Search Results (219)

The yellowing effect of camphorquinone (CQ) has led manufacturers to add alternative initiators into resin composites (RCs) to reduce the amount of CQ used. The aim of this study was to investigate the color change in commercial RCs with alternative photoinitiators besides CQ. Color change upon polymerization and aging in air and artificial saliva for up to 3 months was tested for seven commercial RCs (traditional and bulk-fill) with either CQ only or CQ and additional photoinitiators (CQ+). Color measurements were obtained with a spectrophotometer. Color change (ΔE) was calculated using the CIELab and CIEDE2000 formulae. ANOVA and a post hoc SNK test were conducted for statistical analysis. Upon polymerization, the ΔE of CQ+ was greater than that of CQ only, except in the case of dual-cure HyperFIL. The storage conditions did not affect the color change within 24 h for either air or artificial saliva, whereas they did have an influence on color stability when RCs were aged for 1 month and 3 months. The color changes in the RCs aged in artificial saliva were considered clinically acceptable for all RCs tested except HyperFIL. Additional photoinitiator systems tended to result in a greater color change upon polymerization but did not affect color change upon aging. During shade selection, especially when additional photoinitiators besides CQ are used, a guide reflecting the color after polymerization should be used. Full article

Novel universal bulk-fill composites with reversible addition–fragmentation chain-transfer (RAFT)-modulated polymerization continue the trend towards increasing simplification of the restoration process to facilitate the reconstruction of deep posterior restorations in 4 mm increments as well as anterior restorations through improved aesthetics. This study aims to assess the suitability of such materials for rapid curing (3 s) with high-radiant emittance in terms of degree of conversion (DC) and polymerization kinetics at relevant depths (2 mm vs. 4 mm). For this purpose, two newly introduced bulk-fill universal composites (Tetric^® plus Flow and Tetric^® plus Fill) were compared with already established fast-curing composites (Tetric^® Power Flow and Tetric^® Power Fill). DC was measured in real time over 300 s using ATR-FTIR spectroscopy. The temporal DC evolution was modelled using an exponential sum function. Novel bulk-fill composites showed DC results that were independent of the measured sample depth or curing mode. The polymerization kinetics of all composites are somewhat slower in the gel phase at moderate irradiance or when measured at deeper layers, but compensate for the differences in the glass phase, finally reaching equivalent DC values by the end of the 300-s observation period. These novel composites are therefore suitable for rapid curing (3 s) at high irradiance. Full article

Finite element analysis has been widely applied in restorative dentistry, but there is limited evidence directly comparing the biomechanical behavior of amalgam and bulk-fill composite resins in standardized cavity designs. This study aimed to evaluate the stress distribution in enamel, dentin, and restorative materials under different cavity configurations and filling materials. A 3D model of a maxillary molar was reconstructed from dental tomography using Geomagic Design X 2020. Four cavity models were created with Solidworks 2013: Class I (occlusal, Group A), Class II disto-occlusal (Group B), Class II mesio-occlusal (Group C), and Class II mesio-occluso-distal (Group D) cavities. Each model was restored with either amalgam or bulk-fill composite and a 600 N occlusal force was applied. Maximum principal stresses were analyzed with ABAQUS software. The highest stress was observed in the bulk-fill composite restoration of the Class II MO cavity (231 Mpa), whereas the lowest stress occurred in amalgam restoration of Class I cavity. Overall, amalgam restorations showed lower stress concentrations than bulk-fill composites, especially in complex cavity designs. These results suggest that cavity configuration and restorative material selection influence stress distribution and may impact the long-term biomechanical stability of restored teeth. Full article

