Two-year clinical and radiographic evaluation of ACTIVA BioACTIVE versus Compomer (Dyract® eXtra) in the restoration of class-2 cavities of primary molars: a non-inferior split-mouth randomised clinical trial.

OBJECTIVES: The trial aimed to compare the clinical performance and radiographic success of ACTIVA BioACTIVE versus Compomer in restoring class-II cavities of primary molars. MATERIALS AND METHODS: A non-inferior split-mouth design was considered. A pre-calculated sample size of 96 molars (48 per group) with class-2 cavities of twenty-one children whose ages ranged from 5 to 10 years were randomly included in the trial. Pre-operative Plaque Index (PI), DMFT/dmft scores and the time required to fill the cavity were recorded. Over 24 months, the teeth were clinically evaluated every six months and radiographically every 12 months by two calibrated and blinded evaluators using the United States public health service (USPHS)-Ryge criteria. The two-sided 95% confidence interval (CI) for the difference in success rate was considered to assess non-inferiority, and the margin was set at -18%. The linear mixed model and Firth's logistic regression model were used for data analysis (P < 0.05). RESULTS: After 24 months, 86 teeth (43 per group) were evaluated. The mean PI score was 1.1(± 0.9), while DMFT/dmft was 0.35 (± 0.74) and 6.55 (± 2.25) respectively. The clinical and radiographic success rate of Dyract vs. ACTIVA was 95.3% and 88.3% vs. 93% and 86%, respectively. The two-sided 95% CI for the difference in success rate (-2.3%) was - 3.2 to 1.3% and didn't reach the predetermined margin of -18% which had been anticipated as the non-inferiority margin. Clinically, ACTIVA had a significantly better colour match (P = 0.002) but worse marginal discolouration (P = 0.0143). There were no significant differences regarding other clinical or radiographic criteria (P > 0.05). ACTIVA took significantly less placement time than Dyract, with a mean difference of 2.37 (± 0.63) minutes (P < 0.001). CONCLUSION: The performance of ACTIVA was not inferior to Dyract and both materials had a comparable high clinical and radiographic performance in children with high-caries experience. ACTIVA had a significantly better colour match but more marginal discolouration. It took significantly less time to be placed in the oral cavity. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov on 4 May 2018 (#NCT03516838).

Evaluation of fracture resistance of maxillary premolars of different geometrical cavities restored with different composite resins incorporated with chitosan nanoparticles.

Background: Composites with 0.2% chitosan nanoparticles (CSN) are used recently; however, this combination needs to be studied in different cavity designs. Aims: The aim of the study was to compare the fracture resistance of maxillary premolars with different cavity geometries restored with different types of composite resins incorporated with 0.2% CSN. Methods: About 130 extracted human single-rooted maxillary premolars were embedded in acrylic molds 2 mm below cementoenamel junction, divided into five groups for cavity preparations of standardized dimensions. Group 1: (control) intact teeth (n = 10), Group 2: Class I cavities (n = 40), Group 3: Class II mesio-occlusal (MO) (n = 40), Group 4: Class II mesio-occluso-distal (MOD) (n = 40). Groups 2, 3, and 4 were subdivided into four subgroups for composite restoration; A: Neo spectra ST-Universal (NST); B: Tetric N-Ceram Bulk-fill (TNC); C: NST + CSN; and D: TNC + CSN and tested for fracture resistance using universal testing machine. Statistical Analysis: One-way analysis of variance and post hoc Tukey's tests were used for data analysis (P ≤ 0.05). Results: In all groups, the highest fracture resistance was found in MOD cavities, followed by MO and least in Class I cavities. Subgroup D (TNC with CSN) showed the highest fracture resistance in all groups (P ≤ 0.05). Conclusion: Tetric N-Ceramic bulk fill with 0.25% CSN showed high fracture resistance in cavities with different geometries.

Initial bacterial adherence and biofilm formation on novel restorative materials used in paediatric dentistry.

