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.     

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.     

Direct composite resin inlay

Posterior composite resin restorations have several physical limitations. Polymerization shrinkage during curing and resistance to wear are two factors that can be alleviated by a composite resin inlay. Curing the restoration extraorally in a heat-and-light curing unit and cementing the restoration with a composite resin cement reduces the deleterious effects of polymerization shrinkage and increases wear resistance of the material. A method to make a direct composite resin inlay is detailed.     

复合树脂聚合收缩应力的研究进展

复合树脂作为常用的牙色充填材料,具有美观、操作方便等优点,但也存在聚合收缩、不耐磨、变色等问题.其中,聚合收缩可引起充填复合树脂与牙体之间形成间隙、釉质裂纹和牙尖移动,导致充填失败.影响收缩应力大小的因素包括复合树脂的组成、窝洞形态和临床操作.通过减小聚合收缩应力可提高复合树脂充填的成功率.     

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).     

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.     

大块充填树脂的研究进展

目前大块充填树脂已经越来越广泛应用于临床。一次4-6mm的固化深度是大块充填树脂最突出的优点,便于临床操作。树脂的聚合收缩和边缘微渗漏及性能的长期稳定性与材料的临床应用效果密切相关。如何保证树脂具有较高的固化深度,较低的聚合收缩和边缘微渗漏,以及临床效果评价是大块充填树脂的研究热点,本文将对上述方面的研究进展进行综述。     

口腔环境对牙科树脂复合材料摩擦学的影响

树脂复合体越来越多的用于口腔修复领域,但耐磨性能不足等因素限制了其发展,本文就其摩擦磨损机理及口腔环境因素对其耐磨性能的影响和树脂复合体材料的研究进展作一综述。     

Wear of resin-modified glass ionomers: an in vitro study

The purpose of this study was to evaluate the wear resistance and clinical applicability of resin-modified glass ionomer cements as restorative or fissure-sealing materials. The in vitro wear of resin-modified glass ionomers was compared to conventional glass ionomers, a resin-based sealant, and a composite resin. A three-body wear test (enamel block--polymethylmethacrylate powder--experimental dental material) was performed by 20,000 cycles with a load of 4 kgf/cm2. The depth of wear of the experimental materials was measured and calculated using a computerized laser surface scanner. The glass ionomers generally showed more wear than the resin-based sealant and the composite resin, but there was no difference in wear between resin-modified and conventional glass ionomers. Type III ionomers (used for sealant) showed lower wear resistance than type II ionomers (used for restoration).     

Light-curing considerations for resin-based composite materials: a review. Part I

There has been a continual advent of improved technologies in dentistry. Among these are the material sciences of resin-based composites (RBCs). Since the introduction of light-cured RBCs, the problem of polymerization shrinkage and the methods used to overcome this have concerned clinicians and researchers. Types of curing light and modes of curing have been shown to affect the degree of polymerization and related shrinkage of RBCs. This review, which is divided into two parts, discusses the contemporary light-curing units. Part I explores the evolution in light-curing units and different curing modes. Part II highlights the clinical considerations regarding light curing of RBCs that are important for achieving optimal curing and maximum polymerization of RBCs in a clinical setting.     

Extended setting shrinkage behavior of endodontic sealers

The aim of this study was to investigate the polymerization shrinkage behavior of newly introduced root canal sealers. Three recently developed sealers; EndoRez (dual cure resin-based), RealSeal (dual cure resin-based), and GuttaFlow (silicon-based) were tested and compared with TubliSeal (zinc oxide-eugenol-based). The bonded disk method was used. Sixty specimens were tested at body and room temperatures. Dual cure resin-based sealers were tested as chemically cured only and as dual cured. Samples were tested for 24 hours. It was found that there were statistically significant differences between the tested sealers. EndoRez had the highest shrinkage-strain value, followed by RealSeal, whereas TubliSeal had the lowest. GuttaFlow exhibited expansion on polymerization. It was concluded that shrinkage associated with setting might jeopardize the seal of the root canal, leading to root canal failure.     

Effect of adhesive layer properties on stress distribution in composite restorations--a 3D finite element analysis.

