1874-2106/19 Send Orders for Reprints to reprints@benthamscience.

net

422

The Open Dentistry Journal

Content list available at: https://opendentistryjournal.com

RESEARCH ARTICLE

Curing Depth and Degree of Conversion of Five Bulk-Fill Composite Resins

Compared to a Conventional Composite
2
Samaneh Rezaei1,2, Mehdi Abbasi2, Farzaneh Sadeghi Mahounak and Zohreh Moradi2,*
1
Department of Restorative Dentistry, School of Dentistry, Arak University of Medical Science, Arak, Iran
2
Department of Restorative Dentistry, School of Dentistry, Tehran University of Medical Science, Tehran, Iran

Abstract:
Background:
Limited curing depth and its effect on the degree of conversion are among the challenges of working with light-cure composite resins. The use of
bulk-fill composites is one strategy to overcome these limitations.

Methods:
Ever X Posterior (EXP), Filtek Bulk-Fill Posterior (FBP), Sonic Fill 2 (SF2), Tetric N-Ceram Bulk-Fill (TNB), and X-tra Fil (XF) bulk-fill and
Filtek Z250 conventional composite were evaluated in this in vitro experimental study. Six samples for the assessment of microhardness and three
samples for the evaluation of DC were fabricated of each composite. After light curing and polishing, the samples were incubated at 37°C for 24
hours. Microhardness was measured by a Vickers hardness tester three times and the mean value was calculated. DC of the top and bottom surfaces
was determined using Fourier-Transform Infrared Spectroscopy (FTIR). Data were analyzed using one-way ANOVA and Tukey’s test.

Results:
Microhardness and DC were significantly different among the groups (P<0.001). XF and Z250 equally showed the highest bottom-to-top surface
microhardness ratio (0.97 ± 0.01) and significantly higher DC in the top (P<0.001) and bottom (P<0.005) surfaces compared to other groups. TNB
showed the lowest microhardness ratio (0.88 ± 0.04) and DC (68.66 ± 1.52 and 61.00 ± 2.00); the difference in DC of the bottom surface was
statistically significant (P<0.003).

Conclusion:
It appears that bulk-fill composites evaluated in this study are adequately polymerized at 4 mm depth. Their DC was optimal and within the range
of conventional composites.

Keywords: Ever X Posterior (EXP), Composite resins, Hardness tests, Fourier transform infrared spectroscopy, Filtek Z250, X-tra fil composite
resin.

Article History Received: July 13, 2019 Revised: October 19, 2019 Accepted: November 21, 2019

1. INTRODUCTION polymerized only to a certain depth, which depends on the

penetration of visible light through the composite mass. The
The application of composite resins has greatly increased
energy of light radiated by the light-curing unit is gradually
due to their optimal physical, mechanical, and esthetic
attenuated as it passes through the composite mass. As a result,
properties. However, they still have drawbacks that limit their
a gradual reduction in Degree of Conversion (DC) of com-
application [1]. Limited curing depth and the risk of
posite resin monomer occurs as the distance from the irradiated
insufficient conversion of monomer to polymer in deep areas
surface increases. Reduction in DC compromises the physical
are among the shortcomings of light-polymerizing composite
properties of the composite and enhances the release of
resins [1, 2]. In other words, light-cure composite resins can be
monomers, which eventually leads to early restoration failure
* Address correspondence to this author at the Department of Restorative or may negatively affect the pulp tissue [3].
Dentistry, School of Dentistry, Tehran University of Medical Science, North
Kargar St, Po. Code: 14399-55991, Tehran, Iran; Tel: +98-912-1242140; Fax: The term “hardness” is used to predict the wear resistance
+9821-88015950; E-mail: [email protected] and the wearability of materials by the opposing tooth

DOI: 10.2174/1874210601913010422, 2019, 13, 422-429

Curing Depth and Degree of Conversion of Bulk-Fill Paste The Open Dentistry Journal, 2019, Volume 13 423

