Factors involved in the development of polymerization shrinkage stress in resin-composites: a systematic review.

OBJECTIVES: Polymerization shrinkage stress of resin-composite materials may have a negative impact on the clinical performance of bonded restorations. The purpose of this systematic review is to discuss the primary factors involved with polymerization shrinkage stress development. DATA: According to the current literature, polymerization stress of resin composites is determined by their volumetric shrinkage, viscoelastic behavior and by restrictions imposed to polymerization shrinkage. Therefore, the material's composition, its degree of conversion and reaction kinetics become aspects of interest, together with the confinement and compliance of the cavity preparation. SOURCES: Information provided in this review was based on original scientific research published in Dental, Chemistry and Biomaterials journals. Textbooks on Chemistry and Dental Materials were also referenced for basic concepts. CONCLUSIONS: Shrinkage stress development must be considered a multi-factorial phenomenon. Therefore, accessing the specific contribution of volumetric shrinkage, viscoelastic behavior, reaction kinetics and local conditions on stress magnitude seems impractical. Some of the restorative techniques aiming at stress reduction have limited applicability, because their efficiency varies depending upon the materials employed. Due to an intense research activity over the years, the understanding of this matter has increased remarkably, leading to the development of new restorative techniques and materials that may help minimize this problem.     

Clinical challenges and the relevance of materials testing for posterior composite restorations.

Posterior composite restorations have been in use for approximately 30 years. The early experiences with this treatment indicated there were more clinical challenges and higher failure rates than amalgam restorations. Since the early days of posterior composites, many improvements in materials, techniques, and instruments for placing these restorations have occurred. This paper reviews what is known regarding current clinical challenges with posterior composite restorations and reviews the primary method for collecting clinical performance data. This review categorizes the challenges as those related to the restorative materials, those related to the dentist, and those related to the patient. The clinical relevance of laboratory tests is discussed from the perspective of solving the remaining clinical challenges of current materials and of screening new materials. The clinical problems related to early composite materials are no longer serious clinical challenges. Clinical data indicate that secondary caries and restoration fracture are the most common clinical problems and merit further investigation. The effect of the dentist and patient on performance of posterior composite restorations is unclear and more clinical data from hypothesis-driven clinical trials are needed to understand these factors. Improvements in handling properties to ensure void-free placement and complete cure should be investigated to improve clinical outcomes. There is a general lack of data that correlates clinical performance with laboratory materials testing. A proposed list of materials tests that may predict performance in a variety of clinical factors is presented. Polymerization shrinkage and the problems that have been attributed to this property of composite are reviewed. There is a lack of evidence that indicates polymerization shrinkage is the primary cause of secondary caries. It is recommended that composite materials be developed with antibacterial properties as a way of reducing failures due to secondary caries. Post-operative sensitivity appears to be more related to the dentin adhesives' ability to seal open dentinal tubules rather than the effects of polymerization shrinkage on cuspal deflections and marginal adaptation.     

Dimensional stability of silicone-based impression materials.

This study attempts to demonstrate that the polymerization reaction is not the only factor that affects the shrinkage of silicone-based impression materials because evaporation of the constituents also contributes to the shrinkage. These factors can be evaluated by the study of time-dependent dimensional changes. This is shown both by chemical kinetics and by experimental testing of condensation and addition polymerizing impression materials with different viscosities. Comparison of the different materials shows that the two contributions, polymerization shrinkage, and evaporation shrinkage, can be assessed separately by analysis of the time-dependent shrinkage diagrams. The instability due to the polymerization reaction is complete after a few hours, but the contribution of the constituent evaporation, if present, can have a significant long-term role.     

A review of polymerization shrinkage stress: current techniques for posterior direct resin restorations

In general excellent results cannot be guaranteed when using resin-based composites for posterior restorations. This is due to polymerization shrinkage which can still be regarded as the primary negative characteristic of composite resins. A review of available literature regarding the polymerization process, its flaws, and suggested strategies to avoid shrinkage stress was conducted. Several factors responsible for the polymerization process may negatively affect the integrity of the tooth-restoration complex. There is no straightforward way of handling adhesive restorative materials that can guarantee the reliability of a restoration. At present, the practitioner has to coexist with the problem of polymerization shrinkage and destructive shrinkage stress. However, evolving improvements associated with resin-based composite materials, dental adhesives, filling, and light curing techniques have improved the predictability of such restorations. This critical review paper is meant to be a useful contribution to the recognition and understanding of problems related to polymerization shrinkage and to provide clinicians with the opportunity to improve the quality of composite resin restorations.     

