The comparative evaluation of depth of cure of bulk-fill composites - An in vitro study

Dental restoration operative time and analysis of the internal gap of conventional resins (Incremental Technique) vs. Bulk Fill (Single-Increment Technique): In vitro study

Background

To determine the operative time and the internal restoration gap in the restoration-tooth interface in the cavity floor using an incremental technique for conventional resins and the single-increment technique for the bulk fill resin.

Material and Methods

In this in vitro experimental study, the internal gaps of the restoration-tooth interfaces in the cavity floors of two conventional resins and two bulk fill resins were microscopically analyzed, and the restoration times of the single-increment technique and the incremental technique were determined.

Results

Bulk fill resins had smaller internal gap (63.31 µm) than conventional resins (333.14 µm). Regarding the restoration time, the single-increment technique obtained the best results in operative time (3.52 minutes), with significant differences relative to the incremental technique.

Conclusions

The Tetric N-Ceram bulk fill resin presented better performance than conventional resins relative to the internal gap of the restoration-tooth interface in the cavity floor. In addition, the single-increment technique presented a short clinical restoration time. Key words:Composite, internal gap, restoration technique.

Hardness and Depth of Cure of Conventional and Bulk-Fill Composite Resins in Class II Restorations with Transparent and Metal Matrix Strips

Objectives: Hardness is relevant to the degree of conversion (DC) and depth of cure (DoC). The aim of this study was to determine the micro-hardness and DoC of conventional and bulk-fill composite resins in class II restorations using metal and clear matrix bands. Materials and Methods: Twelve specimens of each of the two composite resins, i.e., Filtek Z350 XT bulk-fill and Gradia posterior conventional composite, were prepared in the form of a class II cavity in a tooth mold, using a clear or metal matrix band. All specimens were cured and stored at 37°C for 24 hours. Vickers hardness was measured as a function of DoC at 2mm intervals. Data were analyzed by two-way ANOVA (alpha=0.05). Results: The bulk-fill composite exhibited significantly higher hardness levels than the conventional composite in all tested surfaces (P<0.001). However, while the metal matrix band had a significant impact on the bottom surface (P=0.059) and also on the furthest surface from the matrix and light source (P=0.04), it did not have a consistent effect across all tested surfaces. The simultaneous interaction of the composites and matrix band types in all surfaces, did not show significant differences in hardness values. The highest bottom-to-top surface hardness ratio (73%) was observed in the conventional composite near the metal matrix band. Conclusion: In deep class II cavities, the bottom-to-top surface hardness ratio did not reach the maximum of 80%, neither for bulk-fill nor conventional posterior composites. Therefore, in such cavities extended light-curing and more incremental composite placement is needed.

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.

Investigating the Cytotoxicity of Dual-Cure Bulk-Fill Resin Materials on L929 Cells

The aim of this in vitro study was to investigate cytotoxic effects of dual-cure bulk-fill resin materials polymerized with a third-generation LED light-curing unit (LCU) on L929 fibroblast cells in terms of morphology and viability. Three novel dual-cure, flowable bulk-fill materials (Fill-Up!™), a bioactive material (ACTIVA™ BioACTIVE-RESTORATIVE™), and a dual-cure bulk-fill composite material (HyperFIL® HAp) polymerized by LED LCU (VALO™ Cordless) were tested. Each material was placed in plastic rings (4 mm × 5 mm) in a single layer. Unpolymerized rings filled with each material were placed in direct contact with cells and then polymerized. After polymerization, the removed medium was readded to wells. In this study, four control groups were performed: the medium-free control group, medium control group, physical control group, and light applied control group. Three samples were prepared from each group. After 24 h, the morphology of cells was examined and a WST-1 test was performed. The percentage of cell viability (PCV) of each group was calculated. The experiment was repeated three times. Data were analyzed by a Kruskal–Wallis Test and a Mann–Whitney U test. p < 0.05 was considered significant. The PCV of all groups were found to be significantly lower than the medium control group (p < 0.05). The lowest PCV was obtained in HyperFIL® Hap, while highest was in the Fill-Up!™. In the morphology of cells related to the experimental groups, it was observed that the spindle structures of cells were disrupted due to cytotoxicity; cells became rounded and intercellular space increased. There were no significant differences between the control groups (p > 0.05). All control groups showed acceptable PCV (>70%) and cells were spindle-like, similar to the original fibroblast cells. It can be suggested that clinicians should pay attention when applying dual-cure bulk-fill materials in deep cavities, or they should use a liner material under these materials.