structure. The bottom to top surface microhardness ratio should namely Ever X Posterior (EXP), Filtek Bulk-Fill Posterior
meet the minimum acceptable value of 0.80 or 0.85 to ensure (FBP), Sonic-Fill 2 (SF2), Tetric-N-Ceram Bulk-Fill (TNB),
that the bottom surface is adequately polymerized [4]. Factors and X-tra fil (XF) and one conventional composite namely
affecting the curing depth include the type of composite resin, Filtek Z250 (as control) using a mold. Sample size for the
its color and translucency, thickness of each increment, assessment of microhardness was calculated to be six samples
distance from the tip of the light-curing unit to the composite in each of the six groups by means of One Way ANOVA
surface, and size and distribution of filler particles [2, 5]. Power Analysis of PASSII software and in accordance to a
Polymerization of composite resins includes conversion of study by Moharam et al. [9], and considering an investigation
carbon double bonds to carbon single bonds which determine by Abed et al. [6] and by means of One Way ANOVA Power
the DC. Factors such as the size of filler particles, polymer Analysis of PASSII software the sample size for assessment of
matrix, the radiating light, its intensity, wavelength, and DC was calculated to be three samples in each of the six
duration of radiation, the size of tip of device, type and amount groups.
of photo-initiators, and color of composite resins can all affect
the DC and subsequently the mechanical properties, wear 2.1. Sample Preparation
resistance, and color stability of composite resins [4, 6].
Table 1 shows the characteristics of the five bulk-fill and
To overcome the aforementioned drawbacks of the one conventional composite (control) used in this study. A two-
conventional composite resins, bulk-fill composites were piece stainless steel mold measuring 4.1 x 4.1 x 4.1 mm was
developed, which can be applied in the cavity as bulk in up to 4 used and the bulk-fill composites were packed in the mold as
mm thickness, requiring one single curing cycle, with no bulk with 4 mm thickness. After packing, a glass slab
adverse effect on their adaptation or DC [6, 7]. Bulk-fill measuring 1x25x75 mm was placed over it and light-curing
composites have unique properties, which ensure adequate was performed for 30 seconds using a poly-wave LED light-
curing of the bulk mass even in deep areas. The manufacturers curing unit (BluePhase N, Ivoclar Vivadent AG, Schaan,
of bulk-fill composites claim that they are superior to Liechtenstein) with 385-515 nm wavelength and 1200 mW/cm2
conventional composites in many aspects; however, some light intensity periodically checked by a radiometer (Model
controversies still exist in this respect. For instance, the DC of 100; Optilux, SDS, Kerr, Orange, CA, USA). The tip of the
>55% is clinically acceptable for bulk-fill composites but this light-curing unit was in direct contact with the glass slab during
value is still lower than the DC of conventional composites [8]. curing in order to standardize the distance from the tip to the
Considering such controversies and the gap of information surface of samples during polymerization. In the control group,
regarding the DC and curing depth of different bulk-fill Filtek Z250 conventional composite was applied in to the mold
composites available in the market, this study aimed to assess measuring 2.1x2.1x2.1 mm and was light-cured from the
and compare the curing depth and DC of five commonly used superior surface. After removing the samples from the mold,
bulk-fill composites in comparison to a commonly used their lateral surfaces were marked to differentiate the top and
conventional composite resin. The null hypothesis was that the bottom surfaces. Next, the top and bottom surfaces were
curing depth of bulk-fill composites is similar to conventional polished with 800, 1000, and 1200-grit abrasive papers,
ones (2 mm) and DC of bulk-fill composites in deep layers is respectively, to obtain a smooth surface. After polishing, the
lower than conventional resins. dimensions of all samples were measured by a digital caliper to
the nearest 0.01 mm (Mitutoyo, Tokyo, Japan). They were then
2. MATERIALS AND METHODS
incubated in a dry environment at 37°C for 24 hours. Three
This in vitro, experimental study was performed on samples in each group were fabricated in the same manner
composite samples fabricated of five bulk-fill composites described above for the assessment of DC.

Table 1. Characteristics of the conventional and bulk-fill composite resins tested in this study.

Commercial Type of
Code Manufacturer Composition Filler Percentage Color
Brand Composite
EverX Posterior Short fiber GC Corp., Tokyo, Short E-glass fiber filler, barium glass, Bis-GMA,
1 74.2wt% 53.6vol% Universal
(EXP) composite Japan PMMA, TEGDMA
Non- agglomerated/non-aggregated 20 nm silica
filler,non-agglomerated/non-aggregated 4 to 11 nm
Filtek Bulk Fill 3M ESPE, St. zirconia filler,aggregated zirconia/silica cluster
2 Nano fill 76.5wt%58.4vol% A2
Posterior(FBP) Paul, MN, USA filler,ytterbium trifluoride filler consisting of
agglomerate 100 nm particles,ERGP-
DMA,diurethane-DMA,1, 12-dodecane-DMA
Poly(oxy-1,2-ethanediyl), α,α′-[(1-
methylethylidene)di-4, 1-phenylene]bis[ω-[(2-
Kerr corp.,
3 Sonic Fill 2(SF2) Nano Hybrid methyl-1-oxo-2-propen-1-yl)oxy]-Not available. 2,2′- 81.3wt% unreported. A2
Orange, CA, USA
ethylenedioxydiethyl
dimethacrylate.
424 The Open Dentistry Journal, 2019, Volume 13 Rezaei et al.

(Table 1) contd.....
Commercial Type of
Code Manufacturer Composition Filler Percentage Color
Brand Composite
Ivoclar Vivadent
Tetric N-Ceram Barium glass,Prepolymer,Ytterbium trifluoride,Mixed
4 Hybrid AG, Schaan, 75-77wt%53-55vol% IVA
Bulk Fill(TNB) oxideBis-GMA, DMA
Liechtenstein
VOCO Cuxhaven, Barium-boron- aluminosilicate glass,Bis-GMA,
5 X-tra fil(XF) Hybrid 86wt%70.1vol% Universal
Germany UDMA, TEGDMA
Filtek Z250 Micro 3M ESPE, St. zirconia/silica without
6 82wt%60vol% A2
Universal(Z250) Hybrid Paul, MN, USA silane treatment,Bis-GMA, UDMA, Bis-EMA

