In vitro comparison of marginal infiltration between a conventional resin and a bulk-fill resin, in the relocation of cervical margins technique / Comparación in vitro de la infiltración marginal entre una resina convencional y una resina bulk-fill, en la técnica de reubicación de márgenes cervicales

Introduction: Proximal lesions that exceed the cement enamel limit (ACE) under the gingival margin complicate impressions and the adhesive technique. Compare the magnitude of micro infiltration between conventional resin and bulk fill resin in the cervical margin relocation technique. Materials and Methods: 48 samples of human teeth re-ceived two preparations: occluso-mesial (OM) and occluso-distal (OD) under LAC; first they received the cervical margin relocation technique (RMC) with bulk fill and conventional resin; then restored with semi-direct resinous inlays. Sample analysis: immersion in 50% colloidal silver nitrate solution, 24 hours, 37°C and cut mesiodistally. Observed under a stereoscopic magnifying glass to assess dye penetration and digitally photographed, analyzed with "Image J" software. Results: Sample of 96 cavities in two groups of 48 units; control group restored with conventional resin with incremental technique and study group restored with bulk fill resin, mono-incremental technique. Probabilistic sampling. No statistically significant diffe-rences in percentage of microinfiltrated area between Filtek™ Z250™ and Filtek™ Bulk Fill™ (p-value= 0.68). Discussion: Various studies show that the presence of marginal microinfiltration exist independent of: restorative technique, consistency, adhesive mechanism and polyme-rization technique. The research carried out is no exception, observing a similar degree for both systems. Conclusions: Results allow us to conclude that conventi-onal resin and bulk fill resin did not show significant differences in microleakage percentages for the RMC technique. Outside the study framework, bulk fill resins would have comparative advantages; better behavior against light in depths greater than 2 mm, less sensitivity to the "C" factor, and less clinical time.

Introducción: Las lesiones proximales que superan el límite cemento esmalte (ACE) por debajo del margen gingival complican las impresiones y la técnica adhesiva. Comparar la magnitud de la microinfiltración entre la resina convencional y la resina de relleno en la técnica de reubicación del margen cervical. Materiales y Métodos: 48 muestras de dientes humanos recibieron dos preparaciones: ocluso-mesial (OM) y ocluso-distal (OD) bajo LAC, primero recibieron la técnica de reubicación del margen cervical (RMC) con relleno en bloque y resina convencional; luego restaurado con incrustaciones resinosas semidirectas. Análisis de la muestra: inmersión en solución de nitrato de plata coloidal al 50%, 24 horas, 37°C y corte mesiodistal. Observado bajo una lupa estereoscópica para evaluar la penetración del tinte y fotografiado digitalmente, analizado con el software "Image J". Resultados: Muestra de 96 cavidades en dos grupos de 48 unidades; grupo control restaurado con resina convencional con técnica incremental y grupo estudio restaurado con resina bulk fill, técnica mono-incremental. Muestreo probabilístico. No hubo diferencias estadísticamente significativas en el porcentaje de área microinfiltrada entre Filtek™ Z250™ y Filtek™ Bulk Fill™ (p-value = 0,68) Discusión: Diversos estudios evidencian presencia de microinfiltración marginal, independiente de técnica restauradora, consistencia, mecanismo adhesivo y técnica polimerizadora. La investigación realizada no es excepción, observándose grado similar para ambos sistemas. Conclusiones: Los resultados permiten concluir que resina convencional y resina bulk fill no presentaron diferencias significativas en porcentajes de microinfiltración para técnica RMC. Fuera del marco del estudio, resinas bulk fill tendrían ventajas comparativas; mejor comportamiento frente a la luz en profundidades superiores a 2 mm, menor sensibilidad al factor "C", y menor tiempo clínico.

Clinical study of different composite resin systems in Class I cavities (an 18-month randomized clinical trial) / Estudo clínico de diferentes sistemas de resina composta em cavidades de Classe I (um ensaio clínico randomizado de 18 meses)

Objective: this double-blind randomized clinical trial evaluate the clinical performance of Thermo-Viscous Bulk Fill composite, Self-Adhesive Flowable composite, and Filtek Bulk Fill Composites restorations in Class I cavities over a period of 18 months. Material and Methods: twenty individuals between the ages of 30 and 45 participated in this research. Each patient should have at least three occlusal Class I carious lesions on their molars. They were dispersed at random, with n=20 teeth representing each tested material. Group I (Futurabond M+ and VisCalor Bulk Fill which heated in a viscolar dispenser at 68 °C for 30s and placed in a 4 mm thickness), Group II (Fusio Liquid Dentin self-adhesive composite which put in a thin layer (1mm increment)), and Group III (Single Bond Universal and Filtek Bulk Fill Posterior composite which applied in 4 mm thickness without heating). Using (USPHS) criteria, all restorations were assessed clinically at baseline, 6 months, 12 months, and 18 months. Using an inverse replica, the marginal seal of the investigated restorations was further evaluated under SEM. Statistical analysis was performed with Chi-square test for all USPH parameters. Results: the three tested groups recorded a one hundred percent retention rate after 18 months follow up period. Concerning marginal adaptation, marginal discoloration, anatomical form, surface texture, and color matching, there was a significant difference (p˂0.05) between the three tested groups after 12 & 18 months. After 12 & 18 months, SEM analysis of the marginal seal revealed a statistically significant difference between the three groups. Conclusion: Bulk fill resin composite restorations showed satisfactory acceptable clinical performance after 18 months of clinical service compared to self-adhesive flowable composites, and Viscalor Bulk Fill composite demonstrated excellent results with considerable changes in marginal integrity as a consequence of thermal viscous technology and increased adaptability of restorations toward cavity walls and margins (AU)

Objetivo: este ensaio clínico randomizado duplo-cego avaliou o desempenho clínico de restaurações de resina Bulk Fill Termo-Viscosa, resina autoadesiva Flowable e Filtek Bulk Fill Composites em cavidades Classe I durante um período de 18 meses. Material e Métodos: 20 indivíduos com idade entre 30 e 45 anos participaram da pesquisa. Cada paciente deveria ter pelo menos três lesões de cárie oclusais de Classe I nos molares. Eles foram divididos aleatoriamente, com n=20 dentes representando cada material testado. Grupo I (Futurabond M+ e VisCalor Bulk Fill aquecido em dispensador viscolar a 68 °C por 30s e colocado em uma espessura de 4 mm), Grupo II (resina composta autoadesiva Fusio Liquid Dentin colocada em uma camada fina (incremento de 1 mm)) e Grupo III (resina composta Single Bond Universal e Filtek Bulk Fill Posterior aplicado em espessura de 4 mm sem aquecimento). Usando os critérios (USPHS), todas as restaurações foram avaliadas clinicamente no início, 6 meses, 12 meses e 18 meses. Usando uma réplica inversa, o selamento marginal das restaurações investigadas foi avaliado em MEV. A análise estatística foi realizada com o teste qui-quadrado para todos os parâmetros USPH. Resultados: os três grupos testados registraram uma taxa de retenção de cem por cento após um período de acompanhamento de 18 meses. Em relação à adaptação marginal, descoloração marginal, forma anatômica, textura da superfície e combinação de cores, houve uma diferença significativa (p˂0,05) entre os três grupos testados após 12 e 18 meses. Após 12 e 18 meses, a análise SEM do selamento marginal revelou uma diferença estatisticamente significativa entre os três grupos. Conclusão: as restaurações de resina composta Bulk Fill apresentaram desempenho clínico aceitável satisfatório após 18 meses de atendimento clínico em comparação com as resinas compostas fluidas autoadesivas, e a resina composta Viscalor Bulk Fill demonstrou excelentes resultados com mudanças consideráveis na integridade marginal, como consequência da tecnologia viscosa térmica e maior adaptabilidade de restaurações nas paredes e margens da cavidade (AU)

