Tetric N-Ceram Bulk Fill Research Articles

Color Stability and Micro-Hardness of Bulk-Fill Composite Materials after Exposure to Common Beverages.

Objectives: To assess the color stability and surface microhardness of Bulk-Fill composite materials available in the Saudi Arabia market. Methods: Five composite materials (Filtek Z350, Filtek Bulk-Fill, Tetric N-Ceram Bulk-Fill, Sonic Fill 2, and SDR) were investigated. Samples (n = 20; 10 mm in diameter and 2 mm in thickness) were fabricated using a stainless-steel mold and were immersed in tea, coffee, berry juice, and distilled water (control). Baseline (T0) shades of specimens were recorded using a spectrophotometer and after 10 (T1), 30 (T2), 60 (T3), and 90 days (T4) of immersion. Measurements were obtained against a black background and CIE L*a*b* data was used to calculate ΔE for each group. Vickers microhardness values were obtained at T0 and T4. Data was analyzed using mixed model repeated measure ANOVA at 0.05 significance level. Results: Time, material, and solution effects have statistically significant effect on ΔE. Tea was the most staining solution. Z350 was associated with the highest ΔE values while SDR showed the lowest values. No other materials showed significant difference between each other. Solutions were statistically different from each other. All materials were different from each other regarding microhardness. Conclusion: Bulk-Fill materials showed more color stability but lower microhardness values compared to universal resin control.

A Preliminary Research Study on the Cytotoxicity of Expired and Non-expired Composite Resins: In Vitro Study

Objective: Studies have focused on use of non-expired composites. Unfortunately some clinicians still use expired composite resins without considering their effects. The objective of this in vitro preliminary research was to investigate cytotoxicity of expired(6-months) and non-expired composite resins. Materials and methods: Expired (E) and non-expired (NE) samples of one bulk-fill (Tetric N-Ceram Bulk-fill [TNB], Ivoclar Vivadent), two nano-hybrid (Tetric N-Ceram [TN], Ivoclar Vivadent; Clearfil Majesty ES-2 [CM], Kuraray) composite resins were tested on L929 fibroblast cells. Medium covering cells was removed then plastic rings (2-mm height) were filled with non-polymerized composite resins, placed in direct contact with cells and polymerized with LED light curing unit (LCU). Three samples were prepared for each group. After polymerization, removed medium was added to the cells. Cells that were left without medium (WOM) and cells that were exposed to LCU were used as positive control groups. Cells without any treatment were used as negative control group (C). Cells were incubated with tested materials for 7-days to evaluate cytotoxicity. Cell viability was calculated by sulforhodamine B test as a percentage (%). One-way ANOVA and post-hoc Tukey tests were used for statistical analyses (p<0.05). Results: Comparison between E and NE groups of same composite resins did not result in statistically significant differences (p>0.05), except between TN NE and TN E (p<0.05). TN E group was significantly more cytotoxic than TN NE group. When NE composite resin groups were compared to each other, statistically significant difference was only obtained between TNB NE and TN NE (p<0.05). Among all tested groups, TN NE group showed the least cytotoxic profile. No statistically significant differences were determined when E composite resin groups were compared to each other (p>0.05). All experimental groups compared with C group showed statistically significant cytotoxicity (p<0.05). A statistically significant difference existed between LCU and C groups (p<0.05). Conclusions: In clinical practice, expired composite resins should never be used. Although a correlation was found between expiration dates of nano-hybrid composite resins and cell viability, opposite data were obtained for bulk-fill composite resin. Researches are still required to evaluate biocompatibility of bulk-fill composite resins at various thicknesses with current LCUs.

Effect of Composite Resin and Restorative Technique on Polymerization Shrinkage Stress, Cuspal Strain and Fracture Load of Weakened Premolars.

