This study compared the effect of different adhesive systems and composite resins on the shear bond strength (SBS) of repaired high-viscosity bulk-fill composites(Tetric EvoCeram Bulk Fill) and investigated failure modes. One hundred twenty cylindrical bulk-fill composite blocks (diameter 5 mm) were fabricated and thermocycled for 5000 cycles (5–55 °C). Specimens were roughened by diamond bur and divided into 8 groups (n = 15). Bulk-fill blocks were repaired with the same material or nanohybrid composite resin(Tetric EvoCeram Nanohybrid) (diameter 3 mm) using different adhesive systems:Tetric N-Bond Universal (TSE);37% phosphoric acid etching + Tetric N-Bond Universal (TER); Clearfil SE Bond (CSE); 37% phosphoric acid etching + Adper^TMSingle Bond 2(SB). After repair procedures, all specimens were thermocycled again. The shear bond strengths were measured for all specimens using a universal test machine (crosshead speed of 1 mm/min). Cohesive strengths of bulk-fill composites were measured and described as control group. Debonded surfaces were observed with a stereomicroscope under 10x magnification to determine mode of failure. The SBS data of all groups was statistically analyzed by two-way ANOVA and Bonferroni correction test (p < 0.05). The specimens repaired with bulk-fill composites showed significantly higher SBS values (25.86 ± 5.74, 27.05 ± 4.93, 24.49 ± 6.95MPa) than those with nanohybrid composites (20.41 ± 3.70, 22.08 ± 6.37, 18.74 ± 6.40 MPa) for TER,CSE,SB, respectively (p < 0.05). There were no significant differences in SBS according to the type of adhesive systems for both repair materials (p > 0.05). The predominant mode of failure was a mixed type in the restorative material except for the ones repaired with nanohybrid composites using Adper^TMSingle Bond 2. High-viscosity bulk-fill composites could be successfully repaired with the same materials. SBS of repaired bulk-fill composites reached cohesive strength for all tested groups.

Gap formation of composite resin restorations is a serious shortcoming in clinical practice. Polymerization shrinkage stress exceeds the tooth-restoration bond strength, and it causes bacterial infiltration within gaps between cavity walls and the restorative material. Thus, an intermediate liner application with a low elastic modulus has been advised to minimize polymerization shrinkage as well as gap formation. The purpose of this in vitro study was to assess gap formation volume in premolars restored with different bulk-fill composites, with and without a resin-modified glass-ionomer cement (RMGIC) liner, using x-ray micro-computed tomography (micro-CT). Sixty extracted human maxillary premolars were divided into six groups according to bucco-palatal dimensions (n=10). Standardized Class II mesio-occluso-distal cavities were prepared. G-Premio Bond (GC Corp., Japan) was applied in the selective-etch mode. Teeth were restored with high-viscosity (Filtek Bulk Fill, 3M ESPE, USA)-FB, sonic-activated (SonicFill 2, Kerr, USA)-SF and low viscosity (Estelite Bulk Fill Flow, Tokuyama, Japan)-EB bulk-fill composites, with and without a liner (Ionoseal, Voco GmbH, Germany)-L. The specimens were subjected to 10,000 thermocycles (5-55°C) and 50,000 simulated chewing cycles (100 N). Gap formation based on the volume of black spaces at the tooth-restoration interface was quantified in mm3 using micro-computed tomography (SkyScan, Belgium), and analyses were performed. Data were analyzed using repeated-measures ANOVA and the Bonferroni correction test (p < 0.05). The gap volume of all tested bulk-fill composites demonstrated that Group SF (1.581±0.773) had significantly higher values than Group EB (0.717±0.679). Regarding the use of a liner, a significant reduction in gap formation volume was observed only in Group SFL (0.927±0.630) compared with Group SF (1.581±0.773). It can be concluded that different types of bulk-fill composite resins affected gap formation volume. Low-viscosity bulk-fill composites exhibited better adaptation to cavity walls and less gap formation than did sonic-activated bulk-fill composites. The use of an RMGIC liner produced a significant reduction in gap formation volume for sonic-activated bulk-fill composites.