OBJECTIVE: To evaluate the initial bacterial adherence and biofilm formation on novel restorative materials in paediatric dentistry and compare the results to stainless steel crown and primary enamel. MATERIALS AND METHODS: Twenty-five samples (Diameter = 4 mm) from five restorative materials (Tetric Power Fill light cured for 3 s or 10 s, Fuji II LC, Equia Forte HT Fil, Cention Forte, Stainless-steel crown) and primary enamel were prepared. Four samples served for recording of surface roughness (Ra) using a contact profilometer, 21 samples were incubated in stimulated human saliva for 2 h (initial bacterial adherence) and 72 h (biofilm formation) and served to determine ion releasing and bacterial growth. After 2 and 72 h, the number of colony-forming units (CFU) per ml was counted and expressed in Log10 CFU/ml. Data were analysed with two-way ANOVA and Tuckey's multiple comparisons test (p < 0.05). RESULTS: All tested materials showed similar initial bacterial adherence (p > 0.1). Stainless steel crown showed statistically significantly less biofilm formation than all other tested materials (p ≤ 0.02), except for Fuji II LC (p = 0.06). In terms of biofilm formation, the differences between all tested materials were not statistically significant (p ≥ 0.9). SIGNIFICANCE: Novel restorative materials in paediatric dentistry show similar initial bacterial adherence and biofilm formation. However, compared to other restorative materials, stainless steel crowns demonstrate the lowest level of biofilm formation. Ion-releasing materials may not necessarily show better antimicrobial properties than conventional materials.

Profiling Elastoplastic and Chemical Parameters to Assess Polymerization Quality in Flowable Bulk-Fill Composites.

In the chronology of polymer-based composite materials, flowable bulk-fill composites represent the most recent development. They enable a significant reduction in treatment time by being applied in larger increments of 4 to 5 mm. The aim of the investigation was to assess the polymerization quality and mechanical performance of a new formulation that has just entered the market and was still in experimental formulation at the time of the investigation, and to compare these results in the context of clinically established materials of the same category. Adequate curing in increments of up to 4 mm could be confirmed both by profiling the elastoplastic material behavior of large increments in 100 µm steps and by real-time assessment of the degree of conversion and the associated polymerization kinetic. A slightly lower amount of filler in the experimental material was associated with slightly lower hardness and elastic modulus parameters, but the creep was similar and the elastic and total indentation work was higher. The kinetic parameters were assigned to the specific characteristics of each tested material. The mechanical macroscopic strength, evaluated in a three-point bending test and supplemented by a reliability analysis, met or exceeded the standards and values measured in clinically established materials, which for all materials is related to the higher flexibility of the beams during testing, while the modulus of elasticity was low. The low elastic modulus of all flowable bulk-fill materials must be taken into account when deciding the clinical indication of this material category.

Clinical performance of different bulk-fill composite resin systems in class II cavities: A 2-year randomized clinical trial.

OBJECTIVES: This study evaluated the clinical performance of bulk-fill resin composite systems with different viscosities in class II cavities. MATERIALS AND METHODS: A total of 80 class II restorations were performed with a single operator in 50 patients using four different bulk-fill resin composite materials: Filtek™ Bulk Fill, Heated Filtek™ Bulk Fill, G-aenial™ BULK Injectable, and SonicFill3. A double-blinded randomized clinical trial was designed to evaluate the two-year clinical performance of the four bulk-fill composite resins using modified FDI criteria. Data were analyzed descriptively. Level of significance was set at 0.05. Differences between groups were tested using Wilcoxon-signed-rank and Mann-Whitney-U test as nonparametric tests. RESULTS: Data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests (p < 0.05). Eighty restorations were available for evaluation, with a survival function of 100%. No statistically significant differences were observed between the four groups regarding assessing esthetic, functional, and biological properties during different follow-up periods. CONCLUSIONS: After 2 years of clinical follow-up, the bulk-fill composite systems with different viscosities seem to be esthetically, functionally, and biologically acceptable, with a promising clinical performance in class II cavities.

In vitro remineralization of adjacent interproximal enamel carious lesions in primary molars using a bioactive bulk-fill composite.

