d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 801809

Available online at www.sciencedirect.com

journal homepage: www.intl.elsevierhealth.com/journals/dema

Effect of layering methods, composite type, and owable liner on the polymerization shrinkage stress of light cured composites
Youngchul Kwon a , Jack Ferracane b , In-Bog Lee a,
a b

Department of Conservative Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea Department of Restorative Dentistry, Division of Biomaterials and Biomechanics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA

a r t i c l e
Article history:

i n f o

a b s t r a c t
Objectives. The aim of this study was to investigate the effect of layering methods, owable composite liner and use of low shrinkage silorane-based composite on the polymerization shrinkage stress of light cured composites. Methods. Aluminum blocks were used to prepare MOD cavities and divided into four groups. A universal hybrid methacrylate-based composite (Z250), a owable composite (Z350 owable), and a silorane-based composite (P90) were used to ll the cavities. Cavities were restored using four different lling protocols. Group 1 was lled in bulk with Z250, group 2

Received 21 September 2011 Received in revised form 14 December 2011 Accepted 16 April 2012

Keywords: Polymerization shrinkage stress Silorane composite Flowable composite lining Incremental lling Cuspal deection

was restored by an increment technique with the same composite, group 3 by an increment technique with Z250 and a Z350 owable lining, and group 4 was restored by an increment technique with P90. The axial shrinkage strain and exural modulus of the three composites were determined, and cuspal deection of each group was measured with LVDT probes and compared among groups using ANOVA and Tukeys post hoc test ( = 0.05). Results. The axial shrinkage strains of P90, Z250, and Z350 owable were 1.09 (0.11), 2.29 (0.06), and 4.12 (0.08)%, respectively. The exural modulus of P90 was 10.1 (0.9), Z250 was 13.6 (2.0), and that of Z350 owable was 7.6 (0.9) GPa. The cuspal deections at 33 min in groups 14 were 18.2 (1.54), 14.5 (0.47), 16.2 (1.10), and 6.6 (0.44) m, respectively. The incremental lling technique yielded signicantly lower cuspal deection than the bulk lling technique. Flowable composite lining under universal composite (Z250) layering showed higher cuspal deection than that without owable composite lining. Siloranebased (P90) composite exhibited lower cuspal deection than metacrylate based (Z250) composite. Signicance. Cuspal deection resulting from polymerization shrinkage stress may be reduced by an incremental lling technique and by the use of low shrinking composite to obtain optimal clinical outcomes. Flowable composite lining under conventional composite layering did not reduce polymerization shrinkage stress as assessed by cuspal deection. 2012 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Corresponding author at: Department of Conservative Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, 28 Daehak-ro 5-gil, Jongno-gu, Seoul 110-749, South Korea. Tel.: +82 2 2072 3953; fax: +82 2 2072 3859. E-mail address: inboglee@snu.ac.kr (I.-B. Lee). 0109-5641/$ see front matter 2012 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.dental.2012.04.028

802

d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 801809

1.

Introduction

Composite restoration has become an essential part of everyday dental practice with the improvement in dental adhesive systems, the increase in patients demand for esthetics and more emphasis on preservation of tooth structure. The abrasion resistance of dental composites has continued to improve since their introduction as dental restoratives, enabling expanded use in posterior restorations with good longevity. However, the polymerization shrinkage and its associated stress still remains a major drawback of dental composite materials, and numerous studies have been performed to assess and reduce the polymerization shrinkage stress [18]. Polymerization shrinkage causes stress at the interface between a tooth and a restoration as the elastic modulus of the composite increases during curing. This stress manifests as bond failure, cuspal exure, enamel microcracking, pulpal irritation and secondary caries due to bacterial inltration, and post operative sensitivity, which in turn can lead to restoration failure requiring re-restoration [2,4,7,9]. Efforts have been made to increase inorganic ller loading and to develop a new resin matrix to reduce polymerization shrinkage of composites. However, increasing inorganic ller loading is limited to a level that the surface of llers can be harmoniously combined physico-chemically with the resin matrix. Polymerization shrinkage can also be reduced by decreasing reactive sites per unit volume through increasing molecular weight per reactive groups. But this strategy also has its limitations because the use of high molecular weight monomers produces increased viscosity, resulting in poor handling characteristics [2,4,5], as well potentially reducing strength [6]. Therefore, attempts to develop composites with completely new resin matrices that do not shrink or shrink considerably less, have been ongoing, and recently a composite with silorane resin matrix containing siloxane and oxirane has been introduced [10,11]. Clinical strategies suggested to minimize shrinkage stress of composites include incremental lling technique to decrease C-factor (conguration factor = bonded surface area/non-bonded surface area) [1214], soft-cure or pulsedelay cure methods to slow polymerization by more gradually increasing light intensity from the curing units [15,16], and the use of low-modulus intermediate liner material such as owable composites to absorb shrinkage stress [1719]. Conicting results have been reported regarding the efcacy of incremental lling technique. Studies using the nite element analysis method [20,21], and a study measuring cuspal exure in premolar teeth [22] reported incremental lling of composites produces higher shrinkage stress and cuspal deection. In contrast, other studies have shown considerably reduced cuspal deection with incremental lling compared to the bulk lling technique [13,14]. It has also been reported that the incremental lling technique resulted in higher resindentin micro-tensile bond strength compared to bulk lling in large cavities whereas there was no signicant difference in small cavities [23,24]. The controversy over incremental and bulk lling techniques can be ascribed to the difculty in exactly simulating the transitional changes of resin ow during polymerization, to the different testing

