Belge No: 1G1
CLINICAL DENTISTRY AND RESEARCH 2018; 42(2): 49-56 Original Research Article
EVALUATION OF CERVICAL INTEGRITY FOLLOWING THERMO-
MECHANICAL LOADING OF CLASS II BOX CAVITIES RESTORED
WITH BULK-FILL COMPOSITES
Bilge Ersöz, DDS
Research Assistant, Department of Restorative Dentistry,
Faculty of Dentistry Ankara University,
Ankara, Turkey
Gürkan Gür, DDS, PhD
Professor, Department of Restorative Dentistry,
Faculty of Dentistry, Ankara University,
Ankara, Turkey
Gülbike Demirel, DDS, PhD
Research Assistant, Department of Restorative Dentistry,
Faculty of Dentistry, Ankara University,
Ankara, Turkey
Correspondence
Gülbike Demirel DDS, PhD
Department of Restorative Dentistry,
Faculty of Dentistry,
Ankara University,
Phone: +90 312 296 5594
E- Mail: gulbikedemirel@gmail.com
gdemirel@ankara.edu.tr
Submitted for Publication: 12.19.2017
Accepted for Publication : 06.19.2018
ABSTRACT
Background and Aims: This in-vitro study aimed to evaluate
the effects of thermo-mechanical loading on the microleakage
of proximal box cavities restored with bulk-fill composites.
Materials and Methods: Four different combinations of
restorative materials were evaluated: conventional flowable
composite+conventional paste-like composite, conventional
paste-like composite, bulk-fill flowable composite+conventional
paste-like composite, and bulk-fill paste-like composite. The
gingival margins of the mesial proximal box cavities were
terminated 1 mm below the cemento-enamel junction,
whereas those of the distal proximal box cavities were
terminated 1 mm above. Before and after thermo-mechanical
loading (240,000×50 N for 2500 thermal cycles between
5°C-55°C), the teeth were immersed in a 0.5% basic fuchsin
dye at 23°C for 24 h. Sectioned samples were examined under
a stereomicroscope, and the degree of microleakage was
statistically analyzed using three-way analysis of variance and
Tukey post hoc test (p< 0.05).
Results: Statistically significant differences in the degree of
microleakage between the margins within the enamel and
dentin were observed in all test groups (p< 0.05). Similarly,
greater microleakage was observed in all samples subjected to
thermo-mechanical loading (p< 0.05). No statistically significant
differences were observed in the microleakage between different
combinations of restorative materials used (p > 0.05).
Conclusions: Restorations with margins located within
dentin had greater microleakage. Thermo-mechanical loading
negatively influenced the samples, thus exacerbating
microleakage values at margins located within both the enamel
and the dentin. There was no statistically significant difference
in microleakage among the bulk-fill and conventional composite
groups, with or without thermo-mechanical loading.
