Hindawi

e Scientific World Journal

Volume 2024, Article ID 9420336, 7 pages
https://doi.org/10.1155/2024/9420336

Research Article
In Vitro Evaluation of Mechanical Properties of Cention N and Its
Comparison with Resin Modified Glass Ionomer Cement (RMGIC)
Restorative Material as Used in Primary Teeth

Deepika Pai ,1 P. A. Anirudhmaadhava ,2 and Kishore Ginjupalli 3

1
Department of Pedodontics & Preventive Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education,
Manipal 576104, India
2
Kerala Institute of Medical Sciences, Trivandrum 695029, India
3
Department of Dental Materials, Manipal College of Dental Sciences, Manipal Academy of Higher Education,
Manipal 576104, India

Correspondence should be addressed to P. A. Anirudhmaadhava; [email protected]

Received 28 August 2023; Revised 4 December 2023; Accepted 12 December 2023; Published 2 January 2024

Academic Editor: Kawaljit Singh Randhawa

Copyright © 2024 Deepika Pai et al. Tis is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background and Objectives. Te child’s behaviour and cooperating ability are a crucial factor in deciding the restorative material
for pediatric patients. Among the adhesive materials, glass ionomer cement has been the choice of restorative material while
restoring primary teeth. However, due to poor physical properties such as wear resistance and water sorption, resin modifed glass
ionomer cements and composites that are light-cured adhesive restorative materials are preferred. Since the introduction of
Cention N, as a self-cured smart alkasite material for restoration, some studies have demonstrated superior mechanical properties
in comparison with conventional glass ionomers, modifed glass ionomers, and composites. Predominantly, these studies
evaluated properties such as microleakage, fuoride release, and marginal adaptation. We conducted this study to evaluate the
compressive strength, fexural strength, and shear bond strength of Cention N in the primary teeth. Methods. 22 specimens
prepared with Cention and RMGIC were embedded in primary teeth mounted in acrylic for analysing shear bond strength. Shear
bond strength was analysed using a universal testing machine. Te modes of failure in samples were observed under a ste-
reomicroscope and scanning electron microscope. 22 customised samples of Cention N and RMGIC were prepared and cat-
egorised as group A and group B, respectively. Te fexural and compressive strengths of these samples were evaluated using
a universal testing machine. Results. Te shear bond strength of RMGIC was higher than that of Cention N, whereas the
compressive and fexural strengths of Cention N were signifcantly higher than those of RMGIC. Te modes of failure were
predominantly adhesive followed by mixed failures. Conclusion. Te results of this study suggest that Cention N demonstrated
superior mechanical properties compared with RMGIC and can therefore be recommended for restorations in primary posterior
teeth. Cention N being a smart, esthetic, self-cured, or dual-cured material with better mechanical properties ofers a wide range of
applicability in primary teeth.

1. Introduction strength, high wear resistance, low water sorption, no

microleakage, and biocompatibility are some of the prop-
In the era of minimal invasive dentistry, adhesive restorative erties that an ideal restorative material should possess [2].
materials are widely used for restoration of occlusal, Among these materials, resin modifed glass ionomers
approximal, cervical, or multisurface cavities and as bulk (RMGIC) and composites are considered superior to others
restorative materials [1]. Tese include conventional glass because of their better mechanical properties. Additionally,
ionomers, modifed glass ionomers, compomers, and RMGIC and composites have fuoride-releasing ability that
composites. Good compressive strength, fexural and tensile is anticariogenic.
2 Te Scientifc World Journal