The stamp technique with bulk-fill composites aims to enhance occlusal surface replication in Class I restorations. Limited research exists on its void formation and volumetric changes. This study measures internal and external voids as well as volumetric changes in occlusal surfaces for both the stamp and conventional bulk-fill techniques. Materials and methods: Twenty-four permanent molars were divided into two groups (n = 12 each): Group 1 (conventional bulk fill) and Group 2 (stamp technique with bulk-fill composite). Standardized Class I cavities were prepared and restored using Tetric EvoCeram^® Bulk Fill composite. Micro-CT scanning was performed before and after restoration to quantify internal and external void percentages and volumetric changes. An independent samples t-test (α = 0.05) was used to compare void percentages and volumetric changes between groups. Results: The mean internal void percentage was similar between groups (Group 1: 0.38 ± 0.22%; Group 2: 0.39 ± 0.30%; p = 0.914), indicating comparable internal adaptation. Group 2 showed a significantly higher external void percentage (17.59 ± 1.76%) compared to Group 1 (9.05 ± 1.98%; p < 0.001), attributed to the stamp technique’s precise replication of occlusal micromorphology, misinterpreted as porosity by analysis software. Fractal dimension analysis revealed that the stamp technique resulted in the formation of a more complex structure. Restoration volumes (Group 1: 34.10 ± 8.09 mm³; Group 2: 35.52 ± 4.80 mm³; p = 0.639) and volumetric changes (Group 1: 5.91 ± 2.72 mm³; Group 2: 4.64 ± 1.31 mm³; p = 0.199) showed no significant differences. in conclusion, the stamp technique produced internal void percentages comparable to the conventional bulk-fill method in Class I restorations. The significantly higher external void percentage in the stamp technique group was due to the accurate replication of occlusal micromorphology, which was detected as porosity by analysis software. No significant differences were observed in volumetric changes of the occlusal surface before and after restoration between the two techniques, supporting the clinical viability of the stamp technique for precise occlusal restorations. Full article

This study evaluated the influence of different surface treatments and composite materials on the microtensile bond strength (μTBS) of repaired aged bulk-fill resin composite restorations, aligning with the principles of minimal intervention dentistry. Seventy-two specimens of bulk-fill resin composite (Tetric EvoCeram) were prepared, sectioned into bars (1 × 1 × 5 mm), and subjected to thermocycling to simulate aging. Specimens were randomly allocated into six groups (n = 12) based on surface treatment and repair material: phosphoric acid etching followed by repair with either Tetric EvoCeram (Group 1) or Filtek Z350 XT (Group 2); diamond bur roughening followed by repair with Tetric EvoCeram (Group 3) or Filtek Z350 XT (Group 4); and air abrasion followed by repair with Tetric EvoCeram (Group 5) or Filtek Z350 XT (Group 6). μTBS testing was performed using a universal testing machine, and failure patterns were examined under a stereomicroscope at 40× magnification. The highest bond strength values were observed in Groups 5 and 6 (air abrasion), followed by Group 3 (diamond bur). Groups 1, 2, and 4 showed significantly lower bond strength values (p < 0.05). No significant differences in failure modes were reported across groups. These findings suggest that air abrasion is a superior surface treatment for repairing aged bulk-fill resin composites, as it significantly enhanced μTBS compared to phosphoric acid etching and diamond bur roughening. Full article

Background: This study aimed to compare the stress distribution and fracture resistance of dental tissues and restorative materials with varying adhesive layer thicknesses and different restorative materials. Methods: A caries-free mandibular first molar (tooth #36) was scanned using CBCT. The scanned files were processed in Mimics 12 software for segmentation of enamel, dentin, and pulp tissues and then exported to STP format. Cavity preparations (DO, MO, MOD, and O) were designed in SolidWorks 2023. Bulk-fill composite, conventional composite, and hybrid composite were used for restorations with adhesive layers of 10, 15, and 20 μm thick. Stress distribution and fracture resistance were analyzed using 3D finite element analysis. Results: The highest stress values in enamel, dentin, and adhesive material were observed in models restored with bulk-fill composite, while the highest stress values within the restoration were found in models restored with hybrid composite. As the adhesive layer thickness decreased, stress accumulation within the restorative material increased. Enamel fractures occurred first in models with bulk-fill composite. Among restorative materials, fractures initiated first in models restored with hybrid composite, while the latest fracture onset was observed in models with bulk-fill composite. Conclusions: Restorative materials with low Young’s modulus cause excessive stress accumulation in enamel and dentin, leading to early fracture of these tissues. In contrast, materials with a high Young’s modulus transfer more stress to the restoration, causing premature fracture of the restorative material. Full article