Clinical follow-up at 18 months of two bulk fill occlusal composite resins: a double-blind randomized clinical study / Seguimiento clínico a 18 meses de dos resinas compuestas oclusales bulk fill: estudio clínico aleatorio doble ciego

Objetive: To compare the clinical behavior of two types of Bulk Fill composite resins and a nanohybrid resin at 18 months in occlusal restorations. Material and Methods: Three occlusal restorations were performed in each one of the 55 participants. They were randomly distributed into three groups, TN: Tetric-N-Ceram Bulk-Fill, FK: Filtek Bulk-Fill, and Z350: Filtek Z350XT. Adhesive techniques and restorative procedures were performed according to the manufacturer's instructions for each restorative material used. In TN and FK an increment of 4mm was applied, and in Z350 increments of ≤2mm depth were applied. Two calibrated operators evaluated the restorations at baseline and at 18 months using the FDI World Dental Federations system (1: excellent, 2: good, 3: satisfactory, 4: unsatisfactory, 5: poor) for clinical marginal staining (MS) properties, fracture-retention (FR), superficial texture (ST), marginal integrity (MI), postoperative sensitivity (PS) and caries (C). Kruskal-Wallis and Wilcoxon were used to compare the 3 groups at 18 months (5% significance). Results: 38 patients with a total of 114 restorations were assessed, being evaluated with excellent clinical behavior; MI, 78.9% in Z350, 89.51% in TN and 81.6% in FK; ST 73.5% in Z350, 86.8% in TN, and 84.2% in FK; MS 84.2% in Z350, 84.2% in TN, and 91.2% in FK; PS 100% in Z350 and 97.3% in TN and FK; in C and FR, 100% in the 3 groups. There were no significant differences between the three groups (p>0.05). Conclusion: The three resins studied presented a good clinical performance at 18 months without showing significant differences in the clinical properties evaluated.

Objetivo: Comparar el comportamiento clínico a 18 meses en restauraciones oclusales entre dos tipos de resinas compuestas Bulk Fill y una resina nanohíbrida. Material y Métodos: En 55 participantes se realizaron 3 restauraciones oclusales en cada paciente, distribuidas aleatoriamente en 3 grupos, TN: Tetric-N-Ceram Bulk-Fill, FK: Filtek Bulk-Fill y Z350: Filtek Z350XT. Las técnicas adhesivas y procedimientos restauradores fueron realizados según las instrucciones de los fabricantes de cada material restaurador utilizado. En TN y FK se aplicó un incremento de 4mm y en Z350 se aplicó incrementos ≤ 2 mm de profundidad. Dos operadores calibrados evaluaron las restauraciones al baseline y a los 18 meses mediante el sistema FDI World Dental Federations (1: excelente, 2: aceptable, 3: suficiente, 4: insatisfactorio, 5: inaceptable) en las propiedades clínicas de tinción marginal (TM), fractura-retención (FR), textura superficial (TS), integridad marginal (IM), sensibilidad postoperatoria (SP) y caries (C). Se utilizó Kruskal-Wallis y Wilcoxon para la comparación de los 3 grupos a 18 meses (significancia de 5%). Resultados: Se controlaron 38 pacientes con un total de 114 restauraciones, siendo evaluados con comportamiento clínico excelente; IM, 78.9% en Z350, 89.51% en TN y 81.6% en FK; TS 73.5%, en Z350, 86.8% en TN y 84.2% en FK; TM, 84.2% en Z350, 84.2% en TN y 91.2% en FK; SP 100% en Z350 y 97,3% en TN y FK; en C y FR 100% en los 3 grupos. No hubo diferencias significativas entre los 3 grupos (p>0,05). Conclusión: Las 3 resinas estudiadas presentaron un buen desempeño clínico a 18 meses sin mostrar diferencias significativas en las propiedades clínicas evaluadas.

Clinical evaluation of bioactive resin-modified glass ionomer and giomer in restoring primary molars A randomized, parallel-group, and split-mouth controlled clinical study

Aim: This study aims to evaluate and compare the clinical performance of two restorative materials – bioactive resin-modified glass ionomer (ACTIVA BioACTIVE restorative) and giomer hybrid composite (Beautifil Flow Plus) in restoring class I carious primary molars. Materials and Methods: The split-mouth randomized controlled study was conducted on 100 primary molars from 50 children (28 – males, 22 – females) from 50 children in age range of 5-9 years (Mean-7.29±1.34) with at least two occlusal carious lesions on either maxillary or mandibular primary molars. Each child had both the control and the experimental teeth restored with respective restorative materials, Group I (Control, n = 50) ? Giomer, Group II (Experimental, n = 50) ? Bioactive resin-modified glass ionomer. The restorations were evaluated by two independent investigators using modified United State Public Health Service criteria at immediate postoperative, 6 months, and 12 months. The Chi-square test was used for the statistical analysis after collecting the data. Results: At the 12-month follow-up, 33 children (66 teeth) reported with an attrition rate of 33%. The color match between the groups was not statistically significant at all intervals. The marginal discoloration, marginal integrity, anatomic form, and retention had no significant difference at 6 months. But at 12 months, there was a statistically significant difference between the groups with p value of 0.04,<0.001,<0.02 and <0.001 respectively. respectively. At 12 months, there was no postoperative sensitivity in both groups. Conclusion: Bioactive resin-modified glass ionomer with enhanced properties can be used as an effective restorative material, especially in children with excessive salivation.