methods, and to the difculty in standardizing tested specimens [13,14]. Measurement of cuspal deection is a useful way for evaluating polymerization shrinkage stress, but the use of extracted teeth for cuspal deection measurement can produce signicant discrepancies among specimens due to the lack of standardizing the anatomical and histochemical characteristics of each individual tooth [13,2527]. Park et al. [14] fabricated aluminum blocks with identical shape and dimension instead of using extracted teeth and measured cuspal deections of the aluminum blocks. The cuspal deection in the incremental lling technique was shown to be considerably lower than for the bulk lling technique, and there was no signicant difference between horizontal and oblique incremental lling techniques. Flowable composite has been recommended as a stressabsorbing liner or base owing to its relatively low modulus of elasticity and greater ability to deform to contribute to reduction of polymerization shrinkage stress from the overlying composite restorative [24]. Cuspal deection has been shown to be signicantly lower with the use of a owable composite as an intermediate layer than without a owable composite [27]. In contrast, a study using a photoelastic model reported that the use of owable composite increased shrinkage stress at the adhesive interface [28]. Silorane-based composite shows lower polymerization shrinkage compared to conventional methacrylate-based composite [29], however studies using a stressstrain analyzer and a universal testing machine reported that simply reducing the shrinkage does not ensure reduced stress development in composites [30,31]. Most studies have used indirect methods, such as microleakage and micro-tensile bond strength tests, to evaluate the effects of various clinical methods to reduce polymerization shrinkage stress. Measuring cuspal deection of teeth provides a more direct representation of contraction stress effects, but is made difcult by the morphological and histochemical differences of natural tooth substrates. This study measured cuspal deection in real time during composite curing, using standardized, uniform aluminum blocks with MOD cavity preparations. The aim of this study was to investigate the effects of layering methods, the use of owable composite liner, or the use of low shrinkage silorane-based composite on polymerization shrinkage stress effects of composites.

2.
2.1.

Materials and methods

Cuspal deection measurement instrument

Two LVDT (linear variable differential transformer) probes (AX-1, Solartron Metrology, West Sussex, UK) were set on two XYZ tables (Micro Motion Technology, Bucheon, Korea) with three attached micrometers (Mitutoyo, Kawasaki, Japan) (Fig. 1). Cuspal deection was detected by LVDT probes and the measured value was collected using a data acquisition board (PCI-6024, National Instruments, Austin, TX, USA) and data acquisition and analysis software (Labview, National

d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 801809

803

Fig. 1 Schematic diagram of the instrument for measurement of cuspal deection.

Instruments). The sensitivity of the LVDT probes exceeded 0.1 m in the range of 1 mm.

2.2.

Specimen preparation

Twenty four aluminum blocks (10 mm 8 mm 30 mm) with a MOD cavity [6 (W) mm 8 (L) mm 4 (D) mm] were fabricated using a milling machine, creating two remaining cusps [2 (T) mm 8 (L) mm 4 (H) mm] (Fig. 2a). The inside of the cavity was air-abraded with 50 m Al2 O3 powder and thoroughly rinsed with water using a three-way syringe. Composites used for lling the MOD cavities were a methacrylate-based universal hybrid composite (Z250: 3 M ESPE, St. Paul, MN, USA), a owable composite (Z350 owable:

