ArticleLiterature Review

Bulk-Fill Composites: A Review of the Current Literature

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  • Self-employed, Leuven, Belgium
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Abstract

Purpose: The aim of this article was to provide an overview of the literature on the currently available bulk-fill composites, and to describe the common trends as well as the wide variations. The findings may help the clinician to select the proper material with regard to its applicability in various clinical situations. Methods: The literature up to October 2016 was reviewed based on a PubMed search (keywords: "bulk-fill OR bulkfill OR bulk fill" AND "composite OR composites"). Results: This review revealed that bulk-fill composites differ most from conventional composites in their increased depth of cure, which could mainly be attributed to an increase in translucency. However, the literature is inconsistent regarding the determination of the depth of cure. Flowable "base" bulk-fill composites seem most suitable for narrow cavities deeper than 4 mm, in particular when a higher adaptation potential thanks to better flowability in less accessible cavity configurations is desirable. In more extensive cavities, "full-body" bulk-fill composites with a high filler load are preferable. Then, resistance against wear and fracture becomes increasingly important, while a thicker consistency might also help in obtaining a good contact point. Tests related to shrinkage stress induced by bulk-filling seem inconsistent and their clinical relevance is unclear. Conclusion: More clinical studies that specifically focus on bulk-filling deep and large restorations are definitely required to fully explore the clinical benefits of bulk-fill composites.

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... Fatmanur Sari https://orcid.org/0000-0003- Most of the resin composites are nowadays methacrylate-based and polymerize through a free radical reaction [5,6]. A rigid polymer network forms since increasing the cross-linking of the polymer chains during the polymerization [7]. ...
... Bulk-fill resin composites have recently been developed to simplify the restorative technique because they may be placed in a single increment of 4-5 mm [5]. The bulk-fill composites are divided into 2 groups, the low-and high-viscosity materials. ...
... The bulk-fill composites are divided into 2 groups, the low-and high-viscosity materials. There is a need for a final occlusal layer of conventional resin composite for the low viscosity bulk-fill resin composites, but it is not required for the high viscous ones [5,11]. The first introduced stress-relieving resin technology-based low viscosity bulk-fill resin composite is SDR (Dentsply/DeTrey, Konstanz, Germany), which is used in 4 mm layers by covering the occlusal surface with a conventional resin composite [6]. ...
Article
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Objectives This study aimed to assess the clinical longevity of a bulk-fill resin composite in Class II restorations for 3-year. Materials and Methods Patient record files acquired from the 40 patients who were treated due to needed 2 similar sizes Class II composite restorations were used for this retrospective study. In the experimental cavity, the flowable resin composite SDR was inserted in the dentinal part as a 4 mm intermediate layer. A 2 mm coverage layer with a nano-hybrid resin composite (CeramX) was placed on SDR. The control restoration was performed by an incremental technique of 2 mm using the nano-hybrid resin composite. The restorations were blindly assessed by 2 calibrated examiners using modified United States Public Health Service criteria at baseline and 1, 2, and 3 years. The data were analyzed using non-parametric tests (p = 0.05). Results Eighty Class II restorations were evaluated. After 3-years, 4 restorations (5%) failed, 1 SDR + CeramX, and 3 CeramX restorations. The annual failure rate (AFR) of the restorations was 1.7%. The SDR + CeramX group revealed an AFR of 0.8%, and the CeramX group an AFR of 2.5% (p > 0.05). Regarding anatomical form and marginal adaptation, significant alterations were observed in the CeramX group after 3-years (p < 0.05). The changes in the color match were observed in each group over time (p < 0.05). Conclusions The use of SDR demonstrated good clinical durability in deep Class II resin composite restorations.
... The nanohybrid composites have commonly been employed because of low polymerization shrinkage and high polishability [3]. The use of bulk-fill resin composites has also been increasing due to the ease of their application [4,5]. However, the aged composite restorations might fail because of different reasons, such as secondary caries, wear, discoloration, chipping, and bulk fracture [1,6,7]. ...
... This technique may be time-consuming, especially for deep cavities in the posterior area [28]. The bulk-fill resin composites which have greater depth of cure and may be placed in one increment of 4 mm have been developed to overcome this problem [4]. The bulk-fill resin composites have similar chemical compositions with conventional resin composites excluding some modifications in photo initiators and fillers [4]. ...
... The bulk-fill resin composites which have greater depth of cure and may be placed in one increment of 4 mm have been developed to overcome this problem [4]. The bulk-fill resin composites have similar chemical compositions with conventional resin composites excluding some modifications in photo initiators and fillers [4]. The composite restorations may fail regardless of the composite type [1,29]. ...
Article
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The aim of the study was to investigate the effect of different repair procedures on the repair bond strength of bulk-fill and nanohybrid resin composites after different aging periods. The resin composite blocks (8 × 8 × 4 mm3) were prepared from a bulk-fill (reliaFIL Bulk) and a nanohybrid (reliaFIL LC) resin composite and grouped according to aging duration (6 months, 1 year, and 2 years). Following aging, the blocks were assigned to different surface treatments; air-abrasion with aluminum oxide powder, roughening with a diamond bur, and no treatment. After cleansing with phosphoric acid, a silane layer (Porcelain Primer) was applied on the surface of half of the specimens in each group. The specimens were subdivided into two groups (n = 5): Scotchbond Universal (3M Oral Care) and All-Bond Universal (Bisco). The blocks were repaired with the nanohybrid composite (8 × 8 × 8 mm 3). The repaired specimens were stored in distilled water (37 °C/24 h) and segmented into beams. Half of the beams were immediately subjected to microtensile μTBS testing (1 mm/min), while the other half was stored in distilled water (37 °C) for 6 months before testing. Failure modes were analyzed using stereomicroscope and SEM. Statistical analyses were performed with ANOVA and least significant difference tests (LSD) tests (p = 0.05). The extension of aging periods (6 months, 1 year, and 2 years) reduced the repair bond strength in some groups for both resin composites (p < 0.05). The air-abrasion and bur roughening improved the repair bond strength (p < 0.05). The silane application did not influence the repair bond strength and durability (p > 0.05). There was no difference among the universal adhesives in the same surface treatment groups (p > 0.05). The mechanical roughening treatments are necessary for the repair of resin composite. The universal adhesives might be used for the repair of resin composites regardless of silane content without prior silane application.
... BRCs can be classified into two types: low-viscosity type similar to flowable resin composites and high-viscosity type resembling conventional resin composites. 14 Moreover, they can be classified based on the mode of use as base composites or final filling restoratives, which do not need an additional resin paste. 8,14 Low-viscosity BRCs (LVBRCs) are used more frequently for base materials, owing to their inferior mechanical properties and their ability to conform to the cavity floor more easily, as compared with highviscosity materials. ...
... 14 Moreover, they can be classified based on the mode of use as base composites or final filling restoratives, which do not need an additional resin paste. 8,14 Low-viscosity BRCs (LVBRCs) are used more frequently for base materials, owing to their inferior mechanical properties and their ability to conform to the cavity floor more easily, as compared with highviscosity materials. 8,14,15 However, some LVBRCs are thought to have mechanical properties similar to those of high-viscosity BRCs, along with good handling properties, due to recent advances in flowable resin composite technology. ...
... 8,14 Low-viscosity BRCs (LVBRCs) are used more frequently for base materials, owing to their inferior mechanical properties and their ability to conform to the cavity floor more easily, as compared with highviscosity materials. 8,14,15 However, some LVBRCs are thought to have mechanical properties similar to those of high-viscosity BRCs, along with good handling properties, due to recent advances in flowable resin composite technology. 16 Therefore, it is likely that LVBRCs will be used as final filling restoratives, as for high-viscosity BRCs or flowable resin composites with advanced properties. ...
Article
This study aimed to evaluate the filler contents (FCs), flexural properties, depth of cure (DOC), wear resistance, and handling properties of different low-viscosity bulk-fill resin composites (LVBRCs) and to determine the correlations between the tested parameters. Six LVBRCs, Beautifil-Bulk (BBF), Bulk Base Hard (BBH), Bulk Base Medium (BBM), Filtek Bulk-Fill Flowable Restorative (FBF), G-ænial Bulk Injectable (GBI), and SDR flow+ Bulk-Fill Flowable (SDR) were used. The DOC and flexural property tests were conducted according to the ISO 4049 specifications. The flexural strength, elastic modulus, and resilience were determined in 12 specimens that were obtained from each of the 6 materials. Sliding-impact-wear testing was conducted by evaluating the wear facets of the specimens using a noncontact profilometer and by confocal laser scanning microscopy. The handling properties of the LVBRC was assessed via extrusion force and thread formation measurements. The DOC for the majority of the LVBRCs was approximately 4 mm. Although the FCs and mechanical properties were material dependent, some LVBRCs exhibited excellent flexural properties and wear resistance. The LVBRCs demonstrated a wide range of extrusion force and thread formation. Regarding the correlations between the tested parameters, extremely strong negative and positive correlations were observed for the DOC versus extrusion force, flexural strength versus elastic modulus, maximum depth versus volume loss, and maximum depth versus thread formation. In addition, strong correlations between FCs and DOC, resilience, wear resistance, and extrusion force were observed.
... Moreover, its low consistency requires the occlusal surface to be protected with a conventional composite because of its poor mechanical properties. 18,28,29 In addition, a flowable material was used as a cavity lining in the model in an attempt to reduce the effect of occlusal stress 8 and improve adaptation. 28,30 Thus, two types of bulk-fill composites with different clinical applications were employed in the models. ...
... 18,28,29 In addition, a flowable material was used as a cavity lining in the model in an attempt to reduce the effect of occlusal stress 8 and improve adaptation. 28,30 Thus, two types of bulk-fill composites with different clinical applications were employed in the models. In Model 1, the cavity was restored with Filtek Z250 to a depth of 4 mm and was designed to simulate normal posterior composite restoration. ...
... In addition, the flowable lining was applied to Model 6 to improve clinical adaptation. 28 The highest maximum Von Mises stress was found in Model 1 on the Filtek Z250 composite resin. The occlusal stress on Filtek Z250 could decrease with the application of low viscosity resin (flowable composite) underneath the hybrid composite resin (Model 2 and Model 3) and with the application of a flowable material as the lining (Model 4). ...