Pre-Heating effect on the microhardness and depth of cure of Bulk-Fill composite resins / Efecto del precalentamiento de las resinas compuestas Bulk-Fill en la microdureza y la profundidad de curado

Abstract The aim of this study was to investigate the effect of preheating three bulk-fill and one conventional composite resin on the Vickers microhardness and depth of cure of these composites. In this study, three bulk-fill composites- SDR Plus (SDR), Estelite BULK FILL Flow (EST), Admira® Fusion x-tra (AFX), and one conventional composite resin G-ænial POSTERIOR (GP) were used as the control group. The samples were obtained at room temperature (24°C) and at 55°C in T2 mode after being placed in a heating device for 10 minutes. The samples were divided into eight groups (n=10) according to the type of material and heating process that was utilized (preheated and nonheated). All samples were tested with a Vickers microhardness (VHN) tester on the bottom and top surfaces. The first measurements were obtained at baseline; the second set of measurements was performed after the samples were stored in distilled water at 37°C for 24 hours. The depth of cure was calculated using a bottom/top hardness ratio of measurements. Statistical analysis was performed utilizing the SPSS V23 and Shapiro-Wilk tests. Lastly, the Duncan test was used for multiple comparisons (p<0.05). While the VHN increased after the preheating procedure in bulk-fill composites, it decreased in GP. There was no difference between the baseline and the 24-hour VHN values in SDR and GP. After 24 hours, while the VHN of EST increased, the VHN of AFX decreased. There was no difference between the hardness ratios of the AFX and EST samples (p<0.001) and hardness ratios were greater than GP and SDR. When comparing the baseline and the 24- hour values, the VHN depended on the type of materials. Sufficient curing depth was obtained in all groups with a thickness of 2mm.

Resumen El objetivo fue investigar el efecto del precalentamiento de tres resinas Bulk-fill, una resina compuesta convencional sobre la microdureza Vickers y la profundidad de curado de estas resinas. Se utilizaron tres composites Bulk-Fill-SDR Plus (SDR), Estelite BULK FILL Flow (EST), Admira® Fusion x-tra (AFX), y una resina compuesta convencional G-ænial POSTERIOR (GP) como grupo de control. Las muestras se obtuvieron a temperatura ambiente (24°C) y a 55°C en modo T2 después de haber sido colocadas en un dispositivo de calentamiento durante 10 minutos. Se dividieron en ocho grupos (n=10) según el tipo de material y el proceso de calentamiento que se utilizó (precalentado y no calentado). Se probaron con un medidor de microdureza Vickers (VHN) en las superficies inferior y superior. Las primeras mediciones se obtuvieron en la línea de base; la segunda se realizó después de que las muestras se almacenaran en agua destilada a 37°C durante 24 horas. La profundidad de curado se calculó utilizando una relación de dureza inferior/ superior de las mediciones. El análisis estadístico se realizó utilizando el SPSS V23 y las pruebas de Shapiro-Wilk. Por último, se utilizó la prueba de Duncan para las comparaciones múltiples (p<0,05). VHN aumentó tras el procedimiento de precalentamiento en las resina Bulk-Fill, disminuyó en los GP. No hubo diferencias entre los valores de VHN de referencia y de 24 horas en SDR y GP. Después de 24 horas, mientras que el VHN de EST aumentó, el VHN de AFX disminuyó. No hubo diferencias entre los ratios de dureza de las muestras de AFX y EST (p<0,001) y los ratios de dureza fueron mayores que los de GP y SDR. Al comparar los valores de referencia y los de 24 horas, el VHN dependió del tipo de materiales. Se obtuvo una profundidad de curado suficiente en todos los grupos con un grosor de 2mm.

Restauración clase II MOD mediante uso de resina bulk-fill fluida y resina de estratificación natural: combinando fortalezas en una preparación extensa / Class II MOD restoration using bulk-fill flowable and natural layering resin composites: combining strengths in an extensive preparation

RESUMEN La restauración de grandes preparaciones cavitarias clases II MOD es un escenario clínico de alta complejidad. Elegir correctamente una resina compuesta y planificar la secuencia de estratificación permitirá mejorar la adaptación de las masas de resina y controlar el estrés de contracción de polimerización. En el siguiente reporte de caso clínico, se expone el protocolo paso a paso para el uso combinado de una resina compuesta para estratificación de esmalte de alto índice de refracción para la restauración de los rebordes marginales perdidos y la superficie oclusal, junto a una resina compuesta bulk-fill de baja viscosidad para la reconstrucción dentinaria en un diente posterior con gran destrucción coronaria.

ABSTRACT The restoration of large class II MOD cavity preparations is a highly complex clinical scenario. Selecting correctly a composite resin and planning the stratification sequence will improve the adaptation of the composite resin masses and will control the polymerization shrinkage stress. In the following clinical case report, the step- by-step protocol of the combined use of an high-refractive-index enamel-like composite resin is shown for the restoration of lost marginal ridges and the occlusal surface, together with a low viscosity Bulk-Fill composite resin for dentine reconstruction in a highly damaged posterior tooth.

Evaluation of fracture strength and total void amount in composite restorations on endodontically treated teeth / Resistencia a la fractura y la cantidad total de burbujas en resinas compuestas de dientes tratados endodónticamente

ABSTRACT: The aim of the study was to investigate the fracture strength of different composite resins and the quantity of voids in conventional posterior composite, high- flow flowable composite, bulk-fill flowable composite, and fiber-reinforced composite. Forty-four caries-free, freshly extracted mandibular premolars were used for this study. Teeth were prepared for cavity and root canal treatment. Subsequently, root canal treatment was applied to the teeth and cavities in order to prepare them for restorations. The specimens were then divided into four groups: group-1: Estelite Posterior; group-2: Estelite Flow Quick High Flow; group-3: Estelite Bulk-fill Flow; group-4: everX Posterior. One specimen from each experimental group was examined using micro-CT to perform measurement of voids. The fracture strength values of high-flow flowable, bulk-fill flowable, fiber-reinforced, and conventional micro- hybrid composites were found to be similar (p=0.497). EverX Posterior showed the highest fracture strength values (841.1±149.4 N), followed by Estelite Bulk-fill Flow (822.8±170.8 N). Volume of voids (%) obtained from Micro-CT analysis revealed that restorations with high-flow liner or bulk-fill flowable exhibited more voids. The fiber-reinforced composite showed the lowest percentage volume of incorporating voids and the highest fracture strength results.

RESUMEN: El objetivo del estudio fue investigar la resistencia a la fractura de diferentes resinas compuestas y la cantidad de burbujas en resinas posteriores convencionales, resinas fluidas de alto flujo, resinas fluidas tipo bulk-fill y resinas reforzados con fibras. Cuarenta y cuatro premolares mandibulares libres de caries, recién extraídos, fueron usados para este estudio. Los dientes se prepararon para el tratamiento de conductos radiculares y las cavidades para prepararlos para las restauraciones. Los especímenes se dividieron en cuatro grupos: Grupo-1: Estelite Posterior; Grupo-2: Estelite Flow Quick High Flow; Grupo-3: Estelite Bulk-fill Flow; Grupo-4: everX Posterior. Un espécimen de cada grupo experimental fue examinado usando micro-CT para realizar la medición de las burbujas. Los valores de resistencia a la fractura de los compuestos de alto flujo, flujo de relleno, reforzados con fibra y microhíbridos convencionales fueron similares (p=0,497). EverX Posterior mostró los valores más altos de resistencia a la fractura (841,1±149,4 N), seguido de Estelite Bulk-fill Flow (822,8±170,8 N). El volumen de las burbujas (%) obtenido del análisis de Micro-TC reveló que las restauraciones con revestimiento de alto flujo o con flujo de relleno a granel presentaban más huecos. El compuesto reforzado con fibra mostró el menor porcentaje de volumen de incorporación de vacíos y los resultados más altos de resistencia a la fractura.

