Original papers

Comparative evaluation of the depth of cure and surface roughness

of bulk-fill composites: An in vitro study
Ocena porównawcza głębokości utwardzenia i chropowatości powierzchni
materiałów kompozytowych typu bulk-fill – badanie in vitro
Anusha Parasher1,A,D, Kishore Ginjupalli2,A,C–F, Krishnaraj Somayaji1,A–F, Pradeep Kabbinale3,B
1
Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
2
Department of Dental Materials, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
3
Department of Conservative Dentistry and Endodontics, Subbaiah Institute of Dental Sciences, Shimoga, India

A – research concept and design; B – collection and/or assembly of data; C – data analysis and interpretation;
D – writing the article; E – critical revision of the article; F – final approval of the article

Dental and Medical Problems, ISSN 1644-387X (print), ISSN 2300-9020 (online) Dent Med Probl. 2020;57(1):39–44

Address for correspondence

Krishnaraj Somayaji
Abstract
E-mail: [email protected] Background. Composites are in great demand due to the esthetic needs of the patients, which explains
a wide variation in the types of available composites. However, the mechanical strength of the materials is
Funding sources questionable. Therefore, the mechanical properties of the newly available bulk-fill composites have been
None declared
tested.
Conflict of interest Objectives. The main objective of the study was to compare the depth of cure (DOC) and surface rough-
None declared
ness of 3 different bulk-fill composites: X-tra fil® (XTF), Tetric EvoCeram® Bulk Fill (TEC) and Beautifil®
Received on May 22, 2019 Bulk Restorative (BBR).
Reviewed on October 7, 2019
Accepted on October 12, 2019 Material and methods. Fifty-seven (n = 19 in each group) samples were made using brass molds. All
samples were subjected to Vickers hardness testing and profilometry. The one-way analysis of variance
Published online on January 28, 2020 (ANOVA) test was used for the data analysis, followed by Tukey’s post hoc test.
Results. The differences in the mean surface microhardness values of the materials were statistically sig-
nificant (p < 0.001), with XTF showing the highest value. The TEC composite showed a higher surface
roughness as compared to BBR and XTF.
Conclusions. The results of the present study indicate that variations in the filler size and amount signifi-
cantly influence the DOC and surface roughness of dental composites. Among the tested composites, the
multi-hybrid composite exhibited superior DOC (XTF), whereas the nanohybrid composite exhibited supe-
Cite as rior surface finish (TEC).
Parasher A, Ginjupalli K, Somayaji K, Kabbinale P. Comparative
evaluation of the depth of cure and surface roughness Key words: hardness, surface roughness, bulk-fill composites, depth of cure
of bulk-fill composites: An in vitro study. Dent Med Probl.
2020;57(1):39–44. doi:10.17219/dmp/113003 Słowa kluczowe: wytrzymałość, chropowatość powierzchni, materiały kompozytowe typu bulk-fill,
głębokość utwardzenia
DOI
10.17219/dmp/113003

Copyright
© 2020 by Wroclaw Medical University
This is an article distributed under the terms of the
Creative Commons Attribution 3.0 Unported License (CC BY 3.0)
(https://creativecommons.org/licenses/by/3.0/)
40 A. Parasher, et al. Microhardness of bulk-fill composites