2.2. Assessment of Curing Depth Using Vickers Micro bottom surface microhardness, the ratio of the bottom to top
Hardness Test surface microhardness and DC of the top and bottom surfaces.
Pairwise comparisons were performed using Tukey’s HSD test.
The fabricated samples were subjected to Vickers
All statistical analyses were carried out using SPSS version 22
microhardness test (Bareiss, Germany) and their top and
(SPSS Inc., IL, USA) at P<0.05 level of significance.
bottom surfaces were subjected to indentation by the indenter
of the device applying 300 g load for 15 seconds such that the
3. RESULTS
indenter applied load to each surface 3 times with at least 3
diagonal widths of 20 µm between indentations. The load 3.1. Results of Surface Micro Hardness
application created a symmetrical indentation in each surface,
the dimensions of which were determined under a microscope. One-way ANOVA showed significant differences in the
microhardness of the bottom (P=0.000) and top (P=0.000)
2.2.1. Measurement of DC surfaces and the bottom/top micro hardness ratio (P=0.000). In
the assessment of microhardness of the top and bottom
The DC was measured using Fourier-transform infrared
surfaces, Tukey’s test revealed that the microhardness of the
spectroscopy (FTIR; Nicolet IS 10; USA). First, an uncured
XF group was significantly higher than that of other groups
sample of each composite was subjected to FTIR. Following
(P<0.001). The Z250 composite also showed significantly
the passage of light through the sample, chemical double bonds
higher microhardness than other composite resins except for
were identified and the absorption peak was recorded at
XF. SF2 showed significantly higher microhardness than TNB,
1608-1638 cm-1. Next, three cured samples in each group were EXP, and FBP (P<0.001). TNB showed significantly lower
subjected to FTIR such that the absorption peaks were recorded microhardness than other composite resins (P<0.001), and EXP
once for the top and once for the bottom surface. The DC of the and FBP were not significantly different in this regard
top and bottom surfaces was calculated using the formula (P>0.05). Analysis of the bottom/top surface microhardness
below: ratio by post hoc Tukey’s test (Fig. 1) showed that Z250 had a
(1638 cm−1 ⁄1608 cm−1) 𝑝𝑒𝑎𝑘 ℎ𝑒𝑖𝑔ℎ𝑡 𝑎𝑓𝑡𝑒𝑟 𝑐𝑢𝑟𝑖𝑛𝑔 significantly higher microhardness ratio than SF2, EXP, and
DC % = [1− ] × 100
(1638 cm−1⁄1608 cm−1)𝑝𝑒𝑎𝑘 ℎ𝑒𝑖𝑔ℎ𝑡 𝑏𝑒𝑓𝑜𝑟𝑒 𝑐𝑢𝑟𝑖𝑛𝑔 TNB (P<0.047). XF showed a significantly higher micro-
hardness ratio than EXP and TNB (P<0.022). Thus, XF and
2.2.2. Statistical Analysis
Z250 equally showed the highest microhardness ratio (0.97 ±
One-way ANOVA was used to compare the top and 0.01) followed by FBP (0.95 ± 0.02). TNB showed the lowest
ratio (0.88 ± 0.04).

Fig. (1). Mean and 95% confidence interval of the ratio of the bottom to top surface microhardness.
Curing Depth and Degree of Conversion of Bulk-Fill Paste The Open Dentistry Journal, 2019, Volume 13 425

Fig. (2). Mean and 95% confidence interval of the mean DC of the top surface.

Fig. (3). Mean and 95% confidence interval of the mean DC of the bottom surface.

3.2. Results of DC results showed that the bulk-fill composites tested were well
polymerized at 4 mm depth and their DC was above the
One-way ANOVA showed a significant difference among
standard threshold of 55-65%. Several methods are available
the composite resins in DC of the top (P=0.000) and bottom
for the assessment of curing depth. Laser and FTIR are among
(P=0.000) surfaces. Pairwise comparisons by Tukey’s test
the direct methods for the assessment of curing depth while
(Fig. 2) showed that XF and Z250 had significantly higher DC
microhardness test, scraping, and visual inspection are among
in the top surface compared to other groups (P<0.001). SF2
the indirect methods applied for this purpose [10]. Since the
showed significantly higher DC in the top surface than FBP
optical microscopy and scraping methods, which are approved
and TNB (P=0.009), and TNB showed the lowest DC of the
by the ISO 4049, overestimate the curing depth compared to
top surface (68.66 ± 1.52). Fig. (3) Compares the DC of the
the Vickers or Knoop hardness test [11], the Vickers’s hardness
bottom surfaces. As shown, Z250 and XF had significantly
test was used to assess the curing depth in the present study. In
higher DC of the bottom surface (P=0.005) and TNB had the evaluation of curing depth, the ratio of the bottom to top
significantly lower DC of the bottom surface than other groups surface microhardness for completely cured samples should be
(P=0.003). ideally 1; however, 80% curing depth is often regarded as
clinically acceptable [2, 3, 12]. Our results showed that XF,
4. DISCUSSION
Z250, and SF2 had the highest microhardness in both the top
The null hypothesis of this study was rejected because the and bottom surfaces compared with other groups while TNB
426 The Open Dentistry Journal, 2019, Volume 13 Rezaei et al.