To compare shrinkage stress, cuspal strain and fracture load of weakened premolars restored with different conventional and bulk-fill composite resins and restorative techniques. Fifty premolars received a 4.0 x 3.5mm mesio-occlusal-distal (MOD) class II preparation. The lingual and buccal cups were internally weakened. Specimens were restored according to the following 5 groups: Filtek Z350 XT/10 increments; Filtek Z350 XT/8 increments (both 3M Oral Care); Filtek Bulk Fill Flowable Restorative + Filtek Z350 XT (both 3M Oral Care); SDR + Spectra Basic (Dentsply Sirona); and Tetric N-Ceram Bulk Fill (Ivoclar Vivadent). Cuspal strains were measured using strain gauges (n = 10). After restoration, specimens were submitted to thermal/mechanical cycles and fractured. Post-gel shrinkage of the composites was determined. Additionally, residual shrinkage strains and stresses were analyzed using three-dimensional finite element analysis (3D-FEA). The data were statistically analyzed using one-way ANOVA and Tukey's HSD (α = 0.05). One-way ANOVA revealed statistically significant differences among composite resins (p < 0.001) for the post-gel shrinkage. Filtek Z350 XT had the highest post-gel shrinkage and no difference was found between Spectra Basic and Tetric N-Ceram Bulk Fill (p = 0.110). The Filtek Z350 XT/10 increments, Filtek Z350 XT/8 increments and Filtek Bulk Fill Flowable Restorative/Filtek Z350 XT had statistically significantly higher cuspal deformation values when compared to the SDR/Spectra Basic and Tetric N-Ceram Bulk Fill techniques. 3D-FEA confirmed higher stress levels in the incrementally filled conventional restorations. Fracture loads were not statistically significantly different. The bulk-fill restoration techniques resulted in less cuspal strain and stress than the incremental technique with conventional composite resin. Fracture resistance was not affected by the restorative techniques.

Polymerization Shrinkage, Shrinkage Stress, and Degree of Conversion in Bulk-Fill Resin Composites After Different Photo-Activation Methods

Introduction: The aim of this study was to evaluate the effect of photo-activation methods on the shrinkage behavior of bulk-fill resin composites. Materials and Methods: Three bulk-fill resin composites (Tetric N-Ceram bulk-fill, Xtra fill, and Filtek flowable) were compared in terms of polymerization shrinkage, shrinkage stress, and degree of conversion (DC). Two curing methods were used: 1) conventional and 2) soft-start curing. Five disk-shaped specimens of each bulk-fill composite were fabricated. The deflection disk method and custom-made linear variable differential transformer (LVDT) device evaluated the dimensional changes during polymerization. Universal testing machine was used to measure shrinkage stress. To evaluate DC, the absorbance peaks were obtained using Fourier Transformation Infrared Spectroscopy (FTIR). Data were analyzed by one-way ANOVA and Tukey test. Results: Tetric N-Ceram bulk-fill (conventional mode) showed the highest polymerization shrinkage rate. Filtek flowable resin composite showed least amount of shrinkage stress and highest DC, while Xtra fill (with conventional curing) showed the highest shrinkage stress. Conclusion: Photo-activation method had no effect on decreasing the polymerization shrinkage except for Tetric N-Ceram; also, polymerization shrinkage stress in Filtek flowable composites with both curing methods was less than other groups. DC was product dependent.

Evaluation of microhardness, sorption, solubility, and color stability of bulk fill resins: A comparative study.

Background Due to the increasing popularity of bulk fill resins, there is a concern that their components can be leached; this is because these are inserted in a single 4-5 mm increment. This in vitro study evaluated the microhardness, sorption, solubility, and color stability of three restorative bulk fill resins, namely: Filtek Bulk Fill (FBF), Tetric N-Ceram Bulk Fill (TNC), and Opus Bulk Fill (OBF). Material and MethodsCylindrical samples were fabricated to be 15 mm in diameter and 1 mm thick (n = 10). For the microhardness test, three random indentations were formulated on the samples using a micro-durometer with a load of 300 gf for 15 s. Sorption and solubility were then evaluated (ISO 4049: 2009). Color stability was analyzed with a digital spectrophotometer three times (initially, after 24 h, and after 7 d) during immersion in coffee and distilled water (control). The Shapiro-Wilk test was applied to analyze normality. The Mann-Whitney and Kruskal-Wallis tests were used to compare the groups and the immersion solution, with a significance level of 5%. ResultsThere were a significant difference in microhardness (p<0.001), with the FBF group showing a higher value compared to the other groups (56.38). The highest average of sorption scores was observed in the OBF group (16.9 µg / mm3), followed by FBF (16.8 µg / mm3) and TNC (11.3 µg / mm3). Solubility was lowest in the OBF group (-2.83 µg / mm3), with a significant difference (p = 0.031). There was also a significant difference after 24 h in the mean ∆E score of all groups (p<0.005). After one week of immersion, the group that pigmented most was OBF (p = 0.008). ConclusionsThe three bulk fill resins had acceptable hardness, sorption, and solubility values. However, all groups showed a high pigmentation rate after 7 d of immersion in coffee. Key words:Bulk fill, color stability, composite resins, microhardness, solubility, sorption.

