Clinical comparison of high-viscosity glass-hybrid systems with a sculptable bulk-fill composite resin in different cavity types.

OBJECTIVE: This randomized, double-blind clinical investigation assessed the performance of two high-viscosity glass-ionomer systems and a bulk-fill composite in different cavity types. MATERIALS AND METHODS: In 146 participants, 360 (class I, II, and V) cavities were restored using three different materials (Equia Forte HT, Chemfill Rock, and SonicFill 2) with equal allocation. Using modified World Dental Federation criteria, restorations were assessed after 1 week, 6 months, and 18 months by an experienced examiner. Statistical analysis was conducted using Fisher's exact and Wilcoxon signed rank tests (α = 0.05). RESULTS: After 18 months, 267 restorations were assessed in 116 participants. After 18 months, 5 Equia Forte HT restorations failed due to debonding and fracture. Only one loss was observed in the Chemfill Rock restorations. Equia Forte HT exhibited significantly lower retention than SonicFill 2 after 18 months (p = 0.019), irrespective of cavity type. At 1 week, 3 Class I restorations with SF showed postoperative sensitivity. The type of cavity did not affect the performance of the restorative materials used (p > 0.05). CONCLUSION: Equia Forte HT and Chemfill Rock presented similar clinical performance regardless of color match. Equia Forte HT showed a lower performance compared to SonicFill 2. CLINICAL SIGNIFICANCE: Glass-hybrid materials presented a lower performance in terms of color match or retention when compared to a sculptable bulk-fill composite resin.

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-ænial™ 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.

Fracture resistance of root canal-treated molars restored with ceramic overlays with/without different resin composite base materials: an in vitro study.

The objective of the study was to evaluate the effect of different restorative protocols on fracture resistance of root canal-treated molars. 48 mandibular first molars were used and divided into six groups (n = 8); G1 (negative control): teeth kept intact. G2 (positive control): teeth had root canal treatment and standard MOD cavity preparations but kept unrestored. G3: prepared as G2 and directly restored with VitaEnamic ceramic overlays (CO). G4: as G3, but the pulp chamber was restored first with smart dental restorative (SureFil SDR flow = SDR) bulk-fill flowable composite base. G5: as G3, but the pulp chamber was restored first with SonicFill (SF) bulk-fill composite base. G6: as G3, but the pulp chamber was restored first with a fiber-reinforced composite (FRC) base. All samples were subjected to thermocycling between 5 °C and 55 °C in a water bath for a total of 2000 cycles with 10 s dwell time. Then specimens were individually mounted on a computer-controlled testing machine with a load cell of 5 kN, and the maximum load to produce fracture (N) was recorded. Data were analyzed using one-way ANOVA followed by Tukey's post hoc test (P = 0.05). There was a significant difference between the groups (P < 0.001). Teeth restored with FRC and ceramic overlays had the highest load-bearing capacity. Pulp chamber restoration with either FRC or SDR before ceramic overlay fabrication provided significantly better tooth reinforcement than ceramic overlay alone (P < 0.001). Fracture modes were analyzed to determine the type of fracture as repairable or catastrophic, where FRC + CO and SDR + CO groups had favorable fracture modes that were mostly repairable. When restoring root canal-treated molars with overlays, the pulp chamber should be sealed with either FRC or SDR to ensure the best possible fracture resistance. The clinical relevance of the study is that a new simple restorative protocol is presented to enhance the survival of root canal-treated molars using ceramic overlays.

In vitro Evaluation and Comparison of Microleakage of Two Restorative Composite Resins in Class II Situations using Confocal Laser Scanning Microscopy.

AIM: The placement of composite in teeth is not an easy task and it poses many challenges. Microleakage is one of the factors that affects the success of any composite restoration. It influences the longevity of dental restorations. The present study was aimed to evaluate and compare microleakage of two restorative composites resins in class II cavities using confocal laser scanning microscopy (CLSM). MATERIALS AND METHODS: This was an in vitro study, which included 20 permanent mandibular first molar. On each tooth, 40 class II cavities were prepared with a carbide bur. The teeth were then randomly divided into two groups of 10 each. Group I included teeth in which SonicFill Bulk Fill composite was used. Group II included teeth in which Tetric EvoCeram Bulk Fill composite was used. The microleakage was measured using confocal microscopy at 10* magnification in the fluorescent mode by a scoring system. RESULTS: Estimation was done at cervical and occlusal levels, wherein group I included 10 teeth which were restored with SonicFill Bulk Fill composite and group II included 10 teeth which were restored with Tetric EvoCeram Bulk Fill composite. Microleakage was quantified on scoring basis, which was consecutively based on the dye penetration at different levels. Data thus obtained statistically revealed that microleakage was comparatively more in group II as compared with group I. In addition, it was somewhat similar on both cervical as well as occlusal regions. The difference was significant (p = 0.05). Comparison was also done at cervical and occlusal levels using Wilcoxon signed-rank test, which showed significant levels of differences (p > 0.05). CONCLUSION: There is more microleakage in Tetric EvoCeram Bulk Fill composite as compared with SonicFill Bulk Fill composite. CLINICAL SIGNIFICANCE: No material seems to totally eliminate microleakage in class II situations with gingival margin ended in dentine. However, CLSM is a useful tool in microleakage evaluation that could be used successfully to estimate the severity of microbial penetrations and material of choice as well.