showed the lowest surface microhardness. The high micro- composition. Ivocerin, a germanium-based initiator, has higher
hardness reported for XF in our study was in agreement with photo-curing activity than camphorquinone and absorbs the
other studies [9, 13]. Such a high hardness value can be due to visible light in a wide wavelength range of 380 to 460 nm;
the difference in the chemical composition of organic resin whereas, camphorquinone absorbs light in the range of 450 to
matrix and viscosity of monomers. Also, the flexibility of 490 nm [25 - 27]. Moreover, this initiator can be used without
chemical structure can affect the curing depth of composite the addition of amine as a co-initiator and produces at least 2
resins. The XF organic resin matrix is made of bis-GMA, free radicals. Thus, it has higher efficacy than the cam-
UDMA, and TEGDMA; the latter is considered as the diluting phorquinone-amine system, which only has one free radical
monomer, which has the lowest viscosity and highest DC [28]. On the other hand, other investigations [12, 14] revealed
among the composite resin monomer systems. When Bis-GMA that the TNB composite, despite having high filler content, has
is diluted with low-viscosity monomer, it exerts a synergistic lower than standard bottom to top surface microhardness ratio
effect on DC and curing depth. Thus, high amounts of TEG (80%), which was in contrast to our findings and this con-
DMA monomer can probably be the reason for the higher troversy in the results of the two studies can be due to the
curing depth of the XF composite [9, 14]. In our study, Z250 difference in type of light-curing unit used [12, 14]. We used
conventional composite also showed high microhardness; this the BluePhase N poly-wave LED light-curing unit by Ivoclar in
may be due to the composition of its matrix that contains glass, this study. This device has been specifically designed to
quartz, and ceramic particles as fillers, enhancing its micro- include blue and violet lights and due to having a wide range of
hardness [15, 16]. High microhardness of SF2 can be attributed wavelengths, it can be used for any material and initiator
to the heat generated during vibration since it can enhance (385-515 nm). It has a light intensity of 1200 mW/cm2
polymerization by increasing the movement of free radicals according to the manufacturers’ instructions regarding using a
(directly) and reduction of viscosity (indirectly). However, the light intensity higher than 1000 mW/cm2. Any small
effect of ultrasonic energy on the curing of resin has not yet incompatibility between the wavelength of light source and
been systematically evaluated [17]. Significantly lower sensitivity of the photo-initiator can limit the ability to
microhardness of the top surface of TNB samples may be due maintain free radicals, which are responsible for the
to the initiator/catalyst system, type of monomer, and use of polymerization process [29]. The use of mono-wave LED for
barium glass fillers along with pre-polymerized particles in the curing of bulk-fill composites that contain camphorquinone
composition of this composite resin [14]. along with other photo-initiators with lower wavelength
The parameters affecting microhardness include absorption decreases the DC [30].
morphology and distribution of fillers, shape and density of The current results regarding the curing depth of EXP were
particles, type and amount of monomer, and DC of monomer, in line with other studies [11, 31]. The use of short fibers as
which are highly variable among different composite types fillers in EXP does not seem to negatively affect the curing
[18]. It has been found that the microhardness of the top depth [14]. Its resin matrix composition includes bis-GMA,
surface of composite samples was less dependent on the TEGDMA, and PMMA, which comprise a semi-inter-
intensity of radiated light because the top surface acquires the penetrating polymer network that provides optimal bonding
highest energy from the curing light [19]. In a study by properties. Also, E-glass fibers enhance the toughness of the
Rodriguez et al. [20], similar to our study, the top surface of polymer matrix [32]. In fact, the random orientation of fibers
samples showed higher microhardness than the bottom surface; and semi-interpenetrating polymer network structure of their
the hardness value decreased by an increase in thickness. polymer matrix probably play an important role in the
improvement of the mechanical properties of EXP [21].
In the current study, XF and Z250 equally showed the
Interpenetrating polymer networks are composed of two or
highest curing depth (the bottom to top surface microhardness
more polymers in one network that provide a relative
ratio was 97%) followed by FBP (the bottom to top surface
heterogeneity in the molecular scale in the matrix. The
microhardness ratio was 95%). In fact, the microhardness of
polymers cannot be released unless the chemical bonds are
FBP was less than that of SF2 but its curing depth was higher,
broken [33]. Also, two photo-initiators namely camp-
which indicates that light transmission in FBP is better than in
horquinone and trimethyl benzoyl phosphine oxide (which
SF2 (the bottom to top surface microhardness ratio was 93%).
enhances the general function of free radicals compared with
Regarding the optimal curing depth of FBP at 4 mm thickness,
camphorquinone) are used in its composition. It should be
the results of other studies were in line with ours [21, 22]. The
noted that EXP can be used for filling the entire cavity;
fillers of this composite include a combination of non-
however, according to the manufacturers, it should be
agglomerated/non-aggregated silica fillers measuring 20 nm in
preferably used with another veneering material to obtain an
diameter, non-agglomerated/non-aggregated zirconia fillers
acceptable wear resistance. In other words, EXP is a non-
measuring 4-11 nm, aggregated zirconia/silica cluster fillers
flowable base composite with the highest mechanical
(20 nm silica and 4-11 nm zirconia particles), and yttrium tri-
properties and viscosity among the base materials and is
fluoride including 100 nm agglomerated particles. Such
comparable with non-base bulk-fill composites [34].
nanoparticles cannot scatter or absorb the visible light, which is
important in their light-curing process [23]. TNB also showed The use of novel resins, modulators, and fillers increased
the lowest curing depth; however, its curing depth was still the curing depth of bulk-fill composites [14]. Also, the amount
over 80% (88%). It means that it is well cured at 4 mm depth. of light passed through the composite resin depends on the
Similarly, Al-Mansour et al. [24] reported >80% hardness for amount of reflected light, scattered light and absorbed light,
TNB. This finding can be due to the presence of Ivocerin in its which varies depending on the composition of the composite
Curing Depth and Degree of Conversion of Bulk-Fill Paste The Open Dentistry Journal, 2019, Volume 13 427