Clin Dent Res 2018; 42(2): 49-56
Keywords: Bulk-Fill Composite, Microleakage, Thermo-
Mechanical Loading
49
 CLINICAL DENTISTRY AND RESEARCH 2018; 42(2): 49-56
BULK-FİLL KOMPOZİTLER İLE RESTORE EDİLEN SINIF II KUTU
KAVİTELERİN TERMO-MEKANİK YÜKLEME SONRASI SERVİKAL
BÜTÜNLÜĞÜNÜN DEĞERLENDİRİLMESİ
Bilge Ersöz
Arş. Gör. Ankara Üniversitesi Diş Hekimliği Fakültesi,
Restoratif Diş Tedavisi Anabilim Dalı,
Ankara, Türkiye
Gürkan Gür
Prof. Dr. Ankara Üniversitesi Diş Hekimliği Fakültesi,
Restoratif Diş Tedavisi Anabilim Dalı,
Ankara, Türkiye
Gülbike Demirel
Arş. Gör. Ankara Üniversitesi Diş Hekimliği Fakültesi,
Restoratif Diş Tedavisi Anabilim Dalı,
Ankara, Türkiye
Sorumlu Yazar
Gülbike Demirel
Ankara Üniversitesi, Diş Hekimliği Fakültesi,
Restoratif Diş Tedavisi Anabilim Dalı,
Ankara, Türkiye
Telefon: +90 312 296 5594
E- Mail: gulbikedemirel@gmail.com
gdemirel@ankara.edu.tr
50
Orijinal Araştırma
ÖZ
Amaç: Bu in-vitro çalışmanın amacı, bulk-fill kompozitlerle
restore edilen proksimal kutu kavitelerin, termomekanik
yükleme sonrası mikrosızıntısını değerlendirmektir.
Gereç ve Yöntem: Bu çalışmada dört farklı restoratif
materyalin kombinasyonu (geleneksel akışkan kompozit +
geleneksel kıvamda kompozit, geleneksel kıvamda kompozit,
bulk-fill akışkan kompozit + geleneksel kıvamda kompozit, bulk-
fill geleneksel kıvamda kompozit) incelenmiştir. Yakın zamanda
çekilmiş 3. Mesial proksimal kutu kaviteler mine-sement
birleşiminin 1mm altında, distal kutu kaviteler ise 1mm üstünde
sonlandırılmıştır. Termomekanik yükleme yapılan (240.000 x 50
N, 5°C-55°C arasında 2500 ısıldöngü), ve yapılmayan örnekler
%0.5’lik bazik fuksin içerisinde 23°C’de 24 saat bekletilmiştir.
Kesilen örnekler steriomikroskopta değerlendirilmiş ve
mikrosızıntı skorları üç-yönlü ANOVA ve Tukey Post Hoc testi
(p< 0.05) ile istatistiksel olarak değerlendirilmiştir.
Bulgular: Tüm gruplar için mine ve dentin arasındaki sızıntı
skorları istatistiksel olarak anlamlıdır (p<0.05). Benzer
olarak termomekanik olarak yüklenen örneklerde daha fazla
mikrosızıntı izlenmiştir (p<0.05). Farklı kombinasyonlarda
kullanılan restoratif materyaller arasında istatistiksel olarak
farklılık bulunamamıştır (p>0.05).
Sonuçlar: Bu bulgular sonucunda, dentinde sonlanan
restorasyonların daha fazla mikrosızıntı sergilediği sonucuna
varılmıştır. Restorasyonlar termo-mekanik yüklemeye tabi
tutulduğunda olumsuz etkilenmişlerdir ve mine ve dentinde
mikrosızıntı miktarı artmıştır. Termo-mekanik yükleme yapılan,
bulk-fill ve geleneksel kompozit grupları arasında, mikrosızıntı
yönünden istatistiksel olarak anlamlı fark izlenmemiştir.
Clin Dent Res 2018; 42(2): 49-56
Anahtar Kelimeler: Bulk-Fill Kompozit, Mikrosızıntı, Termo-
Mekanik Yükleme
Yayın Başvuru Tarihi : 19.12.2017
Yayına Kabul Tarihi : 19.06.2018

