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Comparison of Film Thickness of Restorative Composites Considered for

Thermo‐Modified Cementation

Article in Journal of Esthetic and Restorative Dentistry · November 2024

DOI: 10.1111/jerd.13363

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Journal of Esthetic and Restorative Dentistry

RESEARCH ARTICLE

Comparison of Film Thickness of Restorative Composites

Considered for Thermo-­Modified Cementation
Pascal Magne1 | Sam Alawie2 | Michel Magne3 | Marco Carvalho4 | Taban Milani1

1Magne EDUCATION, Beverly Hills, California, USA | 2CEO/Founder Oral Design Beverly Hills, Beverly Hills, California, USA | 3Oral Design Beverly
Hills, Beverly Hills, California, USA | 4 School of Dentistry, Evangelical University of Goias (UniEVANGÉLICA), Anapolis, Brazil

Correspondence: Pascal Magne ([email protected])

Received: 27 August 2024 | Revised: 25 October 2024 | Accepted: 29 October 2024

Funding: The authors received no specific funding for this work.

Keywords: cement | film thickness | inlay | luting | onlay | restorative resin composite | veneer

ABSTRACT
Objective: This study proposes an updated method for the film thickness of 21 resin composites used as cements.
Materials and Methods: A load of 30 N was subjected to two glass plates stacked on a heated base to simulate clinically relevant
pressure and temperature during the seating of inlays/onlays/veneers. The axial position of the actuator was recorded before
and after placing 22.15 mm3 of resin composite between the glass slides. The difference between the two measurements was
calculated for each specimen. A total of 18 condensable restoratives, 1 injectable restorative, and 2 resin cements were tested, 5
specimens each (n = 5, N = 105). One-­way ANOVA was performed for both variables and Games-­Howell post hoc test was used
for pairwise comparisons.
Results: The film thickness range was 6–200 μm, with the lowest values for restorative composites (AP-­X , Z250, and Herculite
XRV Incisal LT with 6–8 μm), followed by Gradia Direct (25 μm) and flowable/injectable composite resins, including designated
cements (15–27 μm). Inspiro, Ultradent Transcend Universal, and ENA Hri dentin stood below 50 μm (range 28–49 μm). The
other materials (range 81–200 μm) cannot be recommended for thermo-­modified cementation.
Conclusions: The initial viscosity of restorative composites is not an indication of the film thickness when used for thermo-­
modified cementation. There is a wide choice of appropriate materials available on the market.
Clinical Significance: Some restorative composites are able to generate very thin films and can be used as cement with numer-
ous advantages when compared to designated flowable or dual-­cure cements.

1   |   Introduction and adhesive properties in addition to their poor resistance

to dissolution compared to adhesive cements such as resin-­
Successful delivery of inlays/onlays and veneers implies that modified glass ionomer and resin composites. The definition
a perfect continuum has been established between the res- of the word cementation, however, also implies adherence/
toration and the tooth through material-­specific (resin com- bond between the substrates involved. Hence, resin-­ based
posite, polymer-­ infiltrated ceramic network, and various cements are recommended for the adhesive delivery of semi-
ceramics) and tissue-­ specific (enamel/dentin) conditioning direct CAD/CAM and indirect restorations such as inlays, on-
[1, 2]. Traditional cementation implies that a certain resis- lays, and veneers because those restorations are intrinsically
tance form (geometry) of the tooth preparation is present and less resistant than traditional porcelain-­f used-­to-­metal or zir-
that the restoration possesses a high intrinsic strength. The conia crowns. The optimal adhesive and mechanical proper-
reason is that conventional cements have limited mechanical ties of resin-­based cements can assure the long-­term perennity

© 2024 Wiley Periodicals LLC.

