Effects of Preheating and Sonic Delivery Techniques on the Internal Adaptation of Bulk-fill Resin Composites

Effect of Three Heating Guns on the Temperature of Two Bulk-Fill Resin-Based Composites

OBJECTIVE

To evaluate the effect of three heating guns-Phasor (Vista Apex, Racine, USA), VisCalor (VOCO, Cuxhaven, Germany), and Compex HD (AdDent Inc. Danbury, USA)-on the temperature changes of two bulk-fill resin-based composites (RBCs): VisCalor Bulk (VBF, VOCO) and Filtek One Bulk Fill Restorative (OBF, Solventum, St. Paul, USA).

MATERIALS AND METHODS

Temperature changes were measured using a thermal camera (PI 640i, Optris Infrared Measurements, Berlin, Germany) during insertion and photocuring in a simulated proximal box of a Class II cavity and within the RBC capsules during heating. The RBCs were photocured using the Bluephase PowerCure (Ivoclar, Schaan, Liechtenstein) for 20s. Data were analyzed using repeated measures ANOVA and Tukey's test for each RBC (α = 0.05). The temperature of the RBCs at the same depth were analyzed by t-test (α = 0.05).

RESULTS

OBF heated with Compex produced the lowest temperature rise at the pulpal floor (2.7°C ± 0.4°C), while VBF heated with Phasor produced the highest (8.8°C ± 2.4°C). The greatest temperature increases were at the top of the restoration. OBF heated with Phasor reached 48.6°C ± 4.7°C. The Phasor and VisCalor produced two temperature peaks in the RBC inside the capsule, while the Compex maintained a steady peak temperature.

CONCLUSION

The heating gun and RBC produced different temperatures when heating, inserting, and light-activation of the RBCs.

CLINICAL SIGNIFICANCE

The choice of RBC and heating gun can substantially affect the temperature of the RBC and influence its handling properties.

Preheated and Injected Bulk-Fill Resin Composites: A Micro-CT Analysis of Internal Voids and Marginal Adaptation in Class II Restorations

The aim of this study was to evaluate, in vitro, the void formation and marginal adaptation in Class II cavities restored with preheated and injected bulk-fill resin composites. Eighty third molars received Class II cavities on their mesial and distal surfaces and were randomly distributed into eight groups (n = 10) according to material (Filtek Universal-control, incremental technique; Filtek One Bulk-Fill; Admira Fusion X-tra Bulk-Fill; VisCalor Bulk-Fill) and the temperature of the material (24 °C or 68 °C). The restored teeth were scanned using a SkyScan 1173 microtomograph. The percentage of internal voids (%IV) was analyzed using CTan software (version 1.23.02) and the percentages of continuous margins (%CM) in enamel and dentin were analyzed using Dataviewer software (version 1.5.6.2). The data of %IV and %CM were subjected to two-way ANOVA on ranks, followed by Tukey's test (α = 0.05). At 24 °C, Filtek Universal had a greater %IV (1.89%) (p < 0.05), which did not differ significantly from that of Admira Fusion X-tra Bulk-Fill (0.29%) (p > 0.05). Filtek One Bulk-Fill (0.07%) and VisCalor Bulk-Fill (0.07%) had lower %IV (p < 0.05). Preheating resulted in a significantly lower %IV for Admira Fusion X-tra Bulk-Fill (p < 0.05). Temperature did not significantly influence marginal adaptation (p > 0.05). VisCalor Bulk-Fill achieved significantly higher %CM in dentin (98%) at 24 °C (p < 0.05). It was concluded that bulk-fill-injected resin composites tend to have fewer internal voids than conventional resin composites using the incremental technique, and the injection of the resin composite into the cavity seems to be more important for marginal adaptation than the preheating procedure.

Clinical evaluation of SonicFill bulk resin technique in the restoration of proximal deep caries of primary molars: a two-year randomized controlled trial

BACKGROUND/PURPOSE

Traditional restorative composites require time-consuming incremental layering techniques which poses challenges in pediatric dentistry. SonicFill bulk resin allows for thicker layers to be placed efficiently, reducing treatment time and enhancing filling quality. This prospective, parallel, randomized, controlled clinical study aimed to compare the operative time and outcomes between SonicFill bulk resin and conventional restorative composite for deep proximal restorations in primary molars.