BACKGROUND: Surface remineralization is recommended for the management of active non-cavitated interproximal carious lesions in primary teeth. According to the American Academy of Pediatric Dentistry, a recently recognized category of materials called bioactive restorative materials can be used for remineralization. This study aimed to evaluate the release of fluoride (F), calcium (Ca) and phosphate (P) ions from Predicta® Bioactive Bulk-fill composite compared with EQUIA Forte® and Filtek™ Z350 and to determine the remineralization effect of these 3 restorative materials on adjacent initial interproximal enamel carious lesions. METHODS: The release of F, Ca and P ions from 3 groups ((n = 10/group) (Group 1- Predicta®, Group 2- EQUIA Forte® and Group 3- Filtek™ Z350)) was determined at 1st, 4th, 7th and 14th days. After creating artificial carious lesions, human enamel samples were randomly assigned into 3 groups (n = 13/group) which were placed in contact with occluso-proximal restorative materials and exposed to a 14-day pH cycling period. Surface microhardness was determined using a Knoop microhardness assay at baseline, after artificial carious lesions formation and after pH cycling. The difference in the percentage of surface microhardness recovery (%SMHR) among groups was compared. Mineral deposition was analyzed with energy-dispersive x-ray spectroscopy (EDS) and the enamel surface morphology was evaluated with scanning electron microscopy (SEM). Kruskal-Wallis's test with Dunn's post hoc test and one-way ANOVA with Tukey's post hoc test were used for data analysis. RESULTS: EQUIA Forte® released the highest cumulative amount of F and P ions, followed by Predicta® and Filtek™ Z350. Predicta® released higher amount of Ca ions than EQUIA Forte® and Filtek™ Z350. Predicta® demonstrated the highest %SMHR, followed by EQUIA Forte® and Filtek™ Z350. There was a significant difference in the %SMHR between Predicta® and Filtek™ Z350 (p < 0.05). However, EQUIA Forte® demonstrated the highest fluoride content, followed by Predicta® and Filtek™ Z350. The SEM images of EQUIA Forte® and Predicta® revealed the greater mineral deposition. CONCLUSION: Predicta® demonstrated a marked increase in surface microhardness and fluoride content of adjacent initial interproximal enamel carious lesions in primary molars compared with Filtek™ Z350. Predicta® is an alternative restorative material to remineralize adjacent initial interproximal enamel carious lesions in primary molars, especially in high-risk caries patients.

Low and high viscosity bulk-fill composite resins stress distribution in primary molar tooth inlay cavity.

The aim of this study is to evaluate the stress distributions of low and high viscosity bulk-fill composite resins at class II MOD inlay cavity in primary molar tooth using Finite Element Analysis (FEA). Original DICOM data of a primary molar tooth from a research archive was used to create a 3D model. Two models were prepared as Model 1: the tooth model without restoration (control group) and Model 2: the tooth model with class II MOD inlay restoration. Two different bulk-fill composite resins were tested in study: Model 2 A (class II MOD inlay cavity model restored with low viscosity bulk-fill composite resin) and Model 2B (class II MOD inlay cavity model restored with high viscosity bulk-fill composite resin). Occlusal vertical loading of 232 N was applied to the teeth in occlusal contact areas. Maximum Von Mises stress values in the models for enamel, dentin, and restorative material were evaluated as MPa. More intense stress accumulation is observed in enamel than in dentin. In addition, more stress values were determined in Model 2B (206.15 MPa, 32.76 MPa, 128.95 MPa) than in Model 2 A (203.39 MPa, 29.77 MPa, 120.61 MPa) for enamel, dentin and restorative material, respectively.

Influence of surface sealants on the quality of posterior restorations with bulk-fill composites: A 4-year randomized clinical trial.

OBJECTIVES: The aim of this study was to evaluate the clinical performance of surface sealants associated with a bulk-fill composite in posterior restorations after 4 years. METHODS: A total of 174 posterior restorations were performed on 57 participants using a self-etch adhesive system and a bulk-fill composite. The groups were then divided into the following categories: 1) without surface sealant (NoS), 2) with surface sealant Biscover (Bisco, SBi), and 3) with surface sealant Permaseal (Ultradent, SPe). Restorations were evaluated using FDI criteria at baseline and after 1 and 4 years. Statistical analysis was conducted using Kaplan-Meier survival analysis and the Chi-square test (α = 0.05). RESULTS: After 4 years, only one restoration was lost (1 in the NoS group). The fracture/retention rate (with 95% confidence interval) was 98% for NoS and 100% for both SBi and SPe (p = 0.76). The majority of secondary outcomes showed minor defects, with no significant differences among the groups (p > 0.05). However, significant differences were observed among the groups in terms of marginal staining and marginal adaptation (p = 0.03). In both items, twelve restorations (nine in NoS, one in SBi, and two in SPe) showed minor marginal discrepancies favoring the sealant groups (SBi and SPe). SIGNIFICANCE: Regardless of the use of surface sealants, the bulk-fill composite restorations showed excellent clinical performance after 4 years. However, the groups that received sealants showed better marginal adaptation and less marginal discoloration compared to those that did not receive sealants.