Effect of handpiece light and material used in pulp chamber on dentin removal during root canal retreatment

Abstract This study evaluated the effect of the use of glass ionomer cement (GIC) and flowable bulk-fill resin composite (BFRC) for filling pulp chambers and the type of high-speed handpiece light used on dentin removal during access preparation for endodontic retreatment in molar teeth. Twenty maxillary molars were treated endodontically. BFRC (Opus Bulk Fill Flow APS, FGM) was used to fill the pulp chamber and replace coronal dentin (n = 10). In the remaining teeth, the pulp chamber was filled with GIC (Maxion R, FGM). Conventional resin composite (Opallis, FGM) was used to restore the enamel layer in all teeth. The samples in each group were divided into two subgroups, and the root canals were reaccessed using a handpiece with white or ultraviolet light. The teeth were scanned using micro-CT before and after root canal reaccess. The dentin volume removed was calculated and analyzed using 2-way analysis of variance and Tukey's test (α = 0.05). The crown and pulp chamber locations with dentin removal are described using frequency distribution. During the access, fewer pulp chamber walls were affected and a lower volume of dentin was removed from the pulpal floor in the group restored with GIC than in the group restored with BFRC. No effect was observed on the coronal dentin walls with respect to the filling protocols and type of light used. For dentin removal from the pulp chamber, handpieces with white light performed better than those with ultraviolet light, irrespective of the filling protocol used. The use of GIC to fill the pulp chamber and use of white handpiece light reduced dentin removal from the pulpal floor and resulted in fewer affected dentin walls.

Resumo Este estudo avaliou os efeitos do cimento de ionômero de vidro (GIC) e da resina composta fluida bulk fill (BFRC) usados como preenchimento da câmara pulpar; e o tipo de iluminação das turbinas de alta rotação na remoção dentinária após cavidades de acesso para retratamento endodôntico em dentes molares. Vinte molares superiores foram tratados endodonticamente. Dez dentes foram restaurados usando BFRC (Opus Bulk Fill Flow APS, FGM) para preencher a câmara pulpar e dentina coronária; e resina composta convencional (Opallis, FGM) para restaurar a camada de esmalte. Os outros dentes foram restaurados usando GIC (Maxion R, FGM) para preencher a câmara pulpar e resina composta (Opallis, FGM). As amostras foram divididas em dois grupos e os canais radiculares foram novamente acessados com turbina de alta-rotação com iluminação branca ou ultravioleta. Os dentes foram escaneados usando micro-CT antes e após o novo acesso ao canal radicular. O volume de dentina removida foi calculado e os dados foram analisados por ANOVA bidirecional e teste de Tukey (α=0,05). As regiões na coroa e na câmara pulpar que apresentaram dentina removida no acesso dos canais foram descritas por meio de distribuição por frequência. A reabertura do canal radicular com GIC resultou em menos paredes afetadas da câmara pulpar e menor volume de dentina removida no assoalho. Nenhum efeito foi observado nas paredes de dentina coronária considerando aos protocolos de preenchimento. A turbina de alta rotação com iluminação branca reduziu a remoção de dentina da câmara pulpar, independentemente do protocolo de restauração utilizado. O uso de turbina de alta rotação com iluminação branca e GIC para preencher a câmara pulpar reduziram a remoção de dentina do assoalho e afetaram menos paredes dentinárias.

Do dual-cure bulk-fill resin composites reduce gaps and improve depth of cure

Abstract This in vitro study aimed to evaluate the gaps length and depth of cure of dual-cure bulk-fill resin composites inserted in box-shaped preparations. Box-shaped preparations (4 mm deep) were made in fifteen human third-molars and divided into three groups according to the resin composites (n=5): Dual-cure bulk-fill BulkEZ (BEZ); Dual-cure bulk-fill HyperFIL (HF); and Tetric Evoceram Bulk-fill (TETRIC), as control. Gaps length (%) was evaluated in tooth-restoration interface with micro-computed tomography (µCT). The restorations were sectioned, and the degree of conversion (DC) and Knoop microhardness were evaluated at five depths (0.3, 1, 2, 3, and 4 mm). Microhardness data were statistically evaluated using absolute values (KHN) and relative values (microhardness percentages in relation to top). Gaps length (%) increased in the following order: BEZ=TETRIC<HF. The microhardness percentages in relation to top significantly decreased from 2 mm for TETRIC and 3 mm for HF. BEZ had constant microhardness and DC at all depths, while HF and TETRIC presented a significant decrease on DC at 4 mm. Dual-cure bulk-fill composites did not reduce gaps compared to light-cure bulk-fill, but they can improve depth of cure of bulk-filled restorations.

Resumo O objetivo neste estudo in vitro foi mensurar as fendas e a profundidade de polimerização de compósitos resinosos bulk-fill duais inseridos em preparos em forma de caixa. Os preparos em forma de caixa (4 mm de profundidade) foram realizados em quinze terceiros molares e separados em 3 grupos, de acordo com o compósito resinoso (n = 5): Bulk-fill dual BulkEZ (BEZ); Bulk-fill dual HyperFIL (HF); Tetric Evoceram Bulk-fill (TETRIC). O comprimento das fendas (%) foi avaliado na interface dente-restauração por meio de micro-tomografia computadorizada (µCT). As restaurações foram seccionadas e o grau de conversão (GC) e microdureza Knoop foram avaliados em cinco profundidades (0,3, 1, 2, 3 e 4 mm). Os dados de microdureza foram avaliados estatisticamente por meio de valores absolutos e relativos (porcentagens de microdureza em relação ao topo). O comprimento das fendas (%) aumentou na seguinte ordem: BEZ = TETRIC <HF. O percentual de microdureza em relação ao topo diminuiu significativamente a partir de 2 mm para TETRIC e 3 mm para HF. BEZ apresentou percentuais de microdureza e de GC constantes em todas as profundidades, enquanto HF e TETRIC apresentaram decréscimo significativo no GC em 4 mm. Os compósitos resinosos bulk-fill duais não reduziram as fendas formadas quando comparados a um compósito bulk-fill fotopolimerizável; entretanto, os mesmos podem melhorar a profundidade de polimerização em restaurações de incremento único.

