (μ-TBS) of the dentin cavity floor was measured. The Weibull modulus and Weibull stress values at 10%/90% probability of failure were analyzed. Single-resin incremental restorations with B or F and bi-resin incremental restorations with F + B and F + C demonstrated superior μ-TBS (quantitative ability), bonding reliability, and durability (qualitative ability) compared with the single-resin restoration with C (as control). Furthermore, F + B and F + C restoration yielded an excellent performance compared with the single-resin restorations with B, F, and C. In particular, the F + C restoration, which indicates not only the maximum mean µ-TBS, but also the highest values of the Weibull parameters, may be the optimal restoration method, including the esthetic benefits.

Comparison of restorative materials and surface alterations after prebiotic and probiotic beverages: A nanoindentation and SEM study

The purpose was to investigate the surface characteristics of various resin-based materials by immersing in probiotic beverages. A total of 420 disc-shaped samples (5 mm × 2 mm) were prepared from resin-based composites. Samples were divided into four groups and immersed for 10 min/day for 1 month in either a probiotic sachet, kefir, kombucha, or artificial saliva (control). Surface roughness was measured at baseline and 1 month. One sample of each of the tested materials was examined under nanoindentation to evaluate the reduced elasticity modulus and nanohardness scores. Scanning electron microscopy (SEM) was used to compare surface differences. Data were analyzed statistically using one-way ANOVA test and the significance was set at p < .05. The lowest roughness scores were observed in Z250, Estelite Bulk Fill, and HRi ENA in most of the test groups. Among conventional composites, Z250 group had the highest nanohardness and elasticity modulus scores. Among bulk-fill composites, Estelite Bulk Fill Flow had the lowest surface roughness after immersion in probiotic beverages and the highest nanohardness values. Reveal HD, as a bulk-fill group showed higher surface roughness and considerably lower nanohardness and elasticity modulus scores. Maximum height levels of samples were recorded. SEM images revealed voids and microcracks on the surfaces of test materials. Dentists may prefer Z250 as microhybrid and Estelite Bulk Fill Flow as bulk-fill composites for the restorations of patients who consume gut-friendly drinks regularly. When there are various types of materials, nanoindentation is a useful method for evaluating surface alterations and sensible comparisons.

The Use of Bulk Fill Resin-Based Composite in the Sealing of Cavity with Margins in Radicular Cementum

The aim of this systematic review was to evaluate if the newly introduced bulk fill resin-based composite provides a better marginal sealing in cavity preparations with margins in dental cementum. The population investigation comparison outcome (PICO) framework was: in cavity preparation with margins in dental cementum of human extracted teeth, do bulk fill resin base composites provide a better marginal sealing than non-bulk fill resin-based composites? We performed our research on April 21, 2020. Two authors independently evaluated the abstract and titles for eligibility criteria. Two authors independently extracted the data and assessed the risk of bias in single studies. After the initial screening of 400 abstract and titles, the full text of the articles, that could meet the eligibility criteria, were obtained via the university library. A total of 36 full-text articles were evaluated; 11 articles were finally eligible for the review. Eight studies showed statistically differences, but not significant, in the marginal sealing between bulk fill and nonbulk fill resin-based composite (p > 0.05). One study showed statistically significant differences: SonicFill and Grandio showed better marginal sealing than GrandioSo and SDR(r) (Sirona Dentsply, New York, United States) and the latter two showed better marginal sealing than Filtek Supreme (p < 0.05). One study showed statistically significant less marginal gap of SDR than Filtek Bulk Fill (p = 0.0015) and Filtek Supreme (p < 0.0001). One study showed SDR to have a significantly higher microleakage than the other materials tested (p < 0.05). Based on our current literature review, there are not enough data to establish if bulk fill resin base composite provides a better or a worse marginal sealing at cementum margins.

Effect of the incorporation of silica blow spun nanofibers containing silver nanoparticles (SiO2/Ag) on the mechanical, physicochemical, and biological properties of a low-viscosity bulk-fill composite resin

OBJECTIVE

This work aimed at producing silica-blow-spun nanofibers containing silver nanoparticles (SiO₂/Ag) and investigating the effect of their incorporation in different proportions, with or without pre-treatment with a silane coupling agent, on the mechanical, physicochemical, and biological properties of a commercial composite low-viscosity bulk-fill resin.