MATERIALS AND METHODS

A total of 129 primary molars in patients with proximal deep caries were randomly assigned to two groups. The experimental group (n = 66) received SonicFill bulk resin treatment, while the control group (n = 63) underwent restoration using traditional composite. The operative time was documented, and all teeth were evaluated at 6, 12, 18, and 24 -months post-treatment based on the modified criteria from the United States Public Health Service and radiographic examination score.

RESULTS

The operative time for SonicFill resin (137.5 ± 5.2 s) revealed a significant reduction compared to traditional composite (193.5 ± 14.4 s), (t = 29.64, P < 0.05). No significant differences were observed between the two groups in terms of colour match, marginal adaptation and so on. Success rates were 95.2% for the control group and 89.4% for the experimental group (χ2 = 1.44, P>0.05).

CONCLUSION

The SonicFill resin technique has proven to be a viable and time-efficient option for the restoration of primary molars with deep proximal caries.

TRIAL REGISTRATION

This study was registered in the Chinese Clinical Trial Registry (ChiCTR2200055570) on the date of 13/01/2022.

Evaluation of preheating methods for bulk-fill thermoviscous composite in non-carious cervical lesions: A 24-month randomized controlled trial

OBJECTIVE

This 24-month, double-blind, split-mouth randomized equivalence clinical trial compared the clinical performance of a bulk-fill thermoviscous composite resin using two different preheating methods for the restoration of non-carious cervical lesions (NCCLs).

MATERIAL AND METHODS

A total of 120 NCCLs were randomized into two groups (n = 60 each). In one group, a bulk-fill thermoviscous composite resin (VisCalor bulk, Voco GmbH) was preheated using a dispenser heater (DH, VisCalor Caps dispenser/warmer), while in the other group, the same resin was preheated with a bench heater (BH, Caps Warmer). In the BH group, the composite underwent preheating at 68 °C using a heating bench for 3 min while in the DH group, the composite was preheated at the same temperature for 30 s using a dispenser heater. Subsequently, the preheated bulk-fill thermoviscous composite resin was directly applied to the NCCLs. The restorations were evaluated at baseline, and after 6, 12, 18, and 24 months of clinical service using the FDI criteria. The total working time was recorded. The study used TOST-P to assess groups equivalence, Kaplan-Meier analysis for retention/fracture rate, log-rank test for secondary outcomes' survival distributions, and paired t-tests for comparing time per clinical step between groups (α = 0.05).

RESULTS

After 24 months, 106 restorations were evaluated. Four restorations were lost-two from the DH group and two from the BH group-resulting in similar retention rates for both groups (96.1%, 95% CI 86.8 - 98.9, p > 0.05). The hazard ratio was 0.83 (95% CI 0.26 to 2.72), indicating no significant difference between the groups (p > 0.05). All other FDI parameters were deemed clinically acceptable. However, the total working time for the BH group was significantly longer than that for the DH group (p < 0.001).

CONCLUSIONS

Both preheating protocols employed for the bulk-fill thermoviscous composite resin demonstrated high and equivalent survival rates after 24 months, the other FDI parameters were deemed clinically acceptable over the same period.

CLINICAL SIGNIFICANCE

Clinicians can choose either method for heating the thermoviscous composite resin for restoration of non-carious cervical lesions, as they do not impact important clinical outcomes after 24 months. The total working time for the bench heater is higher than that for the dispenser heater due to the need for preheating of the bench heater.

Marginal integrity and physicomechanical properties of a thermoviscous and regular bulk-fill resin composites

OBJECTIVES

To evaluate the marginal integrity (MI%) and to characterize specific properties of a thermoviscous bulk-fill resin composite, two regular bulk-fill resin composites, and a non-bulk-fill resin composite.