Fracture Resistance of Teeth Restored with Bulk-Fill and Fiber-Reinforced Composites in Class II Cavities / Resistencia a la fractura de dientes restaurados con resinas de relleno y resinas reforzadas con fibra en cavidades clase II

ABSTRACT: This study aimed to evaluate the fracture resistance of teeth restored with conventional, bulk-fill, and fiber-reinforced composite materials regarding intact teeth. Standard cavities were prepared on 70 sound third molar teeth. The teeth were randomly divided into six groups: intact teeth, conventional Bis-GMA based composite, fiber-reinforced composite, Bis-GMA based bulk-fill composite, ormocer based bulk-fill composite, glass containing resin-based bulk-fill composite. The data was obtained by a Universal Testing Machine and analyzed statistically. Fracture resistance of the teeth restored with conventional composite was significantly lower than the other groups (p0.05). The obtained data showed that restoring teeth with bulk-fill and fiber-reinforced composites could be recommended in Class II cavities.

RESUMEN: El objetivo del presente estudio fue evaluar la resistencia a la fractura de los dientes restaurados con materiales compuestos convencionales, de relleno y reforzados con fibras, en relación con los dientes intactos. Se prepararon cavidades estándar en 70 dientes de terceros molares sanos. Los dientes se dividieron al azar en seis grupos: dientes intactos, compuesto convencional basado en Bis-GMA, compuesto reforzado con fibra, compuesto de relleno a base de Bis-GMA, compuesto de relleno a base de ormocer, compuesto de relleno a base de vidrio que contiene resina. Los resultados fueron obtenidos utilizando una máquina universal de pruebas y analizados estadísticamente. La resistencia a la fractura de los dientes restaurados con el composite convencional fue significativamente menor que la de los otros grupos (p0,05). Los datos obtenidos mostraron que la restauración de dientes con composites de relleno y reforzados con fibra podría ser recomendada en cavidades de Clase II.

Discoloration of Bulk-Fill Versus Conventional Composites: A Spectrophotometric Evaluation / Decoloración de resinas Bulk vs resinas convencionales: Evaluación espectrofotométrica

ABSTRACT: Purpose: The purpose of this study was to evaluate the discoloration of a dual-cure bulk-fill (DCBF) and light-cure bulk-fill (LCBF) composites relative to conventional composites (CC) after water and coffee immersion. Methods: One- hundred disc-shaped specimens (8mm in diameter × 4mm thickness) were prepared using five commercially available composites (n=10); two LCBF (XB-X-trafil Voco, FB-FiltekTM Bulk Fill), one DCBF (FU-Fill-upTM Coltene), and two CC (CE-Clearfil Majesty ES2, EQ-Estelite ΣQuick). Initial and final color readouts were measured with a spectrophotometer (Easyshade,Vita) according to the CIELAB color system. Statistical analyses were performed using 2-way ANOVA with Bonferroni adjustment to evaluate ΔE, ΔL, Δa, and Δb parameters (pFB≥XB>EQ≥CE in water immersion groups and XB>FB>EQ≥FU≥CE in coffee immersion groups. Conclusion: Within the limitations of this study, DCBF composite is more susceptible to intrinsic discoloration compared to LCBF and CC. However, DCBF exhibited lower extrinsic discoloration than LCBF and comparable with CC after coffee immersion. Depending on their chemical and structural compositions, composites will exhibit color change, which compromises the esthetic performance of composite restorations.

RESUMEN: Propósito: El propósito de este estudio fue evaluar la decoloración de resinas bulk de curado dual (DCBF) y bulk activadas por fotopolimerización (LCBF) en relación con las resinas convencionales (CC) después de la inmersión en agua y café. Métodos: Se prepararon cien muestras en forma de disco (8mm de diámetro × 4mm de espesor) utilizando cinco resinas compuestas disponibles comercialmente (n=10); dos LCBF (XB-X-trafil Voco, FB-FiltekTM Bulk Fill), un DCBF (FU-Fill-upTM Coltene) y dos CC (CE-Clearfil Majesty ES2, EQ-Estelite ΣQuick). Las lecturas de color inicial y final se midieron con un espectrofotómetro (Easyshade, Vita) de acuerdo con el sistema de color CIELAB. Los análisis estadísticos se realizaron utilizando ANOVA de 2 vías con ajuste de Bonferroni para evaluar los parámetros ΔE, ΔL, Δa y Δb (pFB≥XB>EQ≥CE en los grupos de inmersión en agua y XB>FB>EQ≥FU≥CE en los grupos de inmersión en café. Conclusión: Dentro de las limitaciones de este estudio, la resina DCBF es más susceptible a la decoloración intrínseca en comparación con LCBF y CC. Sin embargo, DCBF mostró una decoloración extrínseca más baja que LCBF y comparable con CC después de la inmersión en café. Dependiendo de sus composiciones químicas y estructurales, los composites mostrarán cambios de color, lo que compromete el desempeño estético de las restauraciones de resinas con el tiempo.

Bond Strength Evaluation of Bulk- fill Composites to Dentin Under Different Surface Treatments / Evaluación de la resistencia adhesiva de las resinas bulk-fill a la dentina con diferentes tratamientos de superficie

ABSTRACT: Purpose: The aim of this study is to compare the shear bond strength of three high-viscosity bulk-fill composite resins applied as single layers of 4mm thickness and of one microhybrid composite resin applied incrementally with a thickness of 2mm on dentin surfaces prepared with different surface preparation methods. Materials and Methods: A total of 132 caries-free human molars whose dentines had been exposed were used. Three groups, each containing 44 teeth, were formed. The acid group was etched with 32% phosphoric acid; laser group was etched with Er, Cr; YSGG laser and the control group was prepared with silicon carbid paper. Following the application of bonding agent, composite resin materials were applied on teeth using teflon moulds of 4x4mm. The samples were then subjected to shear bond strength tests. Two-way variance analysis and Tukey HSD multiple comparison test were applied on collected data. Results: There was a significant difference between surface treatment methods used regarding shear bond strength (P0.05). Conclusions: Laser etching of the dentin tissues is not as effective as acid etching. Bulk-fill composites had similar effects compared with conventional composite resins with regard to bonding strength. More in vitro studies supported with clinical data are required to investigate the performance of bulk-fill composites and laser.

RESUMEN: Propósito: El objetivo de este estudio es comparar la resistencia adhesiva al cizallamiento de tres resinas compuestas de relleno de alta viscosidad aplicadas como capas individuales de 4 mm de espesor y de una resina compuesta microhíbrida aplicada de forma incremental con un espesor de 2mm en superficies de dentina preparadas con diferentes métodos de preparación de la superficie. Materiales y métodos: Se utilizaron un total de 132 molares humanos sin caries cuyas dentinas habían sido expuestas. Se formaron tres grupos, cada uno con 44 dientes. El grupo ácido se grabó con ácido fosfórico al 32%; el grupo láser se grabó con Er, Cr; el láser YSGG y el grupo de control se preparó con papel de carburo de silicio. Después de la aplicación del agente adhesivo, se aplicaron materiales de resina compuesta en los dientes utilizando moldes de teflón de 4x4mm. A continuación, las muestras se sometieron a pruebas de resistencia adhesiva al cizallamiento. Se aplicó el análisis de varianza bidireccional y la prueba de comparación múltiple Tukey HSD a los datos recogidos. Resultados: Hubo una diferencia significativa entre los métodos de tratamiento de superficie utilizados en cuanto a la resistencia adhesiva al cizallamiento (P0,05). Conclusiones: El grabado láser de los tejidos de la dentina no es tan eficaz como el grabado al ácido. Las resinas de relleno bulk-fill tuvieron efectos similares en comparación con las resinas compuestas convencionales en lo que respecta a la rsistencia adhesiva. Se necesitan más estudios in vitro apoyados con datos clínicos para investigar el rendimiento de los composites de relleno y el láser.