Background: This study aimed to evaluate the cytotoxicity of bulk-fill composite materials compared to conventional compomers on stem cells from human exfoliated deciduous teeth. Methods: 90 standardized resin composite discs (4 mm thick, 4 mm diameter) were fabricated using a 3D-printed plate, comprising four bulk-fill composites (SDR, Tetric EvoCeram Bulk-Fill, VisCalor Bulk, Cention-N) and one compomer (Dyract XP). Samples were polymerized per the manufacturer’s instructions and sterilized. Stem cells were isolated from the pulp of exfoliated primary teeth. Cells were cultured and exposed to extracts of the composite materials soaked in culture medium for 24 h. Cytotoxicity was assessed using the MTT colorimetric assay, measuring cell viability via mitochondrial activity, and the Annexin V assay, quantifying apoptosis and necrosis via flow cytometry. Statistical analysis was performed using ANOVA and Tukey post hoc tests. Results: All materials significantly reduced cell viability compared to the control (p < 0.05), with optical density values indicating high cytotoxicity. Tetric EvoCeram exhibited the lowest necrosis and apoptosis levels, while Dyract XP showed the highest necrosis. Statistical analysis revealed no significant cytotoxicity differences among most bulk-fill composites (p < 0.05). Conclusion: Bulk-fill composites and conventional compomer tested exhibit comparable and significant cytotoxic effects on stem cells from human exfoliated primary teeth pulp. While these materials offer clinical advantages in pediatric dentistry due to ease and speed of application, their use underscores the dilemma of balancing operative efficiency with biological safety, and their cytotoxic profiles should be taken into consideration prior to application. Full article

Objectives: To study the effects of internal and marginal polymerization shrinkage stress and distribution in different resin composite class III dental restorations in relation to the restorative technique using numerical finite element analysis (FEA). Methods: A 3D model of a human hemi-maxilla with a sound maxillary central incisor were created. Four class III distal cavities were shaped and differently restored. Four groups of resin composite combinations were analyzed: group C (three increments of conventional composite); group B (two increments of bulk-fill composite); group FC (flowable base + three increments of conventional composite); and group FB (flowable bulk-fill base + two increments of conventional composite). The resulting four models were exported to FEA software for static structural analysis. Polymerization shrinkage was simulated using thermal analogy, and stress distribution was analyzed using the Maximum Principal Stress criterion at the marginal and internal cavity interfaces. Results: Group FC showed the highest stress at the level in the proximal region (9.05 MPa), while group FB showed the lowest (4.48 MPa). FB also exhibited the highest internal dentin stress, indicating potential risks for long-term bond degradation. In the cavo-surface incisal angle, the average peak stress across all groups was 3.76 MPa. At the cervical cavo-surface angle, stress values were 3.3 MPa (C), ~3.36 MPa (B), 3.41 MPa (FC), and 3.27 MPa (FB). Conclusions: Restorative technique did not significantly influence marginal stress distribution in class III composite restorations. However, the bevel area at the cervical margin showed the highest concentration of shrinkage stress. Full article

Polymerization shrinkage in resin-based composites can lead to gap formation at the tooth–restoration interface, potentially compromising the long-term success of restorations. Bulk-fill composites have been developed to reduce shrinkage stress, but their adaptation and bond strength—especially in deep cavities—remain areas of concern. This study investigated the adaptation and bond strength of a newly developed dual-cure bulk-fill composite in 4 mm deep preparations compared to light-cured and self-adhesive bulk-fill composites in six groups. Standard composite molds were used to observe and measure sealed floor area (SFA%) of the composite after the polymerization process under optical coherence tomography (OCT) imaging. Micro-tensile bond strength (MTBS) testing was conducted in extracted human teeth. OCT showed that the prototype dual-cure composites had the lowest gap formation during polymerization (SFA 91%), while the self-adhesive composite demonstrated the highest debonding from the cavity floor (SFA 26%, p < 0.001). For MTBS analysis, the lowest mean bond strength was recorded for the self-adhesive composite (~21 MPa) and the highest for a light-cured bulk-fill (~50 MPa, p < 0.05). Overall, the dual-cure bulk-fill composites exhibited less gap formation than the light-cured ones. The prototype dual-cure material with 90 s waiting before light-curing showed the best adaptation. However, these differences were not reflected in the bond strength values to the cavity floor dentin using the universal adhesive used in the current study, as the light-cured composite showed the highest bond strength values. The self-adhesive composite showed the poorest results in both experiments, indicating that the application of a bonding system is still necessary for better adaptation and bonding to the cavity floor dentin. Full article

