A randomized, prospective clinical study evaluating effectiveness of a bulk-fill composite resin, a conventional composite resin and a reinforced glass ionomer in Class II cavities: one-year results

Abstract

Objectives: Bulk-fill restorative materials such as bulk-fill composite resins and high viscous glass ionomer cements have become very popular materials in operative dentistry because their application is easy and time-saving. The aim of this clinical study was to evaluate the clinical performance of a highly viscous reinforced glass ionomer material, a bulk-fill composite resin and a micro hybrid composite resin in Class II restorations.

Methodology: In total, 109 Class II restorations were performed in 54 patients using three different restorative materials: Charisma Smart Composite (CSC); Filtek Bulk Fill Posterior Restorative (FBF); Equia Forte Fil (EF). Single Bond Universal adhesive (3M ESPE, Germany) was used with composite resin restorations. The restorations were evaluated using modified USPHS criteria in terms of retention, color match, marginal discoloration, anatomic form, contact point, marginal adaptation, secondary caries, postoperative sensitivity and surface texture. The data were analyzed using Chi-Square, Fischer's and McNemar's tests.

Results: At the end of one year, 103 restorations were followed up. No changes were observed during the first 6 months. At the end of one year, there were small changes in composite restorations (FBF and CSC) but no statistically significant difference was observed between the clinical performances of these materials for all criteria (p>0.05). However, there was a statistically significant difference between EF, FBF and CSC groups in all parameters except marginal discoloration, secondary caries and postoperative sensitivity in one-year evaluation (p<0.05).

Conclusion: Bulk-fill composite resins and conventional composite resins showed more successful clinical performance than highly viscous reinforced glass ionomers in Class II cavities.

Conflict of interest statement

Conflict of interest

The authors declare no conflicts of interest.

Figures

Figure 1. Materials, compositions and batch numbers

Figure 2. Inclusion and exlusion criteria

Figure 3. Modified United States Public Health Service (USPHS) criteria used in this study

Figure 4. Restorations scored as “Charlie” because of marginal fracture in the EF group at one-year evaluation

Figure 5. Glass ionomer material loss that could be radiographically seen in the proximal area as a result of dissolution

Figure 6. a,b) Restorations scored as “Alpha” for all criteria in the FBF group at one-year evaluation. c,d) Restorations scored as “Alpha” for all criteria in the CSC group at one-year evaluation

