• Restorative Dentistry and Endodontics
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• v.46 no.4
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• pp.51.1-51.13
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• 2021

Objectives: This study aimed to evaluate the effect of improper positioning single-peak and multi-peak lights on color change, microhardness of bottom and top, and surface topography of bulk fill and incremental composites after artificial aging for 1 year. Materials and Methods: Bulk fill and incremental composites were cured using multi-peak and single-peak light-emitting diode (LED) following 4 clinical conditions: (1) optimal condition (no angulation or tip displacement), (2) tip-displacement (2 mm), (3) slight tip angulation (α = 20°) and (4) moderate tip angulation (α = 35°). After 1-year of water aging, the specimens were analyzed for color changes (ΔE), Vickers hardness, surface topography (Ra, Rt, and Rv), and scanning electron microscopy. Results: For samples cured by single-peak LED, the improper positioning significantly increases the color change compared to the optimal position regardless of the type of composite (p < 0.001). For multi-peak LED, the type of resin composite and the curing condition displayed a significant effect on ΔE (p < 0.001). For both LEDs, the Vickers hardness and bottom/top ratio of Vickers hardness were affected by the type of composite and the curing condition (p < 0.01). Conclusions: The bulk fill composite presented greater resistance to wear, higher color stability, and better microhardness than the incremental composite when subjected to improper curing. The multi-peak LED improves curing under improper conditions compared to single-peak LED. Prevention of errors when curing composites requires the attention of all personnel involved in the patient's care once the clinical relevance of the appropriate polymerization reflects on reliable long-term outcomes.

• Restorative Dentistry and Endodontics
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• v.45 no.3
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• pp.32.1-32.12
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• 2020

Objectives: To evaluate the polymerization efficiency of a matrix-modified bulk-fill composite, and compare it to a conventional composite which has a similar filler system. The degree of conversion (DC%) and monomer elution were measured over different storage periods. Additionally, fillers' content was examined. Materials and Methods: Cylindrical specimens were prepared, in bulk and incrementally, from Filtek Bulk Fill (B) and Filtek Supreme XTE (S) composites using a Teflon mold, for each test (n = 6). Using attenuated total reflection method of Fourier transformation infrared spectroscopy, DC% was measured after 24 hours, 7 days, and 30 days. Using high-performance liquid chromatography, elution of hydroxyethyl methacrylate, triethylene glycol dimethacrylate, urethane dimethacrylate, and bisphenol-A glycidyl dimethacrylate was measured after 24 hours, 7 days and 30 days. Filler content was examined by scanning electron microscopy (SEM). Data were analyzed using 2-way mixed-model analysis of variance (α = 0.05). Results: There was no significant difference in DC% over different storage periods between B-bulk and S-incremental. Higher monomer elution was detected significantly from S than B. The elution quantity and rate varied significantly over storage periods and between different monomers. SEM images showed differences in fillers' sizes and agglomeration between both materials. Conclusions: Matrix-modified bulk-fill composites could be packed and cured in bulk with polymerization efficiency similar to conventional composites.

• Restorative Dentistry and Endodontics
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• v.47 no.4
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• pp.45.1-45.10
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• 2022

Objectives: This study evaluated the relationship between the battery charge level and irradiance of light-emitting diode (LED) light-curing units (LCUs) and how these variables influence the Vickers hardness number (VHN) of a bulk-fill resin. Materials and Methods: Four LCUs were evaluated: Radii Plus (SDI), Radii-cal (SDI), Elipar Deep Cure (Filtek Bulk Fill, 3M Oral Care), and Poly Wireless (Kavo Kerr). Irradiance was measured using a radiometer every ten 20-second activations until the battery was discharged. Disks (4 mm thick) of a bulk-fill resin (Filtek Bulk Fill, 3M Oral Care) were prepared, and the VHN was determined on the top and bottom surfaces when light-cured with the LCUs with battery levels at 100%, 50% and 10%. Data were analyzed by 2-way analysis of variance, the Tukey's test, and Pearson correlations (α = 5%). Results: Elipar Deep Cure and Poly Wireless showed significant differences between the irradiance when the battery was fully charged versus discharged (10% battery level). Significant differences in irradiance were detected among all LCUs, within each battery condition tested. Hardness ratios below 80% were obtained for Radii-cal (10% battery level) and for Poly Wireless (50% and 10% battery levels). The battery level showed moderate and strong, but non-significant, positive correlations with the VHN and irradiance. Conclusions: Although the irradiance was different among LCUs, it decreased in half of the devices along with a reduction in battery level. In addition, the composite resin effectiveness of curing, measured by the hardness ratio, was reduced when the LCUs' battery was discharged.