The effect of pre-heating on monomer elution from bulk-fill resin composites.

BackgroundThe present study was aimed to evaluate the effect of pre-heating of bulk -fill resin composites on monomer elution from them. Material and MethodsThree different types of resin composites were used including Tetric N-Ceram Bulk Fill, X-tra Fill and X-tra Base. 10 cylindrical samples were prepared from each resin composites. Before light curing, 5 samples were pre-heated until reaching 68˚C, then 5 other samples were polymerized at room temperature. After 24 hours, release of UDMA, TEGDMA and BIS-GMA monomers were measured by High-Performance Liquid Chromatography analysis. Data analysis was performed by two-way ANOVA test, Games-Howell and Sidak post hoc tests. ResultsPre-heating did not have any statistically significant effect on the mean values of UDMA, TEGDMA and Bis-GMA elution (p>0.05). The greatest amount of released Bis-GMA and UDMA was obtained from Tetric N-Ceram Bulk-fill composite. The greatest amount of released TEGDMA was obtained from X-tra Fill composite. X-tra Base composite showed the lowest amount of monomer release (P<0.001). ConclusionsPre-heating did not have any effect on monomer release from bulk-fill resin composites. Moreover, the amount and the type of monomers released from various bulk-fill resin composites were not similar. Key words:Bulk fill composite resin, elution, HPLC, residual monomer, temperature.

Effect of Different LED Light-curing Units on Degree of Conversion and Microhardness of Bulk-fill Composite Resin

The aim of this study is to compare the effect of the use of second-generation and third-generation LED light-curing units (LCUs) on the degree of conversion (DC) and microhardness (VHN) of bulk-fill resin composites. Thirty cylindrical specimens (each n = 5) of Tetric N-Ceram Bulk-Fill, Filtek™ Bulk-Fill Posterior Restorative, and SDR flow were prepared in metal molds (5 mm in diameter and 4 mm in thickness) and cured with second-generation LED (SmartLite® Focus®, Dentsply Sirona) and third-generation LED (Bluephase® style, Ivoclar Vivadent) resulting in six groups. Degree of conversion was determined using Fourier transform infrared spectroscopy (FTIR), and microhardness with Vickers microhardness tester. Data were statistically analyzed using one-way ANOVA and least significance difference (LSD) test, and DC and microhardness were correlated using Pearson's correlation (α = 0.05). There was a significant difference between DC and VHN between all groups of bulk-fill which were cured by second-generation LED curing light and third-generation LED curing light. Then there is no significant difference between DC of the three composite bulk-fill resins by (second-generation LED vs third-generation LED curing light). The second-generation LED curing light can still be used to cure bulk-fill resin composites by increasing the duration of irradiation. In the microhardness test, there was a significant difference in the Filtek™ Bulk-Fill Posterior Restorative resin composites.

Curing Depth and Degree of Conversion of Five Bulk-Fill Composite Resins Compared to a Conventional Composite

Background: Limited curing depth and its effect on the degree of conversion are among the challenges of working with light-cure composite resins. The use of bulk-fill composites is one strategy to overcome these limitations. Methods: Ever X Posterior (EXP), Filtek Bulk-Fill Posterior (FBP), Sonic Fill 2 (SF2), Tetric N-Ceram Bulk-Fill (TNB), and X-tra Fil (XF) bulk-fill and Filtek Z250 conventional composite were evaluated in this in vitro experimental study. Six samples for the assessment of microhardness and three samples for the evaluation of DC were fabricated of each composite. After light curing and polishing, the samples were incubated at 37°C for 24 hours. Microhardness was measured by a Vickers hardness tester three times and the mean value was calculated. DC of the top and bottom surfaces was determined using Fourier-Transform Infrared Spectroscopy (FTIR). Data were analyzed using one-way ANOVA and Tukey’s test. Results: Microhardness and DC were significantly different among the groups (P&lt;0.001). XF and Z250 equally showed the highest bottom-to-top surface microhardness ratio (0.97 ± 0.01) and significantly higher DC in the top (P&lt;0.001) and bottom (P&lt;0.005) surfaces compared to other groups. TNB showed the lowest microhardness ratio (0.88 ± 0.04) and DC (68.66 ± 1.52 and 61.00 ± 2.00); the difference in DC of the bottom surface was statistically significant (P&lt;0.003). Conclusion: It appears that bulk-fill composites evaluated in this study are adequately polymerized at 4 mm depth. Their DC was optimal and within the range of conventional composites.