Figure 7. Clinical appearance of some EF restorations at one-year evaluation

References

1. 1. Andrade AK, Duarte RM, Medeiros e Silva FD, Batista AU, Lima KC, Pontual ML, et al. 30-Month randomised clinical trial to evaluate the clinical performance of a nanofill and a nanohybrid composite. J Dent. 2011;39(1):8–15.
   2. 1- Andrade AK, Duarte RM, Medeiros e Silva FD, Batista AU, Lima KC, Pontual ML, et al. 30-Month randomised clinical trial to evaluate the clinical performance of a nanofill and a nanohybrid composite. J Dent. 2011;39(1):8-15.
2. 1. Chesterman J, Jowett A, Gallacher A, Nixon P. Bulk-fill resin-based composite restorative materials: a review. Br Dent J. 2017;222(5):337–344.
   2. 2- Chesterman J, Jowett A, Gallacher A, Nixon P. Bulk-fill resin-based composite restorative materials: a review. Br Dent J. 2017;222(5):337-44.
3. 1. Turkun LS, Aktener BO, Ates M. Clinical evaluation of different posterior resin composite materials: a 7-year report. Quintessence Int. 2003;34(6):418–426.
   2. 3- Turkun LS, Aktener BO, Ates M. Clinical evaluation of different posterior resin composite materials: a 7-year report. Quintessence Int. 2003;34(6):418-26.
4. 1. Ferracane JL, Hilton TJ. Polymerization stress: is it clinically meaningful? Dent Mater. 2016;32(1):1–10.
   2. 4- Ferracane JL, Hilton TJ. Polymerization stress: is it clinically meaningful? Dent Mater. 2016;32(1):1-10.
5. 1. Zorzin J, Maier E, Harre S, Fey T, Belli R, Lohbauer U, et al. Bulk-fill resin composites: polymerization properties and extended light curing. Dent Mater. 2015;31(3):293–301.
   2. 5- Zorzin J, Maier E, Harre S, Fey T, Belli R, Lohbauer U, et al. Bulk-fill resin composites: polymerization properties and extended light curing. Dent Mater. 2015;31(3):293-301.
6. 1. Ferracane JL. Buonocore Lecture. Placing dental composites: a stressful experience. Oper Dent. 2008;33(3):247–257.
   2. 6- Ferracane JL. Buonocore Lecture. Placing dental composites: a stressful experience. Oper Dent. 2008;33(3):247-57.
7. 1. Ilie N, Hickel R. Investigations on a methacrylate-based flowable composite based on the SDR technology. Dent Mater. 2011;27(4):348–355.
   2. 7- Ilie N, Hickel R. Investigations on a methacrylate-based flowable composite based on the SDR technology. Dent Mater. 2011;27(4):348-55.
8. 1. Ilie N, Bucuta S, Draenert M. Bulk-fill resin-based composites: an in vitro assessment of their mechanical performance. Oper Dent. 2013;38(6):618–625.
   2. 8- Ilie N, Bucuta S, Draenert M. Bulk-fill resin-based composites: an in vitro assessment of their mechanical performance. Oper Dent. 2013;38(6):618-25.
9. 1. Garoushi S, Vallittu P, Shinya A, Lassila L. Influence of increment thickness on light transmission, degree of conversion and micro hardness of bulk fill composites. Odontology. 2016;104(3):291–297.
   2. 9- Garoushi S, Vallittu P, Shinya A, Lassila L. Influence of increment thickness on light transmission, degree of conversion and micro hardness of bulk fill composites. Odontology. 2016;104(3):291-7.
10. 1. Burke FJ. Dental materials: what goes where? The current status of glass ionomer as a material for loadbearing restorations in posterior teeth. Dent Update. 2013;40(10):840–844.
    2. 10- Burke FJ. Dental materials: what goes where? The current status of glass ionomer as a material for loadbearing restorations in posterior teeth. Dent Update. 2013;40(10):840-4.
11. 1. Berg JH, Croll TP. Glass ionomer restorative cement systems: an update. Pediatr Dent. 2015;37(2):116–124.
    2. 11- Berg JH, Croll TP. Glass ionomer restorative cement systems: an update. Pediatr Dent. 2015;37(2):116-24.
