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Original Article

Comparison of the fracture resistance of three

different recent composite systems in large Class II
mesio‑occlusal distal cavities: An in vitro study
Yajuvender Singh Hada, Sumita Panwar
Department of Conservative Dentistry and Endodontics, Daswani Dental College and Research Centre, Kota, Rajasthan, India

Abstract
Background: The present study was undertaken to evaluate the most suitable recent restorative material for extensively mutilated
teeth.
Aim: This study aims to evaluate and compare the fracture resistance of maxillary premolars with Class II mesio‑occlusal distal
(MOD) cavities restored with recent Ever X posterior, bulk‑fill composite, and Estelite sigma quick composite systems.
Materials and Methods: Sixty human maxillary premolars were selected. Fifteen intact teeth served as positive control (Group 1). MOD
cavities were prepared in the remaining 45 teeth with standardized dimensions and were randomly divided into three experimental
groups (Group 2, 3, and 4) (n = 15). Teeth in Group 2, 3, and 4 were reinforced with 3M ESPE Filtek Bulk‑fill posterior, GC Ever X
posterior, and Tokuyama Estelite sigma quick composites, respectively. Fracture resistance was measured in Newton (N).
Results: Group 4 (1432.60 N) showed the highest mean fracture resistance followed by Group 3 (1326.20 N), Group 1
positive controls (1288.53 N), and Group 2 (946.66N), respectively. One‑way analysis of variance (ANOVA) test revealed
a statistically significant difference between all the groups (P = 0.005). Post hoc Tukey test revealed a statistically significant
difference in mean fracture resistance between the Group 2 and Group 4 (P = 0.004), as well as between the Group 2 and
Group 3 (P = 0.033). However, there were no significant differences among the other groups.
Conclusion: Among the experimental groups, Estelite sigma quick composite showed the highest fracture resistance. Statistically,
a significant difference was seen between all groups.
Keywords: Bulk fills; e glass fibers; fracture resistance; mesio‑occlusal distal cavities; spherical supranano fillers

INTRODUCTION Recent materials such as fiber‑reinforced composites,

bulk‑fill composites, and higher filler content composites
Restoration of extensively carious teeth is one of the are introduced with improved handling properties,
biggest challenges in dentistry. Many types of research reduced polymerization shrinkage, and increased fracture
and advancements on the molecular level are going on to toughness.
overcome the shortcomings such as polymerization shrinkage,
microleakage, water sorption, and technique sensitivity, leading Recently, time‑saving composites are introduced which can
to the evolution of composites with improved properties.[1] be placed in 4–5 mm bulk and cured in one step. Rheology
of bulk fills is such that it allows better adaptation to the
cavity walls with self‑leveling effect.[2]
Address for correspondence:
Prof. Yajuvender Singh Hada, Department of Conservative
Dentistry and Endodontics, Daswani Dental College and Fiberreinforced Ever X posterior composite consists of
Research Centre, IPB‑19, RIICO Institutional Area, Ranpur, the combination of Eglass fibers and barium glass filler,
Kota ‑ 324 009, Rajasthan, India.
E‑mail: [email protected] This is an open access journal, and articles are distributed under the terms
Date of submission : 09.05.2018 of the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0
Review completed : 15.06.2018 License, which allows others to remix, tweak, and build upon the work
Date of acceptance : 06.06.2019 non‑commercially, as long as appropriate credit is given and the new
Access this article online creations are licensed under the identical terms.
Quick Response Code: For reprints contact: [email protected]
Website:
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How to cite this article: Hada YS, Panwar S. Comparison of the
fracture resistance of three different recent composite systems in
DOI: large Class II mesio-occlusal distal cavities: An in vitro study. J
10.4103/JCD.JCD_225_18
Conserv Dent 2019;22:287-91.

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Hada and Panwar: Fracture resistance of three different recent composite systems

fiber length in millimeter scale is 1–2 mm.[2] Within a

tough polymer matrix fibers helps in stopping the crack
progression same as the function of dentine, rendering it
a perfect material of choice in large size cavities(MOD).[3]
It is basically a dentine replacement composite and needs
to be covered proximally and occlusally with conventional
composite simulating enamel coverage.[4]

Group of new composites Estelite sigma quick with higher

filler loading and spherical supranano zirconia and silica
fillers not just impart improved physical properties but also
made it esthetically demanding, quick curing time enhance
the handling characteristics.[5] Total filler content in Ever X
posterior is 53.6% by weight.[21,23]

Hence, this study aims to evaluate the fracture toughness of Figure 1: Cavity preparation mesial review
the recent composite materials in severely weakened maxillary
premolars with mesio‑occlusal distal (MOD) cavities. The 3M ESPE Single Bond Universal bonding agent was applied
objective of the study was to evaluate the fracture resistance and cured for 20 s with Dentsply Spectrum curing light.
of all the three materials and to find which restorative material Tofflemire matrix band was applied for a further composite
will provide maximum fracture resistance. restoration.