• Imaging Science in Dentistry
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• v.52 no.3
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• pp.303-308
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• 2022

Purpose: This technical report aims to describe and detail the use of micro-computed tomography for a reliable evaluation of the bulk-fill composite/tooth interface. Materials and Methods: Bulk-fill composite restorations in tooth cavities were scanned using micro-computed tomography to obtain qualitatively and quantitatively valuable information. Two-dimensional information was processed using specific algorithms, and ultimately a 3-dimensional (3D) specimen reconstruction was generated. The 3D rendering allowed the visualization of voids inside bulk-fill composite materials and provided quantitative measurements. The 3D analysis software VG Studio MAX was used to perform image analysis and assess gap formation within the tooth-restoration interface. In particular, to evaluate internal adaptation, the Defect Analysis addon module of VG Studio Max was used. Results: The data, obtained with the processing software, highlighted the presence and the shape of gaps in different colours, representing the volume of porosity within a chromatic scale in which each colour quantitatively represents a well-defined volume. Conclusion: Micro-computed tomography makes it possible to obtain several quantitative parameters, providing fundamental information on defect shape and complexity. However, this technique has the limit of not discriminating materials without radiopacity and with low or no filler content, such as dental adhesives, and hence, they are difficult to visualise through software reconstruction.

• Restorative Dentistry and Endodontics
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• v.45 no.1
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• pp.9.1-9.7
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• 2020

The restorative procedure in posterior teeth involves clinical steps related to professional skill, especially when using the incremental technique, which may fail in the long term. A recent alternative is bulk-fill resins, which can reduce polymerization shrinkage, decreasing clinical problems such as marginal leakage, secondary caries, and fracture. This scientific study aims to report a clinical case using bulk-fill resin with an occlusal matrix. As determined in the treatment plan, an acrylic resin matrix was produced to establish an improved oral and aesthetic rehabilitation of the right mandibular first molar, which presented a carious lesion with dentin involvement. The occlusal matrix is a simple technique that maintains the original dental anatomy, showing satisfactory results regarding function and aesthetic rehabilitation.

• Restorative Dentistry and Endodontics
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• v.45 no.1
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• pp.10.1-10.8
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• 2020

Objectives: This study aimed to compare the shear bond strength (SBS) of a self-adhering flowable composite (Dyad Flow) and a bulk-fill flowable composite (Smart Dentin Replacement [SDR]) to several pulp-capping materials, including MTA Plus, Dycal, Biodentine, and TheraCal. Materials and Methods: Eighty acrylic blocks with 2-mm-deep central holes that were 4 mm in diameter were prepared and divided into 2 groups (n = 40 each) according to the composite used (Dyad Flow or SDR). They were further divided into 4 sub-groups (n = 10 each) according to the pulp-capping agent used. SBS was tested using a universal testing machine at a crosshead speed of 1 mm/min. Data were analyzed using 2-way analysis of variance. A p value of < 0.05 was considered to indicate statistical significance. Results: A statistically significant difference (p = 0.040) was found between Dyad Flow and SDR in terms of bond strength to MTA Plus, Dycal, Biodentine, and TheraCal. Conclusions: Among the 8 sub-groups, the combination of TheraCal and SDR exhibited the highest SBS.