Effect of dentin roughening and type of composite material on the restoration of non-carious cervical lesions: an in vivo study with 18 months of follow-up.

Objectives: The purpose of this study was to evaluate the impact of dentin roughening and the type of composite resin used (either bulk-fill flowable or nanohybrid) on the restoration of non-carious cervical lesions (NCCLs) with an 18-month follow-up period. Materials and Methods: This prospective split-mouth study included 36 patients, each with a minimum of 4 NCCLs. For each patient, 4 types of restorations were performed: unroughened dentin with nanohybrid composite, unroughened dentin with bulk-fill flowable composite, roughened dentin with nanohybrid composite, and roughened dentin with bulk-fill flowable composite. A universal bonding agent (Tetric N Bond Universal) was applied in self-etch mode for all groups. The restorations were subsequently evaluated at 6, 12, and 18 months in accordance with the criteria set by the FDI World Dental Federation. Inferential statistics were computed using the Friedman test, with the level of statistical significance established at 0.05. Results: The 4 groups exhibited no significant differences in relation to fracture and retention, marginal staining, marginal adaptation, postoperative hypersensitivity, or the recurrence of caries at any follow-up point. Conclusions: Within the limitations of the present study, over an 18-month follow-up period, no significant difference was present in the clinical performance of bulk-fill flowable and nanohybrid composite restorations of non-carious cervical lesions. This held true regardless of whether dentin roughening was performed.

Fracture Resistance of Endodontically Treated Teeth Restored With Short Fiber Reinforced Composite and a Low Viscosity Bulk Fill Composite in Class II Mesial-Occlusal-Distal Access Cavities: An Ex-vivo Study.

Background Teeth undergoing endodontic therapy are prone to structural weakening and increased risk of fractures. The absence of marginal ridges and pericervical dentin further compromises the fracture resistance. The choice of the post-endodontic coronal seal is crucial for the effectiveness of endodontic therapy. Aim and Objectives This study compared the fracture resistance and fracture modes of endodontically treated teeth (ETT) with mesial-occlusal-distal (MOD) cavities restored with two different posterior composite resins: e-glass fiber reinforced composite (FRC) (everX Posterior) and flowable bulk fill composite (SDR Flow+).  Materials and Methods Sixty human maxillary first bicuspids were divided into four groups: Group PC- positive control (intact teeth), Group NC- negative control (unrestored endodontically treated teeth), Group EXP- samples restored with everX Posterior and nano-hybrid composite, and Group SDR- samples restored with SDR Flow+ and nano-hybrid composite. The NC, EXP, and Smart Dentin Replacement (SDR) samples underwent endodontic procedures and MOD cavity preparation. The samples from EXP and SDR groups were restored with composite resins as post-endodontic coronal seals. The fracture resistance was evaluated using a Universal Testing Machine (UTM), and fracture modes were examined under a dental operating microscope (DOM) at 6x magnification. Statistical tests were performed using One-way ANOVA and Tukeys' post hoc tests. Results  The mean fracture resistance of the experimental groups was as follows: PC- 880.1 ± 209.3 N; NC- 238.1 ± 15.4 N; EXP- 766.1 ± 50.2 N; SDR- 540.8 ± 49.4 N. The highest fracture resistance values were observed in the PC group, whereas the NC group showed the least. The EXP group exhibited significantly higher fracture resistance than the SDR group. Adhesive failure was observed in most samples in the EXP group, whereas samples in the SDR group showed more cohesive failures. Favorable fractures were more prevalent in samples restored with EverX posterior. Conclusion The study findings suggest that everX Posterior can enhance the fracture resistance of structurally compromised ETT. Samples restored with everX Posterior showed a favorable mode of fracture, which can be restored. Applying FRCs can contribute to the longevity and success of endodontic treatment by reinforcing the weakened tooth structure and preventing fractures.