3 M ESPE), and a silorane-based composite (P90: 3 M ESPE) (Table 1). Scotchbond multipurpose adhesive (3 M ESPE) was applied prior to placement of methacrylate-based composites (Z250 and Z350 owable) and P90 system adhesive was applied prior to silorane-based composite (P90) as recommended by the manufacturer. The adhesive was light cured for 10 s using a LED light curing unit (S10: 3 M ESPE), and the light intensity was measured as 1160 mW/cm2 (EPM 1000 power meter, Molectron Detector Inc., Oregon, USA). The radius of light guide was 10 mm, and the light guide was positioned at approximately 2 mm from the irradiated surface. An acrylic cap with two notches on the cuspal wall sides was fabricated and placed on the aluminum blocks to prevent the composite from being pushed out of the cavity during layering, and to position the LVDT probes precisely 1 mm from the cusp tips (Fig. 2b). The internal surface of the acrylic cap was lubricated with petroleum jelly to prevent the composite from being adhered and to ensure free surfaces of composites on the sides facing the acrylic cap. The acrylic cap also had sufcient compliance to allow the expansion or contraction of composites and aluminum molds.

2.3. Composite lling and measurement of cuspal deection

The required amount of composite to ll the cavity was calculated from the density of the composites and the volume of the cavity, and equal amount of composites for each cavity was ensured by weighing the material before use. The aluminum blocks were randomly divided into four groups and lled with composites by one of following protocols (Fig. 3). Group 1 (bulk lling): Z250 was placed in bulk and light cured from the upper surface for 20 s, the mesial side for 20 s, the distal side for 20 s, and the upper surface for 20 s again (total 80 s). Group 2 (incremental lling): Z250 was placed in four incremental layers. The thickness of rst horizontal increment was 1 mm and it was irradiated at a right angle from occlusal surface. The second and third increments were obliquely layered. The light guide was slightly tilted perpendicular to the irradiated surfaces of second and third oblique layers for optimum irradiation. The fourth horizontal layer was irradiated from occlusal direction. Therefore, the maximum thickness of composite layer for light curing was less than 2.5 mm at the diagonal direction. Each increment was light cured for 20 s (total 80 s). Group 3 (incremental lling with owable liner): The rst layer was lled with Z350 owable composite in 1 mm thickness, followed by three incremental layers with Z250. Each increment was light cured for 20 s as done in group 2 (total 80 s). Group 4 (incremental lling with silorane-based composite): P90 was placed in four incremental layers. Each increment was light cured for 20 s as done in group 2 (total 80 s). In the incremental placement groups (groups 24), the composite was equally divided into four portions with each portion representing a single increment. The composite for the bulk lling group and the rst layers of incremental lling groups were lled before installing the aluminum block on the cuspal deection measurement instrument. After setting the block

Fig. 2 (a) Dimensions (mm) of aluminum block machined for a MOD cavity, (b) aluminum block in the acrylic cap with two notches for probe positioning.

804

d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 801809

Table 1 Composites used in this study. Composite

Filtek Z250 Universal hybrid Filtek Z350 Flowable Filtek P90 Silorane

Lot no.
8LXJ

Resin matrix
Bis-GMA, Bis-EMA, TEGDMA, UDMA Bis-GMA, Bis-EMA, TEGDMA

Filler (wt%)
0.013.5 m Zr/silica particles (82 wt%)

Manufacturer
3 M ESPE St. Paul, MN, USA

7FX

N276998

Silorane

520 nm Zr/silica nanoparticles + 0.61.4 m nano-clusters (65 wt%) 0.013.5 m quartz particles, yttrium uoride (76 wt%)

3 M ESPE

3 M ESPE

onto the metal vise and positioning the two LVDT probes on the cusp tips, light curing and subsequent layering were performed. Measurement of cuspal deection was initiated 30 s prior to light curing to obtain a base line and continued up to 2000 s at a rate of 2 data points/s. The amounts of cuspal displacement measured from both cusps were added to produce total deection. Six measurements were performed for each group at temperature of 25 0.5 C. The data was analyzed by ANOVA and Tukeys post hoc test ( = 0.05).