[35, 36]. Smaller fillers scatter light more than larger fillers analog (bis-EMA) along with the presence of flexible siloxane
[37]. Moreover, evidence shows that by an increase in the methacrylate copolymer may increase the molecular reactivity
amount of filler, the translucency decreases due to an increased of monomers [34]. Moreover, the sonic vibration process
likelihood of light refraction at the filler-resin interface. The during the application of material with a specific hand-piece
translucency increases by an increase in filler size [36]. Thus, may decrease the viscosity and increase the movement of
size, radiopacity, translucency, and pigments of filler particles monomers and subsequently their DC [17]. The findings of
affect the passage of light through the material and curing Goracci et al. [31] and Monterubbianesi [41] supported our
depth [38]. However, nano-filled bulk-fill composites such as results in this respect.
FBP and SF contain specific amounts of small fillers with
Assessment of DC of the bottom surface revealed that
dimensions smaller than the visible light wavelength (390 to
Z250 and XF had significantly highest DC compared to other
750 nm). Due to small size, these nanoparticles cannot scatter
groups. The lowest DC of both surfaces was noted in TNB.
or absorb visible light, which can significantly affect the
Although TNB contains a dibenzoyl germanium photo-initiator
curing, translucency, and esthetics [23, 36]. In our study, only
activated by light at 380-460 nm wavelength, it does not cause
XF had higher microhardness of top and bottom surfaces
a higher DC or greater curing depth in this composite
compared with the control group (Z250). Regarding curing
compared to others, which may be related to low penetration of
depth, XF and Z250 equally showed the highest curing depth.
light into the composite mass [51].
DC is determined by the ratio of the frequency of residual
In bulk-fill composites, two strategies are employed to
C=C aliphatic double bonds in cured composite resin compared
maintain high DC in deep areas. The first strategy is their
with the total number of C=C double bonds in uncured material
[39]. FTIR is used to analyze DC in the polymerization of increased translucency. For the highest light transfer, most
methacrylates [40 - 43]. There is no consensus regarding bulk-fill composites are not available in different colors.
minimum DC required for most restorative materials but it is Increased filler size and compatibility of the refractive index of
assumed that a minimum DC in the range of 55-65% is suitable filler and resin matrix are among the methods to increase the
for the occlusal layer [41]. translucency of composite resins. In fact, minimizing the
difference in the refractive index of filler and resin improves
Factors such as size and composition of fillers, the DC, curing depth, and color match. The second strategy is
translucency of materials, curing type, intensity of LED, curing to enhance the efficiency of the photo-initiator. Most of the
time, composition of monomer, and concentration of photo- currently available composite resins are based on the
initiator can affect the DC of composite resins [44, 45]. Also, camphorquinone-amine system with a limited production of
by an increase in filler content, DC relatively decreases, which free radicals. To increase their function, they are combined
can be attributed to the reduction in resin content and light with accessory photo-initiators including TPO derivatives such
scattering at the resin-filler interface [46]. as Lucerin-TPOTM and Irgacure-819TM or benzoyl-germanium
In our study, XF and Z250 showed significantly higher DC (IvocerinTM) compounds, which have synergistic effects on
in the top surface compared to other groups followed by SF2. camphorquinone with simple photo-scission without amine
Primary viscosity and flexibility of chemical structure are two reduction [51, 52].
important properties of monomers that affect the DC [47].
Future studies are recommended to evaluate other
Higher DC of XF in our study may be due to the unique
properties of bulk-fill composite resins such as their wear
chemical composition of its organic matrix. The organic matrix
resistance, fracture toughness, and effect of thickness on the
of XF is composed of bis-GMA, UDMA, and TEGDMA.
passage of light.
Evidence shows that the maximum DC of different monomer
systems increases in the following order: bis-GMA<bis- CONCLUSION
EMA<UDMA<TEGDMA [48].
Within the limitations of this study, the bulk-fill
Bis-GMA is the most viscous monomer with minimal composites tested were well polymerized at 4 mm depth and
flexibility due to strong intramolecular hydrogen bonds of its their DC was above the standard threshold of 55-65%.
hydroxyl (-OH) groups. UDMA is also a viscous monomer due
to having intra-molecular hydrogen bonds between the amine (- ETHICS APPROVAL AND CONSENT TO
NH-) and carbonyl (-C=O) groups. However, UDMA has much PARTICIPATE
lower viscosity and higher flexibility than bis-GMA due to
having weak hydrogen bonds of amine groups compared with The study was approved by the Ethics Committee of
hydroxyl groups [49]. However, the presence of amine groups Tehran University of Medical Science, Tehran, Iran (Code #.
in the structure of the urethane monomer of UDMA is IR.TUMS.DENTISTRY.REC.1397.003).
responsible for reactions for the continuation of poly-
merization. These reactions increase the mobility of radicals HUMAN AND ANIMAL RIGHTS
and subsequently enhance the polymerization and DC [48]. No animals/humans were used for studies that are the basis
The organic matrix of Z250 includes bis-GMA, bis-EMA, of this research.
and UDMA. The latter has a higher content than the other two,
CONSENT FOR PUBLICATION
which may explain the high DC of this composite [50]. Regar-
ding SF, replacing bis-GMA with a low-viscosity ethoxylated Not applicable.
428 The Open Dentistry Journal, 2019, Volume 13 Rezaei et al.