Introduction Tetric EvoCeram® Bulk Fill (TEC) (Ivoclar Vivadent

AG, Schaan, Liechtenstein) is a nanohybrid composite
The growing demand for life-like restorations and containing dimethacrylates, which make up 20–21 wt%
the motivation of some dentists to provide mercury- of the monomer matrix. Fillers such as ytterbium tri-
free, tooth-colored restorations have led to an increase fluoride (YbF3), barium (Ba) glass, mixed oxides, and
in the use of resin-based composite (RBC) materials. a prepolymer constitute up to about 79–81 wt%. The
Some of the advantages of composite restorations in- particle size of the filler varies between 40 and 3,000 nm,
clude better esthetics, reduced need for extensive tooth with a mean particle size of 500 nm. It also contains Ivo-
preparation and reinforcement of the remaining tooth cerin®, a photoinitiator, which allows DOC of 4 mm and
structure.1 makes it possible to minimize the shrinkage stress.
At present, most RBCs are supplied as light-activated Beautifil® Bulk (Shofu Dental Corporation, San Marcos,
materials and their clinical placement requires the in- USA) is prepared based on the pre-reacted glass (PRG)
cremental layering technique.2 The material has to be technology, in which acid-reactive fluoride glass is made
placed in layers to allow light penetration, which would to react with polyacid in the presence of water, after
ensure complete polymerization. This process is time- which it is milled, silanized and ground to fine powder
consuming and may lead to the inclusion of voids in for use as a filler in the resin matrix. The resin matrix
the restoration. In addition, non-uniform curing may comprises Bis-GMA, UDMA, 2,2-bis[(4-methacryloxy
lead to uncured RBCs at the bottom or in between polyethoxy)phenyl]propane (Bis-MPEPP), and TEGDMA.
the increments, resulting in the restoration with in- It is a radiopaque light-cured material with a 4-millime-
adequate strength and marginal leakage, and thus of ter DOC. Apart from being biocompatible, this material
a reduced longevity. Furthermore, uncured RBCs may has the ability to reduce tooth demineralization by re-
also cause postoperative sensitivity. To overcome the leasing fluoride, which also imparts anti-plaque activity.7
disadvantages of the conventional incremental place- It is available in low viscosity (Beautifil Bulk Flowable) as
ment of RBCs, bulk-fill composites were introduced well as in packable consistency (Beautifil Bulk Restorative
to reduce the chair time and to offer a less technique- – BBR).
sensitive material.3 Bulk-fill composites are newer re- Though the compositional differences account for
storative materials which are said to present improved significant differences in the properties of the commer-
cure, controlled polymerization contraction stresses cially available composites, it is of utmost importance to
and a reduced cuspal deflection; they are effectively ensure the complete polymerization and highly polished
photoactivated in layers up to 4 mm, and as such can surfaces of these materials during clinical placement.
be used in deep preparations.4,5 Surface texture has a great influence on plaque accumu-
A higher translucency observed in bulk-fill com- lation, and on the discoloration, wear and esthetic ap-
posites as compared to conventional resin composites pearance of the restoration.8 The polishability of RBCs
enables superior light transmission, and thus better is directly affected by the structure of the organic matrix
polymerization. A higher percentage degree of conver- and the characteristics of the fillers.
sion (DC) displayed by bulk-fill composites is due to In addition, the extent of polymerization of RBCs
better light penetration, as the materials exhibit a re- also influences their physical, mechanical and biologi-
duced opacity. Other factors, such as the filler content, cal characteristics. Incomplete polymerization due to
size modifications or the use of a monomer of a higher the inadequate curing of RBCs may impair their physical
molecular mass in the resin, also significantly influence and mechanical properties, and even make them toxic
the translucency of these materials.6 to the pulp. Surface hardness has been widely used in
Several bulk-fill composites are now available on the literature as an indicator of the extent of polymeriza-
the market, claimed to exhibit superior depth of cure tion of dental composites. An arbitrary minimum value
(DOC), exceeding 4 mm. Among these, X-tra fil® (XTF) of the bottom-to-top surface hardness ratio is commonly
(Voco GmbH, Cuxhaven, Germany), a posterior com- calculated to establish the DOC of RBCs. For a material
posite based on the multi-hybrid filler technology, is to be considered as adequately cured, the value of the
available in a universal shade, which can be cured up to ratio needs to be in the range of 0.8–0.85.7
a depth of 4 mm in 10 s. It consists of bisphenol A-glyci­ The various available bulk-fill composites certainly
dyl methacrylate (Bis-GMA), urethane dimethacrylate widen the selection of tooth-colored restorative materi-
(UDMA), triethylene glycol dimethacrylate (TEGDMA), als and help reduce the chair time during the placement
and the barium-boron-aluminosilicate (Ba-B-Al-Si) of the restoration due to generally better DOC. However,
glass filler. By adjusting the filler size, an extremely high the performance and longevity of such materials largely
filler content (86 wt%) has been achieved in the material, depend on the exact DOC and complete polymerization.
with a consequent increase in wear resistance and a lower Hence, the aim of the present study was to evaluate the
polymerization shrinkage. In addition, it also exhibits surface roughness and DOC of commercially available
superior radiopacity. bulk-fill composites, such as XTF, TEC and BBR.
Dent Med Probl. 2020;57(1):39–44 41