Analysis of the bond strength between conventional, putty or resin-modified calcium silicate cement and bulk fill composites.

BACKGROUND: The aim of this study was to evaluate the shear bond strength of three different calcium silicate-based cements (CBCs) with two different bulk-fill composite resins (CRs). METHODS: Plexiglas moulds with a diameter of 4 mm and a thickness of 2 mm were prepared (n = 60). The Biodentine, NeoPutty and MTA Cem LC samples were randomly divided into two subgroups containing 10 samples each. Surfaces of samples were air dried and Single Bond universal adhesive was applied. Cylindrical plastic capsules of 4 mm height and 2 mm inner diameter belonging to Filtek Bulk-fill and EverX Posterior CRs were centred on coating material and polymerized for 20 s. After shear bond strength (SBS) testing, all samples were examined by scanning electron microscopy (SEM) to identify failure patterns. Three samples, one from each group, were prepared to evaluate chemical composition of CBCs and examined with an energy dispersive X-ray spectroscopy for surface elemental analysis. RESULTS: The values obtained from the tests were evaluated as statistically significant (P < 0.05). After SBS testing, the difference between all CBCs was statistically significant in both CRs. CONCLUSION: According to the findings in this study, it was concluded that MTA Cem LC had highest SBS values in both CRs. © 2023 Australian Dental Association.

Interfacial integrity of bulk-fill resin composite restorations in deep Class-II cavities.

This study evaluated the interfacial integrity of deep (6 mm) Class-II (OM/OD) restorations placed using different bulk-fill resin composites [Filtek™ Bulk Fill Flowable Restorative (BF) and Filtek™ Bulk Fill Posterior Restorative (BP) (3M ESPE, St. Paul, MN, USA)] of different increment thicknesses (2 or 4 mm). BP was used for capping in all cases, while Filtek™ Z250 Universal Restorative (3M ESPE) was used as the control material. Interfacial debonding was measured during curing through acoustic emission (AE), followed by image analysis using micro-computed tomography and scanning electron microscopy. Microhardness testing was also conducted to assess degree of conversion. Depth of cure was adequate in all restorations. Specimens with 4-mm thick first increment of BF, which had a higher shrinkage strain, produced most AE events and debonding. Thus, bulk filling of deep cavities using bulk-fill resin composites with a high shrinkage strain should be avoided.

Influence of high-irradiance light curing on the marginal integrity of composite restorations in primary teeth.

BACKGROUND: Reducing the necessary time to restore primary teeth improves the cooperation of paediatric patients. This study aimed to investigate the marginal integrity of restorations prepared with a bulk-fill resin-based composite (RBC) containing additional fragmentation chain transfer (AFCT) compared to a conventional RBC when light cured with a rapid high-irradiance (3 s) and a regular (10 s) curing mode. METHODS: Forty class-II cavities were prepared in 40 primary molars. The molars were randomly divided into four groups based on the applied light-curing modes (regular: 10 s @ 1200 mW/cm2 or high-irradiance: 3 s @ 3000 mW/cm2) and the used restorative material (AFCT-containing bulk-fill RBC "Power Fill" or AFCT-free conventional RBC "Prime"). After thermo-mechanical loading, the marginal integrity was analysed using scanning electron microscopy. A beta regression model and pairwise comparisons were used to statistically analyse the data. RESULTS: The mean marginal integrity (% ± SD) of the restorations for each group was as follows: Power Fill (10 s: 79.7 ± 15.6) (3 s: 77.6 ± 11.3), Prime (10 s: 69.7 ± 11.1) (3 s: 75.0 ± 9.7). The difference between the RBCs for the same light-curing mode was statistically significant (p ≤ 0.05). The difference between the light-curing modes for the same RBC was not statistically significant (p ˃ 0.5). CONCLUSIONS: AFCT-containing bulk-fill RBC "Power Fill" achieves similar marginal integrity when light-cured with either high-irradiance or regular light-curing modes. "Power Fill" achieves better marginal integrity than the conventional RBC "Prime" regardless of the applied light-curing mode.