AVAILABILITY OF DATA AND MATERIALS [http://dx.doi.org/10.2341/13-307-L] [PMID: 25136904]

[13] Leprince JG, Palin WM, Vanacker J, Sabbagh J, Devaux J, Leloup G.
The data supporting the findings of the article is available Physico-mechanical characteristics of commercially available bulk-fill
in Tehran University of Medical Science, central library composites. J Dent 2014; 42(8): 993-1000.
[http://dx.doi.org/10.1016/j.jdent.2014.05.009] [PMID: 24874951]
Tehran, Iran, no URL assigned to research projects but data is [14] Yap AUJ, Pandya M, Toh WS. Depth of cure of contemporary bulk-
well protected. fill resin-based composites. Dent Mater J 2016; 35(3): 503-10.
[http://dx.doi.org/10.4012/dmj.2015-402] [PMID: 27252008]
[15] Shortall AC, Uctasli S, Marquis PM. Fracture resistance of anterior,
FUNDING
posterior and universal light activated composite restoratives. Oper
This work was financially supported by the Dental Re- Dent 2001; 26(1): 87-96.
[PMID: 11203782]
search Center, Dentistry Research Institute, Tehran University [16] Ilie N, Hickel R. Investigations on mechanical behaviour of dental
of Medical Sciences, Tehran, Iran (96-03-70-36890). composites. Clin Oral Investig 2009; 13(4): 427-38.
[http://dx.doi.org/10.1007/s00784-009-0258-4] [PMID: 19242739]
CONFLICT OF INTEREST [17] Alshali RZ, Silikas N, Satterthwaite JD. Degree of conversion of bulk-
fill compared to conventional resin-composites at two time intervals.
The authors declare no conflict of interest, financial or Dent Mater 2013; 29(9): e213-7.
[http://dx.doi.org/10.1016/j.dental.2013.05.011] [PMID: 23845799]
otherwise.
[18] Nagi SM, Moharam LM, Zaazou MH. Effect of resin thickness, and
curing time on the micro-hardness of bulk-fill resin composites. J Clin
ACKNOWLEDGEMENTS Exp Dent 2015; 7(5): e600-4.
[http://dx.doi.org/10.4317/jced.52536] [PMID: 26644836]
Declared none. [19] Pires JAF, Cvitko E, Denehy GE, Swift EJ Jr. Effects of curing tip
distance on light intensity and composite resin microhardness.
REFERENCES Quintessence Int 1993; 24(7): 517-21.
[PMID: 8210323]
[1] Al Sunbul H, Silikas N, Watts DC. Polymerization shrinkage kinetics [20] Rodriguez A, Yaman P, Dennison J, Garcia D. Effect of light-curing
and shrinkage-stress in dental resin-composites. Dent Mater 2016; exposure time, shade, and thickness on the depth of cure of bulk fill
32(8): 998-1006. composites. Oper Dent 2017; 42(5): 505-13.
[http://dx.doi.org/10.1016/j.dental.2016.05.006] [PMID: 27240744] [http://dx.doi.org/10.2341/16-057-L] [PMID: 28605610]
[2] Alrahlah A, Silikas N, Watts DC. Post-cure depth of cure of bulk fill [21] Tsujimoto A, Barkmeier WW, Takamizawa T, Latta MA, Miyazaki M.
dental resin-composites. Dent Mater 2014; 30(2): 149-54. Mechanical properties, volumetric shrinkage and depth of cure of short
[http://dx.doi.org/10.1016/j.dental.2013.10.011] [PMID: 24268044] fiber-reinforced resin composite. Dent Mater J 2016; 35(3): 418-24.
[3] Flury S, Hayoz S, Peutzfeldt A, Hüsler J, Lussi A. Depth of cure of [http://dx.doi.org/10.4012/dmj.2015-280] [PMID: 27251997]
resin composites: Is the ISO 4049 method suitable for bulk fill [22] Fronza BM, Rueggeberg FA, Braga RR, et al. Monomer conversion,
materials? Dent Mater 2012; 28(5): 521-8. microhardness, internal marginal adaptation, and shrinkage stress of
[http://dx.doi.org/10.1016/j.dental.2012.02.002] [PMID: 22391146] bulk-fill resin composites. Dent Mater 2015; 31(12): 1542-51.
[4] Lombardini M, Chiesa M, Scribante A, Colombo M, Poggio C. [http://dx.doi.org/10.1016/j.dental.2015.10.001] [PMID: 26608118]
Influence of polymerization time and depth of cure of resin composites [23] Kim JJ, Moon HJ, Lim BS, Lee YK, Rhee SH, Yang HC. The effect of
determined by Vickers hardness. Dent Res J (Isfahan) 2012; 9(6): nanofiller on the opacity of experimental composites. J Biomed Mater
735-40. Res B Appl Biomater 2007; 80(2): 332-8.