Microhardness homogeneity of RBCs light-cured with a multiple-peak LED and surface characterization after wear

Abstract This in vitro study evaluated the effect of the beam homogeneity of a multiple-peak light-curing unit on the surface microhardness and the effect of toothbrushing wear on the microhardness, surface roughness, roughness profile, volume loss, and gloss retention of incremental and bulk-fill resin-based composites (RBCs). A LED light-curing unit (VALO) with four LEDs at the tip end (405, 445, 465A, and 465B nm emission peak) was used according to each manufacturer-recommended time to obtain disks (n=10) of six RBCs: Estelite Sigma Quick, Charisma Classic, Tetric EvoCeram Bulk Fill, Filtek Z250, Filtek Supreme Ultra, and Filtek Bulk Fill. Microhardness values were obtained according to each LED positioning of the light-curing unit on the top surface of the RBCs and were analyzed before and after toothbrushing regarding microhardness, surface roughness, roughness profile, volume loss, and gloss retention. Microhardness was considered homogeneous on the top surface regardless of the type of RBC or wavelength tested (p>0.05). Overall, toothbrushing did not reduce the microhardness of the RBCs but influenced the gloss values for most RBCs (p<0.001). Charisma Classic presented the greatest surface roughness and roughness profile after toothbrushing (p<0.05). Volume loss did not differ among RBCs (p>0.05). In conclusion, different wavelengths of the LED did not affect the top surface microhardness, regardless of the RBCs tested; and bulk-fill composites presented similar surface changes (microhardness, surface roughness, roughness profile, volume loss, and gloss retention) when compared to conventional composites after toothbrushing.

Resumo Este estudo in vitro avaliou a homogeneidade do feixe de um fotopolimerizador de múltiplos picos na microdureza superficial e o efeito da escovação na microdureza, rugosidade superficial, perfil de rugosidade, perda de volume e retenção do brilho de compósitos a base de resina (RBCs) incrementais ou bulk-fill. Um fotopolimerizador LED (VALO) com quatro LEDs na ponteira (405, 445, 465A e 465B nm de pico de emissão) foi usado de acordo com o tempo recomendado por cada fabricante para obtenção de discos (n=10) de seis RBCs: Estelite Sigma Quick, Charisma Classic, Tetric EvoCeram Bulk Fill, Filtek Z250, Filtek Supreme Ultra e Filtek Bulk Fill. Os valores de microdureza foram obtidos seguindo o posicionamento de cada LED na superfície superior das amostras e foram analisados antes e após a escovação quanto a microdureza, rugosidade superficial, perfil de rugosidade, perda de volume e retenção do brilho. A microdureza foi considerada homogênea no topo da superfície, independentemente do tipo de RBCs ou comprimento de onda testados (p>0.05). No geral, a escovação não reduziu a microdureza das RBCs, mas influenciou o brilho para a maioria das RBCs (p<0.001). Charisma Classic apresentou os maiores valores de rugosidade superficial e perfil de rugosidade após a escovação (p<0.05). A perda de volume não diferiu entre as RBCs (p>0.05). Em conclusão, os diferentes comprimentos de onda do LED não alteraram a microdureza do topo da superfície, independentemente das RBCs testadas; e as resinas bulk-fill apresentaram alterações superficiais similares (microdureza, rugosidade superficial, perfil de rugosidade, perda de volume e manutenção do brilho) quando comparadas às resinas convencionais após a escovação.

Effect of Light Sources on Bond Strength of Different Composite Resins Repaired with Bulk-Fill Composite / Efecto del tipo de fuente luz en la resistencia adhesiva de distintas resinas compuestas reparados con una resina bulk-fill

Abstract: The aim of this study was to evaluate and compare the effects of different light sources on shear bond strength when bulk-fill composite was used for the repair of different composite resins. A total of 126 samples made from six resin composites with different properties were aged (thermal-cycling with 5000 cycle), exposed to the same surface treatments and adhesive procedure. Then, they were repaired with a bulk-fill composite. At the polymerization step, each group was divided into three subgroups (n=7) and light cured with a QTH light source for 40s and two different LED light sources for 20s. Subsequently, the specimens were aged in distilled water at 37 ºC for 4 weeks and then subjected to shear bond strength test. Then, the specimens were examined under a stereomicroscope to identify modes of failure and visualized by Scanning Electron Microscope. Data obtained from the study were analyzed using ANOVA and Tukey HSD Test (α=0.05). In all groups, the light curing units had an impact on shear bond strength (p<0.05). Among the study groups, the greatest bond strength values were observed in the specimens repaired using the LED and the specimens repaired with the QTH light curing unit had the lowest bond strength values. It was concluded that the content of composite resins and light curing units may influence bond strength of different composites repaired with the bulk-fill composite.

Resumen: El objetivo de este estudio fue evaluar y comparar los efectos de diferentes fuentes de luz sobre la resistencia de la unión al cizallamiento cuando se utiliza una resina bulk-fill para la reparación de diferentes resinas compuestas. Se envejecieron un total de 126 muestras fabricadas con seis compuestos de resina con diferentes propiedades (ciclo térmico con 5000 ciclos), expuestas a los mismos tratamientos de superficie y procedimiento adhesivo. Luego, fueron reparadas con una resina bulk- fill. En el paso de polimerización, cada grupo fue dividido en tres subgrupos (n=7) y fotopolimerizado con una fuente de luz QTH por 40s y dos fuentes de luz LED por 20s. Posteriormente, los especímenes se envejecieron en agua destilada a 37 ºC durante 4 semanas y luego se sometieron a una prueba de resistencia adhesiva de cizalla. Luego, los especímenes fueron examinados bajo un estereomicroscopio para identificar los modos de falla y visualizados por el Microscopio Electrónico de Barrido. Los datos obtenidos del estudio fueron analizados usando el ANOVA y la prueba Tukey HSD (α=0.05). En todos los grupos, las unidades de fotopolimerización tuvieron un impacto en la fuerza de adhesión al cizallamiento (p<0,05). Entre los grupos de estudio, los mayores valores de fuerza de adhesión se observaron en los especímenes reparados utilizando el LED y los especímenes reparados con la unidad de fotopolimerización QTH tuvieron los valores de fuerza de adhesión más bajos. Se llegó a la conclusión de que el contenido de las resinas compuestas y las unidades de fotopolimerización pueden influir en la fuerza de adhesión de los diferentes compuestos reparados con resinas bulk-fill.