Cention N is a new alkasite material in the class of 2.1. Assessment of Shear Bond Strength
adhesive restorative materials. It contains an alkaline fller
that releases acid-neutralizing ions under acidic conditions 2.1.1. Preparation of Acrylic Blocks. Wax blocks of di-
and helps in regulating the pH, thereby preventing dental mensions 35 mm height, 15 mm width, and 15 mm
caries [3, 4]. It also releases fuoride and calcium which can thickness were carved from modelling wax. Elastomeric
remineralize incipient enamel lesions [4]. Te monomer impression was made that served as a mould for the fab-
matrix of this new bioactive material consists of a mixture of rication of acrylic blocks using cold cure methyl methac-
urethane dimethacrylates UDMA, DCP, an aromatic rylate resin (MMA). Te prepared blocks were polished
aliphatic-UDMA, and PEG-400 DMA. During polymeri- with carbide polishing paper. Te 22 prepared blocks were
zation, the cross linking between these monomer matrix then randomly divided into two groups of 11 blocks each,
complexes imparts strong mechanical properties. Te in- namely, in group A, 11 blocks for CN and, in group B, 11
organic fller barium-aluminum-silicate glass imparts blocks for RMGIC.
strength to the material [5, 6]. Manufacturers claim Cention
N to be a smart material with good mechanical properties 2.1.2. Mounting and Preparation of the Tooth Samples.
and as a competitor to existing time-tested esthetic adhesive Healthy human primary teeth extracted due to preshed-
materials such as composites and RMGIC [4, 5]. ding mobility were cleaned with normal saline and stored
Several studies evaluated properties of Cention N-like for no longer than three months in distilled water before
compressive strength, fexural strength, and fuoride re- testing. A window was made in the acrylic blocks, and the
leasing ability, etc. [5, 7–10]. Tese in vitro studies dem- teeth were placed in them. Te rest of the window was
onstrate that Cention N has superior mechanical properties flled with cold cure MMA that had been freshly mixed. To
than GIC but not composites. Since Cention N does not ofer achieve a consistent fat surface, a slow-speed handpiece
the shade range in colour as composites, composites clearly and a diamond disc were utilised to fatten the occlusal
dominate over Cention. surfaces of the teeth. Te fattened occlusal surfaces were
Since Cention N can be bulk flled and bulk cured like kept exposed.
RMGIC, it is obvious to compare Cention N with RMGIC. A polypropylene straw of height 4 mm and diameter
Terefore, we conducted this in vitro study to evaluate and 3 mm was used as a mould to build the cylinders of re-
compare the compressive strength, fexural strength, and storative material on the prepared tooth surface for SBS
shear bond strength of Cention N on primary teeth as testing. Following 24 hours of storage in distilled water, the
compared to RMGIC. Te compressive strength, fexural samples were subjected to testing.
strength, and shear bond strength of a given material can
directly be correlated to its survival rate in the oral envi-
ronment; hence, we evaluated these parameters [11, 12]. 2.1.3. Group A: CN. Prior to the placement of the material,
We hypothesised that there will be no diference in the tooth surface was air-dried for 60 s. CN was mixed in the
compressive strength, fexural strength, and shear bond powder liquid (P/L) ratio of 4.6 : 1 (by weight) using an
strength between Cention N and RMGIC. electronic weighing scale (EWS) as per the manufacturer’s
directions and condensed onto the prepared tooth surface
2. Materials and Methodology using the polypropylene straw. A plastic spatula and con-
denser were used to condense the material into the straw. It
With the approval from the institutional ethics committee was then light cured for 40 s, and once set, the blocks were
(IEC no. 829/2019), Kasturba Hospital, Manipal, this aged in distilled water for 24 hours.
in vitro experimental study was conducted. Based on the
statistical assessment, a sample size of 66 was derived, 22 2.1.4. Group B: RMGIC. Prior to the placement of the
samples per group with a power of 80% and 95% conf- material, the tooth surface was air-dried for 60 s. Te
dence levels. Vitremer primer was applied onto the tooth surface with
22 healthy primary teeth extracted due to preshedding the help of an applicator tip and light cured for 20 s as per
mobility were used to test the shear bond strength of both the manufacturer’s instructions. Vitremer was mixed in
the materials. 22 customised bar-shaped split moulds of a P/L ratio of 2.5 : 1 (by weight) using an EWS according to
25 × 2 × 2 mm dimension made up of Vitremer TM and the manufacturer’s instructions and was condensed onto
Cention N were used to test the fexural strength, and 22 the prepared tooth surface using the polypropylene straw.
customised cylindrical moulds of 6 mm height and 4 mm A plastic spatula and condenser were used to condense the
diameter made up of Vitremer TM and Cention N were used material into the straw. It was then light cured for 40 s,
to test the compressive strength. and once set, the blocks were aged in distilled water for
Cention N (Ivoclar Vivadent AG Liechtenstein), Ivoclar 24 hours.
India, was used in the experimental group.
VitremerTM (3M ESPE), United States, is a resin
modifed glass ionomer cement used as a comparative 2.1.5. Shear Bond Strength (SBS) Testing. Te prepared
material to the test in this study, along with Vitremer Primer, specimens were placed on the lower platform of the UTM
Vitrebond copolymer, HEMA, ethanol, and photoinitiators (Instron 3366, UK) and held in place using a specifcally built
(3M ESPE). jig for SBS testing. A chisel-shaped debonding blade was
Te Scientifc World Journal 3