Clinical Evaluation of Sonic-Activated High Viscosity Bulk-Fill Nanohybrid Resin Composite Restorations in Class II Cavities: A Prospective Clinical Study up to 2 Years.

This study evaluated the clinical performance of a bulk-fill resin composite in class II cavities for up to 2 years. Class II restorations (N=111) were made using a nanohybrid bulk-fill resin composite (SonicFill, Kerr Corp.) and evaluated following 1 week after placement, at 6 months, and thereafter annually up to 2 years using the United States Public Health Service (USPHS) criteria. The changes were analyzed using the McNemar test and the Kaplan-Meier method. No secondary caries was observed until the final recall. One restoration underwent endodontic treatment after 2 months following the restorative procedure and was deemed a failure. The overall success rate was 99.1%. Colour match deteriorated from a score of 0 to 1 in eight restorations from baseline to 6 months and six restorations showed marginal staining at final recall. Bulk-fill resin composite (SonicFill) showed acceptable clinical performance through 2 years of service but colour match to the tooth started to show some deterioration within the first 6 months.

Bond strength comparison of a fiber-reinforced composite resin: Different dentin conditions and preparation techniques.

This study aimed to compare the bond strength of a fiber-reinforced composite resin with traditional and bulk-fill composite resins under different dentin conditions and preparation techniques. Eighty molar teeth, excluding the mesio-distal half of the occlusal dentin surfaces of each teeth, were isolated with acid-resistant nail varnish and stored in a demineralisation solution (pH 4.5). After mechanical removal of the varnish, the teeth were buried in acrylic resin blocks. In every composite resin group, one-half of the specimens were prepared with a diamond bur and another half with Er: YAG laser. Then, the specimens were divided into four groups of composite resins (Filtek Z250, G-aenial Posterior, SonicFill 2, Ever X Posterior) (n = 10). Shear bond strengths were measured using a universal testing device, and failure types were determined with stereomicroscope images. SEM images were obtained at 1000× magnification. Data were analyzed using a three-way analysis of variance (ANOVA), and Bonferroni correction was used for multiple comparisons (p = .05). Differences in the dentin surface affected the bond strength results (p < .05), whereas there was no significant difference between cavity preparation methods (p > .05). EverX Posterior showed the highest bond strength results. Within the limitations of this study, fiber-reinforced composite resin exhibited successful bond strength results in addition to improved mechanical properties. RESEARCH HIGHLIGHTS: Fiber-reinforced composite had successful bond strength values. Bond strength values of sound dentin groups were higher than those of caries-affected dentin groups. The use of an Er: YAG laser for preparation did not lead to insufficient bond strength results.

Effect of C-factor on Micro-tensile Bond Strength of Bulk fill V/S Micro-hybrid Composite in Class II Restorations - An In-Vitro Study.

Background: High Configuration factor (C-factor) results into increased polymerization shrinkage causing stress at resin-dentin interface leading to failure of the restoration. The purpose of this study was to evaluate the effect of C-factor on micro-tensile bond strength (µTBS) of bulk fill composites in class-II cavities when restored in 4mm of bulk as compared to conventional composite. Methodology: A total of 90 carious, crack free extracted human mandibular permanent molars were selected and randomly divided into 3 groups (n=30). On all samples, class II cavities (3.5X 3.5cm) were made by single operator and divided as Gp1 (2.5mm), Gp2 (4mm), and Gp3 (6mm) on the basis of depth of cavities. Sampling units of 30 in each group were further randomly subdivided into 3 subgroups (n=10 each subgroup), according to the type of composite resin systems to be used for restoration. Experimental Subgroup includes SubGp1 restored with SDR Surefil (Dentsply, caulk, USA) and SubGp2 restored with Sonic fill (kerr, orange, CA, USA), whereas SubGp3 restored with FILTEK Z250 served as control. After storage in water at 37◦C, the teeth were sectioned perpendicular to the restorative tooth interface as 1×1 mm non-trimmed rectangular micro-specimens for micro-tensile bond strength (µTBS) testing. Beams (n=30 max) from each SubGp were fixed to a metal jig and subjected to micro-tensile bond strength testing. The data collected for micro-tensile bond strength (expressed in Mpa) were statistically analysed using one way ANOVA and Tukey's post hoc test. Results: In class II cavities with high C-factor, SDR Surefil showed better µTBS than SonicFill and micro-filled composite when filled in bulk of 4mm, as compared to micro-hybrid composite filled incrementally. Conclusion: There is no effect of high C-factor on µTBS of tooth restored with both SDR Surefil and Sonic Fill in class II cavities as compared to microhybrid composites.