Article
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Objective This study aimed to evaluate the effects of different types and restorative techniques of Class I composite restorations with a single loading force on stress distribution and cyclic loading force on microleakage formation. Materials and Methods Class I cavities were prepared in premolars with 4 mm depth and divided into six groups of different restorations with: (1) Filtek Z250; (2) a 3-mm-thick layer of Filtek Bulk Fill Flowable Restoration and covered with Z250; (3) a 1.5-mm-thick layer of flowable composite and covered with Z250; (4) lining all cavity with flowable composite and restored with Z250; (5) Filtek Bulk Fill Posterior Restoration; and (6) lining all cavity with flowable composite and restored with bulk-fill composite. The specimens with and without cyclic occlusal loading were subjected to microleakage observation. In addition, six different models of Class I restorations corresponding to the microleakage study were generated. Finite element analysis (FEA) was used to identify the stress distribution under a single loading force. Statistical Analysis Data were statistically analyzed by two-way analysis of variance and multiple comparison. The significance level set at 0.05. Results Cavity lining or restoration with flowable composite underneath conventional composite reduced stress on composite resin based on FEA (groups 2 and 3). The cyclic stress on composite increased microleakage. Restoration with flowable composite underneath conventional composite reduced the microleakage in Class I restoration (groups 2, 3, and 4). Conclusion The most effective cavity lining with a flowable composite underneath conventional composite restoration was stress reduction under loading force resulting in microleakage reduction.
... The elastic modulus is a characteristic of the material, while the shrinkage stress is related both to the material and to other factors (for example the cavity configuration). 16 The gold standard materials for restorative dentistry are resin-based composites due to their characteristics. 17 These materials also find application in the cervical region of the dental element where they show better in vivo performances than glass ionomer cements. ...
... Better standardization of the cavity would be useful; also in reference to the fact that bulk-fill composites seem to be more advantageous especially in deep cavities. 16,55 A great variability is also present in the evaluation phase due to the presence of different techniques and consequently, of different methods for evaluating marginal integrity. ...
Article
Full-text available
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.
... Also, another application reason of the incremental technique is to reduce the polymerisation shrinkage of composites [7,8]. Bulk-fill composites, which can be applied and polymerised in a single layer of 4-5 mm thickness, are separated from conventional composites with their increased depth of cure properties [9]. With these features, bulk-fill composites reduce the negative aspects of polymerisation such as polymerisation shrinkage and shrinkage stresses more successfully than conventional composites [10,11]. ...
... With these features, bulk-fill composites reduce the negative aspects of polymerisation such as polymerisation shrinkage and shrinkage stresses more successfully than conventional composites [10,11]. erefore, bulk-fill composites are recommended to be used in deep and narrow cavities deeper than 4 mm, such as postendodontic restorations, instead of conventional composites [9]. ...
Article
Full-text available
The aim of the present study is to evaluate the physical properties of endodontically treated teeth restored with five different restorative techniques and materials. Hundred and forty extracted human molar teeth were used. In addition to five restoration groups, specimens with no restorations were used as the negative control, and intact molar teeth were used as the positive control. For flexural strength tests, material specimens were made from 5 different materials using a mould according to ISO 4049 standards. One-way ANOVA revealed that the fracture resistance was significantly affected by the restoration type. SFRC group showed the best fracture resistance values, while the lowest values were seen in the GWF group. e test results of flexural strength showed values between 140 and 184 MPa and modulus of elasticity between 6.33 and 18.89 GPa (p < 0.05). Under the limits of this study, results showed that SFRC can be used to increase the fracture resistance of ETT.
... To simplify application and make it more time efficient, bulk-fill composites have been developed. According to the manufacturers, bulk-fill composites can be applied and photoactivated at a layer thickness of 4-5 mm without compromising polymerization in deep portions of the materials [5]. By modifying the material composition, these higher incremental layer thicknesses can be achieved. ...
... By modifying the material composition, these higher incremental layer thicknesses can be achieved. In general, bulk-fill composites show higher translucency than conventional composites [5,6] due to a lower filler loading and/or larger incorporated filler particles, which reduces light scattering at filler-matrix interfaces and ensures that more light can penetrate into deeper layers [6,7]. Besides modification of the translucency, the photo-initiator has also been adapted in some bulk-fill materials [8,9]. ...
Article
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The aim of this in vitro study was to investigate the degree of C=C double bond conversion of high-viscosity dimethacrylate- or ormocer-based bulk-fill composites as a function of measurement depth. Four bulk-fill composites (Tetric EvoCeram Bulk Fill, x-tra fil, SonicFill, and Bulk Ormocer) and the conventional nanohybrid composite Tetric EvoCeram were applied in standardized Class II cavities (n = 6 per group) and photoactivated for 20 s at 1350 mW/cm2. The degree of conversion of the composites was assessed using Fourier-transform infrared spectroscopy at seven measurement depths (0.15, 1, 2, 3, 4, 5, 6 mm). Data were analyzed using repeated measures ANOVA and one-way ANOVA with Bonferroni post-hoc tests (α = 0.05). The investigated bulk-fill composites showed at least 80% of their maximum degree of conversion (80% DCmax) up to a measuring depth of at least 4 mm. Tetric EvoCeram Bulk Fill and Bulk Ormocer achieved more than 80% DCmax up to a measuring depth of 5 mm, x-tra fil up to 6 mm. The conventional nanohybrid composite Tetric EvoCeram achieved more than 80% DCmax up to 3 mm. In contrast to the conventional composite, the investigated ormocer- and dimethacrylate-based bulk-fill composites can be photo-polymerized in thick layers of up to at least 4 mm with regard to their degree of C=C double bond conversion.
... The light transmittance differs between these two types of composites. Bulk-fill composite is more translucent and has a higher depth of cure than conventional RBCs [8,9]. The light transmittance up to 4 mm can also be attributed to a different photoinitiator incorporated into the bulkfill composite system [9]. ...
... Therefore, further studies could reproduce similar experiments using varied LCU tip displacement or angulation and different commercial bulk-fill composites. The variations in material components, amount of filler, and photoinitiators may provide different results from one product to another [8]. Another limitation is the use of a single species biofilm [23]. ...
Article
Full-text available
How dentists cure a resin-based material has deleterious effects on the material’s properties and its interaction with surrounding dental tissues. Biofilm accumulation has been implicated in the pathogenesis of carious lesions around dental restorations, with its composition manifesting expressed dysbiosis in patients suffering from dental caries. To evaluate the influence of varying radiant exposure on the degree of conversion (DC%), Streptococcus mutans biofilm growth, and surface roughness of bulk-fill composites under different light-curing conditions. Two light-curing units (LCU) at 600 and 1000 mW/cm2 were used to simulate curing conditions with different angulations (∢20° and ∢35°) or 2 mm-distance displacements of the LCU tip. The radiant exposure (RE) was assessed, and the composites were analyzed for DC%. Biofilm formation was induced over the bulk-fill composites and analyzed via colony-forming units counting and scanning electron microscopy (SEM). The surface roughness was analyzed via a profilometer and SEM after biofilm formation. Curing conditions with different angulation or displacement decreased RE compared to the “optimal condition”. The moderately (∢35°) angulated LCU tip and low (600 mW/cm2) radiant emittance significantly reduced the DC% (p < 0.05). The difference in DC% between the top and bottom of the composites ranged from 8 to 11% for 600 mW/cm2 and 10 to 20% for 1000 mW/cm2. Greater S. mutans biofilm and surface changes were found in composites with non-optimal RE delivery (e.g., tip displacement and angulation) (p < 0.05). Inadequate polymerization of bulk-fill composites was associated with more biofilm accumulation and surface topography changes. Overall, non-optimally performed curing procedures reduced the amount of delivered RE, which led to low DC%, more biofilm formation, and higher surface roughness. The improper light-curing of bulk-fill composites compromises their physicochemical and biological properties, which could lead to inferior clinical performance and reduced restorative treatments’ longevity.
... Estes problemas são decorrentes da indicação inadequada, da dieta do paciente e de alguns equívocos de técnicas clínicas, como por exemplo, o método incorreto de aplicação da resina nas cavidades e a deficiência de acabamento e polimento (JARAMILLO-CARTAGENA et al., 2021). A superfície da restauração dentária sem acabamento e polimento apresenta rugosidades, o que facilita o manchamento e a adesão bacteriana na superfície do compósito (JARAMILLO-CARTAGENA et al., 2021 permitido a obtenção de materiais com menor contração de polimerização ou estresse de contração, assim como aqueles que apresentam propriedades autoadesivas (VAN ENDE et al., 2017). ...
... Baseado nas diferentes estratégias restauradoras, as resinas bulk fill estão disponíveis nas consistências média, que são colocadas nas cavidades com espátulas de inserção, ou fluidas (flow), onde o material é inserido na cavidade diretamente através da seringa onde o material está armazenado. Nota-se que a resina de média viscosidade é única que permite que a cavidade realmente seja restaurada com um único incremento, visto que a resina Bulk-Fill flow necessita de uma cobertura de resina convencional para finalizar a restauração da cavidade ( VAN ENDE et al., 2017). ...
... Several studies have evaluated the marginal microleakage of bulk fill resin composites, which show a varied composition among them [13][14][15][16][17][18][19]. And also, several studies have not been able to find statistically significant differences between bulk fill resin composites and the conventional ones [14][15][16]. ...
... In most studies there is no consistency in the in vitro experimental procedures regarding light intensity in the photoactivation unit, the amount of thermal cycles to accelerate the aging process of the resin composite, the number of increments that could lead to bubble accumulation and thus, the creation of microleakage at the resin-tooth interface that would influence the evaluation studies. In addition, it is known that greater the separation between the photoactivation unit and the resin composite, the lower the irradiance, and this could cause an inadequate activation of the monomers in the deeper section of the class II cavity [13][14][15][16][17][18][19][20][21][22][23]. ...
Article
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Background The contraction presented by resin composites causes an increase in stress at the tooth-resin interface, causing micro-gaps that allow microleakage. This study aims to evaluate the degree of in vitro marginal microleakage in class II restorations with two bulk fill resin composites compared to a conventional nanohybrid resin composite. Methods The present study was an in vitro experimental design. A total of 30 standardized class II cavities were prepared in 15 human molars (mesially and distally). These cavities were later distributed in 3 groups according to the type of resin. Groups A and B were restored with bulk fill resin composites (Filtek—3 M/ESPE and Tetric N-Ceram—Ivoclar/Vivadent respectively) in a single increment of 4 mm. Group C was restored with the Filtek Z350 XT – 3 M/ESPE resin composite and two increments of 2 mm. Later, the restorations were subjected to 10,000 thermocycles between 5 °C to 55 °C and immersed in a silver nitrate solution (1 M for 24 h). The crowns were then sectioned mesiodistally and observed under the stereomicroscope to determine the degree of marginal microleakage at the occlusal and cervical areas. The results were analyzed with the Kruskal–Wallis and the Mann–Whitney U statistical tests. Results There were no statistically significant differences regarding the degree of microleakage between the three types of resin composites in the occlusal and cervical areas ( p > 0.05). Similarly, there were no significant differences after comparing each resin type in its occlusal and cervical area ( p > 0.05). Conclusion Filtek Bulk Fill and Tetric N-Ceram Bulk Fill resin composites showed no statistically significant differences with the conventional nanohybrid resin composite Filtek Z350XT at both occlusal and cervical areas.