Material and methods

Three packable bulk-fill composites – XTF, TEC and
BBR – in universal A shades (IVA) were used in the pre­
sent study. The IVA shade was selected to minimize the
effects of colorants on light polymerization.

Specimen preparation
A total of 57 samples were prepared, 19 samples from
each of the 3 selected bulk-fill composite materials
Fig. 2. Schematic representation of a brass mold used for specimen preparation
(Fig. 1). The specimens were prepared using a custom-
made brass mold, consisting of 5 cylindrical slots of a dia­
meter of 10 mm and a height of 4 mm (Fig. 2). The mold
was filled using a single increment of the composite
material and covered with a Mylar strip. The mold was
pressed between 2 transparent glass plates to remove the
excess material. Subsequently, the composite was light-
cured according to the manufacturer’s recommenda-
tions, using the Bluephase® G2 light-cure device (Ivoclar
Vivadent AG) within the range of 1,200–1,400 Mw/cm2.
The tip of the curing device was kept in direct contact
with the glass plate to maintain the standardized dis-
tance from the tip of the device to the top surface of the Fig. 3. Schematic representation of a composite specimen
specimen.
After curing, the samples were retrieved and polished Depth of cure by the Vickers hardness
using the Super-Snap disks (Shofu Dental Corporation)
testing method
at coarse, medium, fine, and superfine grits for 30 s. Af-
ter each step of polishing, the specimens were thorough- The surface hardness of the specimens was measured
ly rinsed with water and air-dried before the next step on both the top and bottom surfaces using the Vickers
until final polishing. The samples were stored in artifi- hardness tester (MMT-X7A; Matsuzawa Co. Ltd., Tokyo,
cial saliva at 37°C for 24 h before testing. All specimens Japan). The specimens were secured onto a platform and
were observed under a bright light source, and speci- were subsequently indented with a square-based diamond
mens with any voids or cracks were not included in the pyramid indenter with a load of 300 g for 15 s, with an au-
study (Fig. 3). tomatic loading and release mechanism. Then, the lengths

Fig. 1. Study design

XTF – X-tra fil; BBR – Beautifil Bulk Restorative; TEC – Tetric Evoceram Bulk Fill; DOC – depth of cure.
42 A. Parasher, et al. Microhardness of bulk-fill composites

