This summary is based on the ADA Professional Product Review: A Laboratory Evaluation of Bulk-Fill Versus Traditional Multi-Increment-Fill Resin-Based Composites
The Review can be accessed through the ADA website
Access the full-text article (PDF)
Context
- Unlike traditional composites, which typically are placed in maximum increments of 2 millimeters (mm), bulk-fill composites are designed to be placed in 4 mm, or sometimes greater, increments.
- Manufacturers claim that bulk-fill materials have greater depth of cure and lower polymerization induced shrinkage stress thanks to technology like “polymerization modulators,” which they say allow a certain amount of flexibility and optimized network structure during polymerization.
- Studies have demonstrated some comparable physical and mechanical properties among a handful of bulk-fill and traditional composites.
Purpose of the Study
The study evaluates more in-depth physical and mechanical properties of currently marketed bulk-fill materials in comparison to one another and to traditional composites.
Conclusions
- This evaluation compared several properties of bulk-fill versus multi-increment–fill, resin-based composites and found performance of restoratives in both categories to be acceptable according to an international standard, with the exception of depth of cure and hardness.
- Three of the bulk-fill resin-based composites did not achieve adequate depth of cure when tested according to the standard (SonicFill, Tetric EvoCeram Bulk Fill, and Alert Condensable Composite).
- All products but one (Alert Condensable Composite) demonstrated adequate hardness after curing in a subsequent test (Knoop hardness test).
- With the exception of depth of cure and Knoop hardness, we found the laboratory performance of bulk-fill resinbased composites to be comparable to that of traditional multi-increment–fill resin-based composites.
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Well, if the internet claims that this is so, I guess it is.
At least for all you young dentists who run your lives via social-network.
For us older dentists, we have had the benefit of time. When composite resin first came out, the claim was made that this would replace amalgam. And I guess in some offices and has. But I’ve been watching amalgams that I have placed for over 30 years and there is still going strong. Can’t say that for composite resin fillings. Yeah, they look good in the first few years, but the material does not stand the test of time. Composite Resin wears and degrades much faster. But if you have high overhead and huge loans to repay, the short lifespan of restorations works to your advantage. Now with bulk fill resin technique, they will fail even faster.
A response to Dr Belzycki: Like many other dentists who have been placing fillings for over 30 years, I still have a place for amalgam in my practice, but that place is getting smaller and smaller. We all pay lip service to the fact that composite is technique sensitive but do we act on that knowledge? It is becoming clear that inadequate cure is a major culprit causing early failures. Paying attention to reviews like this one and using appropriate increments with attention to proper curing technique will lead to improved success.
The report also does not discuss relative shrinkage and marginal seal. I agree with Paul that we are always being upsold on the next best thing. My 30 year amalgams look better than my ten year resins. Posterior composites have built in obsolescence. Great marketing strategy by the dental supply companies.
I personally have 15yo resins in my mouth and haven’t placed amalgam in the past 10. I think there is a lot to be said for technique and well researched products. If your resins are only lasting a few years, then may be something is wrong…