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of totally nonretentive onlays, overlays, and new types of ve- and still obtaining perfect seating [10], hence the term thermo-­
neers made of brittle materials (Figure 1) [3]. modified cementation. In the 2000s, however, new nanohybrid
composite resin formulations prompted the inclusion of large
Because of film thickness requirements to be able to seat the clusters and prepolymerized filler complexes (PPFCs) with a
restoration, resin-­based cements are usually flowable materials. particle size of up to 20–30 μm (Figure 3).
To the authors' knowledge, Dr. Mark Friedman in Beverly Hills
(CA) may have been the first author to propose using a restor- While all restorative resin composites demonstrate a signifi-
ative resin composite as a luting agent, in this case, Herculite cant reduction in viscosity when preheated, they remain gen-
XRV shade Incisal LT, to successfully deliver porcelain veneers erally more viscous than flowable materials and most of them
in the 1990s [4, 5]. Simultaneously in Europe in 1995, a publi- provide film thickness that exceeds the 50-­μm norm under ISO
cation by Besek et al. explored the possibility of using a clas- 4049 standard (150 N between glass slides, room temperature)
sic restorative resin composite to deliver ceramic inlays [6]. At [11, 12]. Hence, there is a need for a new method for testing those
that time, the author used the Cerec 1 CAD/CAM system. The materials under conditions that reflect their clinical applica-
poor fit of those original CAD/CAM ceramic inlays may have tions, including realistic cementation forces [10], body tempera-
prompted them to compensate for the large, exposed gap at the ture, and material preheating.
occlusal surface with a luting agent that could better resist oc-
clusal load and wear. A microhybrid restorative resin composite, This study aims to investigate the film thickness of various types
Brilliant Lux Incisal (Coltene), was used and compared to tra- of preheated composite resins under a new method of better sim-
ditional resin cement. It was concluded that dual-­curing resin ulating clinical conditions (pressure and temperature) and pro-
had no advantages versus light-­curing with respect to polymer- vide the clinician with clear guidelines for the selection of the
ization rate when seating Cerec inlays. In addition, the overall most appropriate luting agent. The null hypothesis is that the
handling of the light-­curing composite resin was judged to be various types of resin composites will present similar film thick-
easier than that of the dual-­cure material (unlimited time for nesses regardless of their viscosity, composition, and filler type.
seating and cleaning excesses before polymerization). As a re-
sult, the use of solely light polymerized restorative composites
as cements gained popularity and significant changes in restor- 2   |   Materials and Methods
ative concepts started to emerge (Figure 2). Because the 1990s
were dominated by the use of microhybrid composites, with As is the case with ISO 4049 standard for film thickness
particle distribution ranging from 0.1 to a maximum of 10 μm, measurements [12], each material was tested between two
combining ultrasonic energy [7, 8] and/or preheating the mate- flat square glass plates (22×22 mm). However, to better un-
rial [9] would provide great assistance in seating the restorations derstand the behavior of the cement in more realistic clinical

FIGURE 1    |    Successful bonded feldspathic porcelain restoration (A) on the left central incisor after 20 years (B and C). Note the perfect color
match with the intact right central incisor despite the extremely nonretentive design and large incisal edge span of almost 5 mm at the distal aspect.
In addition, this restoration happened to have cracked preoperatively (A, arrow). It was delivered regardless of the crack using a restorative resin
composite as a luting agent, not a designated resin cement. Smartphone pictures reproduced with permission [2].

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FIGURE 2    |    Changing concepts about bonded indirect restorations in the 1990s.

FIGURE 3    |    Contemporary filler technology and a wide range of particle sizes (reproduced with permission) [2].

conditions, the measurements were carried out at body tem- of the volume used (22.15 mm [3]) then placed between the
perature with the glass plates seated on a heated base to glass slides for compression at 30 N (Figure 4). The difference
simulate body temperature (Calset device set at 37°C/98°F, between the axial position at baseline (without resin compos-
Addent). A load of 30 N was chosen, instead of 150 N (ISO ite) and during the experimental measurement was calculated
4049), to better simulate the pressure used when seating in- to obtain the film thickness for each material. A total of 21
lays, onlays, or veneers [10]. The Acumen III (MTS Systems) products were tested (Table 1) with 5 specimens each (n = 5,
was used to subject a maximum load of 30 N to the two glass N = 105), including 18 condensable restoratives, 1 injectable
plates stacked on the heated base and the axial position of the restorative, and 2 resin cements (Table 1). The circular spread
actuator was recorded (baseline). The load was repeated after (diameter) of the material was also measured by recording the
placing a calibrated volume of the various cement candidates width and height of the resin composite surface with a stain-
between the glass slides. Beforehand, each material was pre- less steel digital caliper, and averaging the two measurments.
heated in another Calset device for 3 min at 68°C/155 F before The measurment for the spread was maxed at 22 mm (limits
being dispensed into a cylindrical silicon mold for calibration of the glass slide).

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FIGURE 4    |    E xperimental setup with actuator applying 30 N of load to the glass plates and resin composite Z250 in-­between. Note that the
material is so thin that it spreads to the edge of the 22-­mm glass slide. The actuator tip was covered with polyvinilsiloxane to simulate finger pressure
and prevent fracture of the glass slides.