OBJECTIVES: Teeth, adhesively restored with resin-based materials, were modeled by 3D-finite elements analysis that showed a premature failure during polymerization shrinkage and occlusal loading. METHODS: Simulation of Class II MOD composite restorations with a resin bonding system revealed a complex biomechanical behavior arising from the simultaneous effects of polymerization shrinkage, composite stiffness and adhesive interface strain. Due to a polymerization contraction, shrinkage stress increases with the rigidity of the composites utilised in the restoration, while the cusp movements under occlusal loading are inversely proportional to the rigidity of the composites. The adhesive layer's strain also plays a relevant role in the attenuation of the polymerization and occlusal loading stresses. RESULTS: The choice of an appropriately compliant adhesive layer, able to partially absorb the composite deformation, limits the intensity of the stress transmitted to the remaining natural tooth tissues. For adhesives and composites of different rigidities, FEM analysis allows the determination of the optimal adhesive layer thickness leading to maximum stress release while preserving the interface integrity. Application of a thin layer of a more flexible adhesive (lower elastic modulus) leads to the same stress relief as thick layers of less flexible adhesive (higher elastic modulus).     

Alternative methods for determining shrinkage in restorative resin composites

Objectives

The purpose of this study was to evaluate polymerization shrinkage of resin composites using a coordinate measuring machine, optical coherence tomography and a more widely known method, such as Archimedes Principle. Two null hypothesis were tested: (1) there are no differences between the materials tested; (2) there are no differences between the methods used for polymerization shrinkage measurements.

Methods

Polymerization shrinkage of seven resin-based dental composites (Filtek Z250™, Filtek Z350™, Filtek P90™/3M ESPE, Esthet-X™, TPH Spectrum™/Dentsply 4 Seasons™, Tetric Ceram™/Ivoclar-Vivadent) was measured. For coordinate measuring machine measurements, composites were applied to a cylindrical Teflon mold (7 mm × 2 mm), polymerized and removed from the mold. The difference between the volume of the mold and the volume of the specimen was calculated as a percentage. Optical coherence tomography was also used for linear shrinkage evaluations. The thickness of the specimens was measured before and after photoactivation. Polymerization shrinkage was also measured using Archimedes Principle of buoyancy (n = 5). Statistical analysis of the data was performed with ANOVA and the Games-Howell test.

Results

The results show that polymerization shrinkage values vary with the method used. Despite numerical differences the ranking of the resins was very similar with Filtek P90 presenting the lowest shrinkage values.

Significance

Because of the variations in the results, reported values could only be used to compare materials within the same method. However, it is possible rank composites for polymerization shrinkage and to relate these data from different test methods. Independently of the method used, reduced polymerization shrinkage was found for silorane resin-based composite.     

复合树脂预热的研究现状和临床应用

复合树脂作为临床常用牙科充填材料存在耐磨性差、聚合收缩大和牙本质边缘适应性不佳等问题。近年有研究发现预热可以改善复合树脂的性能,本文就预热复合树脂对其单体转化率、边缘微渗漏、机械性能以及牙髓的影响等方面进行探讨,以供临床参考。     

A rational use of dental materials in posterior direct resin restorations in order to control polymerization shrinkage stress

One of the main problems when using resin-based composites is the resulting polymerization shrinkage stress. Composite strain is hindered every time the composite is bonded to the tooth's walls. In the pre-gel phase the shrinkage stress is reduced by the composite flow from the free to the bonded surface areas. Therefore, no stress develops at the dentine-composite interface. When a gel point is reached, the composite flow no longer compensates for the volumetric shrinkage. The generated stress may cause adhesive failure and several other adverse clinical consequences such as enamel fracture, cracked cusps, cuspal movement, microcracking of the restorative material and gaps between the resin and cavity walls which may cause secondary caries and postoperative sensitivity. A sensible use of materials in direct restorations may contribute to a reduced rate of shrinkage stress. To this aim glass-ionomer cement as well as flowable, light-curing and self-curing composites were examined. The aim of this study was to provide some useful information for a sensible choice of restoration materials in order to control shrinkage stress and its negative consequences in direct posterior restorations.     

复合树脂嵌体的研究进展及应用现状

复合树脂嵌体也称间接性树脂修复,是由含有双甲基丙烯酸酯基类的复合树脂在体外固化制作而成。体外固化过程释放了复合树脂嵌体的聚合收缩应力,使修复体的聚合收缩局限在粘接层内;同时提高了复合树脂的聚合程度,提升了其机械性能。同样,由于复合树脂嵌体有体外操作过程,因此在解剖形态方面更佳,有着相比直接树脂充填更良好的邻面接触和面形态。相比瓷嵌体,复合树脂嵌体有着修补方便,不磨耗对牙等特点。随着复合树脂材料及树脂粘接材料的更新,复合树脂嵌体的性能如抗折裂强度、边缘微渗漏、硬度及耐磨性等方面得以提高,复合树脂嵌体在临床方面的应用逐渐广泛,不仅限于牙体严重缺损活髓牙的修复,在完成牙髓治疗后的牙齿、隐裂牙、重度磨损牙等疾患中均有应用。本文就近年来复合树脂嵌体的性能研究及临床应用现状作一综述。     

