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Comparison of Premolar
Cuspal Deflection in Bulk
or in Incremental
Composite Restoration
Methods
ME Kim SH Park
Clinical Relevance
For class II composite restorations, choosing composites with a low shrinkage value and
elastic modulus, applying an incremental filling technique of more than three layers, and
polymerizing them with sufficient curing time are needed to reduce the cuspal deflection,
which is induced by the polymerization shrinkage stress of composites.
SUMMARY
Objectives: This study examined the cuspal
deflection of maxillary premolars when either
a bulk filling or incremental filling technique
was employed using a range of composites
with different elastic moduli.
Methods: Four brands of composite materials,
Heliomolar (HM, Ivoclar Vivadent, Schaan,
Liechtenstein), Heliomolar HB (HH, Ivoclar
Vivadent, Schaan, Liechtenstein), Filtec Supreme XT (FS, 3M Dental Product, St Paul,
Myeung-Eun Kim, DDS, PhD, Department of Conservative
Dentistry, Yonsei University, Seoul, Korea
*Sung-Ho Park, DDS, PhD, professor, Department of Conservative Dentistry, Yonsei University, Seoul, Korea
*Corresponding author: Department of Conservative Dentistry, Yonsei University, 134, Shinchon-Dong, Seodaemun-Gu, Seoul, Korea, 120752; e-mail: sunghopark@
yuhs.ac
DOI: 10.2341/10-315-L
MN, USA), and Renew (RN, Bisco Inc, Schaumburg, IL, USA), as well as three filling techniques, bulk filling, two-layer incremental
filling, and three-layer incremental filling
methods, were used. One hundred twenty
caries-free human premolars were collected
and divided into four groups according to the
filling material used. Each of these four groups
was then subdivided into three groups according to filling method. In group 1, a bulk filling
of 0.15 g of each resin was inserted and lightcured with LED light from the occlusal, mesial,
and distal surfaces for 60 seconds each. Group
2 was given two horizontal increments, 0.08 g
and 0.07 g, with each increment light-cured
from the occlusal, mesial, and distal surfaces
for 30 seconds each. In group 3, three horizontal increments of 0.05 g were used, each of
which was light-cured from the occlusal, mesial, and distal surfaces for 20 seconds each. The
cuspal deflection was measured using a cus-
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Operative Dentistry
328
through greater elastic deformation, which is transferred to the lower levels of cusp deformation.
However, Lee and Park,27 in their in vitro study in
which the amount of polymerization shrinkage and
cuspal deflection was measured using composites
with a known elastic modulus and filler content,
reported that even flexible composites could lead to
greater cuspal deflection than rigid composites. They
suggested that this was possible because both the
amount of polymerization shrinkage and elastic
modulus appeared to affect the cuspal deflection.
The incorporation of less inorganic fillers and
flexible monomers into the composites could help
decrease the elastic modulus but might increase the
amount of polymerization shrinkage significantly.
Therefore, selecting composites with different elastic
moduli but a similar amount of shrinkage would be
needed to examine the influence of the elastic
modulus on cuspal deflection.
The cuspal deflection might be affected differently
in composites with different moduli when a bulk
filling or incremental filling technique is applied.
Rees and others25 and Hyun and Park20 reported no
difference in cuspal deflection between the bulk and
incrementally filled composites. Interestingly, they
used Heliomolar as a filling material, which has a
low elastic modulus.28 A comparison of the cuspal
deflection of a bulk filled or incrementally filled tooth
in which composites with different elastic moduli are
used might provide an answer to this controversy.
This study compared the cuspal deflection of the
maxillary premolars when a bulk filling and incremental filling technique were employed using composites with different elastic moduli. In this study,
sufficient light-curing time was applied to prevent
incomplete cure of the composites. In addition,
composites with a similar amount of polymerization
shrinkage but different elastic moduli were selected.
Code
Manufacturer
Volumetric
shrinkage (%)
Heliomolar
HM
Ivoclar Vivadent,
Schaan, Liechtenstein
3.2
Heliomolar HB
HH
Ivoclar Vivadent,
Schaan, Liechtenstein
3.3
Filtec supreme
XT
FS
3M Dental Products, St
Paul, Minn, USA
2.8
Renew
RN
Bisco Inc,
Schaumburg, IL, USA
3.1
Table 2:
Composite, g
Curing time, s
Group 1
Bulk filling
0.15
606060
Group 2
Two-layer
increments
0.80.7
(303030)
(303030)
Group 3
Three-layer
increments
0.50.50.5
(202020)
(202020)
(202020)
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330
F1l3
;
4bh3 d
Group 2
Group 3
Heliomolar
Heliomolar HB
19.33 6 3.48a
16.17 6 1.37b
14.33 6 1.92b
12.45 6 1.07b
11.58 6 2.27b
Renew
12.02 6 2.37b
10.33 6 1.65b
14.43 6 0.56a
a
Small letters a, b beside figures represent the results of statistical analysis
of one-way analysis of variance with a Tukey test in each material. a and b
are different at the p0.05 level.