2.4. Measurement of the axial shrinkage strain and exural modulus of composites
In order to investigate the effect of polymerization shrinkage and elastic modulus of the composites on the cuspal deection, the axial shrinkage strain and exural modulus of the composites were measured using a modied bonded disc method and a universal testing machine, respectively [32,33] (Fig. 4). To measure axial strain, a xed amount of composite was pressed between a slide glass and a exible cover glass

Fig. 3 (a) Four lling groups and dimensions (mm) of increments. Group 1: Bulk lling with Z250, group 2: Incremental lling with Z250, group 3: Incremental lling with Z250 and Z350 owable liner, group 4: Incremental lling with P90. (b) Un-bonded free surface area in bulk lling group and in each layer of incremental lling group.

d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 801809

805

Fig. 4 (a) Schematic diagram of the axial shrinkage measuring instrument using modied bonded disc method. (b) Specimen geometry in the modied bonded disc method, h: thickness of disc-shaped composite, d: diameter of composite. Fig. 5 Schematic diagram of the instrument for measuring the cusp compliance of aluminum block. (Marienfeld, Germany) using a metal wire with 0.5 mm diameter as a spacer, producing a disc-shaped specimen 0.5 mm in thickness and 6.0 mm in diameter (aspect ratio = 12). The tip of a LVDT probe was placed on the center of the cover glass and set to zero. A base line was obtained for 20 s, and then the curing light was irradiated for 40 s. The output voltage from the LVDT was stored on a computer using a data acquisition device (PCI-6024, National instruments) at a rate of 10 data points/s for 10 min to determine the axial shrinkage of the composites. Bar type specimens for exural modulus tests were prepared by placing the composites into stainless steel mold with 2 mm 2 mm 30 mm space, and light cured in three portions for 40 s each, and stored in distilled water at 37 C for 24 h. The width and thickness of the specimens were measured, and exural modulus was obtained by performing 3 point exural test. Specimens were installed on a universal testing machine (4465, Instron, USA), load was applied at the rate of 0.5 mm/min (distance between the two supporting bases = 20 mm), and the loaddisplacement curve was measured. The exural modulus of elasticity was calculated from the equation: E= L3 P , 4WT 3 D

(Fig. 5). The cusp compliance was obtained from the measured loaddisplacement relationship (n = 5).

3.
3.1.

Results
Cuspal deection during composite lling

where E is the exural elastic modulus (Pa), L is the support span (m), P is the load (N), W is the specimen width (m), T is the specimen thickness (m), and D is the displacement at the center of the beam (m). Five specimens were tested for each composite.

Representative cuspal deection curves vs. time are shown in Fig. 6ad. Cuspal deection increased rapidly with the beginning of light curing and most of the cusp displacement occurred within 500 s, and gradually increased thereafter. In the bulk lling group (group 1), 50% of the total cuspal deection occurred within 40 s after the initiation of light curing. In the incremental lling groups (group 24), the amount of deection increased in a stepwise manner. The mean values of cuspal deection in groups 14 were 18.2 (1.54), 14.5 (0.47), 16.2 (1.10), and 6.6 (0.44) m, respectively, at 2000 s after initiation of measurement (Fig. 7). The cuspal deection in the incremental lling group was signicantly lower than that in the bulk lling group (P < 0.001). The incremental lling group with owable liner showed higher cuspal deection than the incremental lling group without owable liner (P = 0.035). The deection of the incremental lling group with silorane-based composite (P90) was significantly lower than that in the incremental lling group with methacrylate-based composite (Z250) (P < 0.001).

2.5. Measurement of the compliance of the cusp of aluminum block

Weights of 15.016.0 kg at an interval of 200 g were applied at a point 1 mm from the cusp tip of the aluminum block and displacement of the cusp was measured using a LVDT probe

3.2. Axial shrinkage strain and exural modulus of composites

The axial shrinkage strains of composites were 4.12% (Z350 owable), 2.29% (Z250), and 1.09% (P90). The exural

806

d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 801809

Fig. 6 Representative curves of cuspal deection as a function of time. (a) Group 1: Bulk lling with Z250, (b) group 2: Incremental lling with Z250, (c) group 3: Incremental lling with Z250 and Z350 owable liner, (d) group 4: Incremental lling with P90. The asterisks (*) indicate the downward drops in cuspal deection curves caused by the effect of thermal expansion at the initiation of each light curing. The arrows indicate the spikes caused by mechanical noises during composite layering into the cavity.

modulus of composite was the highest in Z250 (13.6 GPa), followed by P90 (10.1 GPa), and the lowest in Z350 owable (7.6 GPa) (Table 2).

4.

Discussion

3.3.

Compliance of the cusp of aluminum block

The compliance of the cusp of aluminum block at 1 mm from the cusp tip was 0.27 m/N.