Degree of conversion and microhardness of bulk-fill dental composites polymerized by LED and QTH light curing units

ObjectivesThe degree of monomer conversion is crucial in determining the mechanical and clinical performance of dental resin composites. This study investigated the polymerization adequacy of two bulk-fill resin composites polymerized by Quartz-Tungsten-Halogen (QTH) and Light Emitting Diode (LED) light curing units at different depths. MethodsTwo bulk-fill resin composites (X-tra Fil; Voco and Tetric N-Ceram Bulk-fill; Ivoclar-Vivadent) with diameters of 7 mm and thicknesses of 1–4 mm were prepared and light-cured by LED or QTH. Then, the degree of conversion (DC) and microhardness of the two bulk-fill composites were evaluated. ResultsThe microhardness of X-tra fill was significantly higher than that of Tetric N-Ceram polymerized by LED or QTH. The microhardness and DC of X-tra fil exhibited no significant difference among the increments regardless of type of light source. The DC, however, significantly decreased in deep increments for Tetric N-Ceram polymerized by QTH. ConclusionsThe polymerization efficacies of the two bulk-fill composites were different in terms of the depth of cure and type of light source. The DC and microhardness of the X-tra fill bulk-fill composite polymerized by either QTH or LED did not decrease up to a thickness of 4 mm. Thus, new generations of LED light sources are better options for polymerizing the bulk-fill resin composites than QTH.

Impact of additional polishing method on physical, micromorphological, and microtopographical properties of conventional composites and bulk fill.

The objective of this study was to evaluate the surface roughness (SR), contact angle (CA), depth distribution of the charge particles (DDCP), mapping of chemical elements, 3D microtopography (3DM), and the micromorphology of the composites (MOR) of conventional and bulk fill after additional polishing. The specimens were prepared from Filtek Bulk Fill (FBF), Tetric N-Ceram Bulk Fill (TNCBF), Opus Bulk Fill (OBF), X-tra Fil (XTFL), Filtek Z250 XT (XT), Grandioso (GRA), Tetric N-Ceram (TNC), Vittra APS (VT), according to three additional techniques (n = 10): without finishing and polishing, finishing and polishing with abrasive rubbers (Astropol), finishing and polishing with Astropol plus additional polishing with silicon carbide brush. The SR and CA were measured using a profilometer and adapted goniometer, respectively; 3DM used atomic force microscopy (AFM); the micromorphology and DDCP by scanning electron microscopy (SEM) and the MOR by means of X-ray dispersive energy spectroscopy (EDS). The SR and CA were analyzed by ANOVA-two factors and Tukey test (p < .05); the others data were analyzed descriptively. The DDCP of all the resins had an organic matrix rich surface layer and a particulate rich subsurface layer of smaller dimensions. Additional polishing: reduced SR of FBF, VT, TNCBF, and XTFL resins; increased the CA value of the XTFL and decreased of XT. In the analyzes for 3DM, smoother and more uniform surfaces were observed in all a resins. The elements: carbon (predominant), oxygen, silicon, zirconia, and aluminum were present in all composite resins. Therefore, additional polishing improved the surface properties of the resins studied.

Effect of pH Cycling Followed by Simulated Toothbrushing on the Surface Roughness and Bacterial Adhesion of Bulk-fill Composite Resins.