then attached to the UTM’s crosshead. Te load was applied 2.3. Assessment of Compressive Strength. For the testing of
at the interface between the bonded materials at a crosshead CS, customised cylindrical split moulds of dimensions 6 mm
speed of 0.5 mm/min until debonding occurred. Te highest height and 4 mm diameter were fabricated with a non-
load measured during the test was divided by the bond area, reactive material.
and the result was expressed in MPa. Tese data were then
statistically analysed [13].
2.3.1. Group A: CN. CN was mixed as per the manufac-
Te fractured test specimens were then studied under
turer’s directions in the P/L ratio of 4.6 : 1 (by weight). Te
a stereomicroscope at magnifcations of 20x, 25x, and 32x,
mix was introduced into the mould with the help of a plastic
and the failures observed were categorised as follows: (a)
spatula. A lacron carver was used to remove the surplus
Cohesive failure occurs when the failure occurs within the
material, and a condenser was used to compact the material
restorative material. (b) Adhesive failure occurs when the
into the cylindrical mould. Celluloid strips were placed
bond between the tooth surface and the restorative material
above and below the mould to contain the material within
fails. (c) Mixed failure occurs when there is evidence of both
the mould and get a smooth fnish. A glass slab was used to
adhesive and cohesive fractures. Tree representative sam-
apply pressure and compact the material into the bar-shaped
ples in each group selected randomly underwent gold
mould to reduce porosities. Following light curing for 40 s,
sputtering and were examined under a scanning electron
the material was left undisturbed for 15 minutes with
microscope at magnifcations of 500x and 1000x. Te images
weights placed over it. After the material had set, the mould
were analysed in order to determine the characteristics of the
was split to retrieve the sample and was checked for po-
interface between the two bonding surfaces at the failure site.
rosities. If present, the sample was discarded. Te cylinders
were aged in distilled water for 24 hours till the CS testing
2.2. Assessment of Flexural Strength. A split mould with two was performed.
sections held together by two screws was fabricated with an
inert material that would not react with any of the com- 2.3.2. Group B: RMGIC. Vitremer was mixed as per the
ponents of materials used in the study. Te dimensions of directions provided by the manufacturer in the P/L ratio of
the bar-shaped split mould were 25 mm × 2 mm × 2 mm. 2.5 : 1 (by weight). Cylindrical samples of Vitremer were
prepared in the fabricated mould as described above for
group A. Te cylinders were aged in distilled water for
2.2.1. Group A: CN. CN was mixed according to the
24 hours till the CS testing was performed.
manufacturer’s recommendations in the P/L ratio of 4.6 : 1
(by weight) using an EWS. Te mix was introduced into the
mould with the help of a plastic spatula. A lacron carver was 2.3.3. Compressive Strength (CS) Test. Te prepared cylin-
used to remove the surplus material. A celluloid strip was drical specimens were placed on the UTM (Instron 3366
placed over the material, and a glass slab was used to apply UK) which was attached to a load measuring cell and
pressure and compact the material into the bar-shaped continuously recorded the load applied to the samples at
mould to reduce porosities. Following light curing for a crosshead speed of 0.5 mm/min until the samples cracked.
40 s, the material was left undisturbed for 15 minutes with Te CS was measured in MPa, and the data were analysed
weights placed over it. After the material had set, the mould using statistical methods [9, 13].
was split to retrieve the sample. Te bars were aged in
distilled water for 24 hours till the FS was tested.
2.4. Statistical Analysis. SPSS 22.0 (SPSS Inc., Chicago, IL)
software was used to interpret the data. Te level of sig-
2.2.2. Group B: RMGIC. Vitremer was mixed according to nifcance was set at p < 0.05. Te mean and standard de-
the manufacturer’s recommendations in the P/L ratio of 2.5 : viation of the groups were calculated using descriptive
1 (by weight) using an EWS. Te samples of Vitremer were statistics. Te Shapiro–Wilk test was used to determine the
prepared in the fabricated mould as described above for data’s normality. As the data did not follow a normal dis-
group A. Te bars were aged in distilled water for 24 hours tribution, inferential statistics were used with the help of the
till the FS testing was performed. Mann–Whitney U test to determine the diference between
the groups.