Marginal Adaptation and Micropermeability of Class II Cavities Restored with Three Different Types of Resin Composites-A Comparative Ten-Month In Vitro Study.

The development of composite materials is subject to the desire to overcome polymerization shrinkage and generated polymerization stress. An indicator characterizing the properties of restorative materials, with specific importance for preventing secondary caries, is the integrity and durability of marginal sealing. It is a reflection of the effects of polymerization shrinkage and generated stress. The present study aimed to evaluate and correlate marginal integrity and micropermeability in second-class cavities restored with three different types of composites, representing different strategies to reduce polymerization shrinkage and stress: nanocomposite, silorane, and bulk-fill composite after a ten-month ageing period. Thirty standardized class ΙΙ cavities were prepared on extracted human molars. Gingival margins were 1 mm apical to the cementoenamel junction. Cavities were randomly divided into three groups, based on the composites used: FiltekUltimate-nanocomposite; Filtek Silorane LS-silorane; SonicFill-bulk-fill composite. All specimens were subjected to thermal cycles after that, dipped in saline for 10-mounds. After ageing, samples were immersed in a 2% methylene blue. Thus prepared, they were covered directly with gold and analyzed on SEM for assessment of marginal seal. When the SEM analysis was completed, the teeth were included into epoxy blocks and cut longitudinally on three slices for each cavity. An assessment of microleakage on stereomicroscope followed. Results were statistically analyzed. For marginal seal evaluation: F.Ultimate and F.Silorane differ statistically with more excellent results than SonicFill for marginal adaptation to the gingival margin, located entirely in the dentin. For microleakage evaluation: F.Ultimate and F.Silorane differ statistically with less microleakage than SonicFill. Based on the results obtained: a strong correlation is found between excellent results for marginal adaptation to the marginal gingival ridge and micropermeability at the direction to the axial wall. We observe a more significant influence of time at the gingival margin of the cavities. There is a significant increase in the presence of marginal fissures (p = 0.001). A significant impact of time (p < 0.000) and of the material (p < 0.000) was found in the analysis of the microleakage.

Effect of Different Composite Restorations on the Cuspal Deflection of Premolars Restored with Different Insertion Techniques- An In vitro Study.

INTRODUCTION: This study was conducted to assess the effect of different composite materials on the cuspal deflection of premolars restored with bulk placement of resin composite in comparison to horizontal incremental placement and modified tangential incremental placement. AIM: The aim of this study was to evaluate the cuspal deflection caused by different composite materials when different insertion techniques were used. MATERIALS AND METHODS: Two different composite materials were used that is Tetric N Ceram (Ivoclar Vivadent marketing, India) and SonicFillTM (Kerr Sybron Dental). Forty standardized Mesio-Occluso-Distal (MOD) preparations were prepared on maxillary first premolars. Each group was divided according to composite insertion technique (n=10), as follows: Group I - bulk insertion using Tetric N Ceram, Group II - Horizontal incremental insertion technique using Tetric N Ceram, Group III- Modified tangential incremental technique using Tetric N Ceram, and Group IV- bulk insertion using SonicFillTM. Preparations were acid-etched, and bonded with adhesive resin to provide micro mechanical attachment before restoration using a uniform etching and bonding protocol in all the groups. All groups received the same total photo-polymerization time. Cuspal deflection was measured during the restorative procedure using customized digital micrometer assembly. One-way ANOVA test was applied for the analysis of significant difference between the groups, p-value less than 0.05 was considered statistically significant. RESULTS: The average cuspal deflections for the different groups were as follows: Group I 0.045±0.018, Group II 0.029±0.009, Group III 0.018±0.005 and Group IV 0.017±0.004. The intergroup comparison revealed statistically significant difference. CONCLUSION: A measurable amount of cuspal deflection was present in all the four studied groups. In general, bulkfill restoration technique with conventional composite showed significantly highest cusp deflection. There were no significant differences in cuspal deflection among sonicFillTM and modified tangential incremental insertion techniques.