Background. Physicomechanical properties and clinical service of bulk-fill composites depend on their adequate polymerization and depth of cure. Some manufacturers claim that these composites can be adequately cured when used in bulks exceeding 4 mm. Objective. The aim of this study was to compare Vickers microhardness (VMH) and depth of cure (DOC) of six contemporary bulk-fill resin composites at depths of 4 mm and 6 mm. Material and methods. Six bulk-fill composites were evaluated in this study: 1. Tetric EvoCeram Bulk (Ivoclar Vivadent, Schaan, Liechtenstein), (TEC); 2. Filtek Bulk Fill Posterior (3M ESPE Dental Products Division, St. Paul, MN, USA), (FBF); 3. Filtek One Bulk Fill (3M ESPE Dental Products Division, St. Paul, MN, USA, (FOB); 4. SonicFill 2 (Kerr, Orange, CA, USA), (SF2); 5. Admira Fusion X-tra (Voco, GmbH, Cuxhaven, Germany), (AFX); 6. GrandioSO X-tra (Voco, GmbH, Cuxhaven, Germany), (GSX). The 18 specimens (3 of each composite) were prepared in split Teflon moulds of 4 mm diameter and 6 mm thickness. All composites were cured in standard mode for 20 s using LED LCU (D-Light Duo, RF-Pharmaceuticals Sarl, Geneva, Switzerland; 1200–1300 mW/cm). The VMH was measured using a digital Micro Hardness Tester Shimadzu (HMV-2T E, Shimadzu Corporation, Kyoto, Japan). A 50 g (0.5 N) load force was applied for 30 s. Each specimen was measured at five places selected by chance at each level (N = 15). The hardness ratio or DOC was calculated for all samples as the ratio of bottom and surface microhardness at levels of 4 and 6 mm. Data were analysed using one-way ANOVA and Tukey’s post hoc test. Results. Significant reduction in VMH was observed for all tested materials when comparing top surface and bottom (p < 0.01). The highest VMH was obtained for GSX and AFX, and the lowest for TEC. The results show that the degree of polymerization was adequate for all tested materials at a depth of 6 mm, since the hardness ratio exceeded 0.80 in all cases. The hardness ratio at 4 mm was high for all tested composites ranging from 0.91 for TEC to 0.98 for GSX. All composites showed adequate DOC at the bottom of the 6 mm bulk samples. However, the hardness ratio was the highest for Admira Fusion X-tra (0.96) and GrandioSO X-tra (0.97). Conclusions. All tested materials showed a significant decrease in microhardness from the top surface to the bottom. The DOC was adequate for all bulk-fill composites at a depth of 6 mm cured under standard mode for 20 s. All bulk-fill resin composites evaluated in this study can be used in bulk, up to 6 mm. Full article

Background/Objectives: This study aimed to investigate the influence of shade and thickness on the polymerization of SDR^® flow+, a low-viscosity bulk-fill composite, by assessing its degree of conversion (DC). Methods: An in vitro study was conducted using SDR^® flow+ composite resin. Specimens were prepared at two thicknesses (2 mm and 4 mm) and four shades (Universal, A1, A2, A3). Polymerization was performed using a high-intensity LED curing unit. The DC was assessed using Fourier-transform infrared spectroscopy (ATR-FTIR). Results: Both shade and thickness significantly influenced DC. Thicker specimens (4 mm) exhibited reduced polymerization compared to thinner specimens (2 mm). Darker shades, particularly A3, demonstrated the lowest DC values due to their higher chroma, which limits light penetration. In contrast, the Universal shade achieved higher DC values, even at increased depths, likely due to its greater translucency. Conclusions: Shade and thickness play a critical role in the polymerization of bulk-fill composites. Ensuring adequate polymerization is essential for the longevity of pediatric restorations. Further in vivo research is needed to confirm these findings and assess their clinical implications. Full article

Reliable adaptation in Class II resin-based composite (RBC) restorations with margins on cementum remains challenging. This study compared the internal adaptation (IA) and closed porosity (CP) of three restorative strategies for such cavities, using either total-etch or self-etch adhesive approaches. Standardized box-only cavities were prepared on both proximal surfaces of 30 extracted molars, applying self-etch on mesial and total-etch on distal cavities. Group 1 used a layered microhybrid RBC; Group 2 used a flowable RBC base beneath a layered microhybrid RBC; and Group 3 used a thermoviscous RBC in a 4 mm bulk increment. Micro-computed tomography was employed to assess IA and CP. ANOVA, Tukey post hoc, and univariate analyses were used to evaluate group differences and the effects of adhesive/restorative strategies. Group 2 demonstrated the best adaptation (0.10%), whereas Group 3 exhibited the highest internal gap ratio (0.63%) and the lowest CP (p = 0.006). Total-etch adhesive significantly improved IA compared to self-etch (p < 0.001). These findings emphasize the impact of material selection and adhesive technique on the quality of restorations in cementum-located Class II cavities. Full article