2.2.3. Flexural Strength (FS) Test. Te prepared bar speci- 3. Results

mens were placed on the UTM (Instron 3366, UK) and kept
frmly in place using a specifcally developed jig for this Te SBS of samples in group A-CN measured the highest
purpose during FS testing. Te crosshead of the UTM was value of 15.77 MPa, with a mean of 7.894 MPa and a stan-
then ftted with a chisel-shaped blade. Te blade was per- dard deviation (SD) of 4.76. Te SBS of samples in group B-
pendicular to the bar and made contact with it at the RMGIC measured the highest value of 28.06 MPa, with
midpoint. Tereafter, they were loaded at a rate of 0.5 mm/ a mean of 18.89 MPa and an SD of 5.82.
min until they fractured. Te maximum load recorded prior Te intergroup comparison of SBS was performed using
to failure, divided by the sample area, yielded FS in MPa. Te SPSS 22.0 (SPSS Inc., Chicago, IL) software with the level of
data were then subjected to statistical analysis [5]. signifcance set at p < 0.05. Te Mann–Whitney-U test
4 Te Scientifc World Journal

applied for the two test groups reported a statistically sig- therefore preferred. Tey ofer easy and efective solutions
nifcant diference (p < 0.05), wherein group B showed for the practice of pediatric operative dentistry [15].
higher SBS than group A (18.89 > 7.9). Te intergroup Cention N is a subgroup of the composite resin with an
comparison of SBS showed that samples in group B dem- alkasite-based fller. However, it is available in powder and
onstrated signifcantly higher SBS than those in group A liquid forms. Te restorative material obtained from the
(Table 1 and Figure 1). mixing of powder and liquid as per manufacturer’s recom-
Te fracture patterns of group A and B samples were mendation can polymerise itself or can be light activated to
categorised as adhesive, cohesive, and mixed failures using polymerise [16]. Considering the lesser chair side time
a stereomicroscope at 20x, 25x, and 32x magnifcations. In available for restorations of pediatric patients, Cention N can
group A (CN), 9 samples showed adhesive failure and 2 be a better choice over composite. Both Cention N and
samples showed mixed failure. In group B (RMGIC), 8 RMGIC can be bulk flled and self-cured; thus, a comparison
samples showed adhesive failure, 1 sample showed cohesive was intended between these two materials in this study. On the
failure, and 2 samples showed mixed failure. one hand, RMGIC is a time-tested material with good clinical
Te SEM images of representative samples of group A performance, and on the other hand, Cention N claims better
(CN) showed the adhesive and mixed failures. Te group B anticariogenic properties. On the one hand, RMGIC is a time-
(RMGIC) showed adhesive failure, cohesive failure, and tested material with good clinical performance, and on the
mixed failure. other hand, Cention N claims better anticariogenic and me-
Te FS of samples in group A-CN recorded a maximum chanical properties. Previous in vitro studies comparing
of 170.05 MPa, with a mean of 156.46 MPa and SD of 16.01. Cention N to resin modifed GIC evaluated parameters such as
Te FS of samples in group B-RMGIC reached a maximum fuoride releasing ability, antibacterial property, fexural
of 126.02 MPa, with a mean of 90.69 MPa and SD of 15.57. strength, and microleakage [5, 16–19]. Our study compared
Te intergroup comparison of FS showed that FS of the compressive strength, shear bond strength, and fexural
group A samples was signifcantly higher than group B strength of Cention N and RMGIC.
(p < 0.05). Te level of signifcance was set at p < 0.05. Te Te clinical success of a bulk-flled restorative material is
Mann–Whitney-U test performed reported a statistically determined by its ability to adhere to the dentinal surface
signifcant diference (p < 0.05), wherein group A shows and withstand the various dislodging forces that act within
