RESEARCH ARTICLE

Microcomputed Tomography Evaluation of Volumetric

Shrinkage of Bulk-Fill Composites in Class II Cavities
HAMAD ALGAMAIAH, BDS*,†, CAMILA S. SAMPAIO, DDS, MS, PhD*,‡,§, LINDIANE C. RIGO, DDS, MS*,
MALVIN N. JANAL, PhD{, MARCELO GIANNINI, DDS, MS, PhD**, ESTEVAM A. BONFANTE, DDS, MS, PhD††,
PAULO G. COELHO, DDS, MS, PhD*, ANDRE F. REIS, DDS, MS, PhD‡‡, RONALDO HIRATA, DDS, MS, PhD§§

ABSTRACT
Purpose: This study aimed to quantifypolymerization shrinkage of one conventional and three bulk-f|llcomposites, under bonded
and unbonded conditions, in Class IIpreparations using 3D microcomputed tomography (lCT) andreportitslocation.
Materials and Methods: Preparations (2.5 mm occlusal depth 3 4 mm wide 3 4 mm mesial box and1mm beyond the
CEJ distal box depth) were made in 48 human extracted molars (n 5 6).Four composites were tested, one regular
(Vitalescence/VIT) and three bulk-f|ll: SureFil SDR Flow (SDR),Tetric EvoCeram Bulk Fill (TET), and Filtek flowable
Bulk Fill (FIL).Teeth were divided into four groups according to restorative material used and subdivided into two
subgroups, according to the presence of an adhesive system (XP Bond) application (bonded [-B]) or its absence
(unbonded [-U]).Each tooth was scanned three times: (1) after cavity preparation, (2) before and (3) after composite
light-curing. Acquired lCT images were imported into 2D and 3D software for analysis.
Results: Signif|cantly different volumetric shrinkage between bonded and unbonded conditions was observed only for
TET group (p < 0.05), unbonded presenting signif|cantly higher volumetric shrinkage. Among the bonded groups,
TET-B presented signif|cantly lower shrinkage than both SDR-B and FIL-B but not signif|cantly different fromVIT-B.
Generally, shrinkage occurred at occlusal and distal surfaces.
Conclusions: When applied to bonded Class II cavities,TETexhibited signif|cantly lower volumetric shrinkage compared
to the other bulk-f|ll composites.However, it also exhibited the highest difference of volumetric shrinkage values
between unbonded and bonded cavities.

CLINICAL SIGNIFICANCE
Volumetric polymerization shrinkage occurred with all composites tested, regardless of material type (conventional or
bulk-f|ll) or presence or absence of bonding.However, volumetric shrinkage has been reduced or at least maintained
when bulk-f|ll composites were used compared to a conventional composite resin, which makes them a potential time
saving alternative for clinicians.
(J Esthet Restor Dent 00:000^000, 2016)

*Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA

Department of Restorative Dental Science, King Saud University, Riyadh, Saudi Arabia
`
Research Professor, Department of Biomaterials, Universidad de Los Andes, Santiago, Chile
‰
Department of Restorative Dentistry, Piracicaba Dental School, UNICAMP, Piracicaba, SP, Brazil

Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA
**Associate Professor, Department of Restorative Dentistry, State University of Campinas, Piracicaba Dental School, Piracicaba, SP, Brazil

Assistant Professor, Department of Phosthodontics, University of S~
ao Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
``
Associate Professor, Department of Operative Dentistry, Guarulhos University, Guarulhos, SP, Brazil
‰‰
Assistant Professor, Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA

C 2016 Wiley Periodicals, Inc.

