Dental Bulk-Fill Resin Composites Polymerization Efficiency: A Systematic Review and Meta-Analysis

Reem Ajaj,Nada Farsi,Nour Nuwaylati,Lama Alzain,Hani Nassar,Raneem Ghurab

doi:10.3390/jcs5060149

Reem Ajaj, Nada Farsi + Show 4 more

Open Access

https://doi.org/10.3390/jcs5060149

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Abstract

Dental Bulk-Fill Composites (BFCs) and Bulk-Fill Flowables (BFFs) were introduced in the market to facilitate efficient bulk filling of cavities up to 5 mm. The aim of this study was to synthesize the literature investigating their polymerization efficiency. A comprehensive search of PubMed and the Cochrane Library from 2010 to January 2019 was performed using the medical subject headings. Screening of the titles, abstracts and full text was performed. Data extraction for relevant information was done on the included studies. Clinically relevant parameters were selected to present the study estimates (meta-analysis) using a random effects model for polymerization efficiency (Degree of Conversion (DC) and Depth of Cure (DoC)). Twenty one studies fulfilled the inclusion criteria and were included in the analysis reporting seven BFCs and nine BFFs. Ten materials reported acceptable DC values of above 55% and ten materials reported adequate DoC values. Most of the stated materials reported adequate DC and DoC values in at least one investigation with BFFs showing higher and more acceptable values compared to packable BFCs. It is suggested that future studies be carried out using a standard methodology following the ISO 4049 standard and manufacturer’s instructions to compare results.

Highlights

The highest reported degree of conversion (DC) value by the Fourier-Transform Infrared Spectroscopy (FTIR) method was for Venus Bulk-Fill (86.07%) [48] and the lowest reported value was for Tetric N-Ceram Bulk-Fill (24.12%) [47]
The highest reported Microhardness Ratio (MHR) was for Venus Bulk-Fill (1.14) by Czasch, 2013 [36]; and the lowest reported MHR was for SonicFill (0.1) by Alshaafi, 2016 [33]
It was evident that Bulk-Fill Flowables (BFFs) have higher and more acceptable depth of cure (DoC) and DC values compared to regular Bulk-Fill Composites (BFCs)

Summary

Introduction

New light-cure composite formulations were introduced in the market in order to facilitate bulk filling of cavities where the manufacturers claim that these materials can fill up to 5 mm with predictable polymerization efficiency [4] without the need for the incremental technique; expediting the restorative procedure [10,11]. These materials tend to be more translucent which allows for more light to pass through [12,13] These modifications would ensure better exposure of the deeper parts of the restoration to the curing light leading to deeper depth of cure (DoC) and facilitating more conversion of monomers into polymers leading to better degree of conversion (DC)

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