INTRODUCTION
Long-term adhesion of restorative biomaterials bound to
hard tooth tissues is essential for clinical success.1, 2 When
weak van der Waals forces between the monomers are
transformed into covalent bonds, the distance between the
monomers reduces, resulting in polymerization shrinkage.
This contraction induces stress at the tooth-restoration
interface, and when this stress exceeds the bond strength,
debonding occurs.3 When marginal integrity is compromised
due to debonding, problems such as leakage, recurrent
caries, and pulpal irritation may occur.4
Recently, a new class of composites, known as bulk-fill
composites, was introduced in the market. These composites
reduced the polymerization stress, demonstrated high
reactivity to light curing, and allowed insertion of a
single 4–5 mm bulk increment.5 These composites can be
categorized into two main groups: base (flowable) and full-
body (paste-like) bulk-fill composites.
Generally, base bulk-fill composites have low viscosity,
enabling precise delivery through a narrow syringe,
facilitating simplification of placement and adaptation to
deep cavities. These composites typically have less filler
content, which reduces surface resistance; therefore,
capping with a conventional composite is required.
Full-body bulk-fill composites can be considered as the only
true bulk-filling type, allowing one-step placement of the
entire restoration without requiring additional capping layer.
These materials generally have a higher filler load, which
makes them highly viscous and their surface more wear
resistant.5, 6
We tested three null hypotheses: (1) there would be
differences in Class II box cavities that were restored using
different restorative materials; (2) the restoratives under
investigation would exhibit significant differences in gap-
free margin extent at the cervical enamel and cervical
dentin interfaces; and (3) thermo-mechanical loading would
not affect the marginal integrity of bulk-fill composites at
either the enamel or the dentin margins.
MATERIALS AND METHODS
This study was approved by the Local Ethical Committee
of the Ankara University Faculty of Dentistry (Approval no:
36290600/46). The study protocol was in accordance with
the Declaration of Helsinki.
Cavity preparation procedure
Forty intact third human molars were extracted and were
immediately stored in normal saline solution. The specimens
for study were prepared within two weeks.
CERVICAL INTEGRITY OF BULK-FILL COMPOSITES
Two proximal box cavities were prepared on each tooth
[80 proximal box cavities (N= 80)], with the occlusal
dimensions being approximately one-third of the
intercuspal dimension. The cervical limit of the mesial
proximal box cavity was approximately 1 mm below the
cemento-enamel junction, whereas that for the distal
proximal box cavity was approximately 1 mm above
the cemento-enamel junction. The inner angles of the
cavities were rounded, and the gingival margins were left
as butt joints. Cavities were created with a new cylindrical
diamond burr (Meisinger, Germany) using a high-speed
hand-piece with water cooling. The cavity depth was
standardized by polishing the occlusal surfaces of the
teeth with silicon carbide paper (P1000–P4000Metkon,
Gripo 2v Grinder-Polisher, Turkey) under water cooling to
5 mm. The final cavity depth was measured using digital
calipers (Mitutoyo 500, Mitutoyo Corporation, Kanagawa,
Japan) to ensure uniformity.
Restorative procedure
After the preparations were completed, metal matrix bands
(Adapt SuperCap Matrix no 2182, Kerr-Hawe, Bioggio,
Switzerland) were placed around each specimen to create
the lost proximal wall. The teeth were then divided into four
groups and restored using the following materials.
Flowable composite + conventional paste-like composite
group: Clearfil S3 Bond Plus (Kuraray Noritake Dental
Inc., Japan) was applied to the entire cavity wall using
an applicator brush. The excess solvent was allowed
to evaporate using a gentle air blast until the bond film
appeared to be set (approximately 10 s). The bonding
agent was then cured for 10 s using an LED curing unit
(SDI Radii Plus, SDI Limited, Australia). The output power of
the curing unit was periodically monitored using a dental
radiometer to ensure a minimum intensity of 1000 mW/cm2.
Cavities were restored using conventional flowable resin
composite (Filtek Supreme Ultra Flowable Restorative, 3M
ESPE, USA) as the first 1-mm layer. This was followed by
restoration using conventional paste-like resin composite
(Filtek Supreme Ultra Universal Restorative, 3M ESPE, USA)
for the residual cavity height and was applied in increments
of 2-mm thickness with each increment light-cured for 20
s (Figure 1 A).
Conventional paste-like composite group: The same
adhesive was applied and cured using the aforementioned
procedure. However, the cavities were restored using
three horizontal increments (2 mm for the first and second
increments and 1 mm for the last increment) of conventional
51
 CLINICAL DENTISTRY AND RESEARCH