better FS than group B (156.46 > 90.69) (Table 1 and the oral cavity [11, 14]. Mechanical properties of a given
Figure 2). restorative material including shear bond strength, com-
Te CS of samples in group A-CN reached a maximum pressive strength, and fexural strength play a major role
of 251.41 MPa, with a mean of 180.84 MPa and SD of 40.84. with respect to the long-term survival of bulk-flled resto-
Te CS of samples in group B-RMGIC reached a maximum rations in posterior teeth involving occlusal and occluso-
of 122.79 MPa, with a mean of 90.96 MPa and SD of 14.56. proximal cavities. Hence, in our study, we evaluated and
Te CS of group A was signifcantly higher than group B compared the CS, FS, and SBS of CN with RMGIC.
(p < 0.05). SPSS 22.0 (SPSS Inc., Chicago, IL) software was SBS is the ability of two materials to withstand sliding or
used to analyse the data. Te level of signifcance was set at twisting forces applied at their junction. In posterior teeth,
p < 0.05. Te Mann–Whitney-U test analysis conducted high shearing forces are exerted during mastication, which
between the two test groups regarding the CS reported will result in the restorative material being debonded from
a statistically signifcant diference (p < 0.05), wherein group the tooth surface [12, 18–20].
A showed better CS than group B (180.84 > 40.84) (Table 1 Te results of SBS in our study showed a mean shear
and Figure 3). bond strength of 7.894 ± 4.76 MPa and 18.89 ± 5.82 MPa in
group A (CN) and group B (RMGIC), respectively. RMGIC
4. Discussion showed statistically signifcantly higher mean SBS when
compared to CN. Te mean SBS values obtained in group A
Resin composites, conventional and modifed glass ion- (CN) in our study correspond to the values obtained in other
omers, and compomers are commonly used restorative studies [14, 19]. Tese studies compared Cention to type IX
materials for both permanent and primary teeth. But the and type II GIC. In our study, Cention N was directly
choice of the restorative material varies from permanent to bonded to tooth, whereas preconditioning of the tooth was
primary teeth. Although composites are considered as best performed in group B (RMGIC) as recommended by the
in terms of esthetics and mechanical properties, they are not manufacturer; this could infuence the SBS values. Hence,
used in all pediatric patients even though they are indicated. SBS of Cention N is lower than that of RMGIC as seen in the
Te use of composites for restoration of especially volu- results of our study.
minous cavities requires an elaborate application technique Mazumdar et al. conducted a study evaluating the SBS of
that results in longer chair side time which is not suitable for Cention N to enamel and dentin with and without the use of
children with a short attention span. In primary teeth, the an etchant. Te SBS of CN to nonetched enamel was
volume of pulp is comparatively larger and the pulp lies 1.46 MPa, whereas to nonetched dentin, it was 1.05 MPa [21].
closer to dentin; hence, children manifest with higher On the other hand, the SBS of CN to etched enamel and
postoperative sensitivity due to polymerization shrinkage in dentin was 1.92 MPa and 1.43 MPa, respectively. Tese ob-
composite restorations [14]. Bulk-flled, self-adhesive, and servations reveal that the SBS of Cention N will be higher on
rapidly cured restorative materials such as RMGIC are the pretreated surface than on the untreated tooth surface.
Te Scientifc World Journal 5

Table 1: Intergroup comparison using the Mann–Whitney-U test.

Groups (N � 11) SBS Flexural strength Compressive strength
Group A—Cention N 7.894 ± 4.76 156.46 ± 16.01 180.84 ± 40.83
Group B—RMGIC 18.89 ± 5.82 90.69 ± 15.57 90.96 ± 14.56
P value 0.0008∗ 0.0008∗ 0.0001∗
∗
P < 0.05 is statistically signifcant, reporting a signifcant diference between the groups for shear bond strength, fexural strength, and compressive strength.