of the diagonals of the indentations were measured using microhardness values for the XTF, BBR and TEC compo­
a built-in microscope, and the surface hardness for each site resins were found to be 91.87 ±3.68, 61.92 ±2.22
indentation was automatically calculated and displayed and 45.44 ±3.05 VHN, respectively (Fig. 4, Table 1). The
on the digital readout of the machine. Three different in- mean surface microhardness values at a depth of 4 mm
dentations were done on both the top and bottom surfaces (the bottom surface of the specimen) for the XTF, BBR
of each specimen. The surface hardness values measured and TEC composite resins were found to be 73.97 ±2.96,
on the top of the specimen were considered as 100%, and 46.78 ±2.34 and 35.40 ±1.81 VHN, respectively (Fig. 4,
the values measured at a 4-millimeter distance were ex- Table 1). The observed differences between the materi-
pressed as a percentage of the top surface hardness value als in the surface hardness values on both the top and
and were obtained using the following formula: bottom surfaces were found to be statistically significant
(p < 0.001). Among the composites, XTF showed a sig-
bottom VHN nificantly higher surface hardness than other materials on
VHN = × 100 [%] (1)
top VHN both surfaces (p < 0.001). As compared to TEC, a signifi-
cantly higher surface hardness was observed for the BBR
where: composite (p < 0.001).
VHN – Vickers hardness number. The calculated DOC at 4 mm for the composite materi-
als used in the present study was found to be 80.62 ±4.20,
Surface roughness measurement 75.56 ±2.67 and 78.24 ±6.72 for XTF, BBR and TEC, re-
spectively (Table 1). The DOC of XTF was significantly
After polishing, the composite surfaces were assessed higher in comparison with other materials (p < 0.001).
quantitatively for surface roughness using profilometry (Taly- The mean surface roughness, Ra, is presented in Fig. 5.
surf®; Taylor-Hobson Ltd., Leicester, UK) with a measure- The mean surface roughness of XTF and BBR was found
ment range of 0.05–10.0 µm and an accuracy of ±0.01 µm. to be 0.04 ±0.02 and 0.04 ±0.01 µm, respectively, which
Surface roughness was described with the arithmetic mean means a statistically non-significant difference (Table 1).
of the absolute ordinate values (average roughness Ra, as per However, the mean surface roughness of TEC was found
ISO 4287). The specimens were secured onto a non-vibrating to be 0.06 ±0.01 µm, which is significantly different from
specimen holder and the stylus of the profilometer was low- that for BBR (p < 0.001).
ered onto the specimen perpendicularly. Surface roughness
was measured by moving the stylus along a 0.8-millimeter
length of the surface at 3 different locations on each surface.

Statistical analysis
The obtained results were then subjected to the sta-
tistical analysis using the PASW Statistics for Windows
software, v. 18.0 (SPSS Inc., Chicago, USA). The one-way
analysis of variance (ANOVA) with Tukey’s post hoc test
for intergroup comparison were performed, and a p-value
of <0.05 was considered statistically significant.

Results
The main aim of the present study was to evaluate the Fig. 4. Top and bottom surface hardness of the composite materials
surface roughness and surface hardness of 3 commer- VHN – Vickers hardness number.
cially available bulk-fill composites. The mean top surface Data presented as mean ± standard deviation (SD).

Table 1. Comparison of surface hardness at the top and bottom (a 4-millimeter depth) surfaces, DOC and surface roughness (Ra) of the composite resins

Property XTF1 BBR2 TEC3 p-value post hoc test

Surface hardness at the top surface [VHN] 91.87 ±3.68 61.92 ±2.22 45.44 ±3.05 <0.001 1>2>3
Surface hardness at the bottom surface [VHN] 73.97 ±2.96 46.78 ±2.34 35.40 ±1.81 <0.001 1>2>3
DOC 80.62 ±4.20 75.56 ±2.67 78.24 ±6.72 <0.001 1>3>2
Surface roughness (Ra) [µm] 0.04 ±0.02 0.04 ±0.01 0.06 ±0.01 <0.001 3 > 2, 1

Data expressed as mean ±SD.