12. 1. Friedl K, Hiller KA, Friedl KH. Clinical performance of a new glass ionomer based restoration system: a retrospective cohort study. Dent Mater. 2011;27(10):1031–1037.
    2. 12- Friedl K, Hiller KA, Friedl KH. Clinical performance of a new glass ionomer based restoration system: a retrospective cohort study. Dent Mater. 2011;27(10):1031-7.
13. 1. Çelik EU, Tunac AT, Yilmaz F. A randomized, controlled, split-mouth trial evaluating the clinical performance of high-viscosity glass-ionomer restorations in noncarious cervical lesions: two-year results. J Adhes Dent. 2018;20(4):299–305.
    2. 13- Çelik EU, Tunac AT, Yilmaz F. A randomized, controlled, split-mouth trial evaluating the clinical performance of high-viscosity glass-ionomer restorations in noncarious cervical lesions: two-year results. J Adhes Dent. 2018;20(4)299-305.
14. 1. Wang XY, Yap AU, Ngo HC. Effect of early water exposure on the strength of glass ionomer restoratives. Oper Dent. 2006;31(5):584–589.
    2. 14- Wang XY, Yap AU, Ngo HC. Effect of early water exposure on the strength of glass ionomer restoratives. Oper Dent. 2006;31(5):584-9.
15. 1. Bagheri R, Palamara J, Mese A, Manton DJ. Effect of a self-adhesive coating on the load-bearing capacity of tooth-colored restorative materials. Aust Dent J. 2017;62(1):71–78.
    2. 15- Bagheri R, Palamara J, Mese A, Manton DJ. Effect of a self-adhesive coating on the load-bearing capacity of tooth-colored restorative materials. Aust Dent J. 2017;62(1):71-8.
16. 1. Gurgan S, Kutuk ZB, Ergin E, Oztas SS, Cakir FY. Clinical performance of a glass ionomer restorative system: a 6-year evaluation. Clin Oral Investig. 2017;21(7):2335–2343.
    2. 16- Gurgan S, Kutuk ZB, Ergin E, Oztas SS, Cakir FY. Clinical performance of a glass ionomer restorative system: a 6-year evaluation. Clin Oral Investig. 2017;21(7):2335-43.
17. 1. Ozturk AN, Ozturk B, Aykent F. Microleakage of different cementation techniques in Class V ceramic inlays. J Oral Rehabil. 2004;31(12):1192–1196.
    2. 17- Ozturk AN, Ozturk B, Aykent F. Microleakage of different cementation techniques in Class V ceramic inlays. J Oral Rehabil. 2004;31(12):1192-6.
18. 1. Demarco FF, Corrêa MB, Cenci MS, Moraes RR, Opdam NJ. Longevity of posterior composite restorations: not only a matter of materials. Dent Mater. 2012;28(1):87–101.
    2. 18- Demarco FF, Corrêa MB, Cenci MS, Moraes RR, Opdam NJ. Longevity of posterior composite restorations: not only a matter of materials. Dent Mater. 2012;28(1):87-101.
19. 1. Sabbagh J, Dagher S, El Osta N, Souhaid P. Randomized clinical trial of a self-adhering flowable composite for class i restorations: 2-year results. Int J Dent. 2017;2017:5041529–5041529.
    2. 19- Sabbagh J, Dagher S, El Osta N, Souhaid P. Randomized clinical trial of a self-adhering flowable composite for class i restorations: 2-year results. Int J Dent. 2017;2017:5041529.
20. 1. Raskin A, Setcos JC, Vreven J, Wilson NH. Influence of the isolation method on the 10-year clinical behaviour of posterior resin composite restorations. Clin Oral Investig. 2000;4(3):148–152.
    2. 20- Raskin A, Setcos JC, Vreven J, Wilson NH. Influence of the isolation method on the 10-year clinical behaviour of posterior resin composite restorations. Clin Oral Investig. 2000;4(3):148-52.
21. 1. Souza FB, Guimarães RP, Silva CH. A clinical evaluation of packable and microhybrid resin composite restorations: one-year report. Quintessence Int. 2005;36(1):41–48.
    2. 21- Souza FB, Guimarães RP, Silva CH. A clinical evaluation of packable and microhybrid resin composite restorations: one-year report. Quintessence Int. 2005;36(1):41-8.