Comparison of Shear Bond Strength and Microleakage between Activa™ Bioactive Restorative™ and Bulk-Fill Composites-An In Vitro Study.

Bioactive materials have emerged as a promising alternative to conventional restorative materials as part of more conservative dentistry. The aim of this study was to evaluate and compare the shear bond strength (SBS) and microleakage of a new bioactive restorative material, two bulk-fill restorative composites, and a conventional composite at 24 h, 4 weeks, and 8 weeks. Three hundred and sixty molars and premolars were divided into four groups: ACTIVA™ BioACTIVE Restorative™, Filtek™ Bulk-Fill Restorative Composite, Tetric® N-Ceram Bulk-Fill Composite, and G-aenial® Composite. The normality of the data was determined with the Kolmogorov-Smirnov test, then the two-way ANOVA and Fisher's test were used for analyzing SBS data, and the Kruskal-Wallis and DSCF tests were conducted to analyze the microleakage. In the SBS test, there were no statistically significant differences between materials (p = 0.587), and the relation between material and time (p = 0.467), time points showed statistically significant differences (p = 0.016). As for the microleakage, statistically significant differences were found for all three time periods (p < 0.05), showing the conventional composite to have the lowest microleakage, followed by the bioactive material, and lastly the two bulk-fill composites. In conclusion, the new bioactive material has similar evaluated properties to bulk-fill composites (bond strength) and conventional composites (bond strength and microleakage) and can be used as an alternative restorative material.

Evaluating the Effect of Different Intra-Orifice Barriers and Various Bleaching Agents on the Fracture Resistance of Teeth After the Walking Bleach Procedure: An In Vitro Study.

Objective This study aimed to evaluate the effect of three different commercially available intra-orifice barriers and bleaching agents on root canal-treated teeth. Materials and methods Forty-five freshly extracted single-rooted incisors, canine, and premolars were collected and stored in 10% formalin. Root canal procedures were performed on the extracted teeth and these were classified into three groups and three subgroups (n=5). Group 1: resin-modified glass ionomer cement (RMGIC); placed at the level of cemento-enamel junction (CEJ) and cured for 20 seconds. Group 2: BiodentinTM (Septodont Ltd., Saint Maur des Fausse´s, France); powder and liquid were mixed according to the manufacturer's instructions and placed at the level of CEJ, and waited for 15 minutes to set. Group 3: bulk-fill composite; placed at the level of CEJ. Group A was treated with 35% carbamide peroxide (Ultradent Opalescence 35% PF regular). Group B was bleached with 35% hydrogen peroxide (Pola Office). Group C, which was the control group, was treated with distilled water. The bleaching procedure was repeated once every seven days for a period of three weeks. After bleaching, every sample was sectioned 2 mm above the level of CEJ to remove the crown. Auniversal testing machine (UTM) was used for the evaluation of the fracture resistance of teeth. Data were analyzed for significance by using analysis of variance (ANOVA) and further pair-wise comparison was performed by pos-hoc analysis. The level of significance was set at p<0.05 Results There was a significant difference between the fracture resistance of the three materials when bleached using distilled water (p<0.05). The fracture resistance of Group 3 was significantly greater than that of Group 2 and Group 1 (p<0.05). The difference in the fracture resistance between Group 1 and Group 2 was nonsignificant (p>0.05). Conclusion Walking bleach performed via bleaching agents 35% carbamide peroxide and 35% hydrogen peroxide leads to a reduction in the fracture resistance of endodontically treated teeth; 35% hydrogen peroxide causes more fracture resistance reduction than carbamide peroxide of the same concentration. The presence of intra-orifice barriers leads to greater fracture resistance and reinforcement of endodontically treated teeth that undergo the walking bleach procedure. Bulk-fill composite can be used as an intra-orifice barrier with good fracture resistance.

Effects of ceramic thickness, ceramic translucency, and light transmission on light-cured bulk-fill resin composites as luting cement of lithium disilicate based-ceramics.