The effect of mouth rinses on the color stability of sonicfill and a nanohybrid composite.

PURPOSE: The aim of this study was to evaluate the effects of 4 mouth rinses on the color stability of two different resin composites. MATERIALS AND METHODS: A2 shade sonic-activated bulk fill material SonicFill (Kerr) and conventional nanohybrid composite Filtek Z550 (3M ESPE) were used. Forty disc-shaped specimens (10 mm x 2 mm) were fabricated for both composites and finished using 400-grit SiC paper and polished. After polishing and immersing in distilled water for 24h all specimens were subjected to color measurements. The baseline color values (L*, a*, b*) of each specimen were measured with a colorimeter. Following baseline measurement each composite group was divided into 5 groups: Oral-B Pro Expert Clinic Line Alcoholfree (Oral-B) group, Listerine Tooth Defense Rinse (Listerine) group, Pharmol Zn Mouth rinse (Çözümilaç) group, Nilera Mouth rinse (Nilera) group and Distilled water (control) group. The specimens were incubated in mouth rinses (20 ml) at 37°C for 12 hours and subjected to color measurement. Two-way ANO VA was used for statistical analysis (p<0.05). RESULTS: SonicFill showed significantly higher discoloration when exposed to Oral-B Pro Expert Clinic Line Alcohol-free, Listerine Tooth Defense Rinse and Pharmol Zn Mouth rinse. The color differences of two resin composites were not statistically significant for distilled water and Nilera Mouth rinse. CONCLUSION: Within the limits of this study it can be concluded that the SonicFill showed higher discoloration than nanohybrid resin composite Filtek Z550.

Comparing marginal microleakage of three Bulk Fill composites in Class II cavities using confocal microscope: An in vitro study.

AIM: This study aims to evaluate and compare microleakage at the occlusal wall and cervical wall in Class II cavities restored with one SonicFill Bulk Fill composite and two conventional Bulk Fill composites. MATERIALS AND METHODS: Thirty freshly extracted teeth were divided into three groups of 10 teeth each. Standardized Class II cavities were made on the mesial and distal surfaces of each tooth and restored using SonicFill Bulk Fill composite and two conventional Bulk Fill composites, Tetric Evo Ceram, and X-tra fil. After storage, thermocycling and immersion in 0.6% rhodamine dye solution specimens were sectioned and evaluated for microleakage at the occlusal and cervical walls using confocal microscope. STATISTICAL ANALYSIS USED: Kruskal-Wallis test, Wilcoxon Signed-Rank test and Mann-Whitney U-test. RESULTS: The results demonstrated that in the occlusal wall and cervical wall, SonicFill Bulk Fill composite, showed significantly less marginal microleakage than the other groups. CONCLUSION: Based on the results of this study, SonicFill Bulk Fill composite showed less microleakage than the other conventional Bulk Fill composites.

Longevidade clínica das restaurações de resina composta sonificadas e não sonificadas em dentes permanentes posteriores: revisão sistemática e meta-análise / Clinical longevity of sonicated and non-sonicated composite resin restorations on posterior permanent teeth: a systematic review and meta-analysis

