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Inside Dentistry
August 2016
Volume 12, Issue 8

SureFil® SDR® flow+ Bulk Fill Flowable

Why low stress in a bulk-fill composite matters

Figure 1 | Shrinkage of flowable composites can compromise the success of the restoration and contribute to a poor marginal seal, microleakage, deformation of the tooth, microfracture, and recurrent caries.1 Several factors have been identified as influencing the shrinkage stress of a restoration, including its size and geometry, materials used, and the curing protocol.2-4

Recent advances in monomer technology have ushered in a new category of bulk-fill flowable composites that are designed to address the material shortcomings of earlier products, and promote the effective use of 4-mm increments while decreasing shrinkage stresses generated during polymerization.5,6

SureFil® SDR® flow was the first bulk-fill flowable on the market. Its organic resin matrix comprises a patent-registered urethane dimethacrylate with incorporated photoactive groups that enable it to control polymerization kinetics. In a 2012 Clinician’s Report, Christensen showed that Surefil SDR flow had the lowest polymerization stress among the bulk-fill flowable resins tested.5

C-factor is an estimation of the stresses generated through a given cavity configuration by a ratio of bonded to unbonded surfaces. According to Feilzer et al, the higher the C-factor, the higher the stress generated (eg, Class I and II). Conversely, a cavity with a higher ratio of unbonded surfaces should result in lower shrinkage stress (eg, Class III and IV).8 Two studies have also suggested that cavity depth and diameter may impact shrinkage stress and resulting microleakage.9,10 Examining the effect of bulk-filling high C-factor cavities with a low shrinkage flowable composite (SureFil SDR flow), Van Ende et al showed that 4-mm increments placed in high C-factor preparations (mimicking Class I and II) did not compromise bond strength secondary to shrinkage stress.11,12 If bulk-fill techniques are desired for restoration of high C-factor cavities, the dentist should consider low-stress materials to avoid adhesive de-bonding and microleakage. Studies show bulk-fill, low-shrinkage, flowable resin can be used in an open-sandwich technique without a negative impact on marginal integrity.13

In another study, cuspal deflection and tooth deformation in Class II preparations were examined.14 After restoration, cuspal deflection was measured and found to be reduced by over 50% when SureFil SDR flow was used. Bulk filling to within 2 mm of the occlusal cavosurface can reduce operator time because of reduced incremental layers without additional shrinkage stress or loss of marginal quality.

To learn more about how SureFil SDR flow+ can increase the chairside efficiency and effectiveness of your posterior composite restorations, visit www.surefilsdrflow.com.

References

1. Margolis FS. Flowable composites: aesthetics for tots and teens. Dent Today. 2011;30(4):132-137.

2. Malhotra N, Kundabala M, Shashirashmi A. Strategies to overcome polymerization shrinkage—materials and techniques. A review. Dent Update. 2010;37(2):115-125.

3. Versluis A, Douglas WH, Cross M, Sakaguchi RL. Does an incremental filling technique reduce polymerization shrinkage stresses? J Dent Res.1996;75(3):871-878.

4. Xavier JC, de Melo Monteiro GQ, Resende Montes MAJ. Polymerization shrinkage and flexural modulus of flowable dental composites. Materials Research. 2010;13(3):380-384.

5. Christensen GJ. Advantages and challenges of bulk-fill resins. Clinician’s Report. 2012;5(1):1-6.

6. SureFil® SDR® flow posterior bulk fill flowable base. Inside Dentistry. 2009;5(9):124.

7. SureFil® SDR® flow. SureFil SDR flow+ website. http://www.surefilsdrflow.com. Accessed July 5, 2016.

8. Feilzer AJ, De Gee AJ, Davidson CL. Setting stress in composite resin in relation to configuration of the restoration. J Dent Res.1987;66(11):1636-1639.

9. Braga RR, Boaro LC, Kuroe T, et al. Influence of cavity dimensions and their derivatives (volume and 'C' factor) on shrinkage stress development and microleakage of composite restorations. Dent Mater. 2006;22(9):818-823.

10. Watts DC, Satterthwaite JD. Axial shrinkage-stress depends upon both C-factor and composite mass. Dent Mater. 2008;24(1):1-8.

11. Van Ende A, De Munck J, Van Landuyt KL, et al. Bulk-filling of high C-factor posterior cavities: effect on adhesion to cavity-bottom dentin. Dent Mater. 2013;29(3):269-277.

12. de la Macorra JC, Gomez-Fernandez S. Quantification of the configuration factor in Class I and II cavities and simulated cervical erosions. Eur J Prosthodont Restor Dent. 1996;4(1):29-33.

13. Roggendorf MJ, Krämer N, Appelt A, et al. Marginal quality of flowable 4-mm base vs. conventionally layered resin composite. J Dent. 2011;39(10):643-647.

14. Moorthy A, Hogg CH, Dowling AH, et al. Cuspal deflection and microleakage in premolar teeth restored with bulk-fill flowable resin-based composite base materials. J Dent. 2012;40(6):500-505.

For more information, contact:
Dentsply Sirona
800-532-2855
www.surefilsdrflow.com

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