25

20

a b

Cuspal deformation resulting from polymerization shrinkage of composites is of clinical importance, and it can be a valuable method of assessing the effects of polymerization shrinkage stress where stress in a tooth cannot be measured directly [9,22]. The amount of cuspal deformation has been shown to range from 5 to 25 m and varies with testing methods and experimental conditions [13,14,22,25,27,34]. The cuspal deection can be inuenced by physical properties of tooth substrate itself, such as elastic modulus [35], anatomical features of the tooth including cusp size and shape, structural defects [13], and the hydration state of the teeth [25,26]. In this study, precisely fabricated aluminum blocks were used

Flexure (um)

15

10

d
5

Table 2 Axial shrinkage strain and exural modulus of composites. Composite

Z250 Z350 owable P90

Axial shrinkage strain (%)

2.29 (0.06)b 4.12 (0.08)a 1.09 (0.11)c

Flexural modulus (GPa)

13.6 (2.0)a 7.6 (0.9)c 10.1 (0.9)b

0 Group 1 Group 2 Group 3 Group 4

Filling Method

Fig. 7 Cuspal deection for each group at 2000 s.

Numbers in parenthesis are standard deviations.

d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 801809

807

to minimize these variables. In addition, aluminum may simulate the whole tooth well because its elastic modulus of 68.5 GPa is between that of the enamel (84.1 GPa) and dentin (18.3 GPa) [36,37]. The aluminum blocks used in this study had identical-sized MOD cavities to minimize the discrepancies in remaining cusp dimensions, and to simulate the compliance of real tooth. The amount of the composite used to ll each cavity was precisely weighed prior to use to ensure equal amounts placed for each layer. Prepared composites were stored in light protected containers until placement since sensitivity of composites to ambient light can affect the results. Deection of the cusps of the aluminum mold can be observed only when there is strong bond at the interface of an aluminum mold and a composite restoration. Each increment with composite showed a clear and consistent pattern of cuspal deection which suggests sufcient bond established at the interface. In addition, acoustic emission tests were performed in a supplementary experiment to assure adhesion between composite and the aluminum molds, and no debonding was observed. The cuspal deection curves showed slight drops when the light curing started, which could be interpreted as the thermal expansion effect by the heat of curing light and of polymerization reaction of composite. Thereafter, this temporary expansion of composites caused by the thermal effect of light curing was offset by the polymerization shrinkage. In the bulk lling group 1, the thermal expansion effect could be observed only at the beginning of the nal light curing (Fig. 6a). The possible explanation would be that the thermal expansion by the rst, second and third consecutive light curing have been masked by the rapidly developing polymerization shrinkage. On the other hand, in the incremental lling groups 24, each thermal expansion effect by the rst, second, third, and fourth light curing was clearly observed in the cuspal deection curves (Fig. 6bd). There were time intervals for each composite layering between light curing, which allowed the composite to cool down before thermal expansion caused by the beginning of the each light curing. As the incremental lling proceeded, the magnitude of the thermal effect also increased. Since the total volume of composite increased as each layer was added, the more volume of composite was available for thermal expansion by the heat of the curing light, and resulted in more prominent drop in the deection curves as layering proceeded. Cuspal deection in the incremental lling group was signicantly lower (20.3% reduction) than that in the bulk lling group, which corroborates the results of previous studies [13,14]. Incremental layering can present additional free surface areas between layers, allowing the composite of each layer to have compensatory ow during curing with the same bonded surface area as in bulk lling. If there are enough time and free surface area at the boundary layer for the re-arrangement of monomers in polymer network, the polymerization stress can be reduced [3,12,17]. The total sum of unbonded free surface area (215 mm2 ) by each layer in the incremental lling group was much larger than that (96 mm2 ) in the bulk lling group while both groups having the identical bonded surface area (112 mm2 ) (Fig. 3b). This difference in the free surface area can explain signicantly lower total

