Abstract
With the increasing acceptance of the clinical use of bulk-fill resins, it is necessary to investigate the in vivo performance of these restorative materials. In this perspective, this systematic review to evaluate the clinical performance of Bulk-fill resins in restorations of vital, primary and permanent posterior teeth. PubMed, Cochrane, Scopus, LILACS, BBO and Capes publications search base were searched without restriction regarding the year of publication or language of the article. The inclusion criteria were clinical trials that evaluated the efficacy of resins composed of bulk-fill compared to the incremental technique. For the selection of articles and data extraction, two calibrated evaluators evaluated abstracts and complete articles. A total of 1443 abstracts were identified, of which 14 articles were included in the review. Of these, 01 was classified with a high level of evidence; 08 were moderate and 05 with a low level of evidence. The studies presented an average follow-up of the restorations of 35.1 months. A large part of the studies (75%) demonstrated that the occurrence of postoperative sensitivity. The high failure rate was more prevalent in class II restorations. The marginal adaptation/color change was material dependent and the occurrence of secondary caries in bulk-fill resin restorations was not significant concerning conventional resins in most studies. In the short term, the satisfactory clinical performance of bulk-fill resins used in primary and permanent restorations, with clinical outcomes and results equivalent to conventional composite resins were observed.
Highlights
The decrease in tension and polymerization shrinkage stresses of composite resin is a great desired challenge, contributing to a good clinical performance of direct restorations (Al Sunbul et al, 2016; Gonçalves et al, 2008; Stansbury et al, 2005)
In vitro studies have demonstrated that bulk-fill resins present microhardness values (Fronza et al, 2015), polymerization shrinkage(Schneider et al, 2010), conversion degree (Czasch & Ilie, 2013; Fronza et al, 2015) and marginal sealing(Orlowski et al, 2015) equivalent to the conventional resins inserted by the incremental technique
The final selection consisted of 14 articles that were included in the systematic review
Summary
The decrease in tension and polymerization shrinkage stresses of composite resin is a great desired challenge, contributing to a good clinical performance of direct restorations (Al Sunbul et al, 2016; Gonçalves et al, 2008; Stansbury et al, 2005). In vitro studies have demonstrated that bulk-fill resins present microhardness values (Fronza et al, 2015), polymerization shrinkage(Schneider et al, 2010), conversion degree (Czasch & Ilie, 2013; Fronza et al, 2015) and marginal sealing(Orlowski et al, 2015) equivalent to the conventional resins inserted by the incremental technique. Bulk-fill resins present as an advantage the reduction of clinical time, since they may be inserted and photopolymerized in large increments (45mm) (Olegário et al, 2017; Roggendorf et al, 2011). The evaluation of the polymerization shrinkage of composite resin restorations is largely related to marginal adaptation and sealing within the cavity(Schneider et al, 2010). High polymerization tension may lead to cusp deflection, increasing the likelihood of dental hypersensitivity or cracks/fractures formation in the cavity walls (Ferracane & Hilton, 2016)
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