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52]

Original Article

Comparative evaluation of the microtensile bond

strength of bulk fill and low shrinkage composite for
different depths of ClassII cavities with the cervical
margin in cementum: An invitro study
Sonali Taneja, Pragya Kumar, Avnish Kumar
Department of Conservative Dentistry and Endodontics, ITSCDSR, Ghaziabad, Uttar Pradesh, India

Abstract
Aim: The aim of this study was to evaluate the microtensile bond strength(TBS) of bulk fill and low shrinkage composite for
different depths of ClassII cavities with the cervical margin in cementum.
Materials and Methods: Standardized conservative boxshaped ClassII cavities were prepared on sixty soundimpacted human
third molars. The samples were randomly divided into two groups: GroupI(n=30)horizontal incremental technique and
GroupII(n=30)bulk fill technique(SonicFill). They were further subdivided into three subgroups of(n=10) samples
each according to the different occlusogingival height: subgroup(A4mm, B5mm, and C6mm). The gingival
margins for all the samples were located 1mm below the cementoenamel junction. The restored samples were subjected to
thermocycling(500cycles) followed by TBS testing. The scores were statistically analyzed using ANOVA and post hoc test
using SPSS software version16.
Results: SubgroupsIA and IB showed lower TBS than subgroupsIIA and IIB(P<0.05) whereas subgroupIC showed higher
TBS than subgroupIIC(P<0.05). SonicFill showed a significant reduction in TBS as the depth increased.
Conclusion: SonicFill should be used in two increments for cavities with a depth of more than 5mm.
Keywords: Bulk fill technique; incremental technique; microtensile bond strength; thermocycling

INTRODUCTION approximal contacts are difficult to obtain, especially in

large cavities and areas of difficult access. Polymerization
There have been tremendous changes and developments stresses generated by polymerization shrinkage may
in restorative dentistry over the past few decades and compromise the bond integrity, thereby increasing the
the pace is accelerating. Although various manufacturers potential for mechanical failure by allowing the ingress
have attempted to improve the physical and mechanical of bacteria, microleakage, postoperative sensitivity, and
properties of composite resins, some drawbacks are ultimately secondary caries, pulpal inflammation, or
still inherent to direct composite restoration, such as necrosis.[3] Various clinical methods have been proposed to
polymerization stresses induced during and after their reduce the shrinkage stresses such as the control of curing
insertion.[1,2] In addition, optimal occlusal anatomy and light intensity,[4] flowable resin liner application,[5] indirect
resin restoration,[6] and incremental layering technique.[7]
Address for correspondence:
Dr.Sonali Taneja, Department of Conservative Dentistry and Incremental insertion techniques are recommended to
Endodontics, ITSCDSR, Muradnagar, Ghaziabad 201206, reduce the undesirable effects of polymerization shrinkage
Uttar Pradesh, India.
Email:drsonali_taneja@yahoo.com This is an open access article distributed under the terms of the Creative
Date of submission : 27.07.2016 Commons AttributionNonCommercialShareAlike 3.0 License, which
Review completed : 20.09.2016 allows others to remix, tweak, and build upon the work noncommercially,
Date of acceptance : 06.10.2016 as long as the author is credited and the new creations are licensed under
the identical terms.
Access this article online
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www.jcd.org.in How to cite this article: Taneja S, Kumar P, Kumar A.
Comparative evaluation of the microtensile bond strength of bulk
fill and low shrinkage composite for different depths of Class II
DOI:
cavities with the cervical margin in cementum: An in vitro study.
10.4103/0972-0707.194023
J Conserv Dent 2016;19:532-5.

532 2016 Journal of Conservative Dentistry | Published by Wolters Kluwer - Medknow