Figure 1. Representative figures of restorative procedure. A: Flowable composite (1mm, one layer) + Conventional paste-like composite (2mm,
two layers), B: Conventional paste-like composite group (2mm, three layers), C: Bulk-fill flowable composite (4mm, one layer) + Conventional
paste-like composite (1mm, capping layer), D: Bulk-fill paste-like composite group (4mm, one layer).

paste-like resin composite with 20 s of light curing for each
increment (Figure 1B).
Bulk-fill flowable composite + conventional paste-like
composite group: The same adhesive was applied and
cured as described above. The cavities restored with bulk-
fill flowable composite (Filtek Bulk-fill Flowable Restorative,
3M ESPE, USA) for the first increment (4 mm) were light-
cured for 20 s. Conventional paste-like composite was used
as the capping layer, followed by light curing for 20 s (Figure
1C).
Bulk-fill paste-like composite group: The same adhesive was
applied and cured as described above, and the cavities were
restored using the bulk-fill paste-like composite as a 5-mm
bulk, followed by light curing for 10 s from the occlusal side,
10 s from the buccal side, and 10 s from the lingual side
(Figure 1D).
Details of the composite materials used in the study are
indicated in Table 1.
Mechanical loading
After the cavities were restored, apices of the teeth were
sealed with a layer of sticky wax, and all tooth surfaces
were covered with two coats of nail polish, except for the
restorations and 1 mm from the restoration margins. Teeth
specimens were embedded in cylindrical PVC molds in self-
curing acrylic resin up to 2 mm apical to the cervical wall of
the restoration.
The groups were then subdivided as follows:
1. Flowable composite + conventional paste-like composite
group with thermo-mechanical loading (n = 10),
2. Flowable composite + conventional paste-like composite
group without thermo-mechanical loading (n = 10),
3. Conventional paste-like composite group with thermo-
mechanical loading (n = 10),
4. Conventional paste-like composite group without
thermo-mechanical loading (n = 10),
5. Bulk-fill flowable composite + conventional paste-like
composite group with thermo-mechanical loading (n = 10),
6. Bulk-fill flowable composite + conventional paste-like
composite group without thermo-mechanical loading (n = 10),
7. Bulk-fill paste-like composite group with thermo-
mechanical loading (n = 10), and
8. Bulk-fill paste-like composite group without thermo-
mechanical loading (n = 10).
For subgroups with thermo-mechanical loading, the
specimens were subjected to thermal and mechanical
loading cycles using the chewing simulator with
simultaneous thermal cycling (Esetron chewing simulator,
Turkey). Specimens were arranged in a simulator chamber
and occluded against a stainless steel antagonist (2-mm
diameter) striking two lateral ridges of the restorations
for 240,000 cycles at 50 N at a frequency of 1.6 Hz. The
specimens were simultaneously subjected to thermal

52
 CERVICAL INTEGRITY OF BULK-FILL COMPOSITES

Table 1. The composition of bulk-fill and conventional composite materials used in the study
Recommended
Filler
Material Recommended Capping curing time
Material Shade Matrix composition % by Manufacturer
Type tickness layer and
weight
light intensity
bisGMA, TEGDMA
and Procrylat resins,
ytterbium trifluoride,
Filtek 20s ≥ 400-1000
non-agglomerated/ 3M Dental
Ultimate Convetional mW/cm2 10 s
A2 non-aggregated 65 2mm No Products.
Flowable flowable ≥1000-2000
surface modified silica St.Paul, USA.
Restorative mW/cm2
filler, surface modified
aggregated zirconia/
silica cluster filler
bis-GMA, UDMA,
TEGDMA, PEGDMA,
bis-EMA,non-
agglomerated/
Filtek 20s ≥ 400-1000
non-aggregated 3M Dental
Ultimate Convetional mW/cm2 10 s
A2 silica filler, a non- 78,5 2mm No Products.
Universal paste-like ≥1000-2000
agglomerated/non- St.Paul, USA.
Restorative mW/cm2
aggregated zirconia
filler, aggregated
zirconia/silica cluster
filler
BisGMA, UDMA,
20s ≥ 500-1000
Filtek Bulk- bisEMA, procrylat 3M Dental
Bulk-fill mW/cm2 10 s
fill Fowable Universal resins, ytterbium 64,5 4mm Required Products.
flowable ≥1000-2000
Restorative trifloride, zirconia/ St.Paul, USA.
mW/cm2
slica
AUDMA, AFM,
diurethane-DMA, 10 s occlusal,
Filtek One 3M Dental
Bulk-fill and 1, 12-dodecane- 10 s buccal, 10 s
Bulk-fill A2 76,5 5mm No Products.
paste-like DMA,ytterbium lingual ≥1000-
Restorative St.Paul, USA.
trifluoride, zirconia/ 2000 mW/cm2
slica