Clinical performance and chemical-physical properties of bulk fill composites resin —a systematic review and meta-analysis

Objectives: The objective of this study was to perform a meta-analysis of clinical and laboratory studies to compare the performance of bulk-fill and conventional composite resins in terms of polymerization shrinkage, polymerization stress, cusp deflection, marginal quality, degree of conversion, microhardness, flexural strength, fracture strength and clinical performance. Data: One hundred three articles were included in this study, and the Peto method was used to compare the bulk-fill and conventional composites using the RevMan software. Sources: Searches were performed in the PubMed and Scopus databases. Study selection: Laboratory studies and randomized clinical trials comparing one of the previous detailed outcomes between bulk-fill and control composites were included. Conclusions: The bulk-fill composite resins showed less shrinkage, polymerization stress, cusp deflection and microhardness than conventional composites, while both materials presented a similar marginal quality, flexural strength and fracture strength. Also, bulk-fill materials with regular viscosity showed similar shrinkage. The conversion of bulk-fill materials with flowable consistency were similar to conventional composite resins with a thickness of up to 2 mm and greater than conventional composites with a thickness greater than 2 mm. Despite these in vitro differences, the clinical performance of bulk-fill and conventional composite resins was similar in randomized clinical trials, with one to ten years of follow up. In conclusion, the bulk-fill materials show better or similar performance to the conventional materials in clinical trials and laboratory studies in terms of volumetric shrinkage, polymerization stress, cusps deflection and marginal quality, with the only exception being the lower level of microhardness observed for bulk-fill composites with thickness up to 2 mm.     

Polymerization shrinkage of resin-based restorative materials

A bstract — The polymerization shrinkage of a range of chemical and photopolymerized resin-based restorative materials available in Australia was investigated using a previously reported volumetric shrinkage measuring method.
The method proved easy to use, reproducible, independent of specimen size, and capable of use in both chemically and photo-initiated systems. The values obtained for the polymerization shrinkages ranged from 1.67 to 5.68 per cent with most materials being in the 2 to 3 per cent range and the overall average result being 2.81 per cent. It was observed that powder-liquid systems seemed to have the highest shrinkage and light-activated materials the least with the paste-paste materials having intermediate results. An experiment carried out to examine the effect of voids incorporated upon mixing showed that increased void content caused a greater shrinkage of material per unit mass.
This, together with other factors such as amount and size of reacting monomer, is seen to partially explain the observed order of polymerization shrinkages.     

Reducing marginal leakage of posterior composite resin restorations: a review of clinical techniques

It has been well established that composite resin restorations have leakage at the margins. The polymerization shrinkage of the material and its inadequate adhesion to the cavity walls are the primary causes. Unlike silver amalgam restorations, which are self-sealing with age, the gap at the composite-to-tooth interface tends to persist and invite postoperative sensitivity, adverse pulp reactions, and the development of recurrent caries. Many techniques or materials have been advocated to improve the clinical adaptation of this material and to reduce marginal leakage. They limit the effect of polymerization shrinkage and/or enhance the bonding of the composite material to the tooth structure. This article reviews the clinical techniques and materials that have been suggested and are presently available to improve the marginal quality of composite resins, with special reference to posterior restorations.     

The effect of the photopolymerization method on the quality of composite resin samples

An optimal degree of conversion and minimal polymerization shrinkage are generally antagonistic goals, as increased monomer conversion invariably leads to elevated polymerization shrinkage values. However, both parameters are indispensable for an optimal resin composite restoration. A number of approaches have been used to reduce the stress on the restoration cavity wall interface, such as dentine bonding agents to counteract polymerization shrinkage, stress‐absorbing lining materials and low‐intensity curing lights to control the flow capacity of the material during polymerization. However, the configuration of the cavity and cohesive fractures of the material and surrounding tooth tissues are still a problem in day‐to‐day clinical practice. A new photopolymerization light source, pulsed laser, ensures a higher degree of conversion and lower polymerization shrinkage, and differentiates this technique from standard polymerization methods and continuous‐wave argon laser polymerization. The coherence and monochromacity of pulsed laser light set at 468 nm and the far greater intensity of laser nanopulses produce a saturation effect in the depths of the composite, thus resulting in higher monomer conversion. The total amount of energy illuminating the sample surface, which is only one‐fifth of that of conventional methods, and the cooling and relaxation of the material between nanopulses may be responsible for the reduced net polymerization shrinkage.     