Resinas compostas são materiais dentários amplamente utilizados em restaurações diretas na Odontologia. A aplicação da energia sônica na sua técnica restauradora tem sido uma opção para diminuir as consequências das suas tensões de polimerização. O objetivo desse estudo foi avaliar a longevidade clínica de restaurações Classe I e II em resina composta com e sem o uso da energia sônica, através de uma revisão sistemática da literatura e meta-análise. Uma busca sistemática foi realizada nas seguintes bases de dados: PubMed, Biblioteca Cochrane, Web of Science, Scopus, LILACS, BBO e a Literatura Cinzenta sem restrições de idioma ou ano de publicação. Após a remoção das duplicatas foram identificados 5485 estudos. Dezesseis cumpriram os critérios de inclusão após a triagem de resumos. Não foram incluídos artigos após a busca manual da lista de referência dos estudos incluídos. A qualificação do risco de viés foi realizada pelo RoB da Colaboração Cochrane para os estudos randomizados e ROBINS-I para os ensaios clínicos controlados não randomizados. A meta-análise foi realizada utilizando o software RevMan, sendo analisado o número de restaurações com scores UDHS alfa. A heterogeneidade foi avaliada pelo índice I2, com significância definida em p <0,05. Quatro estudos clínicos foram incluídos na análise qualitativa, sendo dois RCTs e dois ensaios clínicos controlados e apresentaram respectivamente moderado e baixo risco de viés. Não foi observada diferença estatística na longevidade das restaurações com o uso da energia da sônica em dentes permanentes (p>0,05), nos critérios avaliados: forma anatômica (IC=1.05[0.95,1.15]; I²=0%; p=0.37); estabilidade de cor (IC=1.02[0.93,1.13, I²=0%, p=0.65); adaptação marginal (IC=1.05[0.95,1.16]; I²=0%; p=0.38); sensibilidade pós-operatória (IC=1.01[0.93,1.10]; I²=0%; p=0.80); cáries secundárias (IC=1.01[0.93,1.10]; I²=0%; p=0.80); descoloração marginal (IC=1.05[0.95,1.16]; I²=0%; p=0.38), rugosidade superficial (IC=1.09[0.97,1.23]; I²=19%; p=0.14) e retenção (IC=1.00[1.91,1.10] I²=0% p=1.00). Com base nos resultados obtidos, não houve diferença na longevidade de restaurações diretas de resina composta com e sem o uso da energia sônica, independente da técnica e do dente restaurado. Significado clínico: A odontologia busca avanços tecnológicos para otimizar a prática clínica dos profissionais e evoluir quanto aos materiais dentários. A indicação de uma técnica restauradora com o uso de novas tecnologias levanta questões sobre a longevidade das restaurações realizadas em comparação a técnicas já sedimentadas na literatura. Estudos in vitro não são capazes de responder esse questionamento, mas a compilação de ensaios clínicos traz uma previsibilidade quanto aos resultados esperados. Através dos resultados obtidos, concluiu-se que não há diferenças estatísticas significativas na longevidade das restaurações em resina composta com e sem o uso da energia sônica. Dessa forma, o estudo esclareceu essa dúvida. (AU)

Composite resins are dental materials widely used in direct restorations in dentistry. The application of sonic energy in its restorative technique has been an option to reduce the consequences of its polymerization stresses in reducing the consequences of its polymerization shrinkage stresses. The objective of this study was to evaluate the clinical longevity of Class I and II restorations in composite resin with and without the use of sonic energy, through a systematic review of the literature and meta-analysis. Searches were conducted on PubMed, Cochrane Library, Web of Science, Scopus, LILACS, BBO and Gray Literature without language restrictions or year of publication. After removing duplicates, 5485 studies were identified. Sixteen met the inclusion criteria after screening abstracts. Articles were not included after manual search of the reference list of the included studies. The qualification of the risk of bias was carried out by the Cochrane Collaboration for randomized studies and ROBINS-I for controlled clinical trials. The meta-analysis was performed using RevMan software, analyzing the number of restorations with alpha UDHS scores. Heterogeneity was assessed using the I² index, with significance set at p<0.05. Four clinical studies were included in the qualitative analysis, two RCTs and two controlled clinical trials, showed, respectively, moderate and low risk of bias. No statistical difference was observed in the longevity of restorations with the use of sonic energy in permanent teeth (p> 0.05), in the evaluated criteria: anatomical shape (CI = 1.05 [0.95,1.15]; I²= 0%; p = 0.37); color stability (CI = 1.02 [0.93,1.13, I² = 0%, p = 0.65); marginal adaptation (CI = 1.05 [0.95,1.16]; I² = 0%; p = 0.38); postoperative sensitivity (CI = 1.01 [0.93,1.10]; I²= 0%; p = 0.80); secondary caries (CI = 1.01 [0.93,1.10]; I² = 0%; p = 0.80); marginal discoloration (CI =1.05 [0.95,1.16]; I² = 0%; p = 0.38), surface texture (CI = 1.09) [0.97,1.23]; I² = 19%; p = 0.14) and retention (CI=1.00[1.91,1.10]; I²=0% p=1.00). Based on the results obtained, there was no difference in the longevity of direct composite resin restorations with and without the use of sonic energy, regardless of the technique and the restored tooth. Clinical significance: Dentistry seeks technological advances to optimize the clinical practice of professionals and evolve in terms of dental materials. The indication of a restorative technique with the use of new technologies raises questions about the longevity of the restorations performed in comparison to techniques already established in literature. In vitro studies are not able to answer this question, but the compilation of clinical trials provides predictability of the expected results. Therefore, this study clarified that doubt.