... From the available Giomers, bulk-fill resin composites seem to be the most advantageous for use in paediatric dentistry because they reduce the session time needed for layering and adapting restorations in posterior teeth. 21 Although Giomer restorative materials have been available for some years and present good behaviour and good mechanical stability, 22 the clinical evidence that supports their use is still scarce, primarily related to primary teeth. 23 Thus, this trial aimed to evaluate the longevity of occlusoproximal ART restorations in primary molars using an encapsulated glass ionomer -GIC (Equia Forte â -GC Corp, Tokyo, Japan) and a Giomer resin composite with a one-step self-etch adhesive -GCR (Beautifil Bulk Restorative â /Beautibond â -Shofu Inc, Kyoto, Japan)after 24 months. ...
... Bulkfill composites have the advantage of increased depth of cure and lower polymerisation shrinkage than conventional composites, which reduces the time needed for layering and adapting restorations in posterior teeth. 21 However, an in vitro study assessed the degree of conversion (DC) of monomers of different bulk-fill composites and found that the Beautifil Bulk Restorative presented poor DC. 35 This might have been an additional reason for failures in the GCR group. It is essential to mention that the limited moisture control in the school setting may have influenced GCR's performance, which can be stated as a limitation of our study. ...
Article
Background Occlusoproximal restorations of primary molars usually fail, so it is necessary to investigate new materials that may overcome this issue. Thus, this trial aimed to evaluate the longevity of occlusoproximal ART restorations in primary molars using a glass ionomer – GIC (Equia Forte® – GC Corp) and a Giomer resin composite – GCR (Beautifil Bulk Restorative® – Shofu Inc) after 24 months. Methods 182 children aged from 4 to 8 years were selected and randomly assigned to GIC or GCR. A paediatric dentist treated them in the school setting in Cerquilho, Brazil, and the restorations were assessed after 3, 6, 12, 18, and 24 months. The primary outcome was the restoration survival, evaluated using the Kaplan-Meier and superiority Cox regression analyses. Intention-to-treat (ITT) was performed as a sensitivity analysis using superiority test p-value and confidence interval (CI=95%), derived by Miettinen and Nurminen's method. Independent variables included gender, age, molar, jaw, cavity volume, and caries experience. Results The restoration survival after 24 months was GIC=58.1% and GCR=49.1% (HR=1.24; CI=0.97-1.59). ITT analysis showed a success of GIC=61.1% and GCR=52.2% (RR=1.17; CI=0.91-1.52). The superiority hypothesis was not proved in both analyses (p>0.05). Conclusion GCR does not have superior longevity than GIC in occlusoproximal ART restorations of primary molars.
... Indeed, flowable composites were introduced to simplify placement procedures, enhance adaptation to internal surfaces of cavity preparations, improve cavity seal, and expand the clinical applications of resin-based composites. Moreover, flowable BFCs seem most suitable for narrow cavities deeper than 4 mm, especially in less accessible cavity configurations, thus allowing a higher adaptation (Van Ende et al., 2017). However, although these advantages, the flowable BFCs may not withstand the occlusal forces and require an occlusal capping (Yap et al., 2016). ...
... The new investigated BF group, based on the snowplow technique, is shown to perform with similar results to BG group, in terms of external margins and internal fit. In addition, this work represents the first study that evaluates the potential performance of the snowplow technique using the combination of μCT and SEM-EDS, highlighting that this technique provides an excellent alternative to BG, since it allows to obtain a proper marginal seal and optimal BFC material adaptation, especially in deep and difficult to access cavities (Borouziniat et al., 2019;Van Ende et al., 2017). Thus, an intermediate liner application, using a flowable composite, has been advised to minimize the PSS as well as gap formation (Ferracane and Lawson, 2021). ...
Article
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: BT (Bulk Traditional), BG (Bulk&Go) and BF (Bulk&Flow). 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.
... Flowable bulk-fill composites are indicated as base in class I and class II cavities, requiring an additional layer of conventional composite resin on the occlusal surface. High viscosity bulk-fill, also named as full-body composites, can be placed in increments up to 5 mm, without the need of a cover layer of regular viscosity composite resin [11]. A third type of bulk-fill composite needs activation with a sonic handpiece to be placed into the cavity (SonicFill, Kerr). ...
... During sonic vibration, the bulk-fill resin increases flowability allowing for a better adaptation into the cavity walls. Similar to full-body bulk-fill composite resins, these sonically vibrated materials are also indicated for class I and II cavities, in monolayer (increments of up to 5 mm deep), with no need of an additional occlusal increment of regular composite resin [11]. ...
Article
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Objectives A systematic review was performed to analyze the clinical performance of class I and II restorations in posterior teeth placed with the incremental or the bulk-filling techniques. The primary outcome was retention/fracture rate, and the secondary outcomes evaluated were anatomical form, surface texture, color match, marginal adaption, marginal discoloration, caries, and postoperative sensitivity. Methods Electronic and manual searches were performed for randomized clinical trials comparing the clinical performance of composite resin restorations in posterior teeth placed with the incremental or the bulk-filling techniques. The Cochrane Collaboration risk of bias tool was used to assess the quality of the studies and the GRADE tool was used to access the quality of the evidence. Results Fourteen studies were included in this systematic review and most of them had unclear risk of bias. The risk difference (RD) for retention/fracture was 0.00 (95%CI = − 0.01, 0.01; p = 0.86) for 1–1.5 years of follow-up; 0.00 (95%CI = − 0.02, 0.02; p = 0.88) for 2–3 years of follow-up; 0.05 (95%CI = − 0.08, 0.18; p = 0.46) for 5 or more years of follow-up. The RD for postoperative sensitivity was 0.04 (95%CI = − 0.02, 0.10; p = 0.18) for up to 30 days; 0.00 (95%CI = − 0.01, 0.02; p = 0.63) for 1–1.5 years of follow-up; and 0.00 (95%CI = − 0.01, 0.02; p = 0.71) for 2–3 years of follow-up. For the other secondary outcomes, no significant differences were observed (p > 0.05) between the restorative techniques. The certainty of evidence was graded as moderate. Conclusions The clinical performance of class I and II restorations in posterior teeth is similar when placed with the incremental and bulk-filling techniques. Clinical relevance: Based on the results of this study, posterior restorations placed with bulk-filling technique present satisfactory clinical performance, which is similar to direct restorations placed with the conventional incremental technique, considering various follow-up periods evaluated. Trial registration: CRD42018108450.
... Direct composite resin restorations are one of the most preferred treatment options in the restorative dentistry (1). Although there are many different restorative materials in the dental field today, composite resins continue to be the first choice of dentists due to their superior esthetic properties and bond strength to the tooth structures, and enabling conservative tooth preparation (2,3). Conventional composite resins require an incremental placement approach, which is necessary to provide sufficient depth of cure for each placed increment (4,5). ...
Article
The aim of this in vitro study is to investigate the effects of acidic beverages on the discoloration of bulk-fill composites with different viscosities. 144 disc-shaped specimens (8mm diameter × 2mm thick) were prepared from four different composite resins including a nanohybrid (Filtek Ultimate), two packable bulk-fill (Filtek Bulk Fill, Tetric N Ceram Bulk Fill), and a flowable bulk-fill composite (Tetric N Flow Bulk Fill). The specimens of each group were divided into 3 subgroups and submerged in distilled water, orange juice and coke (n=12). Color difference (ΔE) were measured using CIELab color space and a compact spectrophotometer (VITA Easyshade) at baseline and after 30 days of immersion. Data were analyzed using two-way ANOVA and Tukey's HSD post-hoc tests (P<0.05). Two-way ANOVA revealed that both material type and staining solution significantly influenced ΔE values (P<0.001). Immersion in orange juice resulted in greater and significant discoloration over time in comparison to distilled water and coke (P<0.05). Tetric N Ceram (ΔE=7.0) and Tetric N Flow (ΔE=7.7) bulk-fill restoratives showed highest color change values after 30 days of immersion in orange juice. This study suggests that a discoloration above the clinically acceptable threshold (ΔE>2.7) was observed for all bulk-fill composites tested. It can be speculated that orange juice has a more negative effect on the color stability compared to coke. Additionally, flowable bulk-fill composite was more prone to discoloration than condensable bulk-fill composites.
... Bulk-fill composites have been increasingly used because they have a faster application method and can be placed in increments up to 5 mm due to modifications in their photoinitiator system, higher translucency and lower filler content, which provides an increased depth of cure. Modifications in their matrix incorporate stress relaxators that counteract shrinkage stresses [13][14][15][16][17][18]. ...
Article
Objectives: Upon initial proximal wall construction, the favorable C-factor of class-II cav- ities may become unfavorable. This study investigated the application method on bulk-fill resin composite polymerization shrinkage. Methods: Occluso-proximal class-II cavities were prepared in 40 molars and bonded with a self-etch adhesive (Adhese Universal). The study groups varied according to the resin composite application: group-1: bulk application, Tetric EvoCeram Bulk Fill (TBF); group-2: proximal wall construction (TBF) and occlusal cavity filling (TBF); group-3: thin flowable liner layer, Tetric EvoFlow Bulk Fill (TEF) and bulk filling (TBF); group-4: flowable liner (TEF), proximal wall (TBF), occlusal cavity (TBF); and group-5: bulk application, SDR (3 mm) and capping layer (TBF, 1 mm). Each resin composite increment was scanned twice using micro-CT (uncured, cured 40 s) at a resolution of 16 μm. Shrinkage vectors and volumetric polymerization shrinkage were evaluated and statistically analyzed (one-way ANOVA). SEM images were used to investigate the tooth-restoration interface. Results: Shrinkage vectors differed significantly among the groups and were greatest in gp5-fl/SDR (47.6 μm), followed by gp1-TBF (23.8 μm) and least in gp5-fl/SDR+TBF (11.1 μm). Volumetric shrinkage varied significantly with the use of SDR (gp5-fl/SDR: 2.6%) and TEF (gp4-fl/TEF: 2.5%) to TBF (gp4-fl/TEF+wl/TBF: 0.6%) in the incremental application. Significance: Building a proximal resin composite wall yielded smaller shrinkage vectors than the bulk application. Applying a thin flowable liner decreased the shrinkage vectors, even more when building a proximal wall. A thin flowable liner is recommended when building a proximal resin composite wall.
... According to a literature review by Van Ende et al., the maximum layer thickness which still ensures adequate material characteristics as recommended by the manufacturers, is 4 mm or in some cases even 5 mm. Although most studies have confirmed the improved depth of cure for bulk-fill RBCs, some controversial data can still be found [23,24]. Besides the DC, polymerization shrinkage stress is another important issue addressing the clinical failures. ...