Polymerization shrinkage of flowable resin-based restorative materials

This study measured the linear polymerization displacement and polymerization forces induced by polymerization shrinkage of a series of flowable resin-based restorative materials. The materials tested were 22 flowable resin-based restorative materials (Admira Flow, Aelite Flow, Aeliteflow LV, Aria, Crystal Essence, Definite Flow, Dyract Flow, Filtek Flow, FloRestore, Flow-it, Flow-Line, Freedom, Glacier, OmegaFlo, PermaFlo, Photo SC, Revolution 2, Star Flow, Synergy Flow, Tetric Flow, Ultraseal XT and Wave). Measurements for linear polymerization displacement and polymerization forces were performed using custom made measuring devices. Polymerization of the test materials was carried out for 60 seconds by means of a light curing unit, and each property was measured for 180 seconds from the start of curing in eight specimens for each material. Statistical evaluation of the data was performed with one-way analysis of variance (ANOVA), Tukey's Studentized Range (HSD) test (p=0.05) and simple linear regression. A wide range of values was recorded for linear polymerization displacement (26.61 to 80.74 microns) and polymerization forces (3.23 to 7.48 kilograms). Statistically significant differences among materials were found for both properties studied. Very few materials (Freedom, Glacier, and Photo SC) presented low values of linear polymerization displacement and polymerization forces (similar to hybrid resin composites), while the majority of materials presented very high values in both properties studied. Study of the shrinkage kinetics revealed the exponential growth process of both properties. The polymerization forces development exhibited a few seconds delay over linear polymerization displacement. Simple linear regression showed that the two polymerization shrinkage properties that were studied were not highly correlated (r2=0.59).     

The polymerization shrinkage of light cure composite resin

The polymerization shrinkage of a number of commercially available composite resin (Starfiil, Durafill, VLC-1 and GD) and an experimental composite #1 which contains 16% DMSOC (a new monomer which expands on polymerization) has been determined using a water-filled dialometer. The results indicated that GD displayed the largest shrinkage value at 2.62 +/- 0.20%, while VLC-1, Durafill and Staifill had smaller values at 2.10 +/- 0.10%, 1.84 +/- 0.20% and 1.42 +/- 0.16%, respectively. The experimental composite. #1 underwent least contraction during setting (0.14 +/- 0.13%). The polymerization shrinkage was influenced by the filler loading and the duration of the exposure to the activating light source. There was little influence of shade of materials on the polymerization shrinkage for VLC-1.     

大块充填树脂在牙体修复中的应用与研究进展

传统复合树脂在临床应用中分层充填,步骤较多,树脂的聚合收缩可导致修复体边缘微渗漏、术后敏感等,导致修复失败.2009年,大块充填树脂(bulk-fill resin-based composite)应运而生,改良的基质单体、改性强化的纳米混合填料以及独特的光引发剂,使得大块充填树脂能够一层充填4 mm,其简化操作步骤、节约椅旁时间、并能显著降低聚合收缩和聚合应力.本文就大块充填树脂的分类、固化原理、性能等方面进行阐述和讨论,并提出大块充填树脂的应用发展方向.     

Consistency in the amount of linear polymerization shrinkage in syringe-type composites

OBJECTIVES: The purpose of this study was to investigate whether the composite resin in a syringe showed a consistent shrinkage through its content. Additionally, the amount of linear shrinkage was compared between materials. METHODS: Five brands of syringe-type and one brand of carpule-type composite resins were used in this study. To each brand, two to three syringes were assigned. In the carpule-type composite, 15 carpules were used. The linear polymerization shrinkage was measured using a custom-made linometer. In this linometer, the amount of displacement of an aluminum disk, which was caused by the linear shrinkage of composite resin, was recorded by a computer every second for 90 s. RESULTS: The syringe-type composites showed similar consistencies in the amount of linear shrinkage except one. The linear shrinkage of the carpule-type Tetric Ceram showed more consistency compared with syringe-type composites. The amount of linear polymerization shrinkage varied between materials. SIGNIFICANCE: This investigation demonstrates that the use of carpule-type composites is recommended instead of syringe-types, because of the consistency in its linear shrinkage. The custom-made linometer provides an effective way to study polymerization shrinkage.     

Modification of resin using reactive polymeric nanoparticles

Volumetric shrinkage during polymerization has always caused problems since polymer based composites are used as dental filling materials. This value has been reduced to 2-4 volume % with the improvement of dental filling materials and of suitable filling technique. The purpose of our study was to synthesize reactive polymeric nanoparticles which can be applied to modify the polymerization shrinkage of dental resin. It means that certain part of a commercial dental resin would be substituted with reactive polymeric nanoparticles as organic filler. According to our hypothesis the volume contraction would significantly be reduced by applying the modified resin with organic filler. Nanoparticles were prepared by free radical copolymerization from mono-, di- and trifunctional monomers in emulsion and organic solution. In emulsion their size distribution is narrow, but it is quite variable in solutions. The size, size distribution and reactivity of nanoparticles were examined, and these properties can be influenced by the mol ratio and concentration of the monomers. It was shown that the nanoparticles could be swollen by the matrix material and these build a unique structure that can be photo-polymerized. During polymerization the shrinkage of the copolymer can be considered zero, consequently the total contraction originates from the shrinkage of the matrix. In the modified resin the reactive groups of monomers and the pendant double bounds of nanoparticles were connected by covalent bond.     