MATERIALS AND METHODS

VisCalor bulk (VBF), Filtek One Bulk Fill (OBF), and Aura Bulk Fill (ABF) were evaluated. Filtek Z250 XT (ZXT) was used as non-bulk-fill control. MI% was evaluated in standardized cylindrical cavities restored with the composites by using a 3D laser confocal microscope. The following properties were characterized: volumetric polymerization shrinkage (VS%), polymerization shrinkage stress (Pss), degree of conversion (DC%), microhardness (KHN), flexural strength (FS), and elastic modulus (EM). Data were analyzed by one-way and two-way ANOVA, and Tukey HSD post-hoc test (α = 0.05).

RESULTS

VBF presented the highest MI% and the lowest VS% and Pss (p < 0.05). DC% ranged from 59.4% (OBF) to 71.0% (ZXT). ZXT and VBF presented similar and highest KHN than OBF and ABF (p < 0.05). ABF presented the lowest FS (p < 0.05). EM ranged from 5.5 GPa to 7.7 GPa, with the values of ZXT and VBF being similar and statistically higher than those of OBF and ABF (p < 0.05).

CONCLUSIONS

Thermoviscous technology employed by VisCalor bulk was able to improve its mechanical behavior comparatively to regular bulk-fill resin composites and to contribute to a better marginal integrity in restorations built up in cylindrical cavities with similar geometry to a class I cavity as well. Although presenting overall better physicomechanical properties, Z250 XT presented the worst MI%.

CLINICAL RELEVANCE

The marginal integrity, which is pivotal for the success of resin composite restorations, could be improved using VisCalor bulk-fill. The worst MI% presented by Z250 XT reinforces that non-bulk-fill resin composites shall not be bulk-inserted in the cavity to be restored.

Physicochemical and mechanical properties of preheated composite resins for luting ceramic laminates

This study analyzed and compared the physicochemical and mechanical properties of preheated resin composite with light-cured resin cement for luting indirect restorations. 210 specimens of resin cement/resin composite were prepared according to preheating treatment heated (Htd) or not (NHtd). Light-cured resin cement (Variolink Veneer, Ivoclar), and resin composite (Microhybrid-Z100, 3 M; Nanohybrid-Empress direct, Ivoclar; and Bulk fill-Filtek One, 3 M) were used (n = 10). Resin cement specimens were not preheated. The response variables were (n = 10): film thickness, microhardness, liquid sorption and solubility. Data were analyzed by 2-way ANOVA and Tukey HSD post-test (α = 0.05). Bulk fill NHtd resin had the highest film thickness values (p < 0.001). Microhybrid and nanohybrid Htd resins had the smallest thicknesses and did not differ from the cement (p > 0.05). The highest microhardness values were found for Bulk fill NHtd and Bulk fill Htd resins. The nanohybrid and microhybrid Htd resins showed the lowest microhardness values, with no difference in cement (p > 0.05). For liquid sorption, there was no significant difference between the groups (p = 0.1941). The microhybrid Htd resin showed higher solubility values than the other materials (p = 0.0023), but it did not differ statistically from resin cement (p > 0.05). Preheating composite resins reduced the film thickness. After heating, nanohybrid and Bulk fill resins retained stable microhardness, sorption, and solubility values.

The clinical performance of dental resin composite repeatedly preheated: A randomized controlled clinical trial

OBJECTIVES

To assess the clinical performance of class II restorations performed by repeatedly preheated resin composite "RC" at 68 °C up to ten times.

METHODS

105 patients were selected and randomized into three groups, each comprising 35 patients. Each patient was provided with a single class II Bulk-fill resin composite "BF-RC" posterior restoration based on the number of preheating cycles; group I (H0): The BF-RC was packed non-heated, group II (H1): BF-RC preheated once, and group III(H10): BF-RC preheated ten cycles. These restorations were evaluated at 1, 3,6, and 12 months, using the modified United States Public Health Service "USPHS". Statistical analysis was performed using Kruskal-Wallis test, Mann Whitney U test, and Friedmann test, where p = 0.05.

RESULTS

All the 105 restorations did not suffer from any clinical situation that recommended replacement regarding retention, fracture, secondary caries, or anatomical form. Although all performed restorations did have Alpha and Bravo scores with good clinical performance, the non-preheated RC restorations"" suffered from relatively inferior clinical performance through the follow-up period regarding marginal adaptation, marginal discoloration, and color matching when compared to preheated groups. One and ten times of preheating conducted better clinical performance.