22. 1. Sarrett DC. Clinical challenges and the relevance of materials testing for posterior composite restorations. Dent Mater. 2005;21(1):9–20.
    2. 22- Sarrett DC. Clinical challenges and the relevance of materials testing for posterior composite restorations. Dent Mater. 2005;21(1):9-20.
23. 1. Perdigão J, Kose C, Mena-Serrano AP, Paula EA, Tay LY, Reis A, et al. A new universal simplified adhesive: 18-month clinical evaluation. Oper Dent. 2014;39(2):113–127.
    2. 23- Perdigão J, Kose C, Mena-Serrano AP, Paula EA, Tay LY, Reis A, et al. A new universal simplified adhesive: 18-month clinical evaluation. Oper Dent. 2014;39(2):113-27.
24. 1. Loguercio AD, Paula EA, Hass V, Luque-Martinez I, Reis A, Perdigão J. A new universal simplified adhesive: 36-Month randomized double-blind clinical trial. J Dent. 2015;43(9):1083–1092.
    2. 24- Loguercio AD, Paula EA, Hass V, Luque-Martinez I, Reis A, Perdigão J. A new universal simplified adhesive: 36-Month randomized double-blind clinical trial. J Dent. 2015;43(9):1083-92.
25. 1. Marchesi G, Frassetto A, Mazzoni A, Apolonio F, Diolosa M, Cadenaro M, et al. Adhesive performance of a multi-mode adhesive system: 1-year in vitro study. J Dent. 2014;42(5):603–612.
    2. 25- Marchesi G, Frassetto A, Mazzoni A, Apolonio F, Diolosa M, Cadenaro M, et al. Adhesive performance of a multi-mode adhesive system: 1-year in vitro study. J Dent. 2014;42(5):603-12.
26. 1. Wagner A, Wendler M, Petschelt A, Belli R, Lohbauer U. Bonding performance of universal adhesives in different etching modes. J Dent. 2014;42(7):800–807.
    2. 26- Wagner A, Wendler M, Petschelt A, Belli R, Lohbauer U. Bonding performance of universal adhesives in different etching modes. J Dent. 2014;42(7):800-7.
27. 1. Muñoz MA, Luque I, Hass V, Reis A, Loguercio AD, Bombarda NH. Immediate bonding properties of universal adhesives to dentine. J Dent. 2013;41(5):404–411.
    2. 27- Muñoz MA, Luque I, Hass V, Reis A, Loguercio AD, Bombarda NH. Immediate bonding properties of universal adhesives to dentine. J Dent. 2013;41(5):404-11.
28. 1. McLean DE, Meyers EJ, Guillory VL, Vandewalle KS. Enamel bond strength of new universal adhesive bonding agents. Oper Dent. 2015;40(4):410–417.
    2. 28- McLean DE, Meyers EJ, Guillory VL, Vandewalle KS. Enamel bond strength of new universal adhesive bonding agents. Oper Dent. 2015;40(4):410-7.
29. 1. Colak H, Tokay U, Uzgur R, Hamidi MM, Ercan E. A prospective, randomized, double-blind clinical trial of one nano-hybrid and one high-viscosity bulk-fill composite restorative systems in class II cavities: 12 months results. Niger J Clin Pract. 2017;20(7):822–831.
    2. 29- Colak H, Tokay U, Uzgur R, Hamidi MM, Ercan E. A prospective, randomized, double-blind clinical trial of one nano-hybrid and one high-viscosity bulk-fill composite restorative systems in class II cavities: 12 months results. Niger J Clin Pract. 2017;20(7):822-31.
30. 1. Bayraktar Y, Ercan E, Hamidi MM, Çolak H. One-year clinical evaluation of different types of bulk-fill composites. J Investig Clin Dent. 2017;8(2):e12210
    2. 30- Bayraktar Y, Ercan E, Hamidi MM, Çolak H. One-year clinical evaluation of different types of bulk-fill composites. J Investig Clin Dent. 2017;8(2):e12210.
31. 1. Yazici AR, Antonson SA, Kutuk ZB, Ergin E. Thirty-six-month clinical comparison of bulk fill and nanofill composite restorations. Oper Dent. 2017;42(5):478–485.
    2. 31- Yazici AR, Antonson SA, Kutuk ZB, Ergin E. Thirty-six-month clinical comparison of bulk fill and nanofill composite restorations. Oper Dent. 2017;42(5):478-85.
32. 1. Diem VT, Tyas MJ, Ngo HC, Phuong LH, Khanh ND. The effect of a nano-filled resin coating on the 3-year clinical performance of a conventional high-viscosity glass-ionomer cement. Clin Oral Investig. 2014;18(3):753–759.