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Taneja, etal.: Microtensile bond strength of low shrinkage versus bulk fill
by decreasing Cfactor(ratio of bonded to unbonded
surfaces).[8] Despite these benefits, the incremental
technique cause incorporation of voids or contaminants
between composite layers[9] and increased deformation of
restored tooth.[10] Furthermore, increased time is required
to place and polymerize each layer. To overcome the
shortcomings of incremental filling techniques, bulk fill
composites have been introduced.
SonicFill(Kerr Dental, Orange, CA, USA) is a sonicactivated
bulk fill composite that has been recently introduced. The
composite contains about 83.5% of filler by weight, mainly
silica and barium aluminosilicate. The SonicFill system
consists of a handpiece, activated sonically and attached to
the highspeed multiflex connection. Aspecial composite
unidose is screwed on the handpiece. Upon activation,
the sonic energy lowers the viscosity and extrudes the
composite that has initially a thick consistency. Upon
deactivation of sonic energy, viscosity of the composite
increases and allows easy adaptation and sculpting
morphology of the composites. Herculite Precise(Kerr
Dental, Orange, CA, USA) is a low shrinkage, nanohybrid
composite which contains prepolymerized filler. The
prepolymerized fillers(particle size0.4m) increase
the surface asperity and reduce surface contact with
instrument, making the material smooth and nonsticky.
The microtensile bond strength(TBS) evaluation reduces
the nonuniform stress distribution at adhesive interface
and has made possible the evaluation of several clinically
relevant substrates and conditions.[11] Very few studies have
been reported in literature evaluating and comparing the
TBS of bulk fill composite(SonicFill) and low shrinkage
composite(Herculite Precise) restored with layering
technique for different occlusogingival depths. Therefore,
the aim of this invitro study was to evaluate the TBS of
bulk fill and low shrinkage composites for different depths
of ClassII cavities with the cervical margin in cementum.
MATERIALS AND METHODS
Specimen preparation
Sixty soundimpacted human third molars which were freshly
extracted and free of any developmental anomalies were
selected. Standardized conservative boxshaped ClassII
cavities were prepared on the proximal surface of each
tooth with buccolingual width of 4mm and axial wall depth
of 2mm in dentin using #245 burs(SS White, Lakewood,
NJ, USA) in an air/watercooled highspeed turbine. Anew
bur was used after every five cavity preparations.
Grouping of specimens
The samples were randomly divided into two groups
of(n=30) samples each according to the type of
restoring technique: GroupIhorizontal incremental
Journal of Conservative Dentistry | Nov-Dec 16 | Vol 19 | Issue 6
technique(Herculite Precis) and GroupIIbulk fill
technique(SonicFill).
Subgrouping of specimens
Occlusal enamel of ClassII cavities was abraded with
600 grit SiC paper to obtain different occlusogingival
heights(4 mmsubgroupA, 5 mmsubgroupB,
and 6 mmsubgroupC), keeping the gingival margins
1mm below the cementoenamel junction(CEJ) for all the
samples. In each subgroup, there were ten samples. Mylar
strip was fixed around each sample. To simulate clinical
conditions during restoration placement, the teeth were
mounted in models using a silicon impression material.
Care was taken that mounting material did not interfere
with the cavity finish lines.
Restoration of samples
GroupI
In GroupI, dentinal surfaces of the specimens cavity were
etched with 37% phosphoric acid for 15 s followed by
cleaning with gentle water spray for 10 s. Optibond Solo
Plus(Kerr, Orange CA, USA) was applied to etched dentin
surface according to manufacturers instructions. The
adhesive was cured for 20 s with a lightguided tip attached
to quartz tungsten halogen(QTH) lightcuring unit having
an inbuilt radiometer. The cavities were restored with
three horizontal increments of Herculite Precis composite
using an incremental method with each increment being
polymerized for 40 s using QTH. The intensity of curing
light was periodically checked.
GroupII
In GroupII, after completion of bonding protocol as in
GroupI, the dispensing rate of SonicFill composite was set
and the tip was placed at the bottom of cavity floor. The
cavity was filled in a steady, continuous stream, withdrawing
the tip as the cavity got restored and then cured for 20 s
from the occlusal surface. The buccal and the lingual aspects
of the tooth were cured for an additional 10 s each.
Thermocycling of specimens
The samples were stored in moist conditions for 24 h at
37C and then subjected to thermocycling of 500cycles
with the temperature changing from 5C to 55C, dwell
time of 15 s, and an interval time of 10 s each.
Sectioning of samples
The restored specimens were serially sectioned creating
approximately 1mm thick slabs. Each slab was trimmed
from cemental and dentinal sides to obtain dentin
restoration interface that had a bonded surface area of
approximately 0.9 mm2. Two sticks were obtained from each
restoration; therefore, twenty specimens were evaluated in
each subgroup. Resin dentin sticks were embedded in cold
cure acrylic blocks at both the ends.
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Taneja, etal.: Microtensile bond strength of low shrinkage versus bulk fill
Microtensile bond strength testing procedure
The TBS was evaluated at a crosshead speed of 0.5mm/min
until debonding at the dentin adhesive interface occurred.
The maximum force at which debonding occurred was
measured. The TBS was calculated in MPa by dividing the
maximum force by the crosssectional area of the bonding
surface for each specimen. The scores were statistically
analyzed using ANOVA and post hoc test using SPSS software
version16 (SPSS Inc. Chicago, U.S.A).
RESULTS
Intersubgroup comparison showed significantly higher
TBS (P<0.05) of subgroupsIIA and IIB in comparison
to subgroupsIA and IB whereas subgroupIIC showed
significantly lower TBS than subgroupIIC(P<0.05).
When intragroup comparison of GroupI was done,
subgroupsIA and IB and IA and IC showed significant
difference in TBS(P>0.05) whereas subgroupsIB
and IC showed nonsignificant difference(P>0.05).
When intragroup comparison of GroupII was done,
subgroupsIIA, IIB, and IIC showed significant difference in