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INTRODUCTION
Tooth colored restorations have gained popularity
since their development due to patients’ esthetic
requirements. Most clinicians have been using
composites as a routine restorative material, despite
the sensitivity of the adhesive technique.1 Regardless of
their acceptance, previous studies have shown that
concerns still remain due to the polymerization
shrinkage stress of resin composites, which can be
affected by the choice of materials and techniques
used. Considering the shrinkage issue, if the composite
insertion technique is not carefully performed,
marginal and internal sealing can be compromised.2
Therefore, potential deleterious effects on the marginal
integrity can occur, such as microleakage, poor
marginal adaptation,1,3 debonding, marginal staining,
enamel cracks, fractures, and cuspal deflection,
especially in large Class II cavities with dentin and
cementum margins.4,5
Polymerization shrinkage is a volumetric change of the
restoration developed by a reduction of distance
between monomer molecules as a result of van der
Waals forces (i.e., due to a covalent bonding), which
produces a reduced free volume densely packed
polymer.3,6 The amount of induced polymerization
stress is influenced by characteristics of the composite
formulation, such as matrix type, filler content,3–5,7
polymerization kinetics, degree of conversion, modulus
of elasticity,4,8,9 and cavity geometry.1,9,10 Several
attempts have been made to minimize the negative
effects of polymerization, such as incremental layering
techniques,4 introduction of a monomer silorane-based
composite,11 or changes in matrix composition and
photoinitiator.7,12,13
To save time during composite placement, the use of
bulk-fill materials with low polymerization shrinkage
recently gained momentum for their clinical and
research potentials as these materials are purportedly
packed into cavities in one increment up to
4 mm.14–19 One manufacturer introduced this new
technology by modifying the urethane dimethacrylate
(UDMA) and incorporating a photoactive group
(hydroxyl-free Bisphenol A glycidyl methacrylate
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(Bis-GMA)), resulting in a 60–70% reduction in
shrinkage stress notwithstanding a flowable
presentation.12,19,20 In addition to the aforementioned
improvements in shrinkage stress, the improved color
translucency of these materials permits the light to
effectively reach up to 4 mm deep when photocured
for 20 seconds. This technique unequivocally simplifies
the restorative procedures.20,21
Several studies have presented methods where the
volumetric polymerization shrinkage is evaluated by
testing the filling materials outside of the dental
cavity.17,22–25 Microcomputed tomography (lCT)
analysis has been recently used to evaluate
polymerization shrinkage, allowing the study of 2D–3D
images to qualitatively and quantitatively compare
morphological changes on dental preparations.14,26–29
To date, few studies have evaluated bulk-fill composite
shrinkage in Class II cavities (without a capping layer),20
and further investigations are warranted. The purpose of
this study was to quantify the volumetric polymerization
shrinkage of one conventional composite versus two
low-viscosity bulk fill composites and one high-viscosity
bulk-fill composite, placed in a single increment in Class
II mesio-occlusal-distal cavities (MOD), in either
bonded or unbonded conditions, evaluated through two
and three-dimensional (2D and 3D) lCT. The null
hypotheses evaluated were that: (1) bonding conditions
would not affect the volumetric shrinkage of Class II
cavities and (2) the tested conventional composite
would not present different volumetric shrinkage
compared to bulk-fill composites.
MATERIALS AND METHODS
Specimen Preparation
Forty-eight recently extracted human third molars
were collected under an Institutional Review Board
protocol approved by the NYU Medical School. A
standardized box-shaped Class II cavity (2.5 mm
occlusal depth 3 4 mm wide 3 4 mm mesial box
depth and 1 mm beyond the cementoenamel junction
(CEJ) distal box depth) was prepared in each tooth
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(Figure 1). In the mesial box, 4 mm depth preparations
were done in all teeth, while in the distal box, CEJs
were visually detected and preparations were done
1 mm beyond them, to have a cementum margin.
Cavities were prepared using two diamond burs (codes
845kr018 and 868A021, Brasseler, Savannah, GA,
USA), which present a standardized active head size to
deliver consistent cavity preparation depth. Burs were
changed after every five uses. The final cavity
preparations were then checked with a digital caliper.
All teeth were maintained in distilled water at room
FIGURE 1. Schematics showing the standardized box-shaped
Class II cavity preparations (2.5 mm occlusal depth 3 4 mm
wide 3 4 mm mesial box depth and 1 mm beyond the CEJ
distal box depth).
TABLE 1. Material, composition and batch number of tested materials
Material
(Abbreviation)
Vitalescence (regular conventional
composite),Ultradent Product, South
Jordan,UT (VIT)
SureFil SDR Flow (flowable bulk-f|ll
composite), Dentsply Caulk, Milford,
DE,USA (SDR)
Tetric EvoCeram Bulk Fill (regular bulk-f|ll
composite), Ivoclar Vivadent, Schaan,
Lichtenstein-(TET)
Filtek Bulk Fill Flowable Restorative
(flowable bulk-f|ll composite), 3M Oral
Care, MN,USA (FIL)
XP Bond (bonding agent), Dentsply De
Trey,Konstanz,Germany (B)
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V DOI 10.1111/jerd.12275
temperature (258C) before and after preparation
procedures. Materials, compositions, and batch
numbers are described in Table 1.
Teeth were randomly divided into eight groups (n 5 6
each) as follows: (i) Group VIT-U—Vitalescence
unbonded; (ii) Group SDR-U—SureFil SDR Flow
unbonded; (iii) Group TET-U—Tetric EvoCeram Bulk
Fill unbonded; (iv) Group FIL-U—Filtek Bulk Fill Flow
unbonded; (v) Group VIT-B—Vitalescence bonded; (vi)
Group SDR-B—SureFil SDR Flow bonded; (vii) Group
TET-B—Tetric EvoCeram Bulk Fill bonded; and (viii)
Group FIL-B—Filtek Bulk Fill Flow bonded. The two-