Dent Med Probl. 2020;57(1):39–44 43

the filler component, but also the surrounding softer resin

matrix. In this regard, VHN indirectly considers the entire
matrix network crosslinking.15,16 A low surface hardness
value is largely related to inadequate wear resistance and
susceptibility to scratch damage, which can compromise the
fatigue strength of the restoration and lead to its failure.17,18
In this study, XTF showed the highest DOC in compari-
son with the other 2 materials. A high DOC shown by XTF
can be attributed to the presence of macrofillers (>20 µm)
in XTF, increasing its translucency, which in turn may have
led to an increased DOC. However, the difference between
the values for XTF and TEC proved to be statistically non-
significant. Both TEC and BBR showed lower DOC values
in a descending order, though the difference was not statis-
tically significant. X-tra fil is a multi-hybrid composite with
86 wt% of the Ba-B-Al-Si glass filler. Tetric EvoCeram Bulk
Fig. 5. Surface roughness (Ra) of the composite materials
Fill contains 79–81 wt% of YbF3, Ba glass, mixed oxides, and
Data presented as mean ±SD.
a prepolymer. On the other hand, BBR contains 87 wt% or
74.5 vol% of fluorine-boron-aluminosilicate (F‑B‑Al‑Si) glass
Discussion as a filler. Light reflection from RBCs, deflection of light from
the filler particles and light absorption by the photoinitiators
Ultimately, any dental restorative material is to mimic the lead to a reduction in light penetration into the depth of con-
biological, functional and esthetic properties of a healthy ventional composites, thus limiting their DOC to 2 mm. The
tooth structure. Over the years, there has been an increas- filler composition as well as the filler size play an important
ing need for better tooth-colored restorative materials to re- role in light diffusion in RBCs, determining their DOC. Bulk-
place the missing tooth structure. The development of resin fill RBCs have an increased filler size (macrofillers). Light
composite materials for direct restorations with improved penetration is higher due to a reduced surface area of the
physical and mechanical properties, esthetics and durabi­ macrofillers with a reduced resin–filler interface, and hence
lity has been the focus of research in the recent past.9 The DOC is increased. Similarly, some of the low-viscosity bulk-
most common strategies to improve the properties of den- fill composites with a lower filler content also exhibit a higher
tal composites include modifications in the filler content, DOC.19
and variations in the size, type and morphology of the filler A decreased DOC of TEC could be due to the difference in
particles and the organic matrix.10 Together, these changes the photoinitiator system. This composite contains Ivocerin
have resulted in the higher mechanical strength and modu- and (2,4,6-trimethylbenzoyl)diphenylphosphine oxide (TPO)
lus of elasticity of newer resin composite materials. as photoinitiators, which are suggested to increase DC as
To facilitate the reduction of the clinical working time compared to camphorquinone (CQ). However, in this study
of composite resin placement, bulk-fill composites were de- TEC showed a lower DOC than XTF. This may be explained
veloped with a single curing depth of 4 mm. Currently, they by the filler size in TEC, which is smaller than in the case
are available as low-viscosity bulk-fill composites for use as of XTF, leading to a higher light reflection and a decreased
a base or high-viscosity bulk-fill composites for restorative translucency, which in turn reduces DOC.20 The BBR com-
purposes.11 The manufacturers of bulk-fill composite mate- posite showed the lowest DOC among the tested materials.
rials claim their higher DOC, and over the years, multiple This could be attributed to an increased filler content (87 wt%
techniques have been investigated to accurately measure or 74.5 vol% ), which may reduce the translucency of the ma-
the DOC of composite resins. Among these, ISO 4049 or terial.21 These results are in agreement with previous studies
the scraping technique is widely used to determine hard- suggesting that filler loading and the filler particle size influ-
ness; still, for bulk-fill RBCs, this technique tends to be over- ence the DOC of composite resins.19,21,22
rated. Some authors have demonstrated a good correlation The longevity of the RBC restoration depends on its re-
between hardness testing and DC using Raman or Fourier sistance to wear in the oral cavity, which is influenced by
transform infrared (FTIR) spectroscopy for measuring the a variety of factors, such as the magnitude of forces of mas-
DOC of composite resins.12 However, in the present study, tication, the patient’s diet, temperature variations, bacterial
the Vickers microhardness tester was used to evaluate the products, enzymes, etc.23–25 Mylar strips enhance surface
DOC of the experimental resin composites. This method is smoothness, but, clinically, restorations need contouring
easy and quick, and requires a minimal area of the specimen in order to eliminate the excess material. Various polishing
surface for testing.12–14 The size of the Vickers hardness in- systems are available on the market. However, in this study,
denter is larger than the size of the filler particles in the ma- the single polishing system with multi-step polishing Super-
terial complex; as a result, VHN takes into account not only Snap was used as a standardized method.26 Profilometry
44 A. Parasher, et al. Microhardness of bulk-fill composites