amount of cuspal deection summed from all increments in the incremental lling group compared with that of the bulk lling group (Fig. 3b). Silorane-based composite (P90) showed signicantly less cuspal deection than that of methacrylate-based composite (Z250). The silorane-based composite is polymerized with cationic ring opening mechanism providing low shrinkage. The measured axial shrinkage of P90 in this study was 1.09%, which corresponds with the results of other studies, 0.940.98 vol% [10,11,38]. Polymerization shrinkage stress causing cuspal deection is primarily dependent on the amount of polymerization shrinkage strain, the elastic modulus of the composite, and the compliance of the cusps. According to the study by Min et al. [33], the shrinkage strain is the major factor determining stress when the instrument compliance is high, whereas shrinkage stress is proportional to the product of shrinkage strain and elastic modulus of the composite when the instrument compliance is low. In our study, the compliance of the cusp of the aluminum block with a MOD cavity was high (0.27 m/N), therefore, P90 with lowshrinkage produced less shrinkage stress resulting in lowest cusp deection. Although the polymerization shrinkage and cusp deection of silorane-based composite (P90) is signicantly lower than those of methacrylate-based composites, the issues of adaptation of silorane-based composite to the cavity wall and curing limitations in deep cavities have been raised [39]. Therefore, further study is needed to validate the clinical efcacy of silorane-based composites (P90). In the cuspal deection curve of P90 (Fig. 6d), the downward spikes were shown. These could be the concern about the possibility of bond failure at the interface between a composite restoration and an aluminum mold. However, these temporary downward spikes were the mechanical noises caused by the movement of the aluminum mold during composite layering, not by de-bonding. We examined thoroughly the graph with an expanded x-axis, and there were no permanent downward steps showing bond failure. The mechanical noises shown as spikes returned immediately to their previous values. The P90 silorane composite showed very high viscosity (consistency), which required more packing force for composite adaptation into the cavity walls of aluminum mold, which might have caused the temporary movement of the aluminum mold attached to the LVDT sensors. As a consequence, the two LVDT probes abruptly shifted to one side, which caused one LVDT probe to move inward and the other probe outward directions, and returned to their previous position immediately after composite packing. The changes of the two LVDT output signals were opposite (one was positive and the other was negative). If there was de-bonding, the polarities of the two LVDT signal changes should be the same both LVDT output signals should be negative, resulting in permanent downward steps in the cuspal deection curve. We conrmed that these temporary spikes occurred during composite placement between light curing, especially during second and third oblique layering of P90. The use of owable composites as a liner is believed to reduce polymerization shrinkage stress owing to its low elastic modulus [40,41]. However, there are conicting studies reporting that the owable composite liners do not reduce stress

808

d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 801809

and microleakage [4244]. In our study, the incremental lling group with a owable composite liner (group 3) showed higher cuspal deection than that without a owable liner (group 2) (P = 0.0351). The cuspal deection of the rst increment layered with a owable composite liner (Z350 owable) was considerably higher than the rst increment layered with a conventional hybrid composite (Z250), and the difference was maintained until 2000 s after initiation of light curing (Fig. 6b and c). This phenomenon could be explained by the high shrinkage strain of owable composite, which is a major factor in producing stress in a high compliance situation like that of the MOD cavity within the aluminum block in this study. Lee et al. [33,35] suggested that teeth with prepared cavities have some compliance and that the testing system should have compliance comparable to that of a tooth in order to perform clinically relevant studies. In this study, aluminum blocks with elastic modulus similar to teeth have been used and MOD cavities were prepared to simulate similar compliance of remaining cusps of a tooth. Theoretical shrinkage stress can be estimated from the shrinkage strain and elastic modulus of a composite. Both the shrinkage strain and elastic modulus of composites change as polymerization progresses. Therefore, multiplying the change in thickness of a composite specimen at a specic time segment by the elastic modulus of the material at that time would correspond to the shrinkage stress increment at that time if the material behaved in a totally elastic manner. Integrating these products from the beginning of light curing to a nal measurement time would give the total cumulative stress in the specimen and can be expressed as:
t

modulus, shrinkage values, and varying thickness might produce different results. Resin modied glass ionomer is also often used as a liner [28,46], and further investigation to compare the resin modied glass ionomer with owable composite liners in terms of cuspal deection and shrinkage stress would add to our understanding on the efcacy of liner material in dental composite restoration.

references

=
0

(ESpecific

Time

dSpecific

Time Segment )

where is the polymerization shrinkage stress, E is the elastic modulus at a specic time, and d is the shrinkage strain at a specic time period. However, it is very difcult to determine directly the exact values of elastic modulus of polymerizing composite throughout the entire polymerization process from the initiation of light curing to the nal curing stage. Therefore, the exact stress values should be measured by experiments in addition to numerical simulation studies. As the compliance is a compound of various mechanical properties, anatomy, bonding conditions, and will vary with the exact location where it is determined, the compliance of cusp at the level of each incremental layer would be different. The compliance of the remaining cusp of the aluminum block at 1 mm from the cusp tip was 0.27 m/N, which is 1/41/5 of teeth with a MOD cavity [35]. From the compliance and measured cuspal deection, the minimum polymerization shrinkage forces exerted on the cusp in groups 14 are estimated as approximately 67.3, 53.7, 59.9, and 24.4 N, respectively. In this study, the compliance of aluminum mold was maintained constant. It requires further study to compare the cuspal deections depending on the varying compliance by changing the thickness of cuspal wall or using other substrates [45]. The composite lining with Z350 owable in 1 mm thickness produced higher cuspal deection in this study. However, using owable composite liners with different elastic