Article
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Detection of unreacted monomers from pre-heated resin-based dental composites (RBC) is not a well-investigated topic so far. The objectives were to determine the temperature changes during the application and polymerization, the degree of conversion (DC) and unreacted monomer elution of room temperature (RT), and pre-heated thermoviscous [VisCalor Bulk(VCB)] and high-viscosity full-body contemporary [Filtek One Bulk(FOB)] bulk-fill RBCs. The RBCs' temperatures during the sample preparation were recorded with a K-type thermocouple. The DC at the top and bottom was measured with micro-Raman spectroscopy and the amounts of eluted BisGMA, UDMA, DDMA, and TEGDMA were assessed with High-Performance Liquid Chromatography. The temperatures of the pre-heated RBCs decreased rapidly during the manipulation phase. The temperature rise during photopolymerization reflects the bottom DCs. The differences in DC% between the top and the bottom were significant. RT VCB had a lower DC% compared to FOB. Pre-heating did not influence the DC, except on the bottom surface of FOB where a significant decrease was measured. Pre-heating significantly decreased the elution of BisGMA, UDMA, DDMA in the case of FOB, meanwhile, it had no effect on monomer release from VCB, except TEGDMA, which elution was decreased. In comparison, RBC composition had a stronger influence on DC and mon-omer elution, than pre-cure temperature.
... 12,13,14 Limited light penetration trough the materials, results in manufacturers recommending layer placement in 1.5 to 2 mm thickness for conventional restorative composites, 12,15 and of 4 to 5 mm for the newer bulk filled products. 16 The same light attenuation is observed in indirect restorations where the resin cement is cured through different types and thicknesses of overlying restorative materials. 17 In either case, light attenuation is associated with a reduction in the degree of conversion and the mechanical properties of polymers activated deep from the restoration surface. ...
Article
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The purpose of this study was to describe the synthesis, characterization, and functionalization of b-NaYF4:30%Yb/0.5%Tm upconverting nanocrystals for use as nanofillers in a dental adhesive and microscopically evaluate the interface between the particles and a commercial adhesive. The upconverting nanoparticles were synthesized and purified by thermal decomposition, and their chemical composition determined by energy dispersive X-Ray spectroscopy. The crystalline structure was characterized using X-Ray diffraction and morphology and size were observed with scanning and transmission electron microscopy. Upconverting emission was evaluated by spectrophotometry irradiating the particles with a 975 nm diode laser. Particles were functionalized with polyacrylic acid and the success was confirmed by measurement of Zeta Potential and transmission electron microscopy. The results of X-ray diffraction found a pure hexagonal phase crystalline pattern. Scanning electron microscopy showed uniform dispersion of hexagonal-shaped particles of approximately 150 nm. Upconversion emission was observed in 344 nm, 361 nm, 450 nm, 474nm, 646 nm, 803 nm. Functionalization success was confirmed by formation of a stable aqueous colloid with a Zeta potential of -29.5mV and the absence of voids in the particle-adhesive interface on the transmission electron microscopy images. The reported synthesis and functionalization process produced upconverting nanoparticles emitting photons within the blue spectral region (450 nm and 474 nm).
... (43) Cention-N Is an alkasite restorative material used in retentive cavity with or without adhesion. (48) Cention-N gave a reading of 1319N which was comparable to composite resin. The high strength of alkasite cement Cention-N is attributed to the high filler contents and the polymerization reaction. ...
... Recent advances in composites, especially regarding new monomers, transparency, initiator systems, and filler technology, have led to the production of bulk-fill composites to overcome these disadvantages (8). Differences in the filler properties of composites, such as monomer resin formulations, type, density, particle size, and distribution, can affect the polymerization depth and mechanical properties of composite resins (8,9). For the mechanical and physical properties (e.g., abrasion resistance and biocompatibility) of resin-based composites to be sufficient, they must be properly polymerized. ...
Article
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Aim: The aim of this study was to investigate the effect of different application techniques on microhardness in one universal resin material and three different bulk-fill composite resin materials. Materials and Methods: In this study, one universal composite resin (Universal Restorative 200 [U], 3M-ESPE, USA) and three different bulk-fill composite resins (Filtek-One Bulk-Fill Restorative [F]; 3M-ESPE, USA: Tetric Evo-Ceram Bulk-Fill [E]; and Ivoclar-Vivadent, Liechtenstein; Tetric N-Ceram Bulk-Fill [N], Ivoclar-Vivadent, Liechtenstein) materials were used. A total of 60 disk-shaped samples, including 20 samples from each bulk-fill composite resin group, were prepared. The polymerization of the bulk-fill composite resins in one group was completed using a 2 mm (40 sec) + 2 mm (40 sec) incremental technique, and in the other group, it was completed using a 4 mm bulk technique (40 sec). The U composite resin (control group) polymerization was completed using a 2 mm + 2 mm (40 sec) incremental technique (n = 10). The Vickers microhardness (VHN) values of the samples were calculated. The data were analyzed with Kruskal–Wallis and Mann–Whitney U tests (p < 0.05). Results: Higher VHN values were found in the U composite resin compared to those in the bulk-fill composite resins (p < 0.05). In the bulk technique, a lower VHN value was observed in the N bulk-fill composite resin than in the control group (p < 0.05), while there was no difference between the N and E composite resin groups (p > 0.05). A lower N bulk-fill composite resin was observed in the groups in which the incremental technique was applied than in the control group (p < 0.05). When the techniques applied to the bulk-fill composite resins were evaluated within themselves, higher VHN values were observed in the E composite resin in the group in which the incremental technique was applied but not in the group in which the bulk was applied. Conclusion: It was observed that the content differences of composite resins were effective at different VHN values. The U composite resin (control) group showed higher VHN values than all the bulk-fill composite groups. How to cite this article: Fidan M, Gönder HY. Investigation of the effect of different application techniques on microhardness in bulk-fill composite resins. Int Dent Res 2021;11(Suppl.1):32-7. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.6 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.
... e introduction of dental resin-based composites (DRCs) in the last century was one of the most important steps in dentistry; since its introduction, it has undergone tremendous improvements enabling them to be more popular over dental amalgams in posterior and anterior teeth [1]. Good esthetics, bonding to tooth structure, and moderate cost compared with ceramics and conservative tooth preparation are the main advantages of DRCs. ...
Article
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Objective: This study aimed to evaluate the effect of nanoparticles, zirconium dioxide (ZrO2), titanium dioxide (TiO2), and silicon dioxide (SiO2), on flexural strength (FS), hardness, and wear resistance of light cured dental composite resin. Materials and methods: 210 rectangular and disc-shaped composite resin specimens were fabricated with dimensions (25 × 2 × 2 ± 0.03 mm) and (6×4 ± 0.03 mm) for FS, hardness, and wear resistance, respectively (70/test). Specimens of each test were divided according to nanofillers into four groups, unmodified as control, ZrO2 (Z), TiO2 (T), and SiO2 (S) groups; each one was further subdivided into two subgroups according to nanoparticles concentration, 3wt.% and 7wt.% (Z3, Z7, T3, T7, S3, and S7), 10 specimens of each subgroup. A3-point bending test and Vickers hardness test were used for FS and hardness measurements, respectively. Wear resistance was evaluated by the differences in surface roughness of tested specimens before and after wear test. Two-way and 1-way ANOVA and Bonferroni's post hoc tests were done for data analysis (α = 0.05). Results: Two-way ANOVA for FS and wear resistance showed that there was a significant interaction between type of nanoparticles and concentration of nanoparticles (p < 0.001) while two-way ANOVA for hardness showed that both type of nanoparticles and concentration of nanoparticles had a significant effect (p < 0.001), while the effect of their interaction was not statistically significant (p=0.142). 1-way-ANOVA test showed significant increase in FS and wear resistance for all tested groups (p < 0.001 and p < 0.001, respectively) except T7 and S7. Also, there was a significant enhancement in hardness for all tested groups (p < 0.001). Conclusion: Modification of light cured composite resin with certain amounts of nanoparticles (3% and 7% of ZrO2 and 3% of TiO2 and SiO2) can be beneficial in improving flexural strength and wear resistance while hardness of composite resin was increased with all NPs additions.
... Bisphenol A (BPA), a kind of endocrine disruptor, is the raw material and possible degradation product of the above monomers expect UDMA. There are limited types of pure UDMA-based bulk-filled DRCs which do not have BPA derivatives such as Filtek™ Bulk Fill Posterior Restorative, but the great majority of bulk-filled DRCs still contain resin monomers derived from BPA to obtain high refractive index, which is essential for bulk-filling (Van Ende et al., 2017;Pratap et al., 2019;Dursun et al., 2016). ...
Article
With the aim to prepare Bis-GMA-free bulk-filled dental resin composite (DRC), Bis-GMA-free resin matrix was prepared by mixing Bis-EFMA with TEGDMA at two mass ratios (Bis-EFMA/TEGDMA = 50 wt./50 wt. and 60 wt./40 wt.), and the bulk-filled resin composites were then obtained by mixing resin matrix with silanated glass fillers at a mass ratio of 30 wt./70 wt. Bis-GMA based resin composites were used as control. Refractive indexes of resin matrixes were measured. Besides the depth of cure mentioned in ISO standard, double bond conversion (DC) and bottom/top Vickers hardness (VHN) ratio of resin composites were investigated to evaluate the curing depth. Physicochemical properties, such as flexural properties, volumetric shrinkage (VS), shrinkage stress (SS), water sorption (WS) and solubility (SL), and cytotoxicity of resin composites were tested and statistically analyzed (ANOVA, Tukey's, p = 0.05). The results showed that Bis-EFMA/TEGDMA resin matrixes had higher refractive indexes than Bis-GMA/TEGDMA resin matrixes. Viscosities of Bis-EFMA based DRCs were higher than Bis-GMA based DRCs. Bis-EFMA-based (50/50) DRC had comparable depth of cure, DC, and VHN as Bis-GMA-based (50/50) DRC (p > 0.05). Though Bis-EFMA/TEGDMA (60/40) had the highest refractive index in all resin matrix, the corresponding DRCs had the lowest depth of cure, DC, and bottom/top VHN ratio in all groups (p < 0.05). Replacing Bis-GMA with Bis-EFMA had no negative effect on flexural properties, WS and SL of DRCs, and could reduce VS and SS of DRCs. Results of CCK8 assay showed that all of DRCs had the same cytotoxicity (p > 0.05), and the thickness of sample had no influence on the cytotoxicity (p > 0.05). All the results indicated that Bis-EFMA could be used to replace Bis-GMA to prepare bulk-filled dental resin composites. According to the results of depth of cure, DC, and bottom/top VHN ratio, 50 wt./50 wt. was more appropriate than 60 wt./40 wt. as the mass ratio of Bis-EFMA and TEGDMA in the resin matrix for bulk-filled dental resin composites.
... Bulk-fill resin composites are categorized according to their restorative strategies into base and full-body bulk-fill composites and according to their viscosity into low-and high-viscosity bulk-fill composites [9]. The latter can be applied in a single increment without the need for coverage as it contains high filler content and, therefore, can be used in high stress-bearing areas [2]. ...