The null hypothesis tested will be that there will be no Subsequently, teeth were randomly divided into three
difference in the fracture resistance of intact teeth and groups (n = 15).
those restored with different composite materials.
Group 2:Teeth restored with Filtek 3M ESPE
MATERIALS AND METHODS bulk fill
Bulk‑fill posterior composite was placed in bulk without
Sixty human maxillary premolars collected from department any incremental technique and cured for 30 s [Figure 3].
oral and maxillofacial surgery which was extracted for
orthodontic reason, were used in the study. Power and the Group 3:Teeth restored with fiber‑reinforced
sample size of the study were calculated by IBM® SPSS® composite GC Ever X posterior
21 SOFTWARE (IBM, Hong Kong). All the specimens were In this case, walls of the MOD cavities were built by
scaled to remove the adhering soft tissue and calculus microhybrid Coltene Swiss Tec composite followed by
and were stored in physiologic saline. Fully erupted teeth placement of Ever X posterior composite in the core. The
with mature apices, intact enamel and dentine without any restoration was completed by placing a 0.5 mm layer of
carious lesion, restorations, and developmental defects microhybrid composite on the occlusal surface[4] [Figure 4].
were included. Teeth with open apices or resorption,
previous restorations, or with any anatomical variation Group 4:Teeth restored with TOKUYAMA
were excluded from the study. Estelite sigma quick
Estelite sigma quick composite was placed by incremental
Fifteen intact teeth were used as positive controls (Group 1). technique and cured for 10 s for each increment [Figure 5].
Standardized MOD cavities was prepared using a tungsten
carbide straight fissure bur (FG 172, KERR Haw, Canada) Manufacturer’s instructions were followed while placing
in high-speed water-cooled hand piece, bur was changed and curing the composites.
after every 10 cavity preparations. Dimensions were
2 mm ± 0.2 mm pulpal width, 1.5 mm ± 0.2 mm gingival Thermocycling (SD Mechatronik, Germany thermocycler)
width, and 2 mm ± 0.2 mm buccolingual width and are was carried out 500 cycles at 5°C ± 2°C–55°C ± 2°C with
verified using periodontal probe.[6] Facial and lingual walls 30 s dwell time and 5 s transfer time. Then, the specimens
of the occlusal segment were prepared parallel to each were stored in an incubator (Bioline technology, India) at
other with the cavosurface angle at 90° [Figures 1 and 2]. 37°C and 100% humidity for 24 h. Teeth were mounted in
square blocks of cold cure acrylic resin 2 cm in dimensions
Prepared cavities were air‑dried, and COLTENE Swiss Tec up to 1.5  mm apical to the cement–enamel junction.
etchant was used for 10 s, and cavities were rinsed for A layer of light body elastomeric impression material
30 s and air‑dried. was applied around the root surface to simulate the

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Hada and Panwar: Fracture resistance of three different recent composite systems

Figure 2: Cavity preparation occlusal view Figure 3: Restoration with bulk‑fill posterior

Figure 4: Restoration with Ever X posterior Figure 5: Restoration with Estelite sigma quick

periodontal ligament. The fracture resistance of the teeth between the groups. On intergroup comparisons, Post hoc
was measured using an Instron India universal testing Tukey test [Table 3] revealed that there is a statistically
machine (model 1011). Each specimen was subjected significant difference in mean fracture resistance between
to compressive loading using a 5 mm round diameter the Group 2 and Group 4 (P = 0.004), as well as between
stainless steel ball at a strain rate of 2  mm/min. The ball the Group 2 and Group 3 (P = 0.033). However, there were
should contact the inclined planes of the facial and palatal no differences between the other groups.
cusps beyond the margins of the restoration, which will
simulate the tendency of the masticatory forces deflecting DISCUSSION
the cusps under stress. The force necessary to fracture the
specimen was recorded in Newton (N), and data obtained Tokuyama Estelite sigma quick is the preferred material
were tabulated and subjected to the statistical analysis for restoring extensive cavities with the highest mean
using IBM SPSS Statistics professional software. fracture resistance (1432.60 N) followed by Ever X Posterior
(1326.20 N), positive controls (1288.53 N), and Bulk‑fill group
RESULTS (946.66N). Hence, our null hypothesis has got rejected.

Highest mean fracture resistance was observed with Fracture is a complete or incomplete break in a material
Group 4 Estelite sigma quick (1432.60 N) followed by resulting from the application of excessive force.[7] Fracture
Group 3 Ever X posterior (1326.20 N), Group 1 Intact teeth resistance is directly related to the stoppage of the crack
(1288.53 N), and Group 2 bulkfill posterior composite propagation. Masticatory forces have a tendency to deflect
(946.66N)[Figure 6]. One‑way ANOVA test [Tables 1 and 2] cusps, and composites decrease the deformation of the
revealed a statistically significant difference (P = 0.005) cusps under masticatory load.[8,9]

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Hada and Panwar: Fracture resistance of three different recent composite systems