The aim was to evaluate, in vitro, quantitatively and qualitatively, the effect of pH cycling and simulated toothbrushing on surface roughness (Ra) and bacterial adhesion (Cn) of bulk-fill composite resins. Thirty specimens of each composite resin, 5 mm wide and 4 mm high, were obtained: group 1 (control): Filtek Z250 (Z250); group 2: Filtek Bulk-Fill (FTK); group 3: Tetric N-Ceram Bulk-Fill (TTC); and group 4: Aura Bulk-Fill (AUR). After 24 hours, the specimens were polished and then alternated with demineralization/remineralization solutions for 15 cycles of 24 hours each at 37°C. Then the specimens were submitted to simulated toothbrushing. The Ra and Cn measurements were quantitatively analyzed in three stages: after polishing (Ra0 and Cn0), after pH cycling (Ra1 and Cn1), and after simulated toothbrushing (Ra2 and Cn2). The Ra values were submitted to two-way analysis of variance, followed by the Tukey test (α=0.05). The Kruskal-Wallis test, followed by multiple comparisons, was applied for Cn analysis. Surface topography and bacterial adhesion were observed by scanning electron microscopy (SEM). Z250, FTK, and TTC showed no significant change in Ra regardless of the treatment performed; AUR obtained increased Ra at Ra2 (p<0.05). FTK differed from the others at Cn0 and Cn1 (p<0.05). At Cn2, there was no difference among the composite resins. SEM images showed the exposure of fillers and microcavities at Ra1 and Ra2. There was greater bacterial adhesion at Cn1 for Z250 and FTK. It was concluded that the pH cycling caused surface degradation of all composite resins, which was potentiated by simulated toothbrushing. However, only AUR presented an increased Ra. Bacterial adhesion occurred on all composite resins after pH cycling; however, after simulated toothbrushing, adhesion of dispersed bacteria was similar for all the composite resin groups.

Fracture Resistance and Marginal Adaptation of Capped and Uncapped Bulk-fill Resin-based Materials.

This study tested the fracture resistance of capped and uncapped bulk-fill composite restorations and compared them to a conventional composite. Also, the effect of different radiant exposure was investigated. Flowable and high-viscosity bulk-fill composites (SureFil SDR, Filtek Bulk-Fill Posterior, and Tetric N-Ceram Bulk-Fill) and a nanohybrid resin composite (Filtek Z350 XT) were used. Standardized class II cavities were prepared on extracted premolars, and different restoration protocols were used. In protocol 1 (control), restoration was applied using a layering technique; in protocol 2, restoration was applied in bulk with a capping layer; in protocol 3, restoration was applied in bulk without a capping layer; and in protocol 4, restoration was applied in bulk without a capping layer, and the light curing time was extended. After thermocycling, the restorations were examined for marginal gaps and then subjected to the fracture resistance test using a universal testing machine. Statistical analysis was carried out using two-way analysis of variance (ANOVA) followed by one-way ANOVA at a significance level of α = 0.05. A statistically significant difference in the fracture resistance of the tested materials and protocols was detected. Filtek Bulk-Fill Posterior achieved the highest fracture resistance values regardless of the protocol used, and its results were comparable to those of Filtek Z350. SDR and Tetric N-Ceram Bulk-Fill achieved their highest strengths when a capping layer was added. Tetric N-Ceram Bulk-Fill showed improvement in fracture resistance with extended light curing, while SDR and Tetric N-Ceram Bulk-Fill achieved similar results with the addition of a capping layer. The uncapped bulk-fill group showed more gap-free margins than the capped group. The new high-viscosity bulk-fill composite restorations seem to have adequate fracture resistance. However, the results are material dependent, and some materials perform better with a capping layer and extended light curing.

Microleakage of class II restoration with zirconia inlay: An in vitro study

Background: Class II restoration with zirconia inlay is concerned by numerous studies about the luting coupling between zirconia inlay and teeth. The present study was performed to evaluate the microleakage of Class II zirconia inlayusing two different luting agents and compare to direct restoration using bulk fill composite. Aims: To evaluate the microleakage of Class II restorations using three different techniques. Materials and methods: The study was performed in laboratory with three groups. Each of thirty extracted human teeth was prepared a class II cavity with the same dimensions, then these teeth were randomly divided into 3 groups restored by 3 different approaches. Group 1: zirconia inlay cemented with self-etch resin cement (Multilink N); Group 2: zirconia inlay cemented with resin-modified glass ionomer cement (Fuji Plus); Group 3: direct composite restoration using bulk fill composite(Tetric N-Ceram Bulk Fill). All restorations were subjected to thermal cycling (100 cycles 50C – 55 0C), then immersed to 2% methylene blue solution for 24 hours. The microleakage determined by the extent of dye penetration along the gingival wall was assessed using two methods: quantitative and semi-quantitative method. Results: Among three types of restorations, group 1 demonstrated the significantly lower rate of leakage compared to the others, while group 2 and 3 showed no significant difference. Conclusion: Zirconia inlay restoration cemented with self-etch resin cement has least microleakage degree when compare to class II zirconia inlay restoration cemented with resin-modified glass ionomer cement and direct composite restoration using bulk fill composite. Key words: inlay, zirconia ceramic, class II restoration, microleakage.