复合树脂预热的研究现状和临床应用

复合树脂作为临床常用牙科充填材料存在耐磨性差、聚合收缩大和牙本质边缘适应性不佳等问题。近年有研究发现预热可以改善复合树脂的性能,本文就预热复合树脂对其单体转化率、边缘微渗漏、机械性能以及牙髓的影响等方面进行探讨,以供临床参考。     

Clinical measurement of palatal tooth wear following coating by a resin sealing system

This study investigated the hypothesis that coating eroded teeth with a resin-based dentin bonding agent gave protection from tooth wear. Nineteen adults with palatal tooth wear exposing dentin were recruited, following referral by their general dental practitioner. Alternate teeth were coated with the resin adhesive, while the uncoated teeth acted as controls. Accurate impressions of the eroded teeth, onto which were cemented machined stainless steel discs to act as reference areas, were scanned with a non-contacting laser profilometer at 3, 6, 12 and 24 months. The mean thickness of resin at baseline application was 0.15 mm and, from 0 to 6 months, the rate of wear of the control teeth was higher than those covered with Seal & Protect. There was a statistically significant difference in "wear" measured between resin covered and control teeth at three months. The Inter Class Correlations (repeated measurements) for the step heights obtained for the original and repeat impressions was excellent at 0.99. This study shows that coating eroded teeth with a resin-based adhesive has the potential to prevent further tooth wear.     

Resin composites in dentistry: the monomer systems

The present review outlines the history of monomers, used in resin composites, motivates further development, and highlights recent and ongoing research reported in the field of dental monomer systems. The monomer systems of most present-day resin composites are based on BisGMA, developed some 40 years ago, or derivatives of BisGMA. In the remaining resin composites, urethane monomers or oligorners are used as the basis of the monomer system. The main deficiencies of current resin composites are polymerization shrinkage and insufficient wear resistance under high masticatory forces. Both factors are highly influenced by the mooonier system, and considerable efforts are being made around the world to reduce or eliminate these undesirable properties. The use of fluoride-releasing monomer systems, some of which are under investigation, has been suggested to mitigate the negative effects of marginal gaps formed in consequence of polymerization shrinkage. The very crux of the problem has also been approached with the synthesis of potentially low-shrinking/non-shrinking resin composites involving ring opening or cyclopolymerizable monomers. By the use of additives with a supposed chain transfer agent function, monomer systems have been formulated that improve the degree of conversion of methacrylate double bonds and mechanical properties. Many promising monomer systems have been devised, the implementation of which may be expected to improve the longevity of resin composite fillings and expand the indications for resin composites.     

Properties of a dental resin composite with a spherical inorganic filler

This study compared the mechanical properties, generalized wear resistance and polymerization shrinkage of a resin composite filled with spherical inorganic filler to other commercial resin composites. Six dental resin composites were tested, including a submicron filled composite (Estelite sigma, Estelite), 1 nano-composite (Filtek Supreme, Supreme), 2 microfilled composites (Heliomolar; Renamel Microfill, Renamel) and 2 microhybrid composites (Esthet X Improved; Tetric Ceram). Compressive strength (CS), diametral tensile strength (DTS), flexural strength (FS), flexural modulus (FM), generalized wear resistance (WV) and polymerization shrinkage (PS) were evaluated for the 6 materials. The specimens were cured according to the manufacturers' instructions in appropriate molds, stored (37 degrees C water, 24 hours), then tested on an Instron testing machine (0.5 mm/minute). PS was tested according to the Archimedes method at 1, 24 and 48 hours continually after polymerization. Data were analyzed by analysis of variance. The results showed that CS values ranged from 252 to 298 MPa, DTS ranged from 35 to 54 MPa, FS from 73 to 140 MPa, FM from 4.8 to 11.1 GPa, WV from 0.037 to 0.086 mm(3) and PS at 24 hours from 2.17 to 3.96 vol%. Composite had statistically significant influence on the in vitro properties tested. Estelite performed similarly to nano-composite and microhybrid composites in mechanical properties and generalized wear resistance, while Estelite and Supreme had the lowest PS among the materials tested. The 2 microhybrid materials had similar properties, while the 2 microfilled composites were different for most properties tested. Overall, the microfilled composites had lower strength than the other composites except Renamel for CS. All the materials had a similar shrinkage pattern in that about 99% of shrinkage occurred in less than 24 hours.