PURPOSE: To assess the effects of ceramic thickness, ceramic translucency, and light transmission on restorative composites used as luting cement for lithium disilicate-based ceramics. METHODS: Four luting types of cement were tested (n=8); a dual-cured resin cement (Multilink N), a light-cured conventional flowable composite (Tetric N-Flow), and two light-cured bulk-fill flowable composites (Tetric N-Flow Bulk Fill and X-tra base). The 20 s- or 40 s-light (1000 mW/cm2) was transmitted through 1- or 2-mm-thick high- or low-translucency (HT- or LT-) ceramic discs (IPS e.Max press) to reach the 1-mm-thick luting cement. Light transmitted to cement without ceramic served as a control. Vickers hardness number (VHN), flexural strength (FS), fractography, and degree of conversion (DC) were evaluated. One-way and multi-way analysis of variance was conducted to determine the effects of factors on VHN and FS. RESULTS: Ceramic thickness, light transmission time, and cement type significantly affected the VHN of the luting cement (P < .000). Only Multilink N (LT- and HT-1mm) and Tetric N-Flow (HT-1mm) reached 90% VHN of corresponding control by 20 s-light transmissions, but Tetric N-Flow exhibited lowest VHN and approximately 1/3-1/2 VHN of Multilink N (P < 0.05). X-tra base expressed superior physicochemical properties to Tetric N-Flow Bulk Fill (P < 0.05) and reached >90% VHN of control in all conditions with 40 s-light transmissions except for LT-2 mm. DC, FS, and fractography supported these findings. CONCLUSIONS: The light-cured bulk-fill composite served as a luting cement for lithium-disilicate-based ceramics in a product-dependent manner. Light transmission time is crucial to ensure sufficient luting cement polymerization.

A comparative evaluation of preheat treatment, postcure heat treatment, and combined heat treatment on degree of conversion of a bulk-fill composite: An in vitro study.

Aims: The aim of this study was to evaluate the effect on the degree of conversion of Tetric N-Ceram Bulk Fill Composite subjected to preheat treatment, postcure heat treatment, and combined heat treatment. Materials and Methods: A total of 90 samples were prepared from Tetric N-Ceram Bulk Fill using customized stainless steel molds and divided into six groups of 15 samples each based on the heat treatment. Group I (control group): no heat treatment, Group II: preheat treatment at 60°C, Group III: postcure heat treatment at 100°C, Group IV: postcure heat treatment at 200°C, Group V: combined preheat treatment at 60°C and postcure heat treatment at 100°C, and Group VI: combined preheat treatment at 60°C and postcure heat treatment at 200°C. The degree of conversion was analyzed using Raman spectrometer. Statistical Analysis Used: Data were analyzed using analysis of variance followed by the Scheffé test using Statistical Package for the Social Sciences 20.0 version. Results: The order of values of degree of conversion from maximum to minimum for the groups are as follows: Group VI (98.77 ± 0.52) > Group V (97.11 ± 0.78) > Group IV (95.00 ± 0.86) > Group III (93.00 ± 1.22) > Group II (86.88 ± 1.36) > Group I (76.55 ± 1.42). The statistical analysis revealed a statistically significant difference between the groups (P < 0.05). Conclusions: Combined heat treatment samples showed better values of degree of conversion.

Micro-shear bond strength of different calcium silicate materials to bulk-fill composite.

Introduction: This study aimed to compare the micro-shear bond strength (µSBS) performances of two resin-based calcium silicate-based cement (CSC) (TheraCal PT and TheraCal LC), Biodentine, and two modified-MTA CSC materials (NeoMTA 2 and BioMTA+) to bulk-fill restorative material. Materials and Methods: Fifty 3D printed cylindrical resin blocks with a central hole were used (2 mm in depth and 4 mm in diameter). CSCs were placed in the holes (per each group n = 10) and incubated for 24 h. Cylindrical polyethylene molds (2 mm in height and diameter) were used to place the bulk-fill restorative materials on the CSCs and polymerize for 20 s. Then, all specimens were incubated for 24 h at 37 °C at a humidity of 100%. Specimen's µSBSs were determined with a universal testing machine. Data were analyzed with one-way ANOVA (Welch) and Tamhane test. Results: Statistically higher µSBS was found for TheraCal PT (29.91 ± 6.13 MPa) (p < 0.05) respect to all the other materials tested. TheraCal LC (20.23 ± 6.32 MPa) (p > 0.05) reported higher µSBS than NeoMTA 2 (11.49 ± 5.78 MPa) and BioMTA+ (6.45 ± 1.89 MPa) (p < 0.05). There was no statistical difference among TheraCal LC, NeoMTA 2 and Biodentine (15.23 ± 7.37 MPa) and between NeoMTA 2 and BioMTA+ (p > 0.05). Conclusion: Choosing TheraCal PT as the pulp capping material may increase the adhesion and µSBS to the bulk-fill composite superstructure and sealing ability.