The effect of curing lights and modes on dentin bond strength of bulk-fill composites applied in different thickness

To investigate shear bond strength (SBS) to dentin of a conventional and three bulk-fill composites applied in different increment thickness and cured by mono- and multi-wave LED LCUs. Two hundred and fifty-two extracted sound human molars were prepared for SBS test. The teeth were divided into four groups according to the resin composites used. Conventional composite: Tetric N-Ceram (control); high-viscosity bulk-fills: Tetric N-Ceram Bulk Fill, X-tra Fil, and SonicFill. Each group was subdivided (n = 7) according to increment thickness (2, 4, and 6 mm) and cured by standard mode of a mono-wave LED or two different modes (standard and xtra power) of a multi-wave LED. The failure mode was stereomicroscopically determined at 40× magnification. Data were analyzed using Three-way ANOVA and further comparisons were assessed by Bonferroni’s multiple comparison test. There were no significant differences within X-tra fil and Tetric N-Ceram Bulk Fill groups for any of the variables (p > 0.05). A significant decrease in SBS values with increase of layer thickness was observed for SonicFill and control groups. Also, curing mode had a significant effect on both composites at 6 mm thickness and standard mode of multi-wave LED caused the highest SBS value (p ˂ 0.05). Adhesive failure was the most common fracture pattern especially at 6 mm thickness applications. Based on the results of this study, the bulk-fill composites can be safely applied in one-step with 4 mm increments, although the examined composites performed better at 2 mm thickness. The performance of the composites at 6 mm increment may show differences related to the curing lights and modes.

Biomechanical behaviour of bulk-fill resin composites in class II restorations

The aim of this study was to evaluate the biomechanical properties expressed by shrinkage stress, cuspal strain, fracture strength and failure mode in molars with large class II mesio-occlusal-distal restorations. Sixty-four human caries-free third molars were selected and distributed randomly into four groups: Z100 restorative material (Z100), Tetric N-Ceram Bulk-Fill (TNC), Filtek Bulk-Fill (FBF) and Aura Ultra Universal (ABF). The bulk-fill materials were inserted in one singular bulk increment and the conventional composite resin in three ones. Polymerisation shrinkage stress was evaluated by optical Fibre Bragg Gratings (FBG) sensors (n = 6). The cuspal deformation was measured using an extensometer during three moments: restorative procedure, axial compressive loading and at fracture (n = 10). The fracture strength was evaluated on a universal machine. The failure mode was analysed by Scanning Electron Microscopy (SEM). Data were analysed using one-way ANOVA tests with Tukey's posthoc test (α = 5%). Data of the failure mode were submitted to a likelihood ratio chi-square test. Z100 presented the highest mean value for the shrinkage stress (p < 0.05) by FBG evaluation, whereas bulk-fill resin groups presented low polymerisation stress mean value, especially the TNC (p < 0.05). The cuspal deformation test showed that Z100 presented a significant difference mean value compared to the other groups (p < 0.01) during the restoration and compressive axial force; however, load until the fracture presented a difference only between TNC and FBF (p < 0.05). The fracture strength of TNC was statistically different from Z100 (p < 0.01). The failure mode was not statistically different in all the groups (p > 0.05). Bulk-fill composites promoted less polymerisation shrinkage stress than conventional microhybrid composite during and after the light curing process in class II posterior resin composite restorations.

Evaluación clínica a 6 meses de restauraciones cervicales en lesiones no cariosas con resinas compuestas Bulk-fill: Estudio aleatorio doble ciego.