step etch-and-rinse adhesive system XP Bond was used
for all bonded groups (B). The same adhesive system
was used in all bonded groups in this study to
emphasize the differences among restorative
composites. To standardize the protocol, all materials,
including the conventional composite, were inserted
using a bulk filling technique. Flowable materials were
disposed in the cavities from their unit-dose capsules
Composition Batch
number
Bisphenol A glycidyl methacrylate, f|llers with average size of 0.7 mm 60717
(f|ller content 75% wt/52% vol)
Barium-alumino-fluoro borosilicate glass, strontium alumino-fluoro- 12152
silicateglass, modif|ed urethane dimethacrylate resin,
ethoxylatedbisphenol A dimethacrylate,
triethyleneglycoldimethacrylate, camphorquinone, photoaccelerator,
butylated hydroxyl toluene; UV stabilizer; titanium dioxide; iron
oxide pigments, fluorescing agent (f|ller content 68% wt/45%vol)
Dimethacrylates, prepolymers, barium glass f|ller, ytterbium S09220
trifluoride, mixed oxide, additive, initiators, stabilizers, pigments
(f|ller content 79^81%wt/60^61%vol)
Silane treated ceramics, diurethanedimethacrylate (UDMA), N616687
substituted dimethacrylate,bisphenol A polyethylene glycol
dietherdimethacrylate (BISEMA-6),Ytterbium fluoride (YbF3),
bisphenol A diglycidyl ether dimethacrylate (BISGMA), benzotriazol,
triethylene glycol dimethacrylate (TEGDMA), ethyl 4-dimethyl
aminobenzoate (f|ller content 64.5% wt/42.5%vol)
Carboxylic acid modif|ed dimethacrylate, phosphoric acid modif|ed 1409001022
acrylate resin, urethane dimethacrylate, triethylene glycol
dimethacrylate, 2-hydroxy ethyl methacrylate,
butylatedbenzenediol, ethyl-4-dimethyl ami-nobenzoate,
camphorquinone, functionalized amorphous silica, t-butanol.
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(for SDR groups) or from their syringes (for FBF
groups), and packable materials were removed from
their syringes and placed in the cavities with a spatula
(for VIT and TET groups).
Filling Procedures and mCT Analysis
Each tooth was scanned three times using a mCT
apparatus (mCT40, Scanco Medical, AG, Basserdorf,
Switzerland): after cavity preparation, before and after
light curing. The mCT was calibrated using a phantom
standard at 70 kVp per beam hardening, 200 mgHA/
ccm. The operating condition for the mCT device was
energy (70 kVp—114 mA) with a medium resolution
and a voxel size created of 16 mm per slice, using a
sample holder of 16.5 mm. The average of the total
number of slices was approximately 250, with an
average scan time of 30 minutes per tooth.
After cavity preparation, teeth underwent mCT
scanning. Since enamel, dentin, and composite present
similar radiodensity, this procedure was required not
only to avoid the scattering and possible noise between
the restorative material and the tooth structure but
also to minimize possible artifacts in the threshold
segmentation. Afterward, superimposition of this first
scan with the two subsequent scans (before and after
light curing) was done. After the first scan, teeth in the
bonded groups were etched with phosphoric acid
(Ultra etch 35%, Ultradent Product, South Jordan, UT,
USA) for 30 seconds in enamel and 15 seconds in
dentin and subsequently rinsed for 20 seconds. Water
excess was removed with a thin absorbent paper. The
one-bottle primer/adhesive system (XP Bond, Dentsply
De Trey, Konstanz, Germany) was applied with a
microbrush (FGM, Joinville, SC, Brazil) and light-cured
following manufacturer’s instructions.
In all groups, a plastic laboratory sealing film (Parafilm
M, SPI Supplies, West Chester, PA, USA) was used as a
matrix and placed around each tooth to keep the
composites in place during uncured and cured scans,
and then each cavity was filled in bulk using their
assigned composites. Since the Parafilm is a transparent
matrix, it was kept in its position during light curing
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and also not removed between scans to avoid any
movements inside the composite resin mass. To avoid
light contact, samples were immediately protected inside
the lCT holder, which was surrounded by a dark duct
tape cover. After that, samples were scanned for the
second time to quantify the volume before light curing.
Then, composites were light cured for 20 seconds in
each tooth wall (occlusal, mesial, and distal) with a
Polywave LED light-curing unit (1,200 mW/cm2,
Bluephase, Ivoclar Vivadent, Schaan, Lichtenstein) and
the third scan was taken. The polymerization unit step-
over distance was kept constant at approximately 5 mm.
All the scans had to be made in nonwet conditions,
since the presence of water in the uncured resin
composite would affect the second scan. However,
between the first and the second scan, teeth were
immersed in water for hydration.
Acquired mCT data were then imported into a
workstation and evaluated with Amira software (version
5.5.2, VSG, Burlington, MA, USA). In the software, all
three scans were superimposed with the Amira tool
called “superimposition,” which allowed us to get a
perfect arrangement of all scans (Figures 2 and 3). The
filled cavities’ scans (uncured and cured) were subtracted
from the unfilled cavity using the Boolean operation,
which made possible to isolate and quantify the volume
of the restoration itself. The “Material Statistics”
command was used to compute volumetric loss changes
due to polymerization shrinkage and afterward calculated
as percentages. Thresholds were visually determined per
sample, since the same threshold could not be used for
all groups due to the different radiopacities and
attenuation levels from the resin composites.14
From these measurements, the volumetric loss
following polymerization shrinkage was calculated as
percentage. In addition, the difference of volumetric
shrinkage between unbonded and bonded specimens
was also calculated.
Statistical Analysis
Data were analyzed by a two-way analysis of variance
(ANOVA) with p 5 0.05 (four levels of composite and
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FIGURE 2. Reconstructed 2D sections showing uncured and cured scans being superimposed.