Article
To evaluate the fracture strength of extended Class I restorations with different restorative techniques using nanofilled and nanohybrid composites. Sixty extracted human third molars were prepared with extended Class I cavities and divided into six groups: groups FS-F (Filtek bulk-fill Flow + Filtek Supreme Ultra, 3 M) and GR-F (X-tra base + GrandioSO, VOCO), restored with a flowable bulk-fill composite as a base covered by a nanofilled or nanohybrid composite; groups FB (Filtek One Bulk-Fill, 3 M) and AF (Admira Fusion X-tra, VOCO), restored with a bulk-fill resin composite; and groups FS (Filtek Supreme Ultra, 3 M) and GR (GrandioSO, VOCO), restored incrementally with a nanofilled or nanohybrid composite. Sound extracted teeth (n = 10) were used as a control group (CTL). The specimens were axially loaded until failure. Data were analyzed using one-way ANOVA and Games Howell test (α = 0.05). Groups CTL and GR-F demonstrated significantly higher mean fracture strength when compared to FS, AF, and GR (p < 0.05). Group AF obtained more repairable fractures than the other groups. Restorations made with a nanofilled bulk-fill composite or with conventional resin composites associated with a flowable bulk-fill base were able to reestablish the fracture strength to that of sound teeth.
... This survey also found that 37.5% of the respondents taught the bulk-fill composite resin technique in undergraduate dentistry programmes when compared to previous surveys of a similar nature [15]. Even though numerous studies showed that bulk fill composite resins are more controversial in their physical and biomechanical properties compared to other types and techniques of composite resin restorations, their feasibility and their major advantage of being able to reduce the chairside time makes them very attractive in dental practices [55][56][57][58]. ...
Article
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There is a current trend to restore posterior teeth with composite resin due to increasing demands on natural tooth colour restoration and increased concern about the safety of amalgam restorations. The objective was to evaluate the current teaching of posterior direct restoration among restorative dental lecturers in Malaysia compared to available international literature. An online questionnaire, which sought information on the teaching of posterior restoration was developed and distributed to 13 dental schools in Malaysia. The response rate for the questionnaire was 53.8%. The most popular posterior restoration teaching methods among the respondents were lecture (95.7%), demonstration (87.0%) and problem-based learning (PBL) (73.9%), while continuous assessment and a practical competency test (82.6%) were the most popular assessment methods. Placing a hard setting calcium hydroxide and GIC base for deep cavity restored by composite restoration was taught in 79.2% of cases. The standard protocols for posterior composite restoration were incremental filling in deep cavity (87.5%), using circumferential metal bands with wooden wedge (91.7%), with a total etch system (95.8%), using a light emitting diode (LED) light curing unit (91.7%), finishing using water cooling (80%) and finishing with a disc (87.5%). Graduates from dental schools in Malaysia received similar theoretical, preclinical and clinical teaching on posterior restoration techniques, although there were variations in the delivery methods, techniques and assessments, pointing to a need for uniformity and consensus.
... On the other hand, it was previously identified that confinement imposed on the RDM by bonding to tooth cavity walls affects the level of PSS 8,9 . This specific relationship described through the concept of C-factor and defined as the ratio of bonded to unbonded (free) surfaces of the restoration 24 , still contributes to layering restorative procedures 25,26 or bulk filling techniques 27 . Meanwhile, during proximal tooth cavity reconstruction, the creation of the missing tooth part is built by using a metal band (matrix-band) to perform a proper tooth crown reconstruction. ...
Article
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Background/Aim. The objective of this study was to measure tooth cusps deflection caused by polymerization shrinkage of a resin-based dental material (RDM), in real-time using digital holographic interferometry (DHI), in two groups of cavities restored with and without an additional wall. Simultaneously, internal tooth mechanical behavior was monitored. Methods. Standardized three class I cavities were prepared on third molar teeth. The teeth were cut in two halves in the longitudinal plane, obtaining six samples for the study (now with class II cavities), divided into two groups (group G1 - with the additional wall, group G2 - without it) and mounted in aluminum blocks. The cavities were filled with the RDM, cured with a light emitting diode (LED) for 40 s from the occlusal direction, and monitored during the curing and post-curing period using DHI. Data were analyzed using student's t-test for independent samples and Anderson-Darling test, with an alpha level of 0.05. Results. At the end of the examined period, the samples from group G1 showed significantly increased tooth cusps deflection (t (10) = 4.7; p = 0.001) compared to samples from group G2. Conclusion. Within the limitations of this study, it was concluded that the presence of the additional wall simulating a dental matrix-band, influenced increased and prolonged tooth cusps deflection during the examined RDM polymerization shrinkage.
... Today, many of commercial bulk-fill resin composites are marketed with an increment depth of 4-5 mm 10,11) . These products simplify the restorative procedure compared with the incremental technique, while also reducing polymerization shrinkage stress. ...
Article
The purpose of this research was to investigate the mechanical behavior of commercially available bulk-fill and conventional flowable resin composites using the dynamic micro-indentation method. The effect of inorganic filler content on mechanical properties was also assessed. Weight percentages of the inorganic filler in the resin composite were measured using the ashing technique. The results showed that dynamic hardness and elastic modulus tended to increase with inorganic filler content. Furthermore, the differences in mechanical properties between top and bottom surfaces were less pronounced in bulk-fill flowable resin composites compared with conventional flowable resin composites. In conclusion, the mechanical properties of bulk-fill flowable resin composites are affected by filler content. Moreover, bulk-fill flowable resin composites have a higher polymerization depth than conventional flowable resin composites when sample thickness is 4 mm.
... Although many studies have been conducted on assessing the fracture resistance of different types of bulk-fill composites as premolar restoration materials [10], further understanding is still required on bulk-fill deep and large restorations with new generation nanocomposites. e aim of this study was to test the fracture resistance of maxillary first premolar restored using multiple types of bulk-fill composite resin materials. ...
Article
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During restorative treatment, premolars restored with resin filling materials using the conventional incremental-fill technique take longer restoration time and undermine the integrity of the tooth. The aim of this study was to assess fracture resistance of premolars restored by various types of novel bulk-fill composite resin materials. Forty-eight (n = 48) freshly extracted sound maxillary first premolars were used in this in vitro study. The teeth were divided into six groups, each having 8 specimens. Group A (positive control) was allocated for the intact teeth. For specimens in Groups B to F, a large cavity (Class-II MOD) was prepared with a standardized dimension of cavity (3 mm depth on the pulpal floor, 4 mm at the gingival seat, and 3 mm cavity width). Group B represented prepared teeth without any restoration. Group C, Group D, Group E, and Group F were restored with Tetric EvoCeram® incremental-fill (conventional), Beautifil bulk-fill, Filtek posterior bulk-fill, and SonicFill 2 bulk-fill restorative materials, respectively. All samples were finished and polished with an enhanced finishing kit and stored in distilled water for a month before the fracture resistance testing. All the samples were exposed to the axial loading (the speed of crosshead was 1 mm/min) in a computer-controlled universal testing machine (LARYEE, China) via a steel bar (6 mm in diameter) and the maximum applied force in Newton was recorded as the fracture resistance. One-way analysis of variance (SPSS 21) was used to compare the fracture resistance within the groups, and Tukey’s post hoc test was used to determine the difference between the groups. The lowest value of fracture resistance was recorded for Group B, and the highest value was recorded for Group A followed by the values of Group D, Group C, Group F, and Group E. One-way ANOVA revealed a statistically significant difference between the groups (P
... Following the evolution of the resin composites, modifications related to their compositions occurred, and the most recent development was the release of the so-called bulk-fill composites [8]. The main advantage of this type of composite is the possibility of placing increments up to 4 or 5 mm thick, without harming their chemical and physical properties [9,10]. ...
Article
Purpose To evaluate polymerization shrinkage stress (PSS), internal gap formation (IGF), and dentin bond strength (DBS) of one conventional resin composite and five bulk-fill restorative materials. Materials and Methods One conventional resin composite (Filtek Supreme Ultra/SU) and five bulk-fill restorative materials: two regular paste-consistency composites (Tetric EvoCeram Bulk Fill/TE and Opus Bulk Fill/OP), one low-viscosity dual-cure composite (Fill-Up!/FI), one bioactive material (Activa BioActive Restorative/AC), and one high-viscosity glass ionomer (Equia Forte Fil/EQ) were tested. PSS was determined with a tensiometer attached to a universal testing machine (n=5). For IGF, Class I cavities prepared in the occlusal surface of extracted third molars (n=5) were filled up, cross-sectioned, and analyzed in scanning electron microscopy. The DBS was evaluated with microtensile bond strength test measured after 24 h or one-year storage. Data were statistically analyzed by one and two-way ANOVA and Tukey post-hoc test (α = 0.05). Results FI, SU, and OP presented higher PPS values and EQ showed the lowest ones. IGF was lower for OP and AC. SU showed the greatest DBS values and OP and FI the lowest after one-year storage. Conclusions No correlation between PSS and IGF was found. Little difference in DBS among the restorative materials was detected, and its stability was material dependent.
... The increments may also increase the potential of occlusal voids to form between two incremental layers of composite, thus using bulk fill in single increment can compensate for occlusal voids. [24] The present study had some limitations which include a smaller sample size. Although the study was conducted on sound natural teeth, it is hard to standardize the invisible microcracks, age changes, and moisture content in in vitro conditions. ...
Article
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Aim: The aim of this study was to evaluate the gingival microleakage and internal voids in Class II composite restoration restored with precure and co-cure lining techniques using stereomicroscopic method. Materials and methods: Forty-five freshly extracted permanent multirooted human molar teeth were collected and used in the study. After surface debridement and scaling of all teeth, standard Class II mesio-occlusal cavities were prepared. Forty-five samples were randomly divided into three experimental groups (n = 15), and filled according to manufacturer's instructions. Group I was precure group, Group II was co-cure group, and Group III was only bulk fill. The finishing and polishing of the restorations was done after 24 h. Then, all the specimens were subjected to thermocycling for 500 cycles. The gingival microleakage and internal voids of all the groups were evaluated using dye penetration method. Samples were then sectioned and examined under the stereomicroscope at ×40. Readings obtained were subjected to statistical analysis using SPSS ver 20.0 (IBM Corp, ARMONK USA) and Chi-square test. Results: The statistical analysis revealed that extent of microleakage was maximum in Group II (co-cure), followed by Group III (only bulk fill) and Group I (precure). The gingival voids were maximum in Group III (only bulk fill), minimum in Group II (co-cure), and least in Group I (precure). The cervical voids were maximum in Group II (co-cure) and Group III (only bulk fill), followed by Group I (precure). The occlusal voids were maximum in Group II (co-cure) and similar in Group I (precure) and Group III (only bulk fill). Conclusion: The precure lining technique was better than co-cure lining technique in terms of both microleakage and internal voids.
... Thus, modern restorative dentistry should focus on prevention and high-quality, long-lasting restorations in order to slow down the "restorative death spiral". In recent decades, considerable developments have been made in dental resin composites [3]. Bulk-fill composite (BFC) materials, in particular, have gained considerable clinical acceptance [4,5], because they enable the placement of thicker composite layers (~4 mm) with a sufficient depth of cure and less polymerization shrinkage stress [4,[6][7][8]. ...