The Microhardness and Surface Roughness Assessment of Bulk-Fill Resin Composites Treated with and without the Application of an Oxygen-Inhibited Layer and a Polishing System: An In Vitro Study

The aim of this study was to assess the microhardness and surface roughness of bulk-fill resin composites treated with and without the application of an oxygen-inhibited layer (OIL) and a polishing system. This in vitro experimental study consisted of 72 resin composite blocks divided into three groups: Tetric N-Ceram Bulk Fill, Opus Bulk Fill APS, and Filtek Bulk Fill. Each resin composite group was further divided into two subgroups: with and without OIL control. Subsequently, surface roughness and microhardness were measured before and after polishing. A t-test was used to compare independent and related measures. For the intergroup comparison of variation before and after polishing, the Kruskal−Wallis test with Bonferroni post hoc was used considering a significance level of p < 0.05. When comparing surface roughness, significant differences were observed between Opus Bulk Fill resin composite with and without OIL control (p = 0.003) before polishing. The same occurred when comparing Tetric N-Ceram resin composite with and without OIL control (p = 0.039) after polishing. In addition, the surface roughness of Filtek Bulk Fill, Opus Bulk Fill, and Tetric N-Ceram Bulk Fill resin composites, with and without OIL control, decreased significantly after polishing (p < 0.001), while surface microhardness significantly increased (p < 0.05), with the exception of Opus Bulk Fill resin with OIL control (p = 0.413). In conclusion, OIL control and polishing significantly improved the surface roughness and surface microhardness of Filtek Bulk Fill and Tetric N-Ceram Bulk Fill resin composites. However, in the case of Opus Bulk Fill resin composite, only its surface roughness was significantly improved.

Depth of Cure, Hardness, Roughness and Filler Dimension of Bulk-Fill Flowable, Conventional Flowable and High-Strength Universal Injectable Composites: An In Vitro Study

(1) Objective: To evaluate and compare the depth of cure (DOC) of two bulk-fill flowable composites (Filtek Bulk Fill Flowable Restorative and Tetric EvoFlow Bulk Fill), two conventional flowable composites (Filtek Supreme XTE Flowable Restorative and G-ænial Flo X) and one high-strength universal injectable composite (G-ænial Universal Injectable). (2) Methods: specimens were placed in a stainless-steel mold with an orifice of 4 mm in diameter and 10 mm in depth and light-cured for 20 s using a light emitting diode (LED) light-curing unit (LCU) with an irradiance of 1000 mW/cm2; depth of cure was assessed using the ISO 4049 scrape technique, and the absolute length of the specimen of cured composite was measured in millimeters with a digital caliper. The same procedure was repeated with 14 samples for each material under investigation, for a total number of 70 test bodies. Material roughness and hardness results were also investigated using, respectively, a 3D laser confocal microscope (LEXT OLS 4100; Olympus) at ×5 magnification and a Vickers diamond indenter (Vickers microhardness tester, Shimadzu®, Kyoto, Japan) under 10-N load and a 30 s dwell time. SEM images at 3000 and 9000 magnification were collected in order to study the materials’ filler content. Statistical analysis were performed by a commercial statistical software package (SPSS) and data were analyzed using multiple comparison Dunnett’s test. (3) Results: The average DOC of both bulk-fill composites was more than 4 mm, as a range of 3.91 and 4.53 mm with an average value of 4.24 and 4.12 mm, while that of the conventional flowable composites was much lower, as a range of 2.47 and 2.90 mm with an average value of 2.58 and 2.84 mm; DOC of the high-strength injectable composite was greater than the one of traditional composites, but not to the level of bulk-fill materials, as a range of 2.82 and 3.01 mm with an average value of 3.02 mm. Statistical analysis revealed significant differences (p-values < 0.05) in the depth of cure between bulk fill flowable composites and other composites, while there was no difference (p-values > 0.05) between the materials of the same type. (4) Conclusions: Bulk-fill flowable composites showed significantly higher depth of cure values than both traditional flowable composites and high-strength injectable composites.