Since the sample size was small (n = 5), determining the distri- and 6. Considering the 50-­μ m threshold from ISO 4049 stan-
bution of the film thickness data was important for choosing dard [12], with the adapted method of this study, 12 pre-
an appropriate statistical method. Therefore, a Shapiro–Wilk heated restorative resin composites and the 2 resin composite
test was performed and did not show evidence of nonnormal- cements from this study would be suitable for cementation:
ity (W > 0.776, p value > 0.05). Based on this outcome, and after ENA HRi (UD1), Transcend Universal (A1D), Gradia Direct
visual examination of the histogram and QQ plot, it was de- Anterior (A2), Inspiro Enamel (WR), Inspiro Dentin (Bi3),
cided to run a parametric test. Levene's test was conducted to Transcend Universal (UB), Gradia Direct X (X-­A 1), Variolink
assess the equality of variance for the film thickness and spread Esthetic LC (Neutral), Gradia Direct X (X-­ BW), G-­ aenial
across the different groups. The results of Levene's test indicate Universal Injectable (BW), G-­CEM Veneer (Bleach), Herculite
that the assumption of homogeneity of variances was violated: XRV-­INCISAL (LT), Z-­250 (A1), and Clearfil AP-­X (XL). The
F(20,84) = 5.451, p = 0.00 for film thickness and F(20,84) = 4.282, resin composites Tetric Powerfill (IVB) and Evanesce Silk
p = 0.00 for spread. Consequently, it opted for the Games-­Howell (B1UX) provided means of film thickness just above the 50-­
post hoc test, which does not assume equal variances, to conduct μm threshold. The other 6 restorative resin composites are not
pairwise comparisons after one-­way ANOVA. Also, the mean suitable for cementation as their mean film thickness ranged
and standard deviation were used to summarize the film thick- from 81.2 to 200.6 μm, which may imply improper seating of
ness and spread. the restoration.

The circular spread correlated with the film thickness, as the

3   |   Results groups with more spread provided the thinner film thickness.

The mean and standard deviations for film thickness and

circular spread are presented in Table 1 and Figures 5 and 4   |   Discussion
6, and reflect a wide range of results, from > 200 μm down
to few micrometers for film thickness and 12 to 22 mm for The mean film thickness of a wide range of resin-­based restor-
the circular spread. Examples of specimens are presented in ative composites, injectable composite, and composite cements
Figure 7. The one-­way ANOVA revealed statistical differences was investigated. The null hypothesis can be rejected because
for film thickness and circular spread between groups: F(20, significant differences were observed.
84) = 227.34, p = 0.000 for film thickness and F(20, 84) = 47.19,
p = 0.000 for spread. The Games-­Howell post hoc test was used Materials were presented in Table 1 according to their compo-
for pairwise comparison and statistical differences (p < 0.05) sition even though such data are extremely difficult to obtain.
are presented in different letters between groups in Figures 5 The authors did a considerable amount of research to obtain

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 TABLE 1    |    Resin composites tested, their composition (manufacturer's data unless in parenthesis), and experimental results for film thickness and circular spread.

Filler Average Average circular Average film

Resin-­based content particle spread in thickness in
composite (color) Manufacturer Resin type Filler type (%) size (μm) mm (SD)* μm (SD)*
Herculite XRV– Kerr Microhybrid Quartz and glass 79 weight 0.6 aver. 12.0 (1.5) 200.6 (21.9)
Enamel (A2) Barium glass 0.5–1
Silica 0.04
G-­aenial A'CHORD GC Ultrafine hybrid Barium glass 70 vol. 0.01–3.2 15.35 (2.1) 167.2 (6.9)
(AO1) (heterogeneous) Silicon dioxide 82 weight
PPFC
Simplishade (LT) Kerr Nanohybrid heterogeneous Mixed oxides 64.5 vol. 0.04–6.0 17.2 (1.5) 102.4 (5.5)
Ytterbium fluoride 81.5
Barium glass weight
Silica
PPFCs
G-­aenial Sculpt (JE) GC Nanohybrid Barium glass 69 vol. 0.02–1.0 17.9 (1.3) 94.4 (20.3)
Silicone dioxide
PPFCs
Essentia (MD) GC Micro-­HDR hybrid Barium glass 63 vol. 0.02–2.9 18.4 (0.4) 81.2 (4.1)
(heterogeneous) Fluoroaluminosilicate 76 weight 10
glass
Silicone dioxide
PPFCs
Tetric Powerfill (IVB) Ivoclar Vivadent Nanohybrid Barium glass 54 vol. 0.6 aver. 17.9 (0.5) 60 (5.5)
Ytterbium trifluoride. 79 weight 0.11–15.5
Si-­Zr mixed oxide,
and copolymers
Evanesce Silk Clinician's Nanohybrid Proprietary nanofillers 66 vol. 0.6 aver. 20.1 (0.7) 54.6 (5.0)
(B1UX) choice— PPFCs 81 weight 3–20
ENA HRi (UD1) Micerium Microhybrid Microparticles 53 vol. 0.7 aver. 18.8 (0.7) 48.8 (2.2)
Silicone dioxide 75 weight 0.04
Transcend Universal Ultradent Microhybrid Silica 61 vol. 0.9 aver. 20.7 (0.8) 43.6 (2.2)
(A1D) Silane-­treated silica 79 weight
Gradia Direct GC Microhybrid Feldspar 64 vol. 0.85 aver 21.2 (0.2) 38.8 (2.3)
Anterior (A2) Silicone dioxide 73 weight 0.02–2.9