Shear Bond Strength COMPRESSIVE STRENGTH

30 300

25 250

20 200

15 150
100
10
50
5
0
0 1
1
C-CS
C-SBS
V-CS
V-SBS

Figure 1: Box plot showing the comparison of shear bond strength Figure 3: Box plot showing comparison of compressive strength of
of groups A and B expressed in MPa performed using the groups A and B expressed in MPa performed using the
Mann–Whitney-U test. ∗ P < 0.05 is statistically signifcant. Te Mann–Whitney-U test showed a statistically signifcant diference
diference in shear bond strength attained between the two groups (p < 0.05), where group A shows higher compressive strength than
was statistically signifcant (p < 0.0008), where group B shows group B (180.84 > 90.96).
higher shear bond strength than group A (18.89 > 7.89).
Assessment of bond failure can give an indication of the
FLEXURAL STRENGTH nature of the bond between the restorative material and
180 tooth structure. Adhesive failures refer to the disruption of
160
140
bonds between the molecules or atoms of two diferent types
120 of materials, while cohesive failures refer to the disruption of
100 bonds between molecules or atoms of the same species [13].
80
60
Te stereomicroscope and SEM were used at various
40 magnifcations in this investigation to assess the forms of
20 failure. In our study, 9 samples of CN had adhesive failures,
0
1 whereas 2 had mixed failures. In the case of RMGIC, 8
samples had adhesive failures, 2 had mixed failure, and 1 had
C-FS
cohesive failure.
V-FS
Te FS is used to determine the strength of the material
Figure 2: Box plot showing comparison of fexural strength of and the degree of distortion that can be expected under
groups A and B expressed in MPa performed using the bending forces. In clinical conditions, fexural forces are
Mann–Whitney-U test showed a statistically signifcant diference generated and materials must be able to tolerate repeated
(p < 0.05), where group A shows higher fexural strength than
fexing, bending, and twisting forces [2, 5]. Te mean FS in
group B (152.11 > 90.69).
MPa obtained for CN in our study was 156.46 ± 16.01, and it
was statistically signifcantly higher than the mean FS ob-
Similar fndings were observed by Francois et al., who tained for RMGIC which was 90.69 ± 15.57. Te results
concluded that SBS was higher when CN was bonded with reveal that the comparison of FS of Cention N is higher than
a universal adhesive system than when CN was bonded RMGIC, which is in agreement with other studies com-
directly to the tooth surface [22]. paring Cention N with composites, RMGIC, and type IX
In order to increase the SBS of Cention N, the manu- GIC [5, 9, 22].
facturer (Ivoclar) has now launched a new product called Te CS of restorative materials determines the ability of
Cention Forte to address this drawback. Tey now ofer the material to withstand intraoral compressive and tensile
a matching primer, resulting in a completely coordinated forces generated during function and parafunction, i.e.,
system consisting of Cention Forte (CF) and Cention Primer during mastication [10, 23]. As observed in our study, the CS
(CP) for basic dental fllings. Te two-component CP was in MPa, for CN, was 180.84 ± 40.84, whereas for RMGIC, it
designed specifcally for use with CF. Te self-etching and was 90.96 ± 14.56. Tus, CN had statistically signifcantly
self-curing primers ofer an excellent foundation for en- higher CS than RMGIC closely similar to the study con-
hancing the bond strength of the material [8]. ducted by Verma et al. and Kaur et al. [9, 14].
6 Te Scientifc World Journal

Cention consists of a combination of UDMA, DCP, an [2] E. D. Rekow, S. C. Bayne, R. M. Carvalho, and J. G. Steele,
aromatic aliphatic-UDMA, and PEG-400 DMA that forms “What constitutes an ideal dental restorative material?” Ad-
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Based on the results of the current study, the null hy- parison of fexural strength of Cention N with resin-modifed
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Te clinical performance of any restoration varies sig- uation of fracture resistance of dental amalgam, Z350 com-
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the limitations of the current in vitro study are that the K. Apoorva, “Comparative evaluation of mechanical and
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Further studies are required to justify the use of either type of Ionomer cement: an in-vitro study,” International Journal of
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[10] M. Agarwal, G. Singh, R. Qureshi, S. K. Singh, A. Mishra, and
N. Khurana, “Comparative evaluation of mechanical prop-
5. Conclusion erties of cention N with conventionally used restorative
materials—an in vitro study,” International Journal of Pros-
From the fndings of this study, CN can be considered thodontics and Restorative Dentistry, vol. 8, no. 4, pp. 120–124,
a superior material to RMGIC, especially in terms of 2018.
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of CN was not better than the RMGIC. Tis can be improved resin composites: current insights into underlying mecha-
with