• Restorative Dentistry and Endodontics
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• v.47 no.1
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• pp.5.1-5.11
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• 2022

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 Journal of the Korean dental association
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• v.57 no.3
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• pp.162-168
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• 2019

Composite resin restorations in posterior teeth are increasing due to the aesthetic needs of patients and the development of materials. This trend will accelerate in line with domestic insurance policies. However, resin composites generate stresses due to their contraction during the polymerization process. To reduce the polymerization shrinkage stress of resin composites, incremental layering technique has been recommended for decades. This technique reduces stress at the cavity wall interface and allows a more efficient light curing of the material. Bulk-fill resin composites have been designed to simplify the restorative technique because they can be placed into cavities in a single increment of 4-5mm. The simplification of the operative procedures is desirable in clinical daily practice. In this context, bulk-fill resin composites are an attractive alternative for posterior restorations. However, a clearer understanding of the clinical performance of this relatively new class of materials in comparison to conventional resin composites is required. Based on previous studies, the aim of the current review was to present the clinical criteria for the use of bulk-fill composites in direct restorations of posterior teeth.

• Restorative Dentistry and Endodontics
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• v.46 no.3
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• pp.39.1-39.12
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• 2021

Objectives: This study analyzed the physical-chemical behavior of 2 bulk fill resin composites (BFCs; Filtek Bulk Fill [FBF], and Tetric-N-Ceram Bulk Fill [TBF]) used in 2- and 4-mm increments and compared them with a conventional resin composite (Filtek Z250). Materials and Methods: Flexural strength and elastic modulus were evaluated by using a 3-point bending test. Knoop hardness was measured at depth areas 0-1, 1-2, 2-3, and 3-4 mm. The translucency parameter was measured using an optical spectrophotometer. Real-time polymerization kinetics was analyzed using Fourier transform infrared spectroscopy. Results: Flexural strength was similar among the materials, while TBF showed lower elastic modulus (Z250: 6.6 ± 1.3, FBF: 6.4 ± 0.9, TBF: 4.3 ± 1.3). The hardness of Z250 was similar only between 0-1 mm and 1-2 mm. Both BFCs had similar hardness until 2-3 mm, and showed significant decreases at 3-4 mm (FBF: 33.45 ± 1.95 at 0-1 mm to 23.19 ± 4.32 at 3-4 mm, TBF: 23.17 ± 2.51 at 0-1 mm to 15.11 ± 1.94 at 3-4 mm). The BFCs showed higher translucency than Z250. The polymerization kinetics of all the materials were similar at 2-mm increments. At 4-mm, only TBF had a similar degree of conversion compared with 2 mm. Conclusions: The BFCs tested had similar performance compared to the conventional composite when used in up to 2-mm increments. When the increment was thicker, the BFCs were properly polymerized only up to 3 mm.

• Restorative Dentistry and Endodontics
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• v.44 no.4
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• pp.37.1-37.10
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• 2019

Objectives: This study evaluated the bond strength of various fiberglass post cementation techniques using different resin-based composites. Materials and Methods: The roots from a total of 100 bovine incisors were randomly assigned to 5 treatment groups: G1, post + Scotchbond Multi-Purpose (SBMP) + RelyX ARC luting agent; G2, relined post (Filtek Z250) + SBMP + RelyX ARC; G3, individualized post (Filtek Z250) + SBMP; G4, individualized post (Filtek Bulk-Fill) + SBMP; G5, individualized post (Filtek Bulk-Fill Flow) + SBMP. The samples were subjected to the push-out (n = 10) and pull-out (n = 10) bond strength tests. Data from the push-out bond strength test were analyzed using 2-way analysis of variance (ANOVA) with the Bonferroni post hoc test, and data from the pull-out bond strength test were analyzed using 1-way ANOVA. Results: The data for push-out bond strength presented higher values for G2 and G5, mainly in the cervical and middle thirds, and the data from the apical third showed a lower mean push-out bond strength in all groups. No significant difference was noted for pull-out bond strength among all groups. The most frequent failure modes observed were adhesive failure between dentine and resin and mixed failure. Conclusions: Fiberglass post cementation using restorative and flowable bulk-fill composites with the individualization technique may be a promising alternative to existing methods of post cementation.