(Continues)

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 TABLE 1    |    (Continued)

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Filler Average Average circular Average film
Resin-­based content particle spread in thickness in
composite (color) Manufacturer Resin type Filler type (%) size (μm) mm (SD)* μm (SD)*
Inspiro Enamel (WR) EdelweissDR Nanohybrid Homogeneous Radiopaque glass filler 65 vol. 0.02–3.0 20.0 (0.7) 38.4 (4.5)
Nonagglomerated 83 weight
silica nanofillers
Inspiro Dentin (Bi3) EdelweissDR Nanohybrid Homogeneous Radiopaque glass filler 65 vol. 0.02–3.0 18.8 (0.3) 38 (5.9)
Silica nanofillers 83 weight
Transcend Universal Ultradent Microhybrid Silica 61 vol. 0.9 aver. 20.8 (0.3) 37.6 (7.5)
(UB) Silane-­treated silica 79 weight
Gradia Direct X GC Microhybrid Fluoroaluminosilicate 65 vol. 0.02–2.9 21.2 (0.4) 28.4 (2.1)
(X-­A1) glass 77 weight
Feldspar
Silicone dioxide
Variolink Esthetic LC Ivoclar Vivadent Light-­cured cement Ytterbium trifluoride. 40 vol. 0.15–15.5 22.0 (0.0)** 27 (2.9)
(Neutral) Si-­Zr mixed oxide
Gradia Direct X GC Microhybrid Feldspar 64 vol. 0.02–2.9 21.8 (0.4) 25 (1.9)
(X–BW) Silicone dioxide 77 weight
G-­aenial Universal GC Flowable resin composite Barium glass 46 vol. 0.01–0.5 21.1 (0.9) 18.4 (1.5)
Injectable (BW) Silicone dioxide 69 weight
G-­CEM Veneer GC Light-­cured cement Barium glass 46 vol. 0.01–0.5 22.0 (0.0)** 15.2 (0.8)
(Bleach) Silicone dioxide 69 weight
Herculite XRV– Kerr Microhybrid Quartz and glass 70 weight 0.02–1.0 22.0 (0.0)** 8.4 (1.1)
INCISAL (LT) Pyrolitic silica
Z-­250 (A1) 3 M ESPE Small-­particle Patented milled 85 weight 0.6 aver. 22.0 (0.0)** 7.6 (1.1)
spheroidal (3 M) spheroidal zirconia-­
silica particles
Clearfil AP-­X (XL) Kuraray Microhybrid Barium glass. 71 vol. 0.02–17 22.0 (0.0)** 6.6 (1.8)
Pyrolytic silica 85 weight
*Data obtained in this study.
**Reached upper limit of spread.

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FIGURE 5    |    Mean film thickness in micrometers for each material tested. Different letters indicate statistical differences between materials.