Article
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Background: To test the hypothesis that transparent matrices result in more continuous margins of bulk-fill composite (BFC) restorations than metal matrices. Methods: Forty standardized MOD cavities in human molars with cervical margins in enamel and dentin were created and randomly assigned to four restorative treatment protocols: conventional nanohybrid composite (NANO) restoration (Tetric EvoCeram, Ivoclar Vivadent, Schaan, Liechtenstein) with a metal matrix (NANO-METAL) versus transparent matrix (NANO-TRANS), and bulk-fill composite restoration (Tetric EvoCeram Bulk Fill, Ivoclar Vivadent, Schaan, Liechtenstein) with a metal matrix (BFC-METAL) versus transparent matrix (BFC-TRANS). After artificial aging (2500 thermal cycles), marginal quality was evaluated by scanning electron microscopy using the replica technique. Statistical analyses were performed using the Mann-Whitney U-test and Wilcoxon test. The level of significance was p < 0.05. Results: Metal matrices yielded significantly (p = 0.0011) more continuous margins (46.211%) than transparent matrices (27.073%). Differences in continuous margins between NANO (34.482%) and BFC (38.802%) were not significant (p = 0.56). Matrix type did not influence marginal gap formation in BFC (p = 0.27) but did in NANO restorations (p = 0.001). Conclusion: Metal matrices positively influence the marginal quality of class II composite restorations, especially in deep cavity areas. The bulk-fill composite seems to be less sensitive to the influence of factors such as light polymerization and matrix type.
... La odontología restauradora actual se sustenta en un nuevo paradigma consolidado por la evolución de los materiales adhesivos; hoy en día, el desarrollo de nuevos monómeros y fotoiniciadores, así como de unidades de fotopolimerización capaces de generar luz de mayor densidad de potencia, ha permitido la aparición de un nuevo grupo de materiales restauradores resinosos para dientes posteriores, con una capacidad de ser incorporada en espesores de 4 a 5 mm.; este nuevo tipo de materiales se conoce como resinas compuestas bulk-fill (1). ...
Article
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La restauración de grandes preparaciones cavitarias clases II MOD es un escenario clínico de alta complejidad. Elegir correctamente una resina compuesta y planificar la secuencia de estratificación permitirá mejorar la adaptación de las masas de resina y controlar el estrés de contracción de polimerización. En el siguiente reporte de caso clínico, se expone el protocolo paso a paso para el uso combinado de una resina compuesta para estratificación de esmalte de alto índice de refracción para la restauración de los rebordes marginales perdidos y la superficie oclusal, junto a una resina compuesta bulk-fill de baja viscosidad para la reconstrucción dentinaria en un diente posterior con gran destrucción coronaria.
... [1] Bulk-fill composite restorative resin was introduced to reduce the chairside time along with favorable properties such as decreased polymerization shrinkage, reduced cuspal deflection, and optimal bond strength. [2] However, a 10-year follow-up clinical trial of bulk-fill composite resin restorations displayed 23% failure rate. [3] To improve the adaptation of viscous bulk-fill composite resin, preheating of resin was introduced. ...
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Introduction: Bulk-fill composite restorations displayed substantial annual failure related to imperfect marginal adaptation. Although preheated composites improved, marginal adaptation demonstrated early loss of plasticity. A new technique of ultrasonics plasticization was used for fabricating restorations. Aim: The aim of this study was to assess the clinical behavior of bulk-fill composite resin restorations plasticized by preheating and ultrasonics. Methodology: Randomized split-mouth double-blinded clinical trial was designed. Bulk-fill composite resin (Tetric N-Ceram Bulk Fill Ivoclar Vivadent products, Delhi) was used to fill 56 cavities. In 28 restorations, composite resin was plasticized by preheating in composite warmer (Delta Co., India) and remaining were plasticized with modified ultrasonic-retreatment tip-RT No 2 (Cricdental, India). Clinical follow-up assessments were done at 6 and 12 months using Ryge's criteria. Mann-Whitney U-test was used for statistical analysis with P < 0.05 and effect size of 0.61. Results: Hundred percent clinical success with ultrasonic plasticized group and 95.2% success with preheated composite resin group were observed without statistical significance. Conclusion: The ultrasonics plasticization of composite resin demonstrated comparable results with that of preheated composite resin after 6- and 12-month recall. Use of vibration energy utilizing the thixotropic effect might have resulted in better clinical performance.
... Algamaiah et al. [39] report that volumetric changes of flowable bulk-fill composites may compromise the precision of proximal contacts, leaving a space between adjacent teeth for food impaction. Van Ende et al. [47], in a review of the literature, suggested that a thicker consistency of bulk-fill composite might also help in obtaining a good contact point. Our findings showed that a mean of 1.9 was detected for all proximal contacts at baseline because the operators carefully observe if the contact was established after final curing. ...
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Objectives This randomized, prospective, and split-mouth study aimed to evaluate flowable bulk-fill resin composites in class II restorations, comparing it with a conventional layering technique after 4-year follow-up. Materials and methods Fifty-three subjects received three class II restorations according to the restorative systems: conventional microhybrid composite resin (PA – Peak Universal + Amelogen Plus, Ultradent); flowable bulk-fill and nanoparticulate composite resins (ABF – Adper Single Bond 2 + Filtek Bulk Fill Flow + Filtek Z350XT, 3M/Espe); and flowable bulk-fill and microhybrid composite resins, (XST – XP Bond + SDR + TPH3, Dentsply). The clinical performance and interproximal contacts were evaluated. Statistical analyses were performed using the Kaplan-Meier, equality test of two proportions, Friedman, Wilcoxon, Kruskal-Wallis, Mann-Whitney, and Logistic regression analysis tests (alpha = 0.05). Results In total, 106 restorations were evaluated at 4 years. Both systems with bulk-fill composites presented higher marginal discoloration than PA. About surface texture, ABF restorative system showed superior bravo scores being statistically similar to XST. Better performance for wear and surface staining was found for XST restorative system. All restorative systems resulted in the decreased interproximal contacts, occurring early for XST. Conclusions The restorative systems that used flowable bulk-fill resin composites showed satisfactory clinical performance compared with conventional resin composite after 4 years. All restorative systems had decreased proximal contact after 4 years. Clinical relevance Initial marginal discoloration was observed in more than 50% of class II restorations performed with restorative systems that used flowable bulk-fill resin composite. All restorative systems had decreased proximal contact strength over time.
... Our findings are in accordance with some studies reporting that bulk fill restorations have similar clinical performances as the restorations applied through the conventional layering technique [41][42][43], as revealed by intergroup comparisons between group I-AX B and other experimental groups (Table S1). Other studies provided contradictory results when comparing bulk-fill or layering techniques [44][45][46]. ...
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The study aimed to evaluate the adhesive performances of two ormocer materials and two micro-hybrid composites placed to restore class II cavities. We tested the null hypothesis, which considered that the adhesive behaviors of tested materials did not differ. On each extracted tooth, two class II cavities were prepared having an enamel located cervical margin and a cementum located cervical margin, respectively, and were restored using two different restoration techniques. The teeth followed a tooth impregnating protocol and were sectioned and evaluated by optical microscopy to highlight the marginal microleakage around restorations. Cervical and occlusal microleakage as well as microleakage ratios were calculated. The microleakage test showed that all tested materials exhibited some degree of dentinal microleakage both on cervical and occlusal areas irrespective of the restoration technique. Some significant differences were recorded in adhesion performance of the materials. The cervical microleakage ratio was significantly increased for one of the micro-hybrid resin composites in comparison with one of the ormocer materials (p = 0.0159). Significantly differences were observed in occlusal microleakage ratios when the two micro-hybrid composites were compared (p = 0.047). The results failed to reject the null hypothesis. The present study could not demonstrate the superiority of ormocer-materials relative to conventional composites.
... incorporation of modified urethane dimethacrylate with photoactive groups in SDR™ Posterior Bulk Fill Flowable Base [14,15]. Bulk-fill composite is also available in low viscosity base similar to flowable composites, which was said to improve marginal adaptability, whereas SonicFill (Kerr, Orange, CA, USA) is ultrasonically dispensed to reduce its viscosity by 84% for the same reason [96]. Swapna et al. (2015) demonstrated that SonicFill showed better microleakage results than other bulk fill composites [97]. ...
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The placement of glass ionomer cement as lining material below composite fillings was introduced by McLean and Wilson in 1977. This technique incorporated different layers of restorative materials placed onto the tooth, similar to layers of a sandwich. It was proposed that this technique will provide a molecular seal to dentine in addition to mechanical and aesthetic properties of composite resin. Placement of a liner or an intermediate layer underneath the main bulk of restorative materials reduces polymerization shrinkage stress and resultant microleakage of the final restoration. To date, dentine adhesion and polymerization shrinkage are limitations of resin-based restorative materials. At present, a wide array of tooth-coloured restorative materials with different formulations is available. Despite advancements in restorative dentistry, no single technique or material is ideal in both clinical effectiveness and simplicity. Moreover, clinicians may find themselves in a dilemma when choosing restorative materials and techniques that can provide the best clinical results with minimal technique sensitivity or chairside time. The aim of this literature review is to present existing scientific evidence in microleakage and sandwich technique in restorations, and to discuss the multiple approaches in sandwich restorations in effort to reduce microleakage of dental restorations. Clinical recommendations will be given based on evidence from multiple studies.
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At present we notice how much all processes in the world accelerated. This concerns both our life and healthcare, in particular, dentistry. Patients become more demanding and informed, they value their time, in turn, young doctors need much more time for restoration by layer-by-layer application of the material, than experienced doctors. In this context, a material is required that will permit to reduce the time of restauration. The article presents the results of assessment of the effectiveness of Filtek Bulk Fill Posterior restorative material of 3M ESPE manufacture in the practice of an aspiring dentist. The findings were assessed according to the criteria for assessments of restorative materials (Ryge’s criteria), by aesthetic appearance quality (AAQ) and also by the quality of direct dental restoration on the stage of rehabilitation.
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The aim of this study was to investigate the effects of titanium dioxide nanotube addition on the water sorption and water solubility values of different composite resins. Titanium dioxide nanotubes were synthesized from titanium dioxide powder in anatase form and in 13 nm diameter by hydrothermal process and then functionalized with methacrylic acid. Characterization of the nanotubes was performed by scanning electron microscopy, energy-dispersive X-ray spectroscopy, X-ray diffraction and Fourier transform infrared spectroscopy. A flowable composite resin (Filtek Ultimate Flowable) and four flowable bulk-fill composite resins (Filtek Bulk Fill Flowable, SDR Bulk Fill Flowable, Venus Bulk Fill, X-tra Base) were tested. Two groups of each composite resin were prepared: groups of the resins without nanotubes; groups of the resins reinforced with 1.0 wt% functionalized titanium dioxide nanotube. Sorption and solubility in water were assessed according to ISO 4049 standards after 1, 7, 14, 21 days immersion periods. Data were analyzed using Mann-Whitney U and Kruskal-Wallis H tests (p < 0.05). Long cylindrical tubular structures with a diameter of 41.09-72.49 nm were observed in electron microscopy analysis. The band at 1636 cm - 1 showed the existence of the vinyl (C=C) bond of methacrylic acid coordinated to the nanotubes in Fourier transform infrared spectroscopy analysis. None of the materials tested in this study exceeded the maximum sorption and solubility values established by ISO. Regarding the water solubility, negative values were obtained. TiO2 nanotube reinforcement decreased the water sorption and solubility values significantly at different evaluation periods in all composite resins except for Venus (p < 0.05).