and atomic force microscopy (AFM) have been commonly 9. Hegde MN, Hegde P, Bhandary S, Deepika K. An evaluation of com-
pressive strength of newer nanocomposite: An in vitro study. J Con-
used to assess surface roughness. A well-established me­
serv Dent. 2011;14(1):36–39.
thod for checking surface roughness is stylus profilometry, 10. Pallesen U, van Dijken JW, Halken J, Hallonsten AL, Höigaard R. Lon-
which is simple and easy to perform.27 gevity of posterior resin composite restorations in permanent teeth
In this study, TEC showed the highest surface roughness as in Public Dental Health Service: A prospective 8 years follow up.
J Dent. 2013;41(4):297–306.
compared to XTF and BBR. The filler content in TEC is lower 11. Kelić K, Matić S, Marović D, Klarić E, Tarle Z. Microhardness of bulk-
(79–81 wt%) than in other composites. Conventionally, it has fill composite materials. Acta Clin Croat. 2016:55(4):607–614.
been observed that RBCs with bigger filler particles show 12. Bouschlicher MR, Rueggeberg FA, Wilson BM. Correlation of bottom-
to-top surface microhardness and conversion ratios for a variety
a greater surface roughness following polishing. In this study, of resin composite compositions. Oper Dent. 2004;29(6):698–704.
the Super-Snap disks were used for polishing and the scope 13. Flury S, Hayoz S, Peutzfeldt A, Hüsler J, Lussi A. Depth of cure
for polishing in the different materials could have varied.28 of resin composites: Is the ISO 4049 method suitable for bulk fill
materials? Dent Mater. 2012;28(5):521–528.
The similar surface roughness of BBR and XTF can be at-
14. Chuenarrom C, Benjakul P, Daosodsai P. Effect of indentation load
tributed to the similar filler size and content (by weight). The and time on Knoop and Vickers microhardness tests for enamel
results of the present study indicate that the surface rough- and dentin. Mater Res. 2009;12(4):473–476.
ness of RBCs is significantly influenced by the filler size and 15. Hosseinalipour M, Javadpour J, Rezaie H, Dadras T, Hayati AN.
Investigation of mechanical properties of experimental Bis-GMA/
content.29 However, the polishability and the resultant sur- TEGDMA dental composite resins containing various mass frac-
face roughness are also affected by other factors, such as the tions of silica nanoparticles. J Prosthodont. 2010;19(2):112–117.
abrasive agent used, the amount of time each abrasive agent 16. Asmussen E, Peutzfeld A. Influence of pulse-delay curing on soften-
ing of polymer structures. J Dent Res. 2001;80(6):1570–1573.
is used, pressure, the number of uses, and the direction in 17. Tchorz JP, Doll R, Wolkewitz M, Hellwig E, Hannig C. Microhard-
which the abrasive agent is used.30 ness of composite materials with different organic phases in deep
class II cavities: An in vitro study. Oper Dent. 2011;36(5):502–511.
18. Erdemir U, Yildiz E, Eren MM, Ozel S. Surface hardness evaluation
of different composite resin materials: Influence of sports and
Conclusions energy drinks immersion after a short-term period. J Appl Oral Sci.
2013;21(2):124–131.
Within the limitations of the present study, it can be 19. Bucuta S, Ilie N. Light transmittance and micro-mechanical pro­
perties of bulk fill vs. conventional resin based composites. Clin
concluded that the DOC and surface roughness of the Oral Investig. 2014;18(8):1991–2000.
tested materials were significantly different. Among the 20. Czasch P, Ilie N. In vitro comparison of mechanical proper-
materials evaluated in the present study, XTF exhibited ties and degree of cure of bulk fill composites. Clin Oral Investig.
2013;17(1):227–235.