Objective: To assess the six-month clinical outcome of restorations of non-carious cervical lesions (NCCL) with two composite resins: Bulk-Fill and nanohybrid resin. Materials and methods: Fifty-one patients, with three NCCLs each, were randomly allocated into three restoration groups: Tetric-N-Ceram Bulk-Fill (TB); Filtek Bulk-Fill (FB); y Filtek Z350XT (Z350). Adhesive techniques and restorative procedures were performed according to the manufacturers’ instructions for the different materials. A 4mm increment was applied in TB and FB, and increments of ≤2mm depth were applied in Z350. Restorations were assessed by two calibrated examiners at baseline and at six months according to the FDI World Dental Federation guidelines (1: excellent, 2: acceptable, 3: sufficient, 4: unsatisfactory, 5: unacceptable) in Marginal Staining (MS), Fracture-Retention (FR), Marginal Adaptation (MA), Postoperative Sensitivity (S) and Caries (C). Wilcoxon test was used for the comparison between baseline and 6 months, and Kruskal-Wallis for the comparison of the three groups at six months (95% significance). Results: Forty-six patients with a total of 138 restorations attended a check-up at six months and were evaluated with excellent clinical outcome. In MS, 91.2% for Z350 and 97.8% for FB and TB; in FR, 97.8% for Z350 and 100% for FB and TB; in MA, 95.6% for Z350, 97.8% for FB and 100% for TN; in S, 95.6% for all three groups; and 100% for C. No statistically significant differences were found between the three groups nor in the comparison between the baseline and 6 months (p&gt;0.05) Conclusion: No significant differences are observed between the three groups of resins in the parameters of MS, MA, S, FR and C regarding clinical outcome at six months.

Effect of Thermocycling on Biaxial Flexural Strength of CAD/CAM, Bulk Fill, and Conventional Resin Composite Materials

New resin-based restorative materials have been developed, such as computer-aided design/computer-aided manufacturing (CAD/CAM) and bulk-fill composites, as an alternative to traditional layering techniques. This study evaluated the biaxial flexural strength (BFS) before and after thermocycling of five different resin composites: one hybrid resin/ceramic CAD/CAM indirect material, Lava Ultimate CAD-CAM Restorative (LU, 3M Oral Care); a conventional composite, Filtek Z350 XT (Z350, 3M Oral Care); two bulk-fill composites, Tetric N-Ceram Bulk Fill (TBF, Ivoclar Vivadent) and Filtek Bulk Fill (FBF, 3M Oral Care); and one bulk-fill flow resin composite, Filtek Bulk Fill Flow (FBFF, 3M Oral Care). Three hundred disc-shaped specimens (6.5 mm in diameter and 0.5 mm thick) were fabricated and divided into five groups (n=30 for each composite and condition). The BFS test was performed in a universal testing machine at a crosshead speed of 0.5 mm/min immediately (i, 24 hours) and after thermocycling (a, 500 thermal cycles of 5°C to 55°C with a 30-second dwell time). The Weibull modulus (m) and characteristic stress (η) were calculated, and a contour plot was used (m vs η) to detect differences between groups (95% two-sided confidence intervals). Significantly higher characteristic stress was observed for LUi (286.6 MPa) and Z350i (248.8 MPa) compared to the bulk-fill groups (FBFi=187.9 MPa, FBFFi=175.9 MPa, TBFi=149.9 MPa), with no differences between LUi and Z350i. Thermocycling significantly decreased the characteristic stress of all groups with the highest values observed for LUa (186.7 MPa) and Z350a (188.9 MPa) and the lowest for FBFFa (90.3 MPa). Intermediate values were observed for FBFa (151.6 MPa) and TBFa (122.8 MPa). The Weibull modulus decreased only for FBFa compared to FBFi. Composition and thermocycling significantly influenced the biaxial flexural strength of resin composite materials.

Randomized 36-month follow-up of posterior bulk-filled resin composite restorations

ObjectiveThe aim of this double blind, randomized controlled trial was to evaluate the 36-month clinical performance of the layering technique (incremental [IF] vs. bulk-fill [BF]) in posterior composite resin restorations bonded with self-etch (SE) and etch-and-rinse (ER) strategies. MethodsPosterior dental cavities of 72 participants (n = 236), with a cavity depth of at least 3 mm, were randomly divided into four groups. The restorations were bonded using either the Tetric N-Bond ER or Tetric N-Bond SE. The composite resin Tetric N-Ceram Bulk-Fill was placed either IF or using BF. Two experienced and calibrated examiners evaluated the restorations using FDI criteria in the baseline and after 12, 24 and 36-month. The statistical analyses were performed using the Wilcoxon Signed rank test (α = 0.05) ResultsAfter 36-month, 14, 21 and 33 restorations showed minor fractures, marginal desadaptation and color mismatch, respectively (p > 0.05). Thirty-three restorations showed some marginal discoloration after 36-month with significant difference between ER (3 for ER-IF; 3 for ER-BF) and SE (14 for SE-IF; 12 for SE-BF; p < 0.05). ConclusionThe BF technique showed excellent clinical performance, which was comparable during the 36-month of clinical evaluation with the 2-mm IF and it was not affected by the adhesive strategy. However, using the ER strategy reduces the risk of some marginal discoloration, irrespectively of the filling technique. Clinical relevanceThe bulk-fill material showed excellent clinical behavior when compared to its use in an incremental filling technique, mainly when associated to etch-and-rinse adhesive material after 3 years of clinical evaluation.