FIGURE 3. Reconstructed 2D sections after complete superimposition of uncured and cured scans.

two bonding protocols used). Post hoc comparisons RESULTS

were carried out using Tukey HSD with p 5 0.05
based on the pooled estimate of residual variability Mean volumetric shrinkage values obtained with the
(SPSS Statistics, IBM, Armonk, NY, USA). lCT are presented in Table 2. The use or not of a

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bonding agent resulted in a significant reduction
(p < 0.01) of approximately 13% (3.65% vs. 3.18%) in
shrinkage values. The use of a bonding agent produced
significantly different polymerization shrinkage values
among groups (p 5 0.02). Comparison between
materials and merging bonded and unbonded
conditions showed the lowest mean value (2.91%) for
TABLE 2. Composite volumetric polymerization shrinkage
(n 5 6), with or without adhesive, reported as % (Standard
Error) using lCT
Composite Bonded Unbonded
resins
VIT 3.20 (0.52) ab 3.39 (0.70) bc
TET, which was significantly lower than FIL and SDR,
but similar to VIT (3.30%). SDR (3.71%) and FIL
(3.77%) presented the highest volumetric shrinkage
percentages but did not differ from VIT.
Concerning resin composites and bonding condition,
TET-B presented the lowest polymerization shrinkage
compared to the flowable bulk-fill materials when a
bonding agent was used (Table 2). Post hoc testing
showed no significant difference in shrinkage between
TET-B and the regular conventional resin composite
VIT-B. In addition, VIT-B did not demonstrate a
statistically significant difference between the flowable
Difference of
mean vol. bulk-fill composites FILT-B and SDR-B. TET was the
shrinkage only material that showed statistically significant
between
unbonded
difference between bonded and unbonded groups. No
and bonded statistically significant difference was found amongst
cavities
composites in unbonded conditions.
0.19