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Bulk-fill composites enable timesaving and less technical-sensitive application of restorations. This study investigated and compared the marginal integrity of classical and bulk-fill composite restorations in primary and permanent molars before and after thermo-mechanical loading (TML). Two Class II cavities were prepared in each of 20 primary and 20 permanent molars. The molars were randomised in four groups for each molar type. Groups 1 and 5 were restored with a high-viscous bulk-fill composite (Tetric PowerFill), groups 2 and 6 were restored with a flowable bulk-fill composite (Tetric PowerFlow), groups 3 and 7 were restored with a high-viscous classical composite (Tetric Prime), and groups 4 and 8 were restored with a flowable classical composite (Tetric EvoFlow). In permanent molars, the flowable composites were covered with a 2-mm layer of high-viscous composite (groups 6 and 8). The restorations were subjected to TML in a custom-made chewing machine (5–50 °C, 2 min dwelling time, × 1000; 400 ,000 loading cycles, 1.7 Hz, 49 N), and quantitative marginal analysis was conducted using scanning electron microscopy. Marginal integrity of each restoration was calculated as a percentage of continuous margins before and after TML. The tested high-viscous bulk-fill restoration showed similarly high marginal integrity in primary and permanent molars as the classical restoration. The tested flowable bulk-fill restoration showed the lowest marginal integrity compared to all other restorations after TML. In contrast to flowable bulk-fill restorations, high-viscous bulk-fill restorations show similar marginal integrity as classical hybrid composite restorations after TML, in both primary and permanent molars.
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This study evaluated the effect of the material thickness on shrinkage stress and bottom‐to‐top hardness ratio of conventional and bulk‐fill composites. Six commercial composites were selected based on their different technologies: Two conventional (C1, C2), two high‐viscosity bulk‐fill (HVB1, HVB2), and two low‐viscosity bulk‐fill (LVB1, LVB2). Shrinkage stress was analyzed for five specimens with 2 mm thickness (C‐factor 0.75 and volume 24 mm3) and five specimens with 4 mm thickness (C‐factor 0.375 and volume 48 mm3) for 300 s in a universal testing machine. Bottom‐to‐top hardness ratio values were obtained from Knoop microhardness measurements in specimens with 2‐ and 4‐mm thickness (n = 5). Thickness increase resulted in significantly higher shrinkage stress for all materials with the exception of HVB2 and LVB1. C1, C2, HVB2, and LVB1 showed lower bottom‐to‐top hardness ratios at 4 mm than at 2 mm. Only LVB2 presented a bottom‐to‐top hardness ratio lower than 80% at 2 mm, while HVB1 surpassed this threshold at 4 mm of depth. The results suggest that the increase of composite thickness affected the shrinkage stress values. Also, thickness increase resulted in lower bottom‐to‐top hardness ratio. HVB1 showed better behavior than other bulk‐fill materials, with low stress and adequate bottom‐to‐top hardness ratio at 4 mm thickness.
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Introduction: Restorations with high surface roughness directly influences restorative procedure longevity. When used correctly, polishing systems optimizes the quality, aesthetics and longevity of composite resins. Aim: To evaluate the influence of three two-step polishing systems of spiral rubber discs on surface roughness of three different bulk fill composite resins. Materials and Methods: This in-vitro study was conducted from May, 2021 to January 2022, at the Universidade Estadual de Pernambuco, School of Dentistry, Recife, Pernambuco, Brazil. Total 20 specimens of each resin {three Bulk Fill resins: Filtek One Bulk Fill (3M-ESPE), Aura Ultra Universal Restorative Bulk Fill (SDI) and Opus Bulk Fill (FGM)} were randomly divided into four groups (n=5 each). The three groups include test polishing systems {Sof-Lex Diamond Polishing System (3M/ ESPE, Saint Paul, Minnesota, USA), Decamp Plus Twist Spiral EVE (Odon omega, Ribera Prato, SP, Brazil), Spiral Swivel (Jota, Ruth, Kanton St. Gallen, Switzerland)} and one control group include no polishing system. To assess surface roughness, before and after polishing, specimens were evaluated on a digital rugosimeter. Data was subjected to the Shapiro-Wilk test to assess normality, followed by Analysis of Variance (ANOVA) to compare the mean between the different types of resins and types of polishers. Results: For the composite resins studied, significant differences were observed only when polished with Soflex Spiral (p-value=0.013). All polishing system caused a significant improvement in the roughness of composite resins compared to the control group. The mean roughness reduction comparison test between the types of polisher was significant (p-value <0.001), there was a significantly greater reduction in the roughness of EVE Decamp Plus Twist Spiral and Swivel Spiral polish system, compared to polish system from Sof-Lex Diamond Polishing System and control group. No statistically significant differences were found between EVE Diacomp Plus Spiral and Spiral Swivel polishing system. Conclusion: The spiral rubber polishers evaluated were effective in reducing the roughness of bulk fill composites. However, EVE Decamp Plus Spiral and Spiral Swivel polishers showed better results than Sof-Lex Spiral.
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Background A biocompatible additive with the ability to establish antibacterial action for restorative materials without sacrificing their physical properties is always in demand. Nano titania (TiO 2 nanoparticles) was shown to have antimicrobial action against a wide range of microorganisms. Alkasite is a modern esthetic restorative material that has outstanding properties; however, it is deficient in antibacterial activity. Objective TiO 2 nanoparticles (NPs) were included in alkasite, and both mechanical properties and antibacterial activity of the new formulations were assessed. Materials and Methods Nano titania powder was coupled to alkasite powder in proportions of 3 and 5% (w/w). There were 105 specimens made in total. Evaluation parameters were compressive strength, surface microhardness, surface roughness, water sorption and solubility, and antibacterial activity. One and two-way ANOVA were used for the statistical analysis, followed by Tukey′s test ( p <0.05). Results Both ratios of nano titania, 3 and 5% (w/w), significantly increased compressive strength, antibacterial activity against different pathogens, and decreased water solubility of alkasite ( p <0.05). Only 5% (w/w) nano titania-modified alkasite exhibited significant decrease in water sorption ( p <0.05). Conversely, an insignificant increase in microhardness and surface roughness was observed with both ratios, 3 and 5% (w/w) of nano titania ( p ˃0.05). Conclusion Nano titania seems to be a very promising complementary additive to the alkasite restorative material, capable of generating considerable antibacterial effectiveness while also enhancing certain mechanical properties.
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Abstract. While continuing the cycle of studies on the human motor activity during sleep, we examined 12 male patients with schizophrenia, mental retardation and other mental disorders caused by damage and dysfunction of the brain or somatic illness. Data on motor activity during sleep were obtained using an information-analytical system with registration of the number of movements, the maximum magnitude of jerk and the coefficient of motor activity. The nosological specificity of motor activity during sleep at night in patients with schizophrenia, mental retardation and other mental disorders caused by damage and dysfunction of the brain or somatic illness was revealed.
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Summary. The authors set a goal to compare the diagnostic significance of the levels of alkaline phosphatase (ALP) of its isomer of intestinal alkaline phosphatase (IAP) and their ratio in blood serum and intestinal contents to assess the degree of acute enteral insufficiency in urgent surgical pathology complicated by peritonitis. The results of examination of 112 patients with acute surgical pathology complicated by peritonitis were retrospectively analyzed. Biochemical data were compared with clinical and instrumental data obtained by ultrasonography and Doppler flowmetry. The main statistical indicator was Spearman's rank correlation coefficient, which showed a moderate direct correlation in patients with stage I and II enteral insufficiency (r=0.63 at p≤0.05), and in the group with st. III it showed a direct correlation with a high closeness of association (r=0.71 at p≤0.05). The IAP/ALP ratio makes it possible to objectively assess the severity of acute intestinal failure in urgent surgery.
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Abstract. In order to monitor the state of patients in the psychotherapy department by assessing motor activity during their night sleep, we examined 16 patients of both sexes with diagnoses of a depressive episode and neurotic, stress-related and somatoform disorders. Data on motor activity during sleep were obtained and processed using a special information-analytical system with the following parameters: the number of movements, the maximum jerk magnitude and the coefficient of motor activity. It showed a high efficiency of monitoring the condition of patients in comparison with healthy people by assessing motor activity during their night sleep.
