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Kaisarly, Dalia; El Gezawi, Moataz; Keßler, Andreas; Rösch, Peter and Kunzelmann, Karl-Heinz (2020): Shrinkage vectors in flowable bulk-fill and conventional composites: bulk versus incremental application. In: Clinical oral investigations, Vol. 25, No. 3: pp. 1127-1139 [PDF, 7MB]


OBJECTIVES Sufficient depth of cure allows bulk-fill composites to be placed with a 4-mm thickness. This study investigated bulk versus incremental application methods by visualizing shrinkage vectors in flowable bulk-fill and conventional composites. MATERIALS AND METHODS Cylindrical cavities (diameter = 6 mm, depth = 4 mm) were prepared in 24 teeth and then etched and bonded with OptiBond FL (Kerr, Italy). The composites were mixed with 2 wt% radiolucent glass beads. In one group, smart dentin replacement (SDR, Dentsply) was applied in bulk "SDR-bulk" (n = 8). In two groups, SDR and Tetric EvoFlow (Ivoclar Vivadent) were applied in two 2-mm-thick increments: "SDR-incrementa" and "EvoFlow-incremental". Each material application was scanned with a micro-CT before and after light-curing (40 s, 1100 mW/cm2), and the shrinkage vectors were computed via image segmentation. Thereafter, linear polymerization shrinkage, shrinkage stress and gelation time were measured (n = 10). RESULTS The greatest shrinkage vectors were found in "SDR-bulk" and "SDR-increment2," and the smallest were found in "SDR-increment1-covered" and "EvoFlow-increment1-covered." Shrinkage away from and toward the cavity floor was greatest in “SDR-bulk“ and “EvoFlow-increment2", respectively. The mean values of the shrinkage vectors were significantly different between groups (one-way ANOVA, Tamhane's T2 test, p < 0.05). The linear polymerization shrinkage and shrinkage stress were greatest in Tetric EvoFlow, and the gelation time was greatest in "SDR-bulk". CONCLUSIONS The bulk application method had greater values of shrinkage vectors and a higher debonding tendency at the cavity floor. CLINICAL RELEVANCE Incremental application remains the gold standard of composite insertion.

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