CONCLUSIONS

After 12-months follow-up, although no restoration needed replacement or repair in the 3 tested groups, restorations with single and ten times of preheating aided in better clinical performance of RC restorations compared to the non-preheated restorations. Preheating of RC for 10 times could be used safely with good clinical performance of restorations.

CLINICAL SIGNIFICANCE

By continually preheating RC syringe up to ten times, the dentist will not only benefit from the enhanced clinical performance and easiness of application but also will use preheated RC syringes without hesitation, relying on the absence of drawbacks related to multiple preheating cycles.

Clinical performance of preheating thermoviscous composite resin for non-carious cervical lesions restoration: A 24-month randomized clinical trial

OBJECTIVES

This 24-month, double-blind, split-mouth randomized clinical trial aimed to compare the retention rates of a preheated thermoviscous composite resin (PHT) compared to a non-heated composite resin (NHT) in non-carious cervical lesions (NCCLs).

METHODS

A total of 120 restorations were restored on NCCLs using a preheated (VisCalor bulk, Voco GmbH) and a non-heated (Admira Fusion, Voco GmbH) composite resins with 60 restorations per group. A universal adhesive in the selective enamel conditioning was applied. In the PHT group, composite was heated at 68 °C for using a bench heater. In the NHT group, no heating was employed. Both restorative materials were dispensed into caps and inserted into the NCCLs. The restorations were evaluated at baseline, 6, 12, 18, and after 24 months of clinical service using the FDI criteria. Statistical analysis was performed with Kaplan-Meier estimation analysis for retention/fracture rate and Chi-square test for the other FDI parameters (α=0.05).

RESULTS

After 24 months 108 restorations were assessed. Seven restorations were lost (two for PHT group and five for NHT group), and the retention rates (95 % confidence interval [CI]) were 96.7 % (81.5-99.9) for PHT group and 90.8 % (81.1-96.0) for NHT group, with no statistical differences between them (p > 0.05). The hazard ratio (95 % CI) was 0.52 (0.27 to 1.01), with no significant difference within groups. In terms of all other FDI parameters that were assessed, all restorations were deemed clinically acceptable.

CONCLUSIONS

Both composites showed high rates of retention rates after 24 months.

CLINICAL SIGNIFICANCE

The clinical performance of the new preheated thermoviscous was found to be as good as the non-heated composite after 24-month of clinical evaluation in non-carious cervical lesions.

REGISTRATION OF CLINICAL TRIALS

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

A laboratory pilot study on voids in flowable bulk-fill composite restorations in bovine Class-II and endodontic access cavities after sonic vibration

This pilot study investigated whether sonic-powered application of a bulk-fill resin-based composite (RBC) in Class-II or endodontic access cavities reduces void formation. The crowns and roots of 60 bovine teeth with Class-II cavities (C) and endodontic access cavities (E) respectively, were assigned to ten groups (C1-C5, E1-E5). Cavities were filled with RBC (SDR flow + , one increment) using different application techniques: no adaptation (C1 + E1), spreading of RBC on the cavity surfaces with a dental explorer tip (C2 + E2), low (C3 + E3) or high frequency (C4 + E4) direct activation by inserting a sonic-powered tip into RBC and high frequency indirect activation with an ultrasonic insertion tip (C5 + E5). The restorations were light-cured and investigated for voids using microtomography. The number of voids and percentage of voids related to the volume were statistically analysed (α < 0.05). While most voids in Class-II restorations were observed in C4 (p ≤ 0.0031), no significant differences were found between the other groups (p > 0.05). The percentage of voids showed no differences in E1-E5 (p > 0.05). C4 showed a significantly higher percentage of voids compared to C2 (p < 0.001). There is no benefit in applying sonic vibration when filling Class-II or endodontic access cavities.