[PMID: 23559951] [http://dx.doi.org/10.1002/jbm.b.30601] [PMID: 16850469]
[5] Rosatto CM, Bicalho AA, Veríssimo C, et al. Mechanical properties, [24] Al-Mansour K, Al-Sada A, Al-Sinan H. Curing depth of bulk-fill
shrinkage stress, cuspal strain and fracture resistance of molars composites-An in-vitro study. Pak Oral Dent J 2015; 35(2)
restored with bulk-fill composites and incremental filling technique. J [25] Ilie N, Stark K. Effect of different curing protocols on the mechanical
Dent 2015; 43(12): 1519-28. properties of low-viscosity bulk-fill composites. Clin Oral Investig
[http://dx.doi.org/10.1016/j.jdent.2015.09.007] [PMID: 26449641] 2015; 19(2): 271-9.
[6] Abed Y, Sabry H, Alrobeigy N. Degree of conversion and surface [http://dx.doi.org/10.1007/s00784-014-1262-x] [PMID: 24859381]
hardness of bulk-fill composite versus incremental-fill composite. [26] Park YJ, Chae KH, Rawls HR. Development of a new photoinitiation
Tanta Dent J 2015; 12(2): 71-80. system for dental light-cure composite resins. Dent Mater 1999; 15(2):
[http://dx.doi.org/10.1016/j.tdj.2015.01.003] 120-7.
[7] Farahat F, Daneshkazemi AR, Hajiahmadi Z. The effect of bulk depth [http://dx.doi.org/10.1016/S0109-5641(99)00021-4] [PMID:
and irradiation time on the surface hardness and degree of cure of 10551103]
bulk-fill composites. J Dent Biomater 2016; 3(3): 284-91. [27] Vivadent Ivoclar. Scientific documentation tetric EvoCeram Bulk Fill.
[PMID: 28959755] Amherst: Ivoclar Vivadent 2013; p. 42.
[8] Rothmund L, Reichl F-X, Hickel R, et al. Effect of layer thickness on [28] Ilie N, Bucuta S, Draenert M. Bulk-fill resin-based composites: An in
the elution of bulk-fill composite components. Dent Mater 2017; vitro assessment of their mechanical performance. Oper Dent 2013;
33(1): 54-62. 38(6): 618-25.
[http://dx.doi.org/10.1016/j.dental.2016.10.006] [PMID: 27836116] [http://dx.doi.org/10.2341/12-395-L] [PMID: 23570302]
[9] Moharam LM, El-Hoshy AZ, Abou-Elenein K. The effect of different [29] Krämer N, Lohbauer U, García-Godoy F, Frankenberger R. Light
insertion techniques on the depth of cure and vickers surface micro- curing of resin-based composites in the LED era. Am J Dent 2008;
hardness of two bulk-fill resin composite materials. J Clin Exp Dent 21(3): 135-42.
2017; 9(2): e266-71. [PMID: 18686762]
[http://dx.doi.org/10.4317/jced.53356] [PMID: 28210447] [30] Rocha MG, de Oliveira D, Correa IC, et al. Light-emitting diode beam
[10] Aguiar FH, Braceiro A, Lima DA, Ambrosano GM, Lovadino JR. profile and spectral output influence on the degree of conversion of
Effect of light curing modes and light curing time on the bulk fill composites. Oper Dent 2017; 42(4): 418-27.
microhardness of a hybrid composite resin. J Contemp Dent Pract [http://dx.doi.org/10.2341/16-164-L] [PMID: 28402730]
2007; 8(6): 1-8. [31] Goracci C, Cadenaro M, Fontanive L, et al. Polymerization efficiency
[http://dx.doi.org/10.5005/jcdp-8-6-1] [PMID: 17846665] and flexural strength of low-stress restorative composites. Dent Mater
[11] Garoushi S, Vallittu P, Shinya A, Lassila L. Influence of increment 2014; 30(6): 688-94.
thickness on light transmission, degree of conversion and micro [http://dx.doi.org/10.1016/j.dental.2014.03.006] [PMID: 24703547]
hardness of bulk fill composites. Odontology 2016; 104(3): 291-7. [32] Garoushi S, Säilynoja E, Vallittu PK, Lassila L. Physical properties
[http://dx.doi.org/10.1007/s10266-015-0227-0] [PMID: 26660101] and depth of cure of a new short fiber reinforced composite. Dent
[12] Jang JH, Park SH, Hwang IN. Polymerization shrinkage and depth of Mater 2013; 29(8): 835-41.
cure of bulk-fill resin composites and highly filled flowable resin. [http://dx.doi.org/10.1016/j.dental.2013.04.016] [PMID: 23726127]
Oper Dent 2015; 40(2): 172-80. [33] Kumar A, Gupta RK. Fundamentals of polymers1998.
Curing Depth and Degree of Conversion of Bulk-Fill Paste The Open Dentistry Journal, 2019, Volume 13 429