cycling between +5°C and +55°C by filling the chambers
with water at each temperature for 60 s. The mechanical
action and water temperature within the chewing chambers
were checked periodically to ensure a precise thermo-
mechanical loading effect.
After the mechanical loading and thermal cycles, the
specimens were immersed in 0.5% basic fuchsin dye at
23°C for 24 h. Following immersion, the teeth were washed
thoroughly with distilled water, and sectioned mid-sagitally
in the mesial-distal plane using a slow-speed diamond
saw (Micracut 175, Metkon Instruments Ltd., Turkey) with
irrigation. The sectioned samples were examined under
a stereomicroscope (Leica MZ 12; Leica Microsystems,
Germany) at 40× magnification to assess the extent of
the cervical gingival microleakage. The microleakage was
scored using the following scale: 0= no leakage; 1= leakage
extends up to half of the cervical wall length; 2= leakage
extends across the entire cervical wall length; 3= leakage
into the cervical and axial walls toward the pulpal wall.
The cervical gingival microleakage scores were statistically
analyzed using three-way analysis of variance, followed by
paired-group comparisons using Tukey post hoc test at a
95% significance level.
RESULTS
The microleakage scores for the enamel and dentin margins
are indicated in Table 2. Statistically significant differences
in the degree of leakage between the enamel and dentin

53
 CLINICAL DENTISTRY AND RESEARCH

margins were observed in all test groups, regardless of the
restorative technique used, and with or without thermo-
mechanical loading. Restorations that ended within dentin
demonstrated greater cervical microleakage than those
that ended within enamel (p= 0.001). Similarly, greater
microleakage was observed in specimens with thermo-
mechanical loading than those without thermos-mechanical
loading (p= 0.001). A statistically significant difference in
microleakage was not observed for the combinations of
restoration materials (p= 0.117) (Table 3).
DISCUSSION
resin composites, manufacturers have produced a new class
of composite materials, bulk-fill composites, and can be
placed in single or deeper increments. These composites
are methacrylate-based similar to traditional composites,
and a majority of bulk-fill materials in the market are purely
light-cured, with a few being dual-cured. Manufacturers
have attempted to increase the curing depth of bulk-fill
composites using various methods, which include reducing
the filler content,10 using additional photo-initiators,5
increasing filler particle size,10 and increasing translucency.11
According to Zorzin et al12 and El-Damanhoury and Platt,13

Marginal integrity is fundamental to increase the longevity
of composite restorations,7 but it may be compromised by
the formation of microgaps. Polymerization shrinkage is
the most common cause of microgaps in direct posterior
composite restorations.8 Different resin composites have
different chemical formulations and consequently exhibit
different degrees of polymerization contraction.9
In order to simplify and speed-up the placement of posterior
these bulk-fill composites allow the use of material
increments of up to 4–5 mm in thickness with low volumetric
polymerization contraction, resulting in low polymerization
contraction stress.
Studies on the marginal integrity of bulk-fill composites have
shown these composites to be superior to conventional
composites,4, 14
whereas others reported no difference
between bulk-fill and conventional composites.15, 16