FIGURE 6    |    Mean circular spread in millimeters for each material tested. Different letters indicate statistical differences between materials.

detailed information about each product, but there remains XRV Enamel A2 displayed 200.6 μm. In contrast for the same
always a possibility of missing information or proprietary brand and product, Herculite XRV Incisal LT, which was
information not divulgated by the manufacturers. Although recommended as a veneer cement by Mark Friedman in the
the experiment did not include rheological measurements, 1990s [4], provided a film thickness of 8.4 μm. Unfortunately,
the authors can ascertain that apparently more viscous mate- this material, due to its filler composition, cannot be recom-
rials, such as Inspiro Enamel WR, could easily produce film mended as luting agent because it is not radiopaque enough.
thicknesses of 38.4, while apparently less viscous Herculite The same lack of radiopacity affects GC Gradia Anterior. On

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FIGURE 7    |    Examples of specimens after the test (compression 30 N at 37°C/98 F). (A) Herculite XRV shade Enamel A2-­F T 200.6 μm, circular
spread 12.0 mm. (B) ENA HRi shade UD1-­F T 48.8 μm, circular spread 18.86 mm. (C) Gradia Direct X shade X-­A1-­F T 28.4 μm, circular spread
21.4 mm. (D) Z250 shade A1-­F T 7.6 μm, circular spread 22 mm.

the other hand, Clearfil AP-­X shade XL (Kuraray) was able First, the 150 N of the ISO norm is too high to simulate clinical
to generate the smallest thickness (6.6 μm), similar to Filtek seating forces [10]. Second, clinical studies indicate that the av-
Z250 (7.6 μm). Both these restorative materials were able to erage marginal and internal gaps in veneers and crowns vary
supersede actual flowable resin composite cements, G-­CEM between 100 and 315 μm [15–17]. In this context, it could be jus-
Veneer (GC) and Variolink Esthetics LC (Ivoclar) with 15.2 and tified to increase that threshold to 120 μm as suggested by other
27 μm, respectively, and the GC G-­aenial Universal Injectable authors [18–20]. This would disqualify only two products in the
(18.4 μm), demonstrating that viscosity should not be cor- current study.
related to film thickness. This is in accordance with other
studies [10, 11]. Specifically, one flowable resin composite Limiting the spread to less than 22 mm was a potential limita-
cement (RelyX Ultimate, 3M) prevented the seating of CAD/ tion of this work. Yet, another criticism of the modified ISO
CAM inlays, while a more viscous restorative resin composite method used in this article could be that it does not mimic ex-
of the same manufacturer (Z100, 3M) allowed better seating of actly the cementation of a restoration, since flat glass plates are
the same inlays [10]. Hence, viscosity alone does not capture used, instead of anatomical tooth preparations with an indirect
the full complexity of how resin composites behave under load restoration. To clarify that potential problem, the authors used
during cementation. Other factors may influence film thick- the same experimental setup (including the baseline measure-
ness beyond the material's initial viscosity such as material ment without cement) to seat three restorations on a typodont
composition, filler distribution, particle type/size/shape, and tooth with a veneer preparation (tooth 2.1., P-­Oclusal, Brazil)
size of monomers in the resin matrix. Manufacturers do not using Herculite XRV Enamel A1, ENA Hri UD1, and Z250 A1
typically disclose such information. (Figure 7). The incomplete seating was obvious when using
Herculite XRV Enamel and generated 254 μm of axial displace-
A reference material that has been widely recommended by cli- ment (elevation), while the veneer seated more than acceptably
nicians and successfully used as a luting agent for veneers (in- using ENA HRi UD1 (21 μm axial displacement) and Z250 A1
cluding clinical studies) is ENA HRi dentin [13, 14]. This product (100% seated, no axial displacement) (Figure 8).
still averaged 48.8 μm. Other good restorative candidates for ce-
ment include GC Gradia Direct X shades A1 and shade BW with It is difficult to correlate the composition and filler content with
28.4 and 25.0 μm, respectively. It seems reasonable to establish the results. Some materials such as Simplishade feature very
that the threshold of 50 μm is a very safe limit and that clinicians small fillers (0.005–0.4 μm) but large film thickness (102.4 μm)
should ideally focus on materials with no greater film thick- but also include a rheological modifier, which acts as a stabi-
ness. Nevertheless, the 50-­μm threshold used in the ISO 4049 lizing network if left undisturbed. Under this condition, the
norm [12] was also used in this study to suggest the suitability apparent viscosity of the material is higher, which prevents ma-
of a resin-­based material for the thermo-­modified cementation terial creep, commonly known as “slump”. Simplishade, alike
technique. This threshold could be questioned for two reasons. G-­aenial Sculpt and GC Essentia, may also contain PPFCs [21],

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FIGURE 8    |    Post hoc test using prefabricated veneers and typodont teeth with a veneer preparation and 30 N seating load. (A) Herculite XRV
shade Enamel A2—254 μm axial displacement. (B) ENA HRi shade UD1—21 μm elevation axial displacement. (C) Z250 shade A1—0 μm, no axial
displacement.