Table 4:
331
Source
Corrected model
df
Significance
11
67.501
14.264
0.000
22,222.136
22,222.136
4695.995
0.000
Material
371.934
123.978
26.199
0.000
Method
362.830
181.415
38.337
0.000
7.742
1.290
.273
0.949
Error
511.072
108
4.732
Total
23,475.714
120
1253.578
119
Intercept
Material3method
Corrected total
742.506(a)
Mean square
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332
Figure 4. Change in the amount of cuspal deflection as a function of time in (a) HM, (b) HH, (c) FS, and (d) RN.
D, mm
E, GPa
Heliomolar
10
0.44 6 0.03
2.81 6 0.23a
Heliomolar HB
10
0.16 6 0.01
7.76 6 1.00d
Filtec supreme XT
10
0.34 6 0.03
3.64 6 0.41b
Renew
10
0.29 6 0.02
4.32 6 0.37c
333
REFERENCES
1. Lien W & Vandewalle KS (2010) Physical properties of a
new silorane-based restorative system Dental Materials
26(4) 337-344.
2. Stansbury JW (1992) Synthesis and evaluation of novel
multifunctional oligomers for dentistry Journal of Dental
Research 71(3) 434-437.
3. Jensen ME & Chan DCN (1985) Polymerization shrinkage and microlekage In: Vanherle G, Smith DC (eds)
Posterior Composite Resin Dental Restorative Materials
3M Co, St Paul, Minn 243262.
4. Suliman AA, Boyer DB & Lakes RS (1993) Cusp
movement in premolars resulting from composite polymerization shrinkage Dental Materials 9(1) 6-10.
5. Causton BE, Miller B & Sefton J (1985) The deformation
of cusps by bonded posterior composite restorations: an in
vitro study British Dental Journal 159(12) 397-400.
6. Pearson GJ & Hegarty SM (1987) Cusp movement in
molar teeth using dentine adhesives and composite filling
materials Biomaterials 8(6) 473-476.
7. Lutz F, Krejci I & Barbakow F (1991) Quality and
durability of marginal adaptation in bonded composite
restorations Dental Materials 7(2) 107-113.
8. Lee SY & Park SH (2006) Correlation between the
amount of linear polymerization shrinkage and cuspal
deflection Operative Dentistry 31(3) 364-370.
9. Abbas G, Fleming GJ, Harrington E, Shortall AC & Burke
FJ (2003) Cuspal movement and microleakage in premolar teeth restored with a packable composite cured in bulk
or in increments Journal of Dentistry 31(6) 437-444.
10. Cara RR, Fleming GJ, Palin WM, Walmsley AD & Burke
FJ (2007) Cuspal deflection and microleakage in premolar
teeth restored with resin-based composites with and
without an intermediary flowable layer Journal of
Dentistry 35(6) 482-489.
16. Lee M-R & Lee I-B (2004) Influence of cavity size and
restoration methods on the cusp deflection in composite
restoration Journal of the Korean Academy of Conservative Dentistry 6 532-540.
17. Meredith N & Setchell DJ (1997) In vitro measurement of
cuspal strain and displacement in composite restored
teeth Journal of Dentistry 25(3-4) 331-337.
18. Ausiello P, Apicella A, Davidson CL & Rengo S (2001) 3Dfinite element analyses of cusp movements in a human
upper premolar, restored with adhesive resin-based
composites Journal of Biomechanics 34(10) 1269-1277.
19. Segura A & Donly KJ (1993) In vitro posterior composite
polymerization recovery following hygroscopic expansion
Journal of Oral Rehabilitation 20(5) 495-499.
20. Hyun JY & Park SH (2006) Comparison of cuspal
deflection according to different placement techniques of
composite resin Masters Thesis of the Graduate School
Yonsei University. Seoul, Korea.
21. McCullock AJ & Smith BG (1986) In vitro studies of
cuspal movement produced by adhesive restorative
materials British Dental Journal 161(11) 405-409.
22. Versluis A, Douglas WH, Cross M & Sakaguchi RL (1996)
Does an incremental filling technique reduce polymerization shrinkage stresses? Journal of Dental Research 75(3)
871-878.
23. Versluis A, Douglas WH, Cross M & Sakaguchi RL (1996)
Does an incremental filling technique reduce polymerization shrinkage stresses? Journal of Dental Research 75(3)
871-878.
24. Crim GA & Chapman KW (1986) Prevention of marginal
leakage by four dentinal adhesives General Dentistry
34(3) 235-236.
25. Rees JS, Jagger DC, Williams DR, Brown G & Duguid W
(2004) A reappraisal of the incremental packing technique for light cured composite resins Journal of Oral
Rehabilitatio 31(1) 81-84.
334
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