[1] Venhoven BAM, De Gee AJ, Davidson CL. Polymerization contraction and conversion of light-curing BisGMA-based methacrylate resins. Biomaterials 1993;14:8715. [2] Braga RR, Ferracane JL. Alternatives in polymerization contraction stress management. Critical Reviews in Oral Biology and Medicine 2004;15:17684. [3] Davidson CL, Feilzer AJ. Polymerization shrinkage and polymerization shrinkage stress in polymer-based restoratives. Journal of Dentistry 1997;25:43540. [4] Ferracane JL. Placing dental compositesa stressful experience. Operative Dentistry 2008;33(3):24757. [5] Stansbury JW, Trujillo-lemon M, Lu H, Ding X, Lin Y, Ge J. Conversion-dependent shrinkage and strain in dental resins and composites. Dental Materials 2005;21:5667. [6] Rttermann S, Dluzhevskaya I, Grosssteinbeck C, Raab WH, Janda R. Impact of replacing Bis-GMA and TEGDMA by other commercially available monomers on the properties of resin-based composites. Dental Materials 2010;26:3539. [7] Dauvillier BS, Aarnts MP, Feilzer AJ. Developments in shrinkage control of adhesive restoratives. Journal of Esthetic Dentistry 2000;12:2919. [8] Byerley TJ, Eick JD, Chen GP, Chappelow CC, Millich F. Synthesis and polymerization of new expanding dental monomers. Dental Materials 1992;8:34550. [9] Tantbirojn D, Versluis A, Pintado MR, DeLong R, Douglas WH. Tooth deformation patterns in molars after composite restoration. Dental Materials 2004;20:53542. [10] Weinmann W, Thalacker C, Guggenberg R. Siloranes in dental composites. Dental Materials 2005;21:6874. [11] Papadogiannis D, Kakaboura A, Palaghias G, Eliades G. Setting characteristics and cavity adaptation of low-shrinkage resin composites. Dental Materials 2009;25:150916. [12] Feilzer AG, De Gee AJ, Davidson CL. Setting stress in composite resin in relation to conguration of the restoration. Journal of Dental Research 1987;66:16369. [13] Lee MR, Cho BH, Son HH, Um CM, Lee IB. Inuence of cavity dimension and restoration methods on the cuspal deection of premolars in composite restoration. Dental Materials 2007;23:28895. [14] Park JK, Chang JH, Ferracane J, Lee IB. How should composite be layered to reduce shrinkage stress: incremental or bulk lling? Dental Materials 2008;24:15015. [15] Suh BI. Controlling and understanding the polymerization shrinkage-induced stresses in light-cured composites. Compendium 1999;20:S3441. [16] Ilie N, Felten K, Trixner K, Hickel R, Kunzelman KH. Shrinkage behavior of a resin-based composite irradiated with modern curing units. Dental Materials 2005;21:4839. [17] Davidson CL, De Gee AJ. Relaxation of polymerization contraction stresses by ow in dental composites. Journal of Dental Research 1984;63:1468. [18] Feilzer AJ, De Gee AJ, Davidson CL. Quantitative determination of stress reduction by ow in composite restorations. Dental Materials 1990;6:16771.