METHODS

The production of SiO₂/Ag nanofibers was confirmed by transmission electron microscopy (TEM) and energy dispersive X-ray analysis (EDX). A portion of the produced nanofibers was silanized. Scanning electronic microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), contact angle measurements, and agar diffusion tests against Streptococcus mutans were used to verify the differences between silanized and non-silanized nanofibers. Different proportions (0.5 wt% and 1 wt%) of silanized (SiO₂/Ag-0.5S and SiO₂/Ag-1S) and non-silanized (SiO₂/Ag-0.5NS and SiO₂/Ag-1NS) nanofibers were incorporated into the bulk-fill composite (Opus Bulk Fill Flow, FGM). A commercial composite was used as the control. Evaluation of the color parameters (L*, a*, and b*), radiopacity, contact angle, antimicrobial activity, Vickers microhardness, surface roughness (Sa and Sq), flexural strength, and SEM of the fractured surfaces were performed. The data were analyzed using the Mann-Whitney U test (fiber morphology), Kruskal-Wallis tests, with Dunn's post hoc test (antimicrobial activity of the specimen against S. mutans), Student's t-test (disk diffusion), one-way ANOVA and Tukey (color, radiopacity, and contact angle), and two-way ANOVA and Tukey (microhardness, surface roughness, and flexural strength) tests. All statistical analyses were performed at a significance level of 1% (α = 0.01).

RESULTS

Porous nanometric SiO₂/Ag fibers were successfully produced. The silanization process, confirmed by FTIR, increased the diameter and contact angle and reduced the growth inhibition halos of the nanofibers (p < 0.01). After the incorporation of nanofibers into the dental composite, all color parameters were altered in all the experimental groups (p < 0.01). All the groups presented adequate radiopacity values. No statistical difference was observed in the contact angles of the experimental composites (p > 0.01). The lowest microbial counts were obtained in the SiO₂/Ag-0.5S group; although no significant difference was observed with the control group (p < 0.01). The SiO₂/Ag-1S, SiO₂/Ag-0.5S, and SiO₂/Ag-0.5NS groups exhibited higher microhardness after 30 d of immersion in water (p < 0.01). The surface roughness (Sa-μm) resembled that of the control at baseline, except for the SiO₂/Ag-1NS group. For the baseline evaluation of flexural strength, all the experimental groups exhibited lower values than the control, except for SiO₂/Ag-0.5NS and SiO₂/Ag-0.5S, but after 30 d of immersion in water, there was no difference (p < 0.01).

SIGNIFICANCE

The incorporation of 0.5% wt. of silanized nanofibers in the commercial composite (SiO₂/Ag-0.5S) seemed to be promising, especially for its greater inhibition of S. mutans, adequate roughness, and flexural strength, in addition to high hardness, even after aging in water.

One-year results of a novel self-adhesive bulk-fill restorative and a conventional bulk-fill composite in class II cavities-a randomized clinical split-mouth study

Objectives

In the context of the phase-down of amalgam, development of easily applicable, permanent restorative materials is of high clinical interest. Aim of this study was to evaluate the clinical performance of a novel, tooth-colored, self-adhesive bulk-fill restorative (SABF, 3M Oral Care) and a conventional bulk-fill composite (Filtek One, 3M Oral Care; FOBF) for restoring class II cavities. The null-hypothesis tested was that both materials perform similar regarding clinical performance.

Materials and methods

In this randomized split-mouth study, 30 patients received one SABF and one FOBF restoration each. Scotchbond Universal (3M Oral Care) was used as adhesive for FOBF (self-etch mode), while SABF was applied directly without adhesive. Restorations were evaluated by two blinded examiners at baseline, 6 months and 12 months employing FDI criteria. Non-parametric statistical analyses and χ²-tests (α = 0.05) were applied.

Results

Thirty patients (60 restorations) were available for the 6- and 12-month recalls exhibiting 100% restoration survival. All restorations revealed clinically acceptable FDI scores at all time points and for all criteria. Only regarding esthetic properties, FOBF performed significantly better than SABF regarding surface lustre (A1) and color match and translucency (A3) at all time points and marginal staining (A2b) at 12 months.

Conclusions

The null-hypothesis could not be rejected. Both materials performed similarly regarding clinical performance within the first year of clinical service. SABF exhibited slightly inferior, but clinically fully acceptable esthetic properties as compared to FOBF.

Clinical relevance

Within the limitations of this study, the self-adhesive bulk-fill restorative showed promising results and may be recommended for clinical use.