Chemical and mechanical properties of dual-polymerizing core build-up materials

OBJECTIVES

To investigate the chemical (degree of conversion (DC)) and mechanical properties (Martens hardness (HM), elastic indentation modulus (E_IT), and biaxial flexural strength (BFS)) of four dual-polymerizing resin composite core build-up materials after light- and self-polymerization.

MATERIALS AND METHODS

Round specimens with a diameter of 12 mm and a thickness of 1.5 mm were manufactured from CLEARFIL DC CORE PLUS (CLE; Kuraray), core·X flow (COR; Dentsply Sirona), MultiCore Flow (MUL; Ivoclar Vivadent), and Rebilda DC (REB; VOCO) (N = 96, n = 24/material). Half of the specimens were light-polymerized (Elipar DeepCure-S, 3 M), while the other half cured by self-polymerization (n = 12/group). Immediately after fabrication, the DC, HM, E_IT, and BFS were determined. Data was analyzed using Kolmogorov-Smirnov, Mann-Whitney U, and Kruskal-Wallis tests, Spearman's correlation, and Weibull statistics (p < 0.05).

RESULTS

Light-polymerization either led to similar E_IT (MUL; p = 0.119) and BFS (MUL and REB; p = 0.094-0.326) values or higher DC, HM, E_IT, and BFS results (all other groups; p < 0.001-0.009). When compared with the other materials, COR showed a high DC (p < 0.001) and HM (p < 0.001) after self-polymerization and the highest BFS (p = 0.020) and Weibull modulus after light-polymerization. Positive correlations between all four tested parameters (R = 0.527-0.963, p < 0.001) were found.

CONCLUSIONS

For the tested resin composite core build-up materials, light-polymerization led to similar or superior values for the degree of conversion, Martens hardness, elastic indentation modulus, and biaxial flexural strength than observed after self-polymerization. Among the tested materials, COR should represent the resin composite core build-up material of choice due to its high chemical (degree of conversion) and mechanical (Martens hardness, elastic indentation modulus, and biaxial flexural strength) properties and its high reliability after light-polymerization. The examined chemical and mechanical properties showed a positive correlation.

CLINICAL RELEVANCE

The chemical and mechanical performance of dual-polymerizing resin composite core build-up materials is significantly affected by the chosen polymerization mode.

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

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

Errors in light-emitting diodes positioning when curing bulk fill and incremental composites: impact on properties after aging

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.

The Effect of Shade and Thickness on the Depth of Cure of Bulk-Fill Composites with Different Viscosities

STATEMENT OF THE PROBLEM

In an attempt to enhance and simplify the restoration process, a new class of composite resins, called the bulk fill composite resins have been introduced. It is claimed that a depth of cure (DOC) of 4 mm can be achieved without affecting the properties of this material.

PURPOSE

The purpose of this study was to investigate the effect of different shades, thicknesses, and viscosities on the DOC of bulk-fill composites.

MATERIALS AND METHOD

In this experimental study, four bulk-fill composites [Filtek™ Bulk Fill Flowable (FBF), Filtek™ Bulk Fill posterior (FBP), Tetric® N-Flow Bulk Fill (TNF), Tetric® N-Ceram Bulk Fill (TNC)] and a conventional composite, Filtek™ Z250 XT Universal (FZ) were evaluated. The samples (n=5) were made using two different shades (light and dark), thicknesses (2 and 4mm), and viscosities (flowable and sculptable). Microhardness test was conducted on top and bottom surface using Vickers microhardness tester and DOC was calculated as the bottom/top ratio of yielded scores. Statistical analysis was done using a Mann Whitney test at p< 0.05.

RESULTS

DOC ranged between 52-95%. FBF composite exhibited the lowest overall hardness numbers. At 2-mm thickness, all the samples achieved an appropriate DOC. However, at 4mm thickness, only the light shades for FBF and TNF samples achieved a DOC very close to 0.8. At 4-mm thickness, the light shades for FBF, TNF and FZ samples exhibited significantly higher DOC compared to dark shades. For 4-mm-thick samples, the DOC of Filtek™ Bulk Fill (dark and light shades (and the DOC of Tetric® Bulk Fill (light shade (were different in flowable type from the sculptable type.

CONCLUSION

The shade and the viscosity of bulk-fill composites influence their DOC at 4-mm depths. Moreover, 20 seconds of light curing appears insufficient for 4mm thickness of bulk-fill composite.