The continuous need for simplified, minimally invasive restorative procedures with a high precision has led to the advancement of highly filled flowable resin-based materials. These materials present excellent initial outcomes in various clinical applications, including the injection molding technique. Given that several clinical reports present signs of wear and staining, this systematic review aims to investigate the mechanical and optical properties of highly filled flowable composite resins. A comprehensive literature research was conducted to identify relevant studies from the PubMed, the Cochrane Library, and Scopus databases. Data extraction and screening was performed by two independent evaluators. Both in vitro studies and clinical trials were included. A total of thirty-one studies were included in this review. A total of 27 in vitro studies investigated highly filled flowable composite resins independently, or in comparison with conventional composite resins, traditional flowable composites, bulk-fill flowable composites, glass ionomer cements, and compomers. Additionally, four randomized controlled clinical trials (RCTs) compared highly filled flowable composite resins with their conventional counterparts. Highly filled flowable composite resins exhibit adequate optical properties. Despite their significant improvements, their mechanical properties remain inferior to those of medium-viscosity composite resins. These materials demonstrate a favorable initial performance in the injection molding technique. Based on a limited number of RCTs, these materials demonstrate an adequate performance in class I and II restorations; however these findings should be interpreted with caution. The reported drawbacks in laboratory studies may contraindicate their clinical application in extensive cavities, load-bearing areas, and in cases of excessive tooth wear and parafunctional activity. A careful clinical case selection is strongly recommended. Full article

Background and Objectives: This is the first systematic review to focus exclusively on in vivo randomized controlled trials that compare bulk-fill and conventional incremental composite restorations in primary teeth. Our aim was to synthesize current evidence on their clinical performance, including retention, two-year survival rates, marginal integrity, and procedural efficiency. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and the Elicit AI platform up to March 2025. Eligible studies were in vivo randomized controlled trials involving children aged 3–12 years with carious primary teeth, directly comparing bulk-fill and incremental composite restorations. Primary outcomes included retention rates, two-year survival, and marginal integrity, while secondary outcomes were postoperative sensitivity, secondary caries, and aesthetic outcomes. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessments using the Cochrane RoB 2.0 tool. A narrative synthesis was undertaken due to substantial heterogeneity in study design and outcome reporting. The review protocol was registered in PROSPERO (CRD420251021433). Results: Thirteen randomized controlled trials met the inclusion criteria. Both restoration techniques demonstrated high short-term retention rates (>90%) and comparable two-year survival (85–90%). Marginal integrity was generally equivalent, though incremental techniques showed modest advantages in complex cavities. Secondary outcomes were inconsistently reported, with no significant group differences. Bulk-fill restorations consistently reduced the procedural time by 2–4 min per restoration, representing a meaningful advantage in pediatric clinical settings. Conclusions: Bulk-fill composites offer a clinically effective and time-efficient alternative to incremental layering in the restoration of primary teeth. This focused synthesis addresses a gap in existing reviews by concentrating solely on primary dentition and in vivo evidence. Despite similar clinical outcomes, the time savings associated with bulk-fill techniques may enhance their utility in pediatric dentistry. Further standardized and long-term trials are warranted to confirm these findings and inform clinical guidelines. Full article

Biomimetic restorative protocols aim to preserve natural tooth structure while enhancing restoration longevity. This in vitro study aimed to evaluate the shear bond strength (SBS) in the repair of additively and subtractively manufactured CAD/CAM materials using bulk-fill resin composites and to assess the effect of thermocycling. Forty rectangular specimens (14.5 × 7 × 3 mm) were prepared from Grandio Blocs (GB, VOCO) and VarseoSmile Crown^Plus (VS, BEGO), and thermocycled (5000 cycles, 5–55 °C, 20 s dwell time). All surfaces were roughened with 50 μm Al₂O₃. Samples were repaired using VisCalor (VCB, VOCO) and Charisma Bulk Flow One (CBO, Kulzer) composites (n = 10 per group) with their respective adhesives. Each group was further divided into immediate and post-thermocycling subgroups. All specimens were tested under shear force until failure, and failure types were examined under a stereomicroscope. Representative samples were examined by SEM to evaluate filler morphology. Statistical analysis was performed with SPSS v23 (p < 0.05). No statistically significant differences in SBS were found between groups (p > 0.05). Mean SBS values were highest in VS-CBO and lowest in GB-CBO. Cohesive failures were more frequent in immediate groups, while adhesive failures predominated after thermocycling. Bulk-fill composites did not influence the repair bond strength of indirect materials. Thermocycling affected the failure type, though not the SBS values. Full article