SDR 3.65 (0.39) bc 3.78 (0.29) bc 0.13 Qualitative 3D analysis (Figures 4 and 5) showed a
trend in shrinkage on free surfaces for all materials
TET 2.44 (0.47) a 3.37 (0.23) bc 0.93
tested, under bonded and unbonded conditions. In
FIL 3.47 (0.30) bc 4.07 (0.37) c 0.6 TET-U group, shrinkage was also observed in the
Means followed by different letters are signif|cantly different by pulpal floor, as well as in the cervical walls. For the
Tukey HSD test. other unbonded groups, most of the samples showed
shrinkage only in free surfaces, while some samples
also showed shrinkage on internal/bonded surfaces and

FIGURE 4. Figure representing the 3D renderings of groups without adhesive (unbonded). (A) external view; (B) internal view.
Red area represents the mass of composite, while gray area represents the area where volumetric polymerization shrinkage
occurred.

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FIGURE 5. Figure representing the 3D renderings of groups with adhesive (bonded). (A) external view; (B) internal view. Red area
represents the mass of composite, while gray area represents the area where volumetric polymerization shrinkage occurred.
cervical walls. When adhesive was used, all groups
showed volumetric shrinkage localized only in free
surfaces, except for VIT-B group, where one sample
showed shrinkage also in the cervical walls, especially
in the margin localized at the cementum.
DISCUSSION
It must be acknowledged that whereas the placement
of composite resins without adhesives for the analysis
of free shrinkage behavior provides immediate data in
a real cavity situation, it is not a clinically
recommended procedure.28 Since TET-B and TET-U
presented significantly different (p 5 0.013) volumetric
polymerization shrinkage, the first null hypothesis was
rejected. Apparently, shrinkage stress did not exceed
the bond strength, because debonding was not
observed.14,28 While the presence of an adhesive
interface played a significant role in reducing around
13% volumetric shrinkage, a study in Class I cavities
reported a 25% reduction,14 likely due to less restricted
surfaces being able to deform the composite material
when compared to Class II MOD cavities. The lower
C factor (represented by cavity walls bonded area
divided by unbonded area) in Class II compared to
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Class I cavities may also corroborate the contrasting
findings.30,31 The presence of a greater unbonded area
in MOD restorations is expected to allow the material
to flow and promote contraction stress relief,32
reducing stresses at bonded interfaces.31
Comparison between all the materials and merging
bonded and unbonded results showed significantly
lower volumetric shrinkage for TET compared to FIL
and SDR, but no difference from VIT. The latter
presented no significant difference between any
composite tested. Therefore, the second null
hypothesis was accepted. In general, the
polymerization shrinkage of all investigated materials
was around 2.44% and 4.07%, which is considered
clinically acceptable.26,27
Previous reports have shown that composites with
lower filler content could result in higher volumetric
shrinkage than the ones with higher percentages.7,33
A regular consistency composite commonly presents
reduced monomer content, which may lead to less
volumetric shrinkage.7 This was observed only for
TET-B in this study, since no statistical difference was
observed between VIT-B, SDR-B and FIL-B. The
regular composite VIT presents 52% (vol.) of fillers and
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the regular bulk fill composite TET presents 61% (vol.),
whereas the flowable composites used in this study
present lower filler content, SDR (45% vol.) and FIL
(42.5% vol.). A previous study also showed similar
results with higher polymerization shrinkage for
flowable bulk fill materials compared to a regular bulk
fill material, however it did not showed a statistical
difference between a regular composite (Filtek Z250,
3M Oral Care) and the flowable bulk-fill composites
FIL and SDR evaluated herein.20,34 A recent study by
Kumagai and colleagues (2015)35 using a similar MOD
cavity design demonstrated that bond strength values
in gingival walls were significantly higher when a
flowable bulk-fill composite (Surefil SDR flow,
Dentsply Caulk) was used in comparison with a
regular nanofilled composite (Filtek Z350, 3M Oral
Care), either placed incrementally or in bulk.35
Higher filler content can result in lower volumetric
shrinkage. Since shrinkage occurs in the course of
monomer conversion to polymer, the lesser the filler
content, the higher the resultant shrinkage will likely
result.36 However, elastic modulus has been shown to
increase with filler content. The elastic modulus is an
important physical property that influences the stress
development.37 Composite resins with high elastic
modulus produce more rigid restorations, which
increase the effect of polymerization contraction on
residual shrinkage stresses.38 Restorative materials with
low elastic modulus may reduce shrinkage stresses but
must present mechanical properties to sufficiently
recover the structural integrity of the original tooth