Table 2. Microleakage scores of Class II box cavity restorations

Without thermo-mechanical loading

Enamel (above cementoenamel junction) Dentin (below cementoenamel junction)

Score 0 Score 1 Score 2 Score 3 Score 0 Score 1 Score 2 Score 3

Flowable composite+ Paste-

8 2 7 3
like composite group
Conventional paste-like
6 4 6 3 1
composite group
Bulk-fill flowable composite
+Conventional paste-like 6 4 9 1
composite group:
Bulk-fill paste-like composite
10 9 1
group

With thermo-mechanical loading

Enamel (above cementoenamel junction) Dentin (below cementoenamel junction)

Score 0 Score 1 Score 2 Score 3 Score 0 Score 1 Score 2 Score 3

Flowable composite+ Paste-

5 4 1 2 5 3
like composite group
Conventional paste-like
1 7 2 1 4 5
composite group
Bulk-fill flowable composite
+Conventional paste-like 4 6 4 6
composite group:
Bulk-fill paste-like composite
7 3 4 3 3
group

54

Table 3. Results of analysis of variance p< 0.05 was considered statistically significant
Type III Sum of
Source
Squares
Location of the cavities 8.100
Thermomechanical loading 28.900
Groups 1.850
The first null hypothesis of this study was that there would
be less microleakage with bulk-fill composites compared with
traditional composites because of their low polymerization
contraction stress. Nevertheless, there was no significant
difference between any of the composites tested (p=
0.001). As a consequence, the first null hypothesis was
rejected.
It is widely accepted that margins located within the
dentin allow for a greater rate of microleakage than those
located in the enamel.17, 18 In the present study, the degree
of microleakage was significantly affected by the marginal
substrate; the amount of dye penetration on the enamel
was significantly lower than that on the dentin (p= 0.001).
Thus, the second null hypothesis was accepted. This
finding is consistent with previous reports on adhesion on
the enamel and dentin19 and is related to the low organic
composition of the enamel compared with the dentin. The
dentin has a complex structure rich in organic particles that
make adhesion to it more variable and challenging.20-22
In vitro laboratory tests regarding the interchange of
thermal and mechanical variations have been demonstrated
to simulate the oral environment.23 The thermo-mechanical
load cycling number in previous studies varied with the
methodology used.23, 24 DeLong and Douglas25, 26 concluded
that 240.000–250.000 thermo-mechanical loading cycles
is equivalent to approximately 1 year of in vivo function.
Therefore, we applied 240.000 thermo-mechanical loads to
the specimens in this study.
In previous studies, thermo-mechanical loading on occlusal
surfaces increased the degree of microleakage in the test
groups compared with that in the control groups.24, 27, 28
Therefore, it can be considered that loads on the occlusal
surface of samples may increase cusp deflection, generating
stress next to the margins, which leads to a gap at the
tooth/restoration interface that facilitates dye leakage
and, consequently, microleakage. Two effects of thermal
cycling have been hypothesized: 1) high temperatures
CERVICAL INTEGRITY OF BULK-FILL COMPOSITES
df Mean Square F Sig.(p)
1 8.100 26.270 0.001
1 28.900 93.730 0.001
3 .617 2.000 0.117
that stimulate the hydrolysis of interface components cause
extraction of breakdown products or poorly polymerized
resin oligomers29, 30 and 2) repetitive contraction/expansion
stresses are generated at the tooth–biomaterial interface
because of the different thermal contraction/expansion