Table 1: Mean fracture resistance in Newton (N) in all four groups

n Mean Standard Standard 95% confidence interval for Mean Minimum Maximum
deviation error Lower bound Upper bound
Control 15 1288.5333 236.67575 61.10942 1157.4667 1419.6000 885.00 1675.00
Bulk‑fill Composite 15 946.6667 179.83630 46.43353 847.0766 1046.2567 684.00 1417.00
Ever X Posterior 15 1326.2000 452.28092 116.77843 1075.7352 1576.6648 965.00 2873.00
Estelite Sigma Quick 15 1432.600 503.26432 129.94229 1153.9015 1711.2985 870.00 2791.00

Table 2: Fracture resistance analysis of variance test

Sum of Degree of Mean square F Sig
squares freedom
Between Groups 1989541.933 3 663180.644 4.857 0.005
Within Groups 7646653.067 56 136547.376
Total 9636195.000 59

The variation in strength between different composites

may be explained due to the differences in the chemical
composition of their matrix, filler content, filler size, and
distribution.[9,10] Thus, a reduction in size and increase in
the volume of fillers are directly proportional to an increase
in compressive strength and surface hardness.[10,11]

High filler loading increases the physical and handling Figure 6: Graphical representation of comparison of mean
properties of the composites, new adhesive materials fracture resistance of composites
not only seal the margin but also increase the retention
and resistance properties of the restored tooth.[12] Recent needed to cure the resin with short exposure times
nanofiller technology with nanometric fillers impregnated (one‑third of that required by conventional composites)
in nanoclusters leads to high filler loading resulting in and requires exposures of 10 s or less. To achieve high
an increase in high compressive strength and flexural esthetic qualities, it has a suprananofillers 0.2‑μm
strength.[13,14] mono‑dispersing spherical filler (Si‑Zr). Particle
diameters of 0.2 μm are known to produce the best
Bulk filling all of the tooth preparation with a composite balance of material properties and esthetics. Estelite
at one time has obvious advantages for both patients and sigma quick itself resists wearing without causing
practitioners. The manufacturers claim that the bulk‑fill unusual wear in opposing teeth. It resists absorbing
materials can achieve a depth of cure of 6 mm.[15,16] Bulk‑fill stains from substances such as coffee better than
technology not only results in fewer voids in the mass of conventional products.[19] It is 82% filled by weight,
the material since all of it is placed at one time but also which allows it to have excellent strength and durability
would be faster than placing numerous increments. to withstand the demands of the posterior dentition
and the harsh environment of the oral cavity.[18]
Filtek™ Bulk Fill Posterior contains two novel
methacrylate monomers that, in combination, act to lower Fibers incorporated into a composite material greatly
polymerization stress. A high molecular weight aromatic enhances its mechanical property. The fibers present helps
urethane dimethacrylate  decreases the number of reactive in stopping crack propagation when the stress is transferred
groups in the resin. This helps to moderate the volumetric from the matrix to the fibers.[20] Ever X posterior containing
shrinkage. The addition–fragmentation monomers contain E‑glass fibers of 1–2 mm in length impregnated within the
a third reactive site that cleaves through a fragmentation nanohybrid composite could be used in 4 mm increment. The
process during polymerization. This process provides a difference in fracture toughness between materials may be
mechanism for the relaxation of the developing network due to the inorganic filler loading – 76.5% by weight in bulk‑fill
and subsequent stress relief. The fragments, however, composites, 53.6% in Ever X posterior, and 82% in Estelite
still retain the capability to react with each other or with sigma quick. The highest filler loading in Tokuyama Estelite
other reactive sites of the developing polymer.[17] sigma quick provides excellent strength and durability.

Radical‑amplified photopolymerization initiator The present results were obtained in optimized laboratory
(RAP technology) is used in Estelite sigma quick. The settings; however, clinical conditions are not similar and
initiator balances the high polymerization activity the aspects such as insertion and handling could have

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Hada and Panwar: Fracture resistance of three different recent composite systems

Table 3: Multiple comparisons using post hoc Tukey test

Reference Comparison Mean Difference Standard Significance 95% Confidence Interval
Group (RG) Group (CG) (RG‑CG) error Lower Bound Upper Bound
Control Bulk‑fill composite 341.86667 134.93079 0.066 ‑15.4149 699.1482
Ever x posterior ‑37.86667 134.93079 0.992 ‑394.9482 312.6149
Estelite sigma quick ‑144.06667 134.93079 0.710 ‑501.3482 213.2149
Bulk‑fill Control ‑341.86667 134.93079 0.066 ‑699.1482 14.4149
Composite Ever x posterior ‑379.53333 134.93079 0.033 ‑736.8149 ‑22.2518
Estelite sigma quick ‑485.93333 134.93079 0.004 ‑843.2129 ‑128.6518
Ever X Control 37.86667 134.93079 0.992 ‑319.6149 394.9482
Posterior Bulk‑fill composite 379.53333 134.93079 0.033 22.2518 736.8149
Estelite sigma quick ‑106.40000 134.93079 0.859 ‑463.6815 250.8815
Estelite Control 0.06667 134.93079 0.710 ‑213.2149 501.3482
Sigma Quick Bulk‑fill composite 485.93333. 134.93079 0.004 128.6518 843.2149
Ever x posterior 106.40000 134.93079 0.859 ‑250.8815 463.6815

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