Teeth Restored with Bulk-Fill Composites and Conventional Resin Composites; Investigation of Stress Distribution and Fracture Lifespan on Enamel, Dentin, and Restorative Materials via Three-Dimensional Finite Element Analysis.

OBJECTIVES: the aim of this study was to examine the stress distribution of enamel, dentin, and restorative materials in sound first molar teeth with restored cavities with conventional resin composites and bulk-fill composites, as well as to determine their fracture lifetimes by using the three-dimensional finite element stress analysis method. MATERIALS AND METHODS: an extracted sound number 26 tooth was scanned with a dental tomography device and recorded. Images were obtained as dicom files, and these files were transferred to the Mimics 12.00 program. In this program, different masks were created for each tooth tissue, and the density thresholds were adjusted manually to create a three-dimensional image of the tooth, and these were converted to a STL file. The obtained STL files were transferred to the Geomagic Design X program, and some necessary adjustments, such as smoothing, were made, and STP files were created. Cavity preparation and adhesive material layers were created by transferring STP files to the Solidworks program. Finally, a FE model was created in the ABAQUS program, and stress distributions were analyzed. RESULTS: when the bulk-fill composite and conventional resin composite materials were used in the restoration of the cavity, the structures that were exposed to the most stress as a result of occlusal forces on the tooth were enamel, dentin, restorative material, and adhesive material. When the bulk-fill composite material was used in restoration, while the restorative material had the longest fracture life as a result of stresses, the enamel tissue had the shortest fracture life. When the conventional resin composite material was used as the restorative material, it had the longest fracture life, followed by dentin and enamel. CONCLUSION: when the bulk-fill composite material was used instead of the conventional resin composite material in the cavity, the stress values on enamel, dentin, and adhesive material increased as a result of occlusal forces, while the amount of stress on the restorative material decreased. In the fracture analysis, when the bulk-fill composite material was used instead of the conventional resin composite material, a decrease in the number of cycles required for the fracture of enamel, dentin, and restorative materials was observed as a result of the forces generated in the oral cavity.

Microleakage and Marginal Integrity of Ormocer/Methacrylate-Based Bulk-Fill Resin Restorations in MOD Cavities: SEM and Stereomicroscopic Evaluation.

This in vitro study aimed to compare the microleakage and marginal integrity of methacrylate/ormocer-based bulk-fill composite (BFC) restorations used in cervical marginal relocation with two different layering thicknesses in mesio-occlusal-distal (MOD) cavities exposed to thermo-mechanical loading. Standard MOD cavities were prepared in 60 mandibular molars and assigned into three groups: x-tra fil/AF + x-tra base/XB, Tetric N-Ceram Bulk Fill/TNB + Tetric N-Flow Bulk Fill/TFB, and Admira Fusion x-tra/AFX + Admira Fusion x-base/AFB. Each group was further divided into two subgroups (2 mm and 4 mm) based on the thickness of flowable BFCs (n = 10). The specimens were subjected to thermo-mechanical loading (240,000 cycles) and immersed in 0.2% methylene blue. Following mesiodistal sectioning, the specimens were examined under stereomicroscope (×25) and scored (0-3) for microleakage. Marginal integrity was examined using a scanning electron microscope (SEM). Descriptive statistical methods and the chi-square test were used to evaluate the data (p < 0.05). While there was no statistically significant difference in gingival cement microleakage in the XB and AFB specimens with a 4 mm thickness, microleakage was significantly increased in the TFB specimen (p = 0.604, 0.481, 0.018 respectively). A significantly higher amount of score 0 coronal microleakage was detected in the AFX2 mm + AFB4 mm compared to the TNB2 mm + TFB4 mm (p = 0.039). The SEM examination demonstrated better marginal integrity in groups with 2 mm thick flowable BFCs. Ormocer and methacrylate-based materials can be used in marginal relocation with thin layers.