SUMMARY: This study investigated the effect of different intermediary layer materials under class II mesio-occluso-distal (MOD) resin composite restorations on volumetric cuspal deflection, gap formation, and fracture strength. In total, 32 sound human maxillary premolars were used. After large, standardized Class II MOD cavities were prepared, a universal adhesive (Clearfil Universal Bond Quick, Kuraray) was applied. The premolars were randomly allocated into four groups according to different intermediary layer materials (n=8): Group Z250 (control)/micro-hybrid composite (Filtek Z250, 3M ESPE); Group EST/low-viscosity bulk-fill resin composite (Estelite Bulk Fill Flow, Tokuyama Dental Corp) + micro-hybrid composite; Group NOV/nanofiber-reinforced low-viscosity composite (NovaPro Flow, Nanova) + micro-hybrid composite; and Group RIB/polyethylene fiber [Ribbond, Ribbond Inc] + micro-hybrid composite. Distilled water was used for storage for 24 hours. Using microcomputed tomography (micro-CT), the teeth were scanned immediately after cavity preparation (T₀), then 24 hours after restorative procedures (T₁). Volumetric cuspal deflection in cubic millimeters (mm³) was analyzed on the palatal and buccal regions of each restoration individually at T₀ and T₁ scans. Gap formation (mm³) was evaluated to quantify the volume of black spaces at the tooth-resin interface on the T₁ scan. After these scans, using a universal testing machine, the teeth were subjected to a fracture strength test (0.5 millimeters/minute [mm/min]). The fracture surfaces were analyzed with a stereomicroscope. The data were analyzed using the Kruskal-Wallis, one-way analysis of variance (ANOVA), and Dunn’s tests (p< 0.05). No significant differences in volumetric cuspal deflection and fracture strength were detected for all tested groups (p>0.05). Group RIB exhibited significantly higher gap formation values in comparison with all other groups (p<0.05). Predominant failure mode was favorable.

The aim of this study was a comprehensive evaluation and comparison of the physical and mechanical properties of a newly developed nano-sized hydroxyapatite fiber-reinforced composite with other fiber-reinforced and particle-filled composites. Commercially available eight composite resins (3 fiber-reinforced and 5 particle-filled) were used: Fiber-reinforced composites: (1) NovaPro Fill (Nanova): newly developed nano-sized hydroxyapatite fiber-reinforced composite (nHAFC-NF); (2) Alert (Pentron): micrometer-scale glass fiber-reinforced composite (µmGFC-AL); (3) Ever X Posterior (GC Corp): millimeter-scale glass fiber-reinforced composite (mmGFC-EX); Particle-filled composites: (4) SDR Plus (Dentsply) low-viscosity bulk-fill (LVBF-SDR); (5) Estelite Bulk Fill (Tokuyama Corp.) low-viscosity bulk-fill (LVBF-EBF); (6) Filtek Bulk Fill Flow (3M ESPE) low-viscosity bulk-fill (LVBF-FBFF); (7) Filtek Bulk Fill (3M ESPE) high-viscosity bulk-fill (HVBF-FBF); and (8) Filtek Z250 (3M ESPE): microhybrid composite (µH-FZ). For Vickers microhardness, cylindrical-shaped specimens (diameter: 4 mm, height: 2 mm) were fabricated (n = 10). For the three-point bending test, bar-shaped (2 × 2 × 25 mm) specimens were fabricated (n = 10). Flexural strength and modulus elasticity were calculated. AcuVol, a video image device, was used for volumetric polymerization shrinkage (VPS) evaluations (n = 6). The polymerization degree of conversion (DC) was measured on the top and bottom surfaces with Fourier Transform Near-Infrared Spectroscopy (FTIR; n = 5). The data were statistically analyzed using one-way ANOVA, Tukey HSD, Welsch ANOVA, and Games–Howell tests (p < 0.05). Pearson coefficient correlation was used to determine the linear correlation. Group µH-FZ displayed the highest microhardness, flexural strength, and modulus elasticity, while Group HVBF-FBF exhibited significantly lower VPS than other composites. When comparing the fiber-reinforced composites, Group mmGFC-EX showed significantly higher microhardness, flexural strength, modulus elasticity, and lower VPS than Group nHAFC-NF but similar DC. A strong correlation was determined between microhardness, VPS and inorganic filler by wt% and vol% (r = 0.572–0.877). Fiber type and length could affect the physical and mechanical properties of fibers containing composite resins.

The aim of this study was to evaluate the effects of different polishing systems on the surface roughness of different nanocomposite resins using various analysis methods. Three types of nanocomposite resins were investigated in this study: supra-nanohybrid (Estelite Asteria), nanohybrid (GrandioSo), and nanoceramic composite resins (Ceram-X Spheretec One). Forty-eight disc-shaped specimens (4 mm in diameter, 2 mm in thickness) were fabricated using a Teflon mold and divided into four groups according to the different polishing systems (n=12). All specimens were processed with one of the following methods: Mylar strip (control), one-step polishers (Opti1step), two-step polishers (Clearfil TwistDia), or multistep polishers (Sof-Lex XT Pop-on). The surface roughness (Ra, μm) was measured by contact profilometry (Mahr, Marsurf PS1) (n=10) and scanning electron microscopy (SEM) (Thermo Fisher Scientific, Phenom XL) at 400× magnification (n=2). The data were statistically analyzed using Kruskal-Wallis and Bonferroni correction tests (p0.05). The multistep polishers created lower surface roughness than the one-step polishers for nanohybrid and nanoceramic composites. In terms of the composite resins, supra-nanohybrid composite exhibited lower surface roughness than nanohybrid composite for all polishing systems (p<0.05). The SEM observations confirmed the surface roughness measurements related to the surface morphology. One-step and two-step polishers created porosity on the surface of nanohybrid and nanoceramic composites. EDS analysis indicated the elemental composition of the particles in the porous zones was quite close to diamond abrasives and glass fillers.