d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 801809

809

[19] Sadeghi M, Lynch CD. The effect of owable materials on the microleakage of class II composite restorations that extend apical to the cemento-enamel junction. Operative Dentistry 2009;34(3):30611. [20] Versluis A, Douglas WH, Cross M, Sakaguchi RL. Does an incremental lling technique reduce polymerization shrinkage stresses? Journal of Dental Research 1996;75:8718. [21] Kuijs RH, Fennis WMM, Kreulen CM, Barink M, Verdonschot N. Does layering minimize shrinkage stresses in composite restorations? Journal of Dental Research 2003;82:96771. [22] Abbas G, Fleming GJP, Harrington E, Shortfall ACC, Burke FJT. Cuspal movement and microleakage in premolar teeth restored with a packable composite cured in bulk or in increments. Journal of Dentistry 2003;31:43744. [23] He Z, Shimada Y, Tagami J. The effects of cavity size and incremental technique on micro-tensile bond strength of resin composite in class I cavities. Dental Materials 2007;23:5338. [24] Nikolaenko SA, Lohbauer U, Roggendorf M, Petschelt A, Dasch W, Frankenberger R. Inuence of c-factor and layering technique on microtensile bond strength to dentin. Dental Materials 2004;20:57985. [25] Meredith N, Sethchell DJ. In vitro measurement of cuspal strain and displacement in composite restored teeth. Journal of Dentistry 1997;25:3317. [26] Suliman A-H, Boyer DB, Lakes RS. Polymerization shrinkage of composite resins: comparison with tooth deformation. Journal of Prosthetic Dentistry 1994;71:712. [27] Cara RR, Fleming GJP, Palin WM, Walmsley AD, Burke FJT. Cuspal deection and microleakage in premolar teeth restored with resin-based composites with and without an intermediary owable layer. Journal of Dentistry 2007;35:4829. [28] Oliveira LCA, Duarte Jr S, Araujo CA, Abraho A. Effect of low-elastic modulus liner and base as stress-absorbing layer in composite resin restorations. Dental Materials 2010;26:e15969. [29] Lien W, Vanderwalle KS. Physical properties of a new silorane-based restorative system. Dental Materials 2010;26:33744. [30] Marchesi G, Breschi L, Antoniolli F, Lenarda RD, Ferracane J, Cadenaro M. Contraction stress of low-shrinkage composite materials assessed with different testing systems. Dental Materials 2010;26:94753. [31] Boaro LC, Gonc alves F, Guimares TC, Ferracane JL, Versluis A, Braga RR. Polymerization stress, shrinkage and elastic modulus of current low-shrinkage restorative composites. Dental Materials 2010;26:114450. [32] Lee IB, Cho BH, Son HH, Um CM, Lim BS. The effect of consistency, specimen geometry and adhesion on the axial

[33]

[34]

[35]

[36] [37] [38]

[39]

[40]

[41]

[42]

[43]

[44]

[45]

[46]

polymerization shrinkage measurement of light cured composites. Dental Materials 2006;22:10719. Min SH, Ferracane J, Lee IB. Effect of shrinkage strain, modulus and instrument compliance on polymerization shrinkage stress of light-cured composites during the initial curing stage. Dental Materials 2010;26:102433. Jantarat J, Panitvisai P, Palamara JEA, Messer HH. Comparison of methods for measuring cuspal deformation in teeth. Journal of Dentistry 2001;29:7582. Lee SH, Chang J, Ferracane J, Lee IB. Inuence of instrument compliance and specimen thickness on the polymerization shrinkage stress measurement of light-cured composites. Dental Materials 2007;23:1093100. Craig RG. Restorative dental materials. 10th ed. Mosby; 1997. p. 66. OBrien WJ. Dental materials and their selection. 3rd ed. Quintessence Publications; 2002. p. 119. Lee IB, Min SH, Seo DK, Kim SY, Kwon YC. A new method to measure the linear polymerization shrinkage of composites using a particle tracking method with computer vision. Journal of Korean Academy of Conservative Dentistry 2010;35:1807. Ende AB, Munck JD, Mine A, Lambrechts P, Meerbeek BV. Does a low-shrinking composite induce less stress at the adhesive interface? Dental Materials 2010;26:21522. Leevailoj C, Cochran MA, Matis BA, Moore BK, Platt JA. Microleakage of posterior packable resin composites with and without owable liners. Operative Dentistry 2001;26:3027. Alomari QD, Reinhardt JW, Boyer DB. Effect of liners on cusp deection and gap formation in composite restorations. Operative Dentistry 2001;26:40611. Neme AL, Maxon BB, Pink FE, Aksu MN. Microleakage of class II packable resin composites lined with owables: an in vitro study. Operative Dentistry 2002;27:6005. Cadenaro M, Marchesi G, Antoniolli F, Davidson C, Dorgio EDS, Breschi L. Flowability of composites is no guarantee for contraction stress reduction. Dental Materials 2009;25:64954. Braga RR, Hilton TJ, Ferracane JL. Contraction stress of owable composite materials and their efcacy as stress-relieving layers. Journal of the American Dental Association 2003;134:7218. Meira JBC, Braga RR, Ballester RY, Tanaka CB, Versluis A. Understanding contradictory data in contraction stress tests. Journal of Dental Research 2011;90:36570. Ichim IP, Schmidlin PR, Kieser JA, Swain MV. Restoration of non-carious cervical lesions. Part II. Restorative material selection to minimise fracture. Dental Materials 2007;23:15629.