Alternativas clínicas para el uso de composites Bulk-Fill compactables y fluidos: Reporte de un caso paso a paso / Clinical Alternatives for the Use of Compactable and Flowable Bulk-Fill Composites: A Step-by-Step Case Report

Resumen: El uso de resinas compuestas Bulk-Fill para la restauración de dientes posteriores ha sido masificada en los últimos años en las diferentes disciplinas clínicas de la Odontología. Esto puede deberse principalmente a la simplicidad en la técnica de aplicación de este material ya que requiere de su inserción dentro de la preparación cavitaria en espesores de resina compuesta de hasta 4-5mm, lográndose una reducción considerable de tiempo de trabajo clínico. Ante la existencia de diferentes viscosidades de este tipo de resinas compuestas, ciertas dificultades han sido identificadas ante la selección de cada material Bulk-Fill en relación a las posibles combinaciones que se pueden realizar entre las diferentes marcas disponibles en el mercado, inclusive cuando se usan junto con resinas compuestas convencionales. El objetivo del siguiente reporte de caso, es mostrar dos posibilidades clínicas paso a paso utilizando inicialmente resinas Bulk-Fill compactable en un solo incremento para un segundo molar superior, y luego, a través de la combinación de resinas compuestas Bulk-Fill del tipo fluidas, junto a resinas compuestas Bulk-Fill compactables y resinas compuestas convencionales de estratificación para esmaltes de alto índice de refracción para un primer molar superior.

Abstract: The use of Bulk-Fill composite resins to perform posterior restorations has been massified in recent years in the different clinical disciplines of Dentistry. This may be due mainly to the simplicity in the application technique of this material as it requires its insertion into the cavity preparation in 4-5mm of composite resin thickness, achieving a considerable reduction of clinical working time. Given the existence of different viscosities of this type of composite resins, certain difficulties have been identified before the selection of each Bulk-Fill material related to the possible combinations that can be made between the different brands available in the market, even when they are used with conventional composite resins. The purpose of the following case report, is to present two step-by-step clinical possibilities using initially, compactable Bulk-Fill composite resin in a single increment for the restoration of a second upper molar, and later, through the combination of Bulk-Fill flowable composite resin together with compactable Bulk-Fill composite resin and a high- refractive-index enamel-like conventional composite resin, for a first upper molar.

Cytotoxic Effects of Bulk-Fill Composites on L929 Fibroblast Cells / Efeitos citotóxicos dos compósitos bulk-fill em células de fibroblastos L929

Objective: Unlike traditional composite resins, bulk-fill composite resins could be polymerized as thicker layers. This study aims to contribute to the field by investigating the cytotoxic effects of various bulk-fill composite resins on L929 mouse fibroblast cells in vitro. Material and Methods: In our study, six bulk fill and one conventional composite resin were used. Composite resin samples (8×4 mm) were prepared in a sterile cabinet by using a glass mod and polymerizing with a led light device (DTE LUX E, Germany). Composite samples (n:3) of which surface area was calculated according to ISO 10993-12: 2012 standards (3 cm2/ml), were kept in media for 24 h and 72 h in 37 oC incubator, their extracts were filtered in 1:1 and 1:2 proportion and were added on L929 mouse fibroblast cells. Cell viability was examined by the MTT assay and cell death by the LDH test. Cell viability results were evaluated using one-way analysis of variance (ANOVA) test (p<0.05). Results: When the 1:1 extracts from 4 mm thick bulk-fill composite samples were applied on L929 mouse fibroblast cells, cell viability rates showed significant differences compared to the control group at the end of 24 h and 72 h (except for Estelite Bulk Fill Flow). Although the extracts of the tested composite samples at 1:1 and 1:2 ratio at the end of 72 hours caused a decrease in L929 mouse fibroblast cell viability, the cell viability rate of only PRG-containing bulk fill composite and conventional composite remained below the cell viability ratio (70%) specified in ISO standards. Bulk fill composites did not produce toxic effects (except Beautifil Bulk Restorative) according to the LDH test. Conclusions: Despite decreasing in general the cell viability, bulk-fill composite resins used in 4 mm thick layers provided cell viability rates over the acceptability level, except PRG-containing bulk fill composite (Beautifil Bulk Restorative), which was cytotoxic to L929 mouse fibroblasts. (AU)

Objetivo: Ao contrário das resinas compostas tradicionais, as resinas compostas bulk-fill podem ser polimerizadas como camadas mais espessas. Este estudo visa investigar in vitro os efeitos citotóxicos de várias resinas compostas bulk-fill em células de fibroblastos de camundongo L929.Material e Métodos: Em nosso estudo, seis resinas tipo bulk fill e uma resina composta convencional foram usadas. Amostras de resina composta (8 × 4 mm) foram preparadas em gabinete estéril usando um molde de vidro e polimerizado com um dispositivo de luz LED (DTE LUX E, Alemanha). Amostras compostas (n=3) cuja área de superfície foi calculada de acordo com os padrões ISO 10993-12:2012 (3cm2/ml), foram mantidas em meio e incubadas por 24 h e 72 h a 37 ºC, seus extratos foram filtrados na Proporção de 1:1 e 1:2 e foram acondicionados em cultura de células de fibroblastos de camundongo L929. A viabilidade celular foi examinada pelo ensaio MTT e a morte celular pelo teste LDH. Os resultados de viabilidade celular foram avaliados usando o teste de análise de variância (ANOVA) um fator (p <0,05). Resultados: Quando os extratos foram plaqueados na proporção 1:1 de amostras de compósito bulk-fill de 4 mm de espessura com as células de fibroblastos de camundongo L929, as taxas de viabilidade celular mostraram diferenças significativas em comparação com o grupo controle no final de 24 h e 72 h (exceto para Estelite Bulk Fluxo de enchimento). Embora os extratos das amostras compostas testadas na proporção de 1:1 e 1:2 ao final de 72 horas tenham causado uma diminuição na viabilidade das células de fibroblastos de camundongo L929, a taxa de viabilidade celular apenas do compósito de preenchimento total contendo PRG e o compósito convencional permaneceram abaixo a taxa de viabilidade celular (70%) especificada nas normas ISO. Os compósitos de preenchimento a granel não produziram efeitos tóxicos (exceto Beautifil Bulk Restorative) de acordo com o teste de LDH. Conclusão: Apesar de diminuir em geral a viabilidade celular, as resinas compostas bulk-fill usadas em camadas de 4 mm de espessura forneceram taxas de viabilidade celular acima do nível aceitável, exceto o compósito bulk fill contendo PRG (Beautifil Bulk Restorative), que foi citotóxico para fibroblastos de camundongos L929 (AU)

Clinical evaluation of bulk-fill composite resin combined with transparent preformed crown for aesthetic restoration of deciduous incisor / 口腔疾病防治