Examining the Impact of Preheating on the Fracture Toughness and Microhardness of Composite Resin: A Systematic Review

The objective of this comprehensive study was to systematically evaluate the effects of preheating on two critical mechanical properties, microhardness and fracture toughness, in resin composite materials. The overarching goal was to provide valuable insights into the potential benefits and limitations of this technique for enhancing the overall mechanical performance of such materials. To achieve this, an extensive and systematic electronic search was conducted across multiple reputable databases, including MEDLINE/PubMed, SCOPUS, ProQuest, SpringerLink, Web of Science, ScienceDirect, and Google Scholar, with data collection extending until June 2023. This rigorous search process resulted in the identification of 29 pertinent articles, which were subjected to a thorough risk of bias assessment employing the Quality Assessment Tool For In Vitro Studies (QUIN). The findings of this comprehensive investigation revealed several noteworthy trends. First, concerning microhardness, all the studies consistently demonstrated a positive effect of preheating on this mechanical property. This uniformity in results corroborates the initial hypothesis that preheating indeed enhances microhardness in resin composite materials. Second, with respect to fracture toughness, a majority of the studies provided evidence supporting the notion that preheating has a favorable influence on this particular mechanical property. This alignment of outcomes suggests that preheating can be a beneficial technique for improving fracture toughness in resin composites. However, it is essential to note that there were a few exceptions within the collected data, where preheating appeared to lead to a decrease in fracture toughness. Additionally, one study reported no statistically significant effect on fracture toughness. These deviations from the general trend highlight the complexity of the relationship between preheating and fracture toughness, indicating that other factors or material-specific nuances may come into play. In conclusion, the results of this study indicate that preheating resin composites can improve microhardness and fracture toughness, offering potential benefits for dental restorations. Yet, conflicting data warrants further research to uncover the reasons behind these discrepancies. Future studies should also investigate preheating's broader impact on composite resin materials to gain a comprehensive understanding of its applications and limitations in the field.

Various ways of pre-heating a bulk-fill thermoviscous composite in restoration in non-carious cervical lesions: 12-month randomized clinical trial

OBJECTIVE

The objective of the study is to evaluate through a randomized clinical trial the best method to preheat a composite resin, if using a Caps dispenser device associated with Caps Warmer (CD) or with a VisCalor Caps dispenser/warmer (VD) for restorations in non-carious cervical lesions (NCCLs).

MATERIAL AND METHODS

One hundred and twenty restorations were distributed to two groups (n = 60) according to the pre-heating way of thermoviscous bulk-fill composite resin. For the CD group, pre-heating was carried at 68 °C using a heating bench for 3 min. For the VD group, pre-heating was performed at 68 °C using a heating gun for 30 s. After that, pre-heated bulk-fill composites were directly inserted in the NCCLs. The total working time was recorded. The restorations were evaluated after 6 and 12 months of clinical performance according to the FDI criteria. Statistical analysis was performed using the Student's t test for unpaired samples for working time, and the Chi-square test for restoration clinical performance (α = 0.05).

RESULTS

Working time was shorter for VD with a statistically significant difference compared to CD (p = 0.01). Few restorations were lost or fractured after 12 months of clinical evaluation (p > 0.05). The retention rates were 96.7% (CI 95 %: 88.6-99.1%) for CD and 98.3% (CI 95 %: 91.1-99.7%) for VD. The other FDI parameters were considered clinically acceptable.

CONCLUSIONS

The different pre-heating ways did not influence the clinical performance of thermoviscous bulk-fill composite restorations in NCCLs after 12 months.

CLINICAL RELEVANCE

Regardless of the bulk-fill thermoviscous composite resin pre-heating ways, the restorations are clinically acceptable after 12 months.

The assessment of internal adaptation and fracture resistance of glass ionomer and resin-based restorative materials applied after different caries removal techniques in primary teeth: an in-vitro study

Background

The aim of this study was to evaluate the 3-dimensional (3D) internal adaptation (IA) and fracture resistance (FR) of compomer and glass ionomers applied after conventional caries removal to sound dentin (CCRSD) and selective caries removal to firm dentin (SCRFD) in in-vitro.