[34] Papadogiannis D, Tolidis K, Gerasimou P, Lakes R, Papadogiannis Y. Lasers Med Sci 2013; 28(5): 1227-31.
Viscoelastic properties, creep behavior and degree of conversion of [http://dx.doi.org/10.1007/s10103-012-1184-2] [PMID: 22971912]
bulk fill composite resins. Dent Mater 2015; 31(12): 1533-41. [44] Johnston WM, Leung RL, Fan PL. A mathematical model for post-
[http://dx.doi.org/10.1016/j.dental.2015.09.022] [PMID: 26498511] irradiation hardening of photoactivated composite resins. Dent Mater
[35] Musanje L, Darvell BW. Curing-light attenuation in filled-resin 1985; 1(5): 191-4.
restorative materials. Dent Mater 2006; 22(9): 804-17. [http://dx.doi.org/10.1016/S0109-5641(85)80017-8] [PMID: 2936641]
[http://dx.doi.org/10.1016/j.dental.2005.11.009] [PMID: 16364419] [45] Saipullaev M, Erdemir U, Yildiz E. Influence of bulk thickness, curing
[36] Fronza BM, Ayres A, Pacheco RR, Rueggeberg FA, Dias C, Giannini time, and curing unit type on the microhardness of different-viscosity
M. Characterization of inorganic filler content, mechanical properties, bulk-fill composites. Mech Compos Mater 2018; 54(5): 675-84.
and light transmission of bulk-fill resin composites. Oper Dent 2017; [http://dx.doi.org/10.1007/s11029-018-9775-z]
42(4): 445-55. [46] Shah PK, Stansbury JW. Role of filler and functional group conversion
[http://dx.doi.org/10.2341/16-024-L] [PMID: 28402731] in the evolution of properties in polymeric dental restoratives. Dent
[37] Lim YK, Lee YK, Lim BS, Rhee SH, Yang HC. Influence of filler on Mater 2014; 30(5): 586-93.
the difference between the transmitted and reflected colors of [http://dx.doi.org/10.1016/j.dental.2014.02.015] [PMID: 24674340]
experimental resin composites. Dent Mater 2008; 24(9): 1243-7. [47] Dickens SH, Stansbury J, Choi K, Floyd C. Photopolymerization
[http://dx.doi.org/10.1016/j.dental.2008.01.014] [PMID: 18343494] kinetics of methacrylate dental resins. Macromolecules 2003; 36(16):
[38] Ilie N, Bauer H, Draenert M, Hickel R. Resin-based composite light- 6043-53.
cured properties assessed by laboratory standards and simulated [http://dx.doi.org/10.1021/ma021675k]
clinical conditions. Oper Dent 2013; 38(2): 159-67. [48] Sideridou I, Tserki V, Papanastasiou G. Effect of chemical structure
[http://dx.doi.org/10.2341/12-084-L] [PMID: 22788727] on degree of conversion in light-cured dimethacrylate-based dental
[39] Ozturk B, Cobanoglu N, Cetin AR, Gunduz B. Conversion degrees of resins. Biomaterials 2002; 23(8): 1819-29.
resin composites using different light sources. Eur J Dent 2013; 7(1): [http://dx.doi.org/10.1016/S0142-9612(01)00308-8] [PMID:
102-9. 11950052]
[PMID: 23407765] [49] Khatri CA, Stansbury JW, Schultheisz CR, Antonucci JM. Synthesis,
[40] Stansbury JW, Dickens SH. Determination of double bond conversion characterization and evaluation of urethane derivatives of Bis-GMA.
in dental resins by near infrared spectroscopy. Dent Mater 2001; 17(1): Dent Mater 2003; 19(7): 584-8.
71-9. [http://dx.doi.org/10.1016/S0109-5641(02)00108-2] [PMID:
[http://dx.doi.org/10.1016/S0109-5641(00)00062-2] [PMID: 12901981]
11124416] [50] Sideridou ID, Achilias DS. Elution study of unreacted Bis-GMA,
[41] Monterubbianesi R, Orsini G, Tosi G, et al. Spectroscopic and TEGDMA, UDMA, and Bis-EMA from light-cured dental resins and
mechanical properties of a new generation of bulk fill composites. resin composites using HPLC. J Biomed Mater Res B Appl Biomater
Front Physiol 2016; 7: 652. 2005; 74(1): 617-26.
[http://dx.doi.org/10.3389/fphys.2016.00652] [PMID: 28082918] [http://dx.doi.org/10.1002/jbm.b.30252] [PMID: 15889433]
[42] Garoushi S, Vallittu PK, Lassila LV. Depth of cure and surface [51] Zorzin J, Maier E, Harre S, et al. Bulk-fill resin composites:
microhardness of experimental short fiber-reinforced composite. Acta Polymerization properties and extended light curing. Dent Mater 2015;
Odontol Scand 2008; 66(1): 38-42. 31(3): 293-301.
[http://dx.doi.org/10.1080/00016350801918377] [PMID: 18320417] [http://dx.doi.org/10.1016/j.dental.2014.12.010] [PMID: 25582061]
[43] Brandt WC, Silva-Concilio LR, Neves AC, de Souza-Junior EJ, [52] Ilie N, Stark K. Curing behaviour of high-viscosity bulk-fill
Sinhoreti MA. Influence of photoactivation method and mold for composites. J Dent 2014; 42(8): 977-85.
restoration on the Knoop hardness of resin composite restorations. [http://dx.doi.org/10.1016/j.jdent.2014.05.012] [PMID: 24887360]

© 2019 Rezaee et al.

This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is
available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.