superior DOC as compared to TEC and BBR. The TEC 21. Dionysopoulos D, Tolidis K, Gerasimou P. The effect of composition,
composite exhibited a higher surface roughness than XTF temperature and post-irradiation curing of bulk fill resin composites
and BBR. on polymerization efficiency. Mater Res. 2016;19(2):466–473.
22. Tuncer S, Demirci M, Öztaş E, Tekçe N, Uysal Ö. Microhybrid versus
nanofill composite in combination with a three step etch and rinse
ORCID iDs adhesive in occlusal cavities: Five year results. Restor Dent Endod.
Anusha Parasher  https://orcid.org/0000-0002-7866-3790 2017;42(4):253–263.
Kishore Ginjupalli  https://orcid.org/0000-0002-1824-2054 23. Drummond JL. Degradation, fatigue and failure of resin dental
Krishnaraj Somayaji  https://orcid.org/0000-0002-5116-4617 composite materials. J Dent Res. 2008;87(8):710–719.
Pradeep Kabbinale  https://orcid.org/0000-0002-5562-2398 24. Opdam NJ, Bronkhorst EM, Loomans BA, Huysmans MC. 12-year
survival of composite vs. amalgam restorations. J Dent Res.
References 2010;89(10):1063–1067.
25. Atai M, Nekoomanesh M, Hashemi SA, Amani S. Physical and
1. Benetti A, Havndrup-Pedersen C, Honoré D, Pedersen MK, Pallesen U. mechanical properties of an experimental dental composite based
Bulk-fill resin composites: Polymerization contraction, depth on a new monomer. Dent Mater. 2004;20(7):663–668.
of cure, and gap formation. Oper Dent. 2015;40(2):190–200. 26. Pereira CA, Eskelson E, Cavalli V, Liporoni PC, Jorge AO, do Rego MA.
2. Roeters JJ, Shortall AC, Opdam NJ. Can a single composite resin Streptococcus mutans biofilm adhesion on composite resin surfaces
serve all purposes? Br Dent J. 2005;199(2):73–79;quiz 114. after different finishing and polishing techniques. Oper Dent.
3. Gonçalves F, Campos LMP, Rodrigues-Júnior EC, et al. A compara- 2011;36(3):311–317.
tive study of bulk-fill composites: Degree of conversion, post-gel 27. Neme AL, Frazier KB, Roeder LB. Debner TL. Effect of prophylac-
shrinkage and cytotoxicity. Braz Oral Res. 2018;32:e17. tic polishing protocols on the surface roughness of esthetic resto­
4. Garoushi S, Vallittu P, Shinya A, Lassila L. Influence of increment rative materials. Oper Dent. 2002:27(1):50–58.
thickness on light transmission, degree of conversion and micro 28. Kaizer MR, de Oliveira-Ogliari A, Cenci MS, Opdam NJ, Moraes RR.
hardness of bulk fill composites. Odontology. 2015;104(3):291–297. Do nanofill or submicron composites show improved smooth-
5. Tanthanuch S, Kukiattrakoon B, Eiam-O-Pas K, et al. Surface changes ness and gloss? A systematic review of in vitro studies. Dent Mater.
of various bulk-fill resin-based composites after exposure to dif- 2014:30(4):e41–e78.
ferent food-simulating liquid and beverages. J Esthet Restor Dent. 29. Mohammadi N, Kimyai S, Abed-Kahnamoii M, Ebrahimi-Chaha-
2018;30(2):126–135. rom ME, Sadr A, Daneshi M. Effect of 15% carbamide peroxide
6. Itota T, Carrick TE, Yoshiyama M, McCabe JF. Fluoride release and bleaching gel on color stability of giomer and microfilled com-
recharge in giomer, compomer and resin composite. Dent Mater. posite resin: An in vitro comparison. Med Oral Pathol Oral Cir Bucal.
2004;20(9):789–795. 2012;17(6):e1082-e1088.
7. Moore BK, Platt JA, Borges G, Chu TM, Katsilieri I. Depth of cure 30. Jefferies SR. Abrasive finishing and polishing in restorative dentistry:
of dental resin composites: ISO 4049 depth and microhardness A state-of-the-art review. Dent Clin North Am. 2007;51(2):379–397.
of types of materials and shades. Oper Dent. 2008;33(4):408–412.
8. Morgan M. Finishing and polishing of direct posterior resin restora-
tions. Pract Proced Aesthet Dent. 2004;16(3):211–218.