Methods

Thirty extracted primary molars were randomly assigned to three main groups (n = 10) as glass hybrid restorative (GHR) (Equia Forte® HT), conventional glass ionomer (CGIR) (Voco Ionofil Molar) and compomer (Dyract XP). Each group was randomly divided into two subgroups according to caries removal technique as CCRSD (n = 5) and SCRFD (n = 5). The restoration procedures were completed after caries removal (CCRSD or SCRFD) in all samples. Then, specimens were subjected to IA and FR tests. Data were analyzed with Student’s t, one-way ANOVA, and Kruskal Wallis-H tests. The correlation between IA and FR results was analyzed with a Pearson test. The statistical significance level was considered as 5%.

Results

While CCRSD showed superior IA results than SCRFD for all restorative materials (p < 0.05), no statistical difference was found between CCRSD and SCRFD in FR assessment (p > 0.05). In CCRSD, compomer showed superior results for IA and FR than glass ionomers (p < 0.05). In SCRFD, it was found no significant difference between the restoratives for IA (p > 0.05). However, compomer showed superior FR results than glass ionomers (p < 0.05). There was moderate negative correlation between internal voids and FR without statistically significant difference (r = −0.333, p = 0.072).

Conclusions

Despite the advantages of SCRFD, it was found to be less superior than CCRSD in IA assessment. Therefore, when SCRFD is preferred, a peripheral seal should be provided for ideal restorative treatment. On the other hand, compomer mostly showed superior results compared to others.

Effect of vibration during bulk and incremental filling on adaptation of a bulk-fill composite resin

This study evaluated the effect of vibration on adaptation of bulk-fill composite resin. A scanning laser doppler vibrometer measured the frequency and amplitude of a vibratory device (COMO; B&L Biotech) used for resin placement and visualized its effect on the resin according to depth. A bulk-fill composite resin (Filtek Bulk Fill; 3M ESPE) was placed in simulated cavities (4 mm diameter, 4 mm depth) by different layering methods (incremental filling with two 2-mm-thick layers vs. bulk filling with a single 4-mm-thick layer). The groups were further divided based on the application of vibration during restoration (no vibration vs. vibration). In addition to the surface void area at the cavity floor, the overall void volume and the void volumes of the bottom, middle, and top thirds were obtained for micro-computed tomography analysis. The frequency and amplitude of the COMO were approximately 149 Hz and between 26 and 51 µm, respectively. When vibration was not applied, incremental filling had a lower void volume in the bottom third of the cavity than did bulk filling (p < 0.05). Vibration applied with a 4-mm-thick bulk fill had no significant effect on the adaptation of composite resin (p > 0.05). In contrast, vibration reduced the amount of void formation in the bottom third of the cavity during incremental filling (p < 0.05). Application of vibration to resin with a 2-mm incremental-layering technique formed a smaller void at the interface between the cavity and resin and within the bulk-fill composite resin.

Current Strategies to Control Recurrent and Residual Caries with Resin Composite Restorations: Operator- and Material-Related Factors

This review addresses the rationale of recurrent and/or residual caries associated with resin composite restorations alongside current strategies and evidence-based recommendations to arrest residual caries and restrain recurrent caries. The PubMed and MEDLINE databases were searched for composite-associated recurrent/residual caries focusing on predisposing factors related to materials and operator’s skills; patient-related factors were out of scope. Recurrent caries and fractures are the main reasons for the failure of resin composites. Recurrent and residual caries are evaluated differently with no exact distinguishment, especially for wall lesions. Recurrent caries correlates to patient factors, the operator’s skills of cavity preparation, and material selection and insertion. Material-related factors are significant. Strong evidence validates the minimally invasive management of deep caries, with concerns regarding residual infected dentin. Promising technologies promote resin composites with antibacterial and remineralizing potentials. Insertion techniques influence adaptation, marginal seal, and proximal contact tightness. A reliable diagnostic method for recurrent or residual caries is urgently required. Ongoing endeavors cannot eliminate recurrent caries or precisely validate residual caries. The operator’s responsibility to precisely diagnose original caries and remaining tooth structure, consider oral environmental conditions, accurately prepare cavities, and select and apply restorative materials are integral aspects. Recurrent caries around composites requires a triad of attention where the operator’s skills are cornerstones.