Thesis
Zielsetzung Eine Weiterentwicklung im Bereich der dentalen Füllungsmaterialien sind die Bulk-Fill Komposite. Laut Hersteller sollen diese Werkstoffe bei der Füllungs-therapie in größeren Inkrementen als konventionelle Füllungsmaterialien eingebracht werden können und dabei weniger Polymerisations-schrumpfungsstress erzeugen. Das Ziel dieser Arbeit ist einen geeigneten Versuchsaufbau zur Messung des Polymerisationsschrumpfungsstresses (PSS) zu entwickeln und die Spannungskräfte von verschiedenen Kompositmaterialien während der Lichtpolymerisation zu erfassen und zu vergleichen. Material und Methode In Vorversuchen wurde die Reproduzierbarkeit und Haftkraft der getesteten Materialien an Glasstäben und PMMA- Stäben mit unterschiedlicher Vorbehandlung untersucht. Dabei zeigten diejenigen Stäbe, die mit Sandstrahlen mit Aluoxid, Silan und Bonding vorbereitet wurden die zuverlässigsten und besten Ergebnisse. Getestet wurden die folgenden elf Komposite: Ceram X Mono (CXM, Dentsply, Konstanz), Clearfil Majesty Esthetic (CME, Kuraray, Japan), Clearfil Majesty Posterior (CMP, Kuraray, Japan), Estelite Sigma Quick (ESQ, Tokuyama, Japan), Filtek Supreme XTE (FIS, 3M ESPE, Seefeld), Grandio SO (GRA, Voco, Cuxhafen), Kalore (KAL, GC, Japan), SDR (SDR, Dentsply, Konstanz), Tetric EvoCeram (TEC, Ivoclar Vivadent, Lichtenstein), Tetric EvoCeram Bulk Fill (TEB, Ivoclar Vivadent, Lichtenstein), Venus Diamond (VED, Heraeus, Dormagen). Die Messung der PSS (n=10) der genannten Kompositmaterialien erfolgte in einer universellen Prüfmaschine mit Hilfe der vorbehandelten PMMA Stäbe (Ø 5mm), die einen Probenraum von 1mm Höhe begrenzten. Eine Kraftmessdose zeichnete die auftretenden Kräfte während der Lichtpolymerisation (40 s, 20 J/ cm² Lichtleistung) auf, während ein Dehnungsaufnehmer den Probenraum konstant bei 1mm hielt. Zur statistischen Analyse wurden eine einfache und zweifache ANOVA und ein Kolmogorov- Smirnov- Anpassungstest durchgeführt (S-N-K, α=0.05). Ergebnisse Die gemessenen Schrumpfungskräfte waren bei Clearfil Majesty Posterior mit 0,94 MPa am geringsten, hingegen bei Tetric EvoCeram Bulk Fill mit 1,56 MPa am größten. Es konnte eine negative Korrelation zwischen vorliegendem Füllergehalt der zu untersuchenden Komposite und entstehender Schrumpfungsspannung beobachtet werden. Die initiale Steigungsrate des Spannungsaufbaus lässt Rückschlüsse auf das zu erwartende Ergebnis zu. So erzielten die Materialien mit schnellem Spannungsaufbau höhere Endwerte, wogegen die Materialien mit einem langsamen Spannungsaufbau kleinere Endwerte vorweisen konnten. Schlussfolgerungen In der Zusammenschau der Untersuchungsergebnisse kann festgehalten werden, dass Kompositmaterialien mit einem geringeren Fülleranteil zu einer höheren Polymerisationsschrumpfungsspannung führen. Das zu untersuchende Bulk-Fill Material konnte keine geringere Schrumpfungsspannung aufweisen. Es erzielte dagegen den größten gemessenen Wert. Kompositmaterialien zur Füllungstherapie sollten eine geringe Steigungsrate des Spannungsaufbaus während der Photopolymerisation aufweisen. Solange die Datenlage der Bulk Fill Komposite uneindeutig ist, sollte die Indikation vorsichtig gestellt werden. Um das Risiko der Desintegration des Adhäsivverbundes zur Kavität zu minimieren, sollten besonders im Seitenzahnbereich Materialien mit einem hohen Füllstoffgehalt und niedriger Polymersiationsschrumpfungsspannung eingesetzt werden. Die Inkrementtechnik kann bei der Kontrolle des Volumens und des C- Faktors bei der Minimierung der Schrumpfungsspannung helfen.
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Atrial fibrillation is one of the most urgent rhythm disturbances leading to permanent disability of the population. Therefore, the aim of this study was to investigate the possibility of left ventricular remodelling after restoration of sinus rhythm. The results of treatment in 821 patients were analyzed, each of them was assigned to one of 4 groups depending on the tactics of surgical intervention: group 1 — electrical cardioversion was performed, group 2 — pacemaker implantation (DDD) and pharmacological cardioversion; 3rd group — electrical cardioversion and pacemaker implantation; and the 4th group — RFA was performed. After the treatment, a decrease in EDV was revealed by 18.7% in the 1st group, 13.7% in the 2nd group, 19.65% in the 3rd group and 11.3% in the 4th group. An increase in the SD was observed: by 14% in the 1st group, 5.6% in the 2nd group, 10.9% in the 3rd group and by 3.65% in the 4th group, as well as an increase in EF by 48% in the 1st group, 17.5% in group 2, 29.76% in group 3 and 4.5% in group 4. Thus, left ventricular remodelling is feasible after restoration of sinus rhythm after persistent atrial fibrillation.
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This study aims to assess the resin composite purchases in a public health system and understand the variables associated with its cost and with the decision-making process over a period of 10 years. Secondary data collection was performed using the Brazilian Healthcare Prices Database (BDHP) from 2010 to 2019. All conventional and bulk-fill composites were selected. Date of purchase, institution type and location, procurement modality, number of purchased items, manufacture, and unit prices were collected. A multiple linear regression model assessed the influence of price in the procurement variables, while a multinomial logistic regression compared purchase probabilities between the materials. In total, 18,138 observations were collected with 2,129,294 purchased units and a total cost of USD 43,504,260.00. Conventional composites appeared in 98.5% of the procurement process. Nanofilled conventional composites were the most purchased materials, with an increased probability of purchase over time, despite its higher prices. An increase in prices was predicted for bulk-fill materials when compared to conventional ones. The odds of purchasing this category increased by 3.14x for every price increase over the years. Sociodemographic and type of institution influences the prices and the probability of procurement in the healthcare system. Nanofilled and bulk-fill resin are increasingly included in clinical practice. These findings highlight possible modifications to the standard-of-care in restorative treatments and how the translation of knowledge may occur from the development of new materials to the clinical application considering the economic impact of these modifications.
Article
Objectives The aim of this randomized controlled clinical trial was to evaluate the clinical survival and quality parameters of class-II restorations using a bulk-fill composite resin compared to a conventional nanohybrid composite resin in a split-mouth design. Methods One hundred and twenty direct restorations were placed in stress bearing class II cavities (n = 60 test group: Filtek™ Bulk Fill Posterior and n = 60 control group: Filtek™ Supreme XTE) in adult permanent teeth. Survival and clinical quality were evaluated at baseline and after 3 years using modified World Dental Federation (FDI) criteria. Participants and clinical evaluators were blinded relating to the group assignment of the restorations. Results Seventeen restorations (14.2%) were lost to follow-up, leading to 51 restorations available for survival analysis in the test group and 52 restorations in the control group. Seven restorations showed unfavorable events and were classified as failure. Four bulk-fill restorations failed due to tooth infracture (n = 1), chipping fractures (n = 2) and recurrent decay (n = 1), whereas three conventional nanohybrid composite restorations failed due to adhesive failure (n = 1), tooth infracture (n = 1) and chipping as well as recurrent decay (n = 1). The mean annual failure rate was 2.4% and 1.8%, respectively. The difference between test and control group was not significant (p = 0.7). Data on the detailed assessment of FDI criteria were available for n = 48 and n = 49 restorations, respectively. No significant differences between the two groups could be found regarding the assessment of esthetic, functional and biological properties. Significance Both materials showed similar clinical performance and survival. The use of bulk-fill composite proved to be an esthetically, functionally and biologically satisfactory alternative in the posterior dentition during the 3-year follow-up.
Article
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.
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Background: Dental caries is a hard tissue disease caused by bacterial metabolic activity that causes demineralization, teeth that have caries should be filled in order to function again. One of the restorative materials closer to natural teeth is composite resin because it is the same colour as natural teeth and is easy to shape. As for the placement technique, bulkfill is also used because it is more time-efficient, and irradiation is accompanied by applying the restoration material in one batch. However, the bulkfill technique often causes micro-leakage of dental caries deposition. The intermediate layer is an intermediate layer used to prevent micro-leakage at the edges of the restoration as a base layer for restoration to create a good adaptation before applying packable composite resin. Therefore, bulkfill coating technique with the intermediate layer can reduce the risk of microleakage. Purpose: To describe the bulkfill technique with an intermediate layer against marginal adaptation with class II composite resin restorations. Review: The literature sources used in the preparation of the articles through several databases with descriptions. More journals say that micro-leakage in class II cavity deposition with the intermediate layer technique is better than the bulkfill technique because the intermediate layer technique has better bond strength than the bulkfill technique. If the Bulkfill technique is modified with the Intermediate layer technique, it can show good correlation and internal adaptation. Conclusion: Bulkfill technique with an intermediate layer against marginal adaptation with class II composite resin restorations can reduce the microleakage rate by reducing the polymerization's shrinkage strain.
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Aim: In the present study, we evaluated the 1-year clinical performance of a conventional posterior composite resin and three bulk-fill composite resins. Methods: Fifty patients with four class II restorations under occlusion were enrolled in the present study. A total of 200 restorations were placed in the cavity, 50 for each material (Clearfil Photo Posterior, Filtek Bulk-Fill Flowable and Filtek P60, Tetric EvoCeram Bulk-Fill, and SonicFill). One operator placed the restorations in the cavity, and 1 week later the patients were called for baseline examination. Two calibrated examiners evaluated the restorations once every 3 months for 1 year, according to United States Public Health Service criteria. The data were analyzed using SPSS. Non-parametric tests (Kruskal-Wallis, Mann-Whitney U-test, and Friedman) were used for the analysis at a confidence level of 95%. Results: The 1-year recall rate was 86%. All restorations showed minor modifications after 1 year. However, no statistically-significant differences were detected between the materials' performance at baseline and after 1 year for all criteria (P > 0.05). Conclusions: The bulk-fill composite resin materials showed similar clinical performance when compared with a conventional posterior composite resin. Further evaluations are necessary for the long-term clinical performance of these materials.
Article
Objectives: To evaluate nanoindentation as an experimental tool for characterizing the viscoelastic time-dependent creep of resin-composites and to compare the resulting parameters with those obtained by bulk compressive creep. Methods: Ten dental resin-composites: five conventional, three bulk-fill and two flowable were investigated using both nanoindentation creep and bulk compressive creep methods. For nano creep, disc specimens (15mm×2mm) were prepared from each material by first injecting the resin-composite paste into metallic molds. Specimens were irradiated from top and bottom surfaces in multiple overlapping points to ensure optimal polymerization using a visible light curing unit with output irradiance of 650mW/cm(2). Specimens then were mounted in 3cm diameter phenolic ring forms and embedded in a self-curing polystyrene resin. Following grinding and polishing, specimens were stored in distilled water at 37°C for 24h. Using an Agilent Technologies XP nanoindenter equipped with a Berkovich diamond tip (100nm radius), the nano creep was measured at a maximum load of 10mN and the creep recovery was determined when each specimen was unloaded to 1mN. For bulk compressive creep, stainless steel split molds (4mm×6mm) were used to prepare cylindrical specimens which were thoroughly irradiated at 650mW/cm(2) from multiple directions and stored in distilled water at 37°C for 24h. Specimens were loaded (20MPa) for 2h and unloaded for 2h. One-way ANOVA, Levene's test for homogeneity of variance and the Bonferroni post hoc test (all at p≤0.05), plus regression plots, were used for statistical analysis. Results: Dependent on the type of resin-composite material and the loading/unloading parameters, nanoindentation creep ranged from 29.58nm to 90.99nm and permanent set ranged from 8.96nm to 30.65nm. Bulk compressive creep ranged from 0.47% to 1.24% and permanent set ranged from 0.09% to 0.38%. There was a significant (p=0.001) strong positive non-linear correlation (r(2)=0.97) between bulk creep and nano creep that could also be expressed via a simple fractional-power function. A significant (p=0.003) positive linear correlation (r(2)=0.69) existed between nano creep recovery and bulk creep recovery. With both methods of examination, except for Venus Bulk Fill™ (VB), the flowable and bulk-fill resin-composites exhibited creep within the range exhibited by the conventional resin-composites. Significance: Despite the differences in loading and unloading conditions, in both methods of examination the correlation observed between the creep and recovery responses for a set of resin-composites was high. Both nano creep and recovery positively correlated with loading and unloading rates, respectively.