TBS(P<0.05).
DISCUSSION
In our study, TBS of two currently used protocols in
composite insertion was evaluated. The gingival margin of
the ClassII cavities was kept 1mm below the CEJ so as to
have a standardized substrate for different occlusogingival
depths. The axial depth and buccolingual width of the
cavities were also standardized.
QTH curing unit was used as it presents a broad
spectrum, which allows efficient activation of different
photoinitiators.[12] In addition, QTH curing units have
shown better depth of cure, marginal adaptation, and
interfacial integrity, when compared to highintensity light
emitting diode.[13]
In GroupI, lightguided curing tip was used to ensure a
uniform light irradiation of each increment at a constant
distance of 1mm. Prati etal. reported that light guide can
be affected by the distance between the light guide tip and
the resin composite, and even 1mm of air can reduce light
intensity by approximately 10%.[14] In our study, bonded
interface used for checking the TBS was reduced to 0.9
mm2 from dentinal and cemental sides to have a purely
dentin restoration interface.
Pashley etal. have recommended 0.8 to 1 mm2
crosssectional area of resindentin interface to assess
the TBS.[15] Literature has shown that there is an inverse
relationship between bond strength and bond area:
The smaller the area, the greater is the bond strength.
534 Journal of Conservative Dentistry | Nov-Dec 16 | Vol 19 | Issue 6
Asmall surface area of the specimen reduces the stress
distribution, thus reducing the number of internal defects
which generally results in only adhesive failures.[16]
In subgroupA, bulk fill showed significantly higher
TBS than incremental fill[Table1]. This might be due
to the chemistry of SonicFill and its viscosity. SonicFill
incorporates highly filled proprietary resin(83.5% filler by
weight) and special modifiers that react to sonic energy. It
has increased percentage of photoinitiator which produces
adequate degree of conversion at the bottom of cavity. In
its initial resting stage, the modifiers form an extended
stabilizing network throughout the resin. As sonic waves
are applied through the handpiece, the modifiers cause
the viscosity of the composite to drop up to 87%. This
increases the flowability, quick placement, and precise
adaptation of the composite to the cavity walls. Composite
returns to a more sticky and nonslumping state as the
sonic energy is stopped. Furthermore, the volumetric
shrinkage of SonicFill is reported to be 1.6% which reduces
the likelihood of composite pulling away from the tooth
surface during the polymerization process. Versluis etal.
reported that the total amount of composite material to
fill a cavity turns out to be low for an incremental filler
technique than single bulk filling technique. In incremental
technique, polymerization contraction of each individual
filling increment causes some deformation of the cavity by
forcing the cavity walls to bend in and downward, thereby
decreasing the cavity volume. Adecreased cavity volume
means less composite can be placed for the next filling
increment. This results in higher shrinkage residual stresses
leading to debonding at tooth restoration interface.[10]
Winkler etal. reported that bulk filled technique fills the
total volume of the preparation and creates less residual
shrinkage stresses than incremental technique.[17]
Nikolaenko etal. showed contradictory results to our
study. In their study, bulk technique(depth: 4mm) led to
low dentin adhesion at the cavity floor.[18] The difference
between the results might be due to difference in composite
used for bulk filling.
In subgroupB, bulk fill showed significantly higher
TBS than incremental fill[Table1]. On the contrary,
Figueiredo Reis etal. reported that bulk filling technique
showed lower TBS values when compared to incremental
techniques. The authors stated that incremental filling
Table 1: Overall means and standard deviation of
microtensile bond strength values (MPa)
Subgroup Group I Group II
Subgroup A 38.061.275 44.2651.1531
Subgroup B 37.0351.1749a 38.941.0344
Subgroup C 36.351.0314a 32.1351.0811
Subgroups with same superscript indicate statistically insignificant difference
(P>0.05)
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Taneja, etal.: Microtensile bond strength of low shrinkage versus bulk fill
technique assures uniform and maximum polymerization at
the bottom of the cavity. In addition, by restoring ClassII
cavities, the Cfactor gets reduced to about 1.3.[19]
In subgroupC, bulk fill showed significantly lower bond
strength values than incremental fill[Table1]. This
might be due to lightdispersing capability of composite
resins. Thus, when light passes through the bulk of the
composite, the irradiance is reduced due to light scattering
caused by filler particles and resin matrix. Although
bulk fill composite(SonicFill) has increased percentage
of photoinitiators, they might still be insufficient to
facilitate adequate curing at 6mm depth due to increased
distance from the light source. This might have resulted in
insufficient polymerization of base of SonicFill composite
at 6mm depth.
Aguiar etal. reported that composite restorations light
cured at 2mm and 4mm(bottom surface) presented
significantly higher microhardness values than samples
light cured at 8mm.[20]
In GroupI, intragroup comparison showed nonsignificant
reduction in TBS between 5mm and 6mm[Table1].
This might be due to the use of lightguided tip which
produced the uniform and adequate polymerization of each
increment at the various depths of the cavity. In GroupII,
intragroup comparison showed a significant reduction
in TBS as the depth increased[Table1]. This might be
because of insufficient irradiance of the composite at the
bottom of the cavity.
CONCLUSION
Both Herculite Precise (incremental technique) and
SonicFill(bulk fill composite) showed highest TBS at
4mm and least at 6 mm
Bulk fill technique showed superior TBS at 4 and
5mm depths and inferior TBS at 6mm depth in
comparison to incremental technique
SonicFill should be used in two increments for cavities
with a depth of more than 5mm.
Financial support and sponsorship
Nil.
Journal of Conservative Dentistry | Nov-Dec 16 | Vol 19 | Issue 6
Conflicts of interest
There are no conflicts of interest.
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