ABSTRACT
Composite resins have been routinely used for posterior cavities due to a phasedown on amalgam as a restorative
option. However, clinical problems related to polymerization shrinkage demands careful and specific techniques for
placement of the composite layers. New low shrinkage composites are now marketed for bulk filling of cavities
without the need of a traditional layering. With this new concept, the restoration can be built in one or two layers,
depending on the classification of the bulk fill material. This article discusses and presents two alternative techniques
using the low shrinkage composites, suggesting a called amalgam-like sculpting technique, one using a flowable bulk fill
and other a regular bulk fill material. Clinical cases illustrate these two alternatives compared with the layered
technique.
CLINICAL SIGNIFICANCE
New techniques using low shrinkage composites for bulk filling can provide a simpler technical approach for the
clinician in sculpting and generating highly esthetic posterior composites.
(J Esthet Restor Dent 27:335343, 2015)
INTRODUCTION
Esthetic restorative materials have been routinely used
due to highly increasing patients demand. Most
commonly used for improved esthetics in operative
dentistry are ceramics of the particle-lled glass family
and composite resins. Although the latter represent a
clinically validated class of material, several concerns
remain regarding its polymerization shrinkage which
has been an active research topic.15 It has been
suggested that polymerization shrinkage may lead to
contraction of the total composite volume, elicited by
the cross-linking of the monomeric chains, and
eventually generate marginal leakage, post-operative
sensitivity, and dental cracks.6,7
*Assistant Professor, Department of Biomaterials and Biomimetics, New York University, New York, NY, USA
Professor of Post Graduation on Restorative Dentistry, Department of Restorative Dentistry, CETAO, Sao Paulo, SP, Brazil
Director of Post Graduation on Restorative Dentistry, Department of Restorative Dentistry, SENAC, Sao Paulo, SP, Brazil
Assistant Professor, Department of Prosthodontics, Bauru School of Dentistry, University of So Paulo, Bauru, So Paulo, Brazil
Associate Professor, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, So Paulo, Brazil
**Associate Professor, Department of Biomaterials and Biomimetics, New York University, New York, NY, USA
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FIGURE 1. Microcomputed tomography (microCT) 3D reconstructions of a regular composite, bonded with its proprietary
adhesive system in a class I preparation, used as bulk filling. Shrinkage (around 4.0%) is depicted at the occlusal surface as well as on
the cavity walls which resulted in gaps. A, 3D rendering of composite restoration with shrinkage after curing (Green). B, 2D slice of
composite restoration showing shrinkage on occlusal surface and bottom of cavity.
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FIGURE 2. Microcomputed
tomography (microCT) threedimensional (3D) reconstruction of a
bulk fill low shrinkage flowable
composite used as a bulk filling along
with its proprietary adhesive system
in a class I preparation. Note the
absence of gaps and the shrinkage
(around 2.5%) concentrated on the
occlusal surface. A, 3D rendering of
composite restoration with shrinkage
after curing (Green). B, 2D slice of
composite restoration showing
shrinkage only on occlusal surface.
TABLE 1 Low shrinkage bulk fill composites and their manufacturers in tandem with their indications
Composite
Manufacturer
Consistency
Indication
flowable
regular
regular
flowable
flowable
EQUIA Fil
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CONCLUSION
restorations showed comparable results to 2 mm resin
composite layering technique.23 These initial results
seem to be promising, yet more research are expected
to validate a long term result.
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REFERENCES
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DISCLOSURE
The authors do not have any nancial interest in the
companies whose materials are included in this article.
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