    2. 32- Diem VT, Tyas MJ, Ngo HC, Phuong LH, Khanh ND. The effect of a nano-filled resin coating on the 3-year clinical performance of a conventional high-viscosity glass-ionomer cement. Clin Oral Investig. 2014;18(3):753-9.
33. 1. Tal E, Kupietzky A, Fuks AB, TicMoskovitz M. Clinical performance of heat-cured high-viscosity glass kotsky n, ıonomer class II restorations in primary molars: a preliminary study. J Clin Pediatr Dent. 2017;41(4):264–270.
    2. 33- Tal E, Kupietzky A, Fuks AB, TicMoskovitz M. Clinical performance of heat-cured high-viscosity glass kotsky n, ıonomer class II restorations in primary molars: a preliminary study. J Clin Pediatr Dent. 2017;41(4):264-70.
34. 1. Scholtanus JD, Huysmans MC. Clinical failure of class-II restorations of a highly viscous glass-ionomer material over a 6-year period: a retrospective study. J Dent. 2007;35(2):156–162.
    2. 34- Scholtanus JD, Huysmans MC. Clinical failure of class-II restorations of a highly viscous glass-ionomer material over a 6-year period: a retrospective study. J Dent. 2007;35(2):156-62.
35. 1. Alvanforoush N, Wong R, Burrow M, Palamara J. Fracture toughness of glass ionomers measured with two different methods. J Mech Behav Biomed Mater. 2019;90:208–216.
    2. 35- Alvanforoush N, Wong R, Burrow M, Palamara J. Fracture toughness of glass ionomers measured with two different methods. J Mech Behav Biomed Mater. 2019;90:208-16.
36. 1. Rosa Rodolpho PA, Cenci MS, Donassollo TA, Loguércio AD, Demarco FF. A clinical evaluation of posterior composite restorations: 17-year findings. J Dent. 2006;34(7):427–435.
    2. 36- Rosa Rodolpho PA, Cenci MS, Donassollo TA, Loguércio AD, Demarco FF. A clinical evaluation of posterior composite restorations: 17-year findings. J Dent. 2006;34(7):427-35.
37. 1. Hesse D, Bonifácio CC, Kleverlaan CJ, Raggio DP. Clinical wear of approximal glass ionomer restorations protected with a nanofilled self-adhesive light-cured protective coating. J Appl Oral Sci. 2018;26:e20180094.
    2. 37- Hesse D, Bonifácio CC, Kleverlaan CJ, Raggio DP. Clinical wear of approximal glass ionomer restorations protected with a nanofilled self-adhesive light-cured protective coating. J Appl Oral Sci. 2018;26:e20180094.
38. 1. Menezes-Silva R, Velasco SR, Bastos RS, Molina G, Honório HM, Frencken JE, et al. Randomized clinical trial of class II restoration in permanent teeth comparing ART with composite resin after 12 months. Clin Oral Investig. Forthcoming. 2019. [[cited 2019 May 9]]. Available from:
    2. 38- Menezes-Silva R, Velasco SR, Bastos RS, Molina G, Honório HM, Frencken JE, et al. Randomized clinical trial of class II restoration in permanent teeth comparing ART with composite resin after 12 months. Clin Oral Investig. Forthcoming 2019 [cited 2019 May 9]. Available from: 10.1007/s00784-018-2787-1
39. 1. Turkun LS, Kanik O. A prospective six-year clinical study evaluating reinforced glass ionomer cements with resin coating on posterior teeth: Quo Vadis? Oper Dent. 2016;41(6):587–598.
    2. 39- Turkun LS, Kanik O. A prospective six-year clinical study evaluating reinforced glass ionomer cements with resin coating on posterior teeth: Quo Vadis? Oper Dent. 2016;41(6): 587-98.
40. 1. Guzmán-Armstrong S, Warren JJ. Management of high caries risk and high caries activity patients: rampant caries control program (RCCP) J Dent Educ. 2007;71(6):767–775.
    2. 40- Guzmán-Armstrong S, Warren JJ. Management of high caries risk and high caries activity patients: rampant caries control program (RCCP). J Dent Educ. 2007;71(6):767-75.