and support masticatory loads.39
Previous literature reported similar low shrinkage
results for TET.15,20,34 Although TET presented lower
volumetric shrinkage, probably due to its high filler
content (61% vol.), this result should be interpreted
with caution, because the highest difference in
volumetric shrinkage between unbonded and bonded
cavities was observed for this material (Table 2). This
difference can represent the inability of the
polymerized composite to shrink freely when
constrained in a bonded cavity, which could be
translated in higher polymerization stress,7 even
though a stress reliever has been introduced to the
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chemistry of this material, according to the
manufacturer.
To achieve an adequate degree of conversion, each
layer of regular composite is not recommended to be
applied in more than 2 mm thickness. Considering
that one of the objectives of this study was to expose
cement margins in one of the proximal cavities, depths
higher than 4 mm could be expected in these areas.
Inappropriate polymerization rate could happen as a
consequence of this cavity depth,20 leading to a lower
degree of conversion and consequently a lower
volumetric shrinkage. Bulk-fill composites allow
polymerization of thicker increments, in general up to
4 mm.15,17,20 The positive relationship between
polymerization rate and volumetric shrinkage has been
reported previously.15,20
The qualitative analyses of the 3D images generated
from the Amira software displayed major shrinkage
localized on occlusal and external proximal surfaces,
thus in agreement with previous literature that depicts
shrinkage occurrence in unbonded free surfaces.14,39
No differences were observed between shrinkage
patterns in cementum and enamel in bonded cavities.
When unbonded, groups TET-U and SDR-U exhibited
shrinkage in proximal areas with no difference between
both substrates. In addition, TET was the only material
that shrank in the pulpal floor. Although TET
presented relatively low volumetric shrinkage, because
of its high filler content, the elastic modulus increase
after curing potentially leading to a higher shrinkage
stress.7 In addition, the flowable, low-viscosity
materials probably presented better adaptation to the
cavity walls than the high viscosity materials in the
absence of an adhesive layer.
Observation of the 3D images (Figures 4 and 5)
obtained from the low-viscosity bulk-fill composites
FIL and SDR demonstrated an occurrence of
volumetric shrinkage directed away from the free
surfaces, due to the friction with the cavity walls (in
unbond condition), which was enhanced in the bond
condition. Directions for use of both composites
recommend a 2 mm capping layer with a regular
composite resin. However, in a clinical situation, if the
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bulk-fill composite application is extended to
reestablish proximal contacts, such volumetric change
could compromise them, leaving a space between
adjacent teeth for food impaction. Our findings may
suggest that clinicians should carefully evaluate the
precision of proximal contacts established with
flowable bulk-fill composites after curing.
Previous results have shown better correlation of gap
formation between elastic modulus and polymerization
stress, rather than volumetric shrinkage absolute
values.15,34 Evidently, the adhesive played a major role
regarding the shrinkage patterns, since almost all
materials tested showed no volumetric changes in
bottom walls and cervical margins, suggesting interface
sealing.40 Higher C-factor than that simulated herein
could negatively influence the adhesive interface, since
gap formation could be generated in Class I cavities
with contraction stresses up to 23 MPa in internal
angles.41,42 Less shrinkage was found at the bottom of
Class II restorations in this study compared to that
observed in Class I restorations in a previous study.14
Lower composite polymerization stress is expected in
MOD restorations due to the presence of more free
surfaces to deform and flow.7,14
As previously described, threshold were visually
determined sample by sample, which can cause
alterations on the calculations, being a limitation of
this study, although it was performed by the same
calibrated operator. In conclusion, and within the
limitations of this study, volumetric shrinkage of the
investigated composites did not present significant
differences when they were allowed to shrink freely, in
unbonded Class II cavities. However, when
polymerized in a constrained, bonded Class II cavity,
different shrinkage patterns were observed for the
flowable and high-viscosity materials.
DISCLOSURE AND ACKNOWLEDGEMENTS
The authors do not have any financial interest in any
of the companies whose products are included in this
article. The authors are grateful to Ivoclar Vivadent,
Ultradent Product, 3M Espe, and Dentsply Caulk for
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V DOI 10.1111/jerd.12275
donating the materials used in the present
investigation.
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DOI 10.1111/jerd.12275 V
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