Physicomechanical evaluation of low-shrinkage dental nanocomposites based on silsesquioxane cores

This study aimed to determine the modulus, hardness, and polymerization shrinkage of novel silsesquioxane (SSQ)-based nanocomposites synthesized for dental applications. Four novel SSQ materials were developed and mixed with control monomers in 5, 10, 20, and 50 wt% SSQ nanocomposite ratios and were evaluated for use as potential low-shrinkage composite restoratives. The postgel polymerization shrinkage of the hybrid materials was then investigated and compared with unfilled 1:1 (control) bisphenol A glycerolate (1 glycerol/phenol) dimethacrylate/tri(ethylene glycol) dimethacrylate (Bis-GMA/TEGDMA) materials using a strain-monitoring device and test configuration. Mechanical properties, such as hardness and modulus, were determined using the depth-sensing microindentation approach. All samples investigated were polymerized using a dental light-curing unit (BISCO VIP) at 500 mW cm(-2) for 40 s. The results obtained were analyzed using analysis of variance/Scheffe's posthoc test at a significance level of 0.05. At 60 min postlight polymerization, postgel shrinkage associated with the control was found to be significantly higher than for all control/SSQ mixtures. Hardness and modulus were found to decrease with increased amount of SSQ monomers added, indicating that the incorporation of SSQ monomers into the control generally helps to reduce both the rigidity and the polymerization shrinkage. Therefore, in the correct formulation, SSQ materials have great potential to be used as low-shrinkage composite restoratives.     

A new method to measure the polymerization shrinkage kinetics of light cured composites

This study was undertaken to develop a new measurement method to determine the initial dynamic volumetric shrinkage of composite resins during polymerization, and to investigate the effect of curing light intensity on the polymerization shrinkage kinetics. The instrument was basically an electromagnetic balance that was constructed with a force transducer using a position sensitive photo detector (PSPD) and a negative feedback servo amplifier. The volumetric change of composites during polymerization was detected continuously as a buoyancy change in distilled water by means of the Archimedes' principle. Using this new instrument, the dynamic patterns of the polymerization shrinkage of seven commercial composite resins were measured. The polymerization shrinkage of the composites was 1.92 approximately 4.05 volume %. The shrinkage of a packable composite was the lowest, and that of a flowable composite was the highest. The maximum rate of polymerization shrinkage increased with increasing light intensity but the peak shrinkage rate time decreased with increasing light intensity. A strong positive relationship was observed between the square root of the light intensity and the maximum shrinkage rate. The shrinkage rate per unit time, dVol%/dt, showed that the instrument can be a valuable research method for investigating the polymerization reaction kinetics. This new shrinkage-measuring instrument has some advantages that it was insensitive to temperature changes and could measure the dynamic volumetric shrinkage in real time without complicated processes. Therefore, it can be used to characterize the shrinkage kinetics in a wide range of commercial and experimental visible-light-cure materials in relation to their composition and chemistry.     

Polymerization shrinkage of visible-light-cured composites

This study investigated the long-term dimensional changes of a conventional and a polyacid-modified composite resin and the effects of hydration on polymerization shrinkage. A strain-monitoring device was used to measure the linear polymerization shrinkage of the composites in the free state when stored in water at 37 degrees C or air at 26 degrees C over a one-month period. Results showed that the polymerization reaction of both conventional and polyacid-modified composite resins was accompanied by a dimensional shrinkage change. The rate of shrinkage for both composites was greatest during the polymerization reaction and continued after removal of the curing light. When stored in water, the greatest shrinkage was noted at one hour for both materials. This was followed by a slow uptake of water and expansion from one day to one month. The polyacid-modified composite had significantly less polymerization shrinkage than the conventional composite after one month of storage in water.     

Polymerization shrinkage and polymerization shrinkage stress in polymer-based restoratives

Objectives: This paper is intended to contribute to the recognition and understanding of problems related to polymerization shrinkage.

Data sources: Scientific publications of relevance with regard to this subject were critically reviewed.

Study selection: The dimensional changes which develop during the curing of resin composites and glass polyalkenoate cements are studied, with special reference to methods of determining shrinkage, shrinkage stress and stress relief.