Polymerization Shrinkage Evaluation of Restorative Resin-Based Composites Using Fiber Bragg Grating Sensors.

The purpose of this study was to compare the linear polymerization shrinkage of different restorative resin-based composites (RBCs) using fiber Bragg grating (FBG) sensors. Five RBCs were evaluated: Zirconfill® (ZFL); Aura Bulk-Fill (ABF); Tetric® N-Ceram Bulk-Fill (TBF); FiltekTM Bulk-Fill (FBF); and Admira Fusion-Ormocer® (ADF). Ten samples per resin were produced in standardized custom-made half-gutter silicone molds. Two optical FBG sensors were used to assess temperature and polymerization shrinkage. Light curing was performed for 40 s and polymerization shrinkage was evaluated at 5, 10, 40, 60, 150, and 300 s. Statistical analysis was accomplished for normal distribution (Shapiro-Wilk, p > 0.05). Two-way repeated measures ANOVA with Greenhouse-Geisser correction followed by Bonferroni′s post-hoc test was used to analyze the linear shrinkage data (p < 0.05). ZFL showed the highest linear shrinkage and ADF the lowest. Shrinkage increased for all RBCs until 300 s, where significant differences were found between ADF and all other resins (p < 0.05). Among bulk-fill RBCs, TBF showed the lowest shrinkage value, but not statistically different from FBF. The ADF presented lower linear shrinkage than all other RBCs, and restorative bulk-fill composites exhibited an intermediate behavior.

Real-time in-depth imaging of gap formation in bulk-fill resin composites

ObjectivesThis study visualized in real-time the gap forming of bulk-fill resin composites during polymerization using optical coherence tomography (OCT). MethodsLight-cured bulk-fill resin composites; Tetric N-ceram Bulk Fill (TNB), SonicFill (SNF), Surefil SDR (SDR), dual-cured bulk-fill resin composite Bulk EZ (BEZ), and light-cured core resin composite Clearfil Photo Core (CPC) were investigated. Swept-source OCT real-time cross-sectional monitoring was obtained during resin composite placement and curing procedure. Gap formation was observed in bonded cylindrical resin composite molds (4-mm depth, 3-mm diameter) and free shrinkage volume was observed at the top and bottom of a tube with similar dimensions (n=10). OCT 3D data were analyzed to calculate sealing floor area percentage (SFA%) and volumetric shrinkage in bonded tube (VS%). Data were analyzed by ANOVA at significance level of 0.05. The bottom-top degree of conversion ratio (DC%-R) through 4-mm depth was measured using the XploRA Plus micro-Raman spectroscopy. ResultsBEZ showed no gap formation at the cavity floor in any specimens while SNF showed the highest gap formation; the statistical order in terms of SFA% was BEZ (100±0)>TNB (84.97±2.98)>CPC (52.13±8.23)=SDR (45.97±9.21)>SNF (16.23±6.00) (p<0.05). On the other hand, total VS% was statistically ordered as BEZ (3.40±0.14)>SDR (3.22±0.09)>TNB (1.82±0.11)>SNF (1.65±0.04)=CPC (1.56±0.04) (p<0.05). Unlike BEZ, the light-cured resin composites showed larger shrinkage at specimen bottom than top. TNB showed the lowest DC%-R followed by SNF (p<0.05). SignificanceLight-cured bulk-fill resin composites showed various degrees of gap formation and shrinkage at 4-mm deep cavity. The dual-cured bulk-filled resin composite showed no decrease of degree of conversion through the depth and the highest cavity adaptation despite its tendency for higher volumetric shrinkage.