coefficients of the restorative material and tooth tissue.31
In this study, severe microleakage in the enamel and dentin
was found in all specimens subjected to thermo-mechanical
loading; therefore, null hypothesis (3) was rejected. However,
higher microleakage scores following thermo-mechanical
loading observed in this study are consistent with previous
studies.23, 24, 32
CONCLUSIONS
Considering limitations of this in vitro study, it can be
concluded that:
1. Restorations with margins within the dentin had a
higher degree of microleakage than those with margins
within the enamel.
2. Restorations that were subjected to thermo-mechanical
loading were negatively influenced with higher
microleakage scores in the enamel and dentin.
3. No statistically significant differences in microleakage
were found in comparisons of the four combinations of
restorative materials.
4. The bulk-fill and conventional composite groups
demonstrated similar microleakage patterns with
or without thermo-mechanical loading. This result
suggests that bulk-fill composite materials may be
particularly helpful for restoring posterior cavities in
cases where the procedural time is of concern, such as
in children and patients with anxiety.
REFERENCES
1. Goldstein GR. The longevity of direct and indirect posterior
restorations is uncertain and may be affected by a number of
dentist-, patient-, and material-related factors. J Evid Based Dent
Pract 2010; 10: 30-31.
55
 CLINICAL DENTISTRY AND RESEARCH
2. Manhart J, Chen H, Hamm G, Hickel R. Buonocore Memorial
Lecture. Review of the clinical survival of direct and indirect
restorations in posterior teeth of the permanent dentition. Oper
Dent 2004; 29: 481-508.
3. Ferracane JL. Developing a more complete understanding of
stresses produced in dental composites during polymerization.
Dent Mater 2005; 21: 36-42.
4. Roggendorf MJ, Krämer N, Appelt A, Naumann M, Frankenberger
R. Marginal quality of flowable 4-mm base vs. conventionally
layered resin composite. J Dent 2011; 39: 643-647.
5. Chesterman J, Jowett A, Gallacher A, Nixon P. Bulk-fill resin-
based composite restorative materials: a review. Br Dent J 2017;
222:337-344.
6. Van Ende A, De Munck J, Lise DP, Van Meerbeek B. Bulk-Fill
Composites: A Review of the Current Literature. J Adhes Dent
2017; 19: 95-109.
7. Taylor MJ, Lynch E. Microleakage. J Dent 1992; 20: 3-10.
8. Moraschini V, Fai CK, Alto RM, dos Santos GO. Amalgam and resin
composite longevity of posterior restorations: A systematic review
and meta-analysis. J Dent 2015; 43: 1043-1050.
9. Kleverlaan CJ, Feilzer AJ. Polymerization shrinkage and
contraction stress of dental resin composites. Dent Mater 2005;
21: 1150-1157.
10. Ilie N, Bucuta S, Draenert M. Bulk-fill resin-based composites:
an in vitro assessment of their mechanical performance. Oper Dent
2013; 38: 618-625.
11. Lassila LV, Nagas E, Vallittu PK, Garoushi S. Translucency of
flowable bulk-filling composites of various thicknesses. Chin J Dent
Res 2012; 15: 31-35.
12. Zorzin J, Maier E, Harre S, Fey T, Belli R, Lohbauer U et al. Bulk-
fill resin composites: Polymerization properties and extended light
curing. Dent Mater 2015; 31: 293-301.
13. El-Damanhoury H, Platt J. Polymerization shrinkage stress
kinetics and related properties of bulk-fill resin composites. Oper
Dent 2014; 39: 374-382.
14. Agarwal RS, Hiremath H, Agarwal J, Garg A. Evaluation of
cervical marginal and internal adaptation using newer bulk fill
composites: An in vitro study. J Conserv Dent 2015; 18: 56-61.
15. Benetti AR, Havndrup-Pedersen C, Honore D, Pedersen MK,