Conclusions: As no method for handling the adhesive restorative materials has yet been described which guarantees a leakproof restoration, the practitioner has to accept the problem of polymerization shrinkage and destructive shrinkage stress. Only a proper understanding of the mechanisms that cause these problems and the techniques that may reduce their effects will enable the practitioner to derive maximum benefit from the application of resin composites and glass polyalkenoate cements in restorative dentistry.     

VOLUMETRIC POLYMERIZATION SHRINKAGE OF CONTEMPORARY COMPOSITE RESINS

The polymerization shrinkage of composite resins may affect negatively the clinical outcome of the restoration. Extensive research has been carried out to develop new formulations of composite resins in order to provide good handling characteristics and some dimensional stability during polymerization. The purpose of this study was to analyze, in vitro, the magnitude of the volumetric polymerization shrinkage of 7 contemporary composite resins (Definite, Suprafill, SureFil, Filtek Z250, Fill Magic, Alert, and Solitaire) to determine whether there are differences among these materials. The tests were conducted with precision of 0.1 mg. The volumetric shrinkage was measured by hydrostatic weighing before and after polymerization and calculated by known mathematical equations. One-way ANOVA (á=0.05) was used to determine statistically significant differences in volumetric shrinkage among the tested composite resins. Suprafill (1.87±0.01) and Definite (1.89±0.01) shrank significantly less than the other composite resins. SureFil (2.01±0.06), Filtek Z250 (1.99±0.03), and Fill Magic (2.02±0.02) presented intermediate levels of polymerization shrinkage. Alert and Solitaire presented the highest degree of polymerization shrinkage. Knowing the polymerization shrinkage rates of the commercially available composite resins, the dentist would be able to choose between using composite resins with lower polymerization shrinkage rates or adopting technical or operational procedures to minimize the adverse effects deriving from resin contraction during light-activation.     

An alternative method to reduce polymerization shrinkage in direct posterior composite restorations

BACKGROUND: Polymerization shrinkage is one of dental clinicians' main concerns when placing direct, posterior, resin-based composite restorations. Evolving improvements associated with resin-based composite materials, dental adhesives, filling techniques and light curing have improved their predictability, but shrinkage problems remain. METHODS: The authors propose restoring enamel and dentin as two different substrates and describe new techniques for placing direct, posterior, resin-based composite restorations. These techniques use flowable and microhybrid resin-based composites that are polymerized with a progressive curing technique to restore dentin, as well as a microhybrid composite polymerized with a pulse-curing technique to restore enamel. Combined with an oblique, successive cusp buildup method, these techniques can minimize polymerization shrinkage greatly. CONCLUSIONS: Selection and appropriate use of materials, better placement techniques and control polymerization shrinkage may result in more predictable and esthetic Class II resin-based composite restorations. CLINICAL IMPLICATIONS: By using the techniques discussed by the authors, clinicians can reduce enamel microcracks and substantially improve the adaptation of resin-based composite to deep dentin. As a consequence, marginal discoloration, recurrent caries and postoperative sensitivity can be reduced, and longevity of these restorations potentially can be improved.     

Correlation between the amount of linear polymerization shrinkage and cuspal deflection

This study evaluated the relationship between the amount of cuspal deflection and linear polymerization shrinkage in resin composites and polyacid modified resin composites (compomers). Materials included were Dyract AP, Compoglass F, Z100, SureFil, Pyramid, Synergy Compact, Heliomolar and Heliomolar HB. To measure polymerization shrinkage, a custom-made linometer (R&B, Daejon) was used. Ten measurements were made for each group, and the amount of linear shrinkage that occurred in 60 seconds was statistically compared by one-way ANOVA analysis and Tukey's test. To measure the cuspal deflection of teeth, standardized MOD cavities were prepared in extracted maxillary premolars. After a self-etching adhesive was applied, the cavities were bulk filled with one of the filling materials. Fifteen teeth were used for each material. Cuspal deflection was measured by a custom-made cuspal-deflection measuring device. One-way ANOVA analysis and Tukey's test were used to determine differences between the materials. The correlation of polymerization shrinkage vs cuspal deflection was analyzed by regression analysis. The amount of polymerization shrinkage from least to greatest was Heliomolar, SureFil < Heliomolar HB < Z100, Synergy Compact < Dyract AP < Pyramid, Compoglass F (p < 0.05). The amount of cuspal deflection from least to greatest was Z100, Heliomolar, Heliomolar HB, Synergy Compact, SureFil, < Compoglass F < Pyramid, Dyract AP (p < 0.05). Both the amount of polymerization shrinkage and cuspal deflection were highly correlated (p < 0.001).