Objective@#To explore the clinical effect of bulk-fill composite resin combined with transparent preformed crowns for aesthetic restoration of deciduous incisor of children.@*Methods@#A predesigned clinical prospective randomized controlled research method was used to select 90 patients (123 teeth). The random number table method was divided into three groups: A, B, and C. Group A was treated with a bulk-fill composite resin of SF (SonicFill) combined with a transparent preformed crown (41 teeth in 30 cases), and group B was treated with a large block of Tetric N-Ceram Bulk Fill Composite resin combined with transparent preformed crowns (39 teeth in 29 cases). Group C was treated with 3M Z350 XT universal nano resin combined with transparent preformed crowns (43 teeth in 31 cases). The visual analog scale (VAS) and the modified USPHS standard were used to evaluate the completeness, marginal steps, marginal discoloration, surface condition, secondary caries and satisfaction of the parents with prostheses after 12 months.@*Results @#Twelve months after the operation, the evaluation indexes of group A were better than those of group B and group C, and the differences were statistically significant, including edge integrity (χ2=10.847, P=0.028), edge step (χ2=7.799, P=0.020), edge discoloration (χ2=10.391, P=0.034), surface state (χ2=11.476, P=0.021), and secondary caries (χ2=10.447, P=0.034). The satisfaction of parents in group A on the overall contour (χ2=10.238, P=0.037), shape and texture (χ2=11.521, P=0.021) were better than those in group B and group C, and the differences were statistically significant. There was no significant difference in the evaluation of color satisfaction among the three groups (χ2=0.990, P=0.610).@* Conclusion@#SonicFill bulk-fill composite resin combined with transparent preformed crown is good for short-term aesthetic restoration of deciduous incisor, and parental satisfaction is high.

Técnica bulk-fill comparada con técnica incremental para restauraciones posteriores en pacientes con dentición permanente / Bulk-fill technique versus conventional resin composite for posterior restorations in permanent teeth

RESUMEN: Introducción: Las restauraciones en el sector posterior son generalmente manejadas mediante el uso de resinas convencionales con técnica incremental. Debido a diversas limitaciones de la técnica convencional, la técnica bulk-fill ha ganado relevancia en la práctica clínica. Este resumen tiene como objetivo evaluar la efectividad de ambas técnicas al momento de realizar restauraciones clase I y clase II de Black en dientes posteriores permanentes. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos cinco revisiones sistemáticas que en conjunto incluyeron 15 estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que la técnica bulk-fill podría aumentar levemente el fracaso de la restauración a mediano plazo, podría resultar en poca o nula diferencia en el fracaso de la restauración a largo plazo y podría resultar en poca o nula diferencia en el desarrollo de caries secundaria, pero la certeza de la evidencia es baja. La técnica bulk-fill probablemente resulta en poca o nula diferencia en el riesgo de sensibilidad postoperatoria.

ABSTRACT: Introduction: Conventional resin composite has been widely used in the restoration of posterior teeth. However, due to its limitations, the bulk-fill technique has been adopted by clinicians. This evidence summary aims to evaluate the effectiveness of both techniques for class I and II restorations in permanent posterior teeth. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified five systematic reviews including fifteen studies overall, of which all were randomized trials. We conclude that bulk-fill technique may slightly improve the risk of medium-term restoration failure, may make little or no difference to long-term restoration failure and may make little or no difference to secondary caries but the certainty of the evidence has been assessed as low. Finally, bulk-fill technique probably makes little or no difference to postoperative sensibility.

Solving color irregularities with a bioactive bulk-fill restorative system: case report and 24-months follow up / Resolución de irregularidades de color con un sistema restaurador bulk-fill bioactivo: reporte de caso y seguimiento de 24 meses

Bulk-fill resin composites represent an excellent alternative to the conventional incremental layering technique for the reduction of polymerization stress on the adhesive interface. Marginal seal can be further improved by the incorporation of bioactive fillers, such as those encountered in Giomers. However, the high translucency required for the adequate polymerization of bulk-fill materials can seriously jeopardize the final aesthetic outcome of the restorations, especially in the presence of inhomogeneous or stained dentin substrates. The aim of this case report was to present the combined use of two bulk-fill Giomer materials (Beautifil Bulk Flowable and Beautifil II LS, Shofu) for the restoration of three posterior maxillary teeth displaying a black stained dentin substrate due to amalgam corrosion products. This technique allowed completion of the restorations with a satisfactory aesthetic and biomimetic outcome. The adequate preservation of the anatomy and function of the three restorations after 24-months follow-up, provides evidence of the enhanced marginal sealing capacity of these bioactive materials and the success of bulk-fill techniques over time.

Las resinas compuestas de tipo bulk-fill representan una excelente alternativa a la técnica incremental para la reducción de la tensión de polimerización sobre la interfaz adhesiva. La incorporación de rellenos bioactivos, como los que se encuentran en los materiales con tecnología giomer, refuerzan aún más el sellado marginal de estas restauraciones. Sin embargo, la alta translucidez, necesaria para la adecuada polimerización de los materiales tipo bulk-fill, puede comprometer seriamente el resultado estético final de las restauraciones, especialmente en presencia de sustratos dentarios no homogéneos u oscurecidos. El objetivo de este reporte de caso fue presentar el uso combinado de dos materiales giomer tipo bulk-fill (Beautifil Bulk Flowable y Beautifil II LS, Shofu) para la restauración de tres dientes maxilares posteriores con un sustrato dentinario ennegrecido debido a productos de corrosión de amalgama. Esta técnica permitió completar las restauraciones con un resultado estético y biomimético satisfactorio. La adecuada conservación de la anatomía y la función de las tres restauraciones tras un período de 24 meses, aporta evidencia sobre la adecuada capacidad de sellado marginal de estos materiales bioactivos y el éxito de las técnicas de restauración tipo bulk-fill en el tiempo.

The effect of different finishing and polishing procedures on the surface gloss of Bulk-Fill resin composites

STATEMENT OF THE PROBLEM: The literature still lacks evidence regarding which polishing techniques have the ideal clinical outcomes for bulk-fill resin composites. PURPOSE: This study evaluated the surface gloss of two commercially available bulk-fill resin composites after different polishing procedures and characterized their micromorphology via scanning electron microscopy. MATERIAL AND METHODS: 80 bulk-fill compactable composite resin discs were created. The control group was left untreated, and remaining samples were subjected to different polishing techniques. Gloss units were measured and surface morphology of disc samples was assessed. The Tukey post-hoc test was used to identify any differences. RESULTS: Statistically significant differences were found between the different polishing systems applied to Filtek BulkFill Posterior and Tetric N Bulk-Fill. No differences were found when the same polishing system was applied for both resins. The highest gloss values were obtained in the control group and the ENA Shiny system; the lowest were obtained with SofLex XT and Soflex Spiral Wheels for the bulk-fill composite resins studied. CONCLUSIONS. Diamond pastes have the highest gloss behavior, followed by diamond rubber points. The systems with aluminum oxide discs present the lower gloss behavior. SEM images provided useful evidence, and future studies should include an evaluation over time.