Pallesen U. Bulk-fill resin composites: polymerization contraction,
depth of cure, and gap formation. Oper Dent 2015; 40: 190-200.
16. Furness A, Tadros MY, Looney SW, Rueggeberg FA. Effect
of bulk/incremental fill on internal gap formation of bulk-fill
composites. J Dent 2014; 42: 439-449.
17. Heintze SD. Clinical relevance of tests on bond strength,
microleakage and marginal adaptation. Dent Mater 2013; 29: 59-84.
56
18. Schwendicke F, Kern M, Blunck U, Dörfer C, Drenck J, Paris S.
Marginal integrity and secondary caries of selectively excavated
teeth in vitro. J Dent 2014; 42: 1261-1268.
19. Bagis YH, Baltacioglu IH, Kahyaogullari S. Comparing microleakage
and the layering methods of silorane-based resin composite in wide
Class II MOD cavities. Oper Dent 2009; 34: 578-85.
20. Hikita K, Van Meerbeek B, De Munck J, Ikeda T, Van Landuyt K,
Maida T et al. Bonding effectiveness of adhesive luting agents to
enamel and dentin. Dent Mater 2007; 23: 71-80.
21. Marshall GW, Marshall SJ, Kinney JH, Balooch M. The dentin
substrate: structure and properties related to bonding. J Dent
1997; 25: 441-458.
22. Van Meerbeek B, De Munck J, Yoshida Y, Inoue S, Vargas M,
Vijay P et al. Buonocore memorial lecture. Adhesion to enamel and
dentin: current status and future challenges. Oper Dent 2003; 28:
215-235.
23. Borges AF, Santos Jde S, Ramos CM, Ishikiriama SK, Shinohara
MS. Effect of thermo-mechanical load cycling on silorane-based
composite restorations. Dent Mater J 2012; 31: 1054-1059.
24. Campos PE, Barceleiro Mde O, Sampaio-Filho HR, Martins LR.
Evaluation of the cervical integrity during occlusal loading of Class
II restorations. Oper Dent 2008; 33: 59-64.
25. DeLong R, Douglas WH. Development of an artificial oral
environment for the testing of dental restoratives: bi-axial force
and movement control. J Dent Res 1983; 62: 32-36.
26. DeLong R, Douglas WH. An artificial oral environment for testing
dental materials. IEEE Trans Biomed Eng 1991; 38: 339- 345.
27. Lundin SA, Noren JG. Marginal leakage in occlusally loaded,
etched, class-II composite resin restorations. Acta Odontol Scand.
1991; 49: 247-254.
28. Mandras RS, Retief DH, Russell CM. The effects of thermal
and occlusal stresses on the microleakage of the Scotchbond 2
dentinal bonding system. Dent Mater 1991; 7: 63-67.
29. Hashimoto M, Ohno H, Kaga M, Endo K, Sano H, Oguchi H.
In vivo degradation of resin-dentin bonds in humans over 1 to 3
years. J Dent Res 2000; 79: 1385-1391.
30. Miyazaki M, Sato M, Onose H, Moore BK. Influence of thermal
cycling on dentin bond strength of two-step bonding systems. Am
J Dent 1998; 11: 118-122.
31. Gale MS, Darvell BW. Thermal cycling procedures for laboratory
testing of dental restorations. J Dent 1999; 27: 89-99.
32. Erdilek D, Dorter C, Koray F, Kunzelmann KH, Efes BG, Gomec Y.
Effect of Thermo-mechanical Load Cycling on Microleakage in Class
II Ormocer Restorations. Eur J Dent 2009; 3:200-205.
16.06.2022 09:50 Clinical Dentistry and Research | TR Dizin

Clinical Dentistry and Research

(Clinical Dentistry and Research)

Editör: Hatice BUZOĞLU Web: http://www.clindentres.hacettepe.edu.tr ISSN: 2146-3964 / 2146-3972

Yayına Başladığı Yıl: 1976

Yayıncı: Yeni Adı: Eski Adı: Hacettepe Dişhekimliği Fakültesi Derg.(. Clinical Dentistry and Research)

Yıllık Yayın Sayısı: 3 Yayın Yapması Gereken Aylar: Nisan, Ağustos, Aralık Yayın Dili: İngilizce
Yayın Formatı: Elektronik, Basılı

Konu Kategorisi: Diş Hekimliği Konu Alanları: Diş Hekimliği

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