which appear to be absent from all materials with film thick- when using designated cement/flowable composite resins [29].
nesses less than 50 μm. It is therefore reasonable to conclude Another useful clinical tip is to place the restoration preloaded
that restoratives with PPFCs should be avoided as cements, in- with preheated composite into a heating device. Once the tooth
cluding those designated cements with nanofiller clusters, espe- preparation surface has been conditioned, it is ideal to seat the
cially when cementing inlays [10]. restoration within a delay of 15 s, after which the temperature
will decrease and the viscosity increase rapidly, stabilizing the
When selected carefully, preheated restorative composites can restoration and facilitating the cleanup without the need for
be used as a cement, which will provide a multitude of advan- tack-­curing [28]. One common lingering question when using
tages. The preheating of the material will initially facilitate the solely light-­polymerizing materials surrounds the depth of po-
seating of the veneer/inlay/onlay, but it was demonstrated that lymerization. This problem, however, has been demystified.
the temperature of the composite resin will quickly drop [9, 22]. In the presence of restorations thicker than 3 mm, the polym-
This is indirectly a benefit because the return to the original erization time can be extended to 90 s per surface. Using this
viscosity will facilitate the cleaning of the excesses. The un- approach, no difference in mechanical performance of thick
limited working time is another reason for using solely light-­ onlays and overlays could be detected up to 7 mm of thickness
polymerized materials, resulting in significantly less excesses when comparing designated dual-­cure cements and light-­cure
and overhangs [23]. The use of restorative composites rather restorative materials [23, 30–33].
than resin cements also proved to increase the fatigue resistance
of the bonded restorations such as laminate veneers [14] and
limit the wear at the exposed interface (margin) [24], in addition 5   |   Conclusions
to other positive effect on the marginal adaptation and strength
[25, 26]. As previously mentioned, internal gaps in veneers and A modified method was proposed to measure the film thickness
crowns can easily exceed 300 μm. Such a gap justifies the use of composite resin to be used as cements. The mean film thick-
of cements with optimal physicomechanical properties, which ness of direct composite resin restoratives, injectables, and ce-
would logically favor restoratives composites over designated ce- ments ranged from 6 to 200 μm. The lowest film thickness was
ments (flowable, dual-­cure, etc.). In this context, color stability generated by some restorative materials, followed by flowable/
is another substantial advantage over dual-­cure cements that are injectable composite resins, including designated cements. It
known for their color variation [27]. is suggested that a restorative material must be in the 0–50 μm
range using the new norm. Some restorative materials, however,
Using restorative composites as cements requires a specific may be problematic for the thermo-­modified cementation tech-
workflow [28]. For instance, the etched/silanated ceramic must nique (range 50–200 μm). Composite resin restorative materials
be wet with low-­v iscosity adhesive resin to assure proper bond- need to be selected carefully to be used as cement. Their initial
ing. This omission of this step does not appear to be as critical viscosity is not an indication of the film thickness when used for

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 17088240, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jerd.13363 by Marco Aurelio Carvalho - CAPES , Wiley Online Library on [15/11/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
the thermo-­modified cementation. Materials with prepolymer- 14. M. M. M. Gresnigt, M. Özcan, M. Carvalho, et al., “Effect of Lut-
ized fillers should be avoided. ing Agent on the Load to Failure and Accelerated-­Fatigue Resistance
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15. A. Akın, S. Toksavul, and M. Toman, “Clinical Marginal and Inter-
Acknowledgments
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The authors wish to express their gratitude to GC (Leuven, Belgium), Year Randomized Controlled Clinical Trial,” Journal of Prosthodontics
Kerr (Orange, CA), Edelweiss DR (Zug, Switzerland), Clinician's Choice 24, no. 5 (2015): 345–350.
(Ontario, Canada), SYNCA (Champlain, NY), 3 M (St. Paul, MN),
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Ultradent (South Jordan, Utah), and Dr. Mehrdad Razaghy, Beverly
of Clinical Marginal and Internal Gap of Porcelain Laminate Veneers
Hills, CA for providing flowable injectable composites. The authors do
With Minimal and Without Tooth Preparation and 2-­Year Clinical Eval-
not have any financial interest in the companies whose materials are
uation,” Quintessence International 47, no. 6 (2016): 461–471.
included in this article.
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Internal Adaptation of Heat-­Pressed and Cad/Cam Porcelain Laminate
Conflicts of Interest
Veneers and a 2-­Year Follow-­Up,” Journal of Prosthodontics 28, no. 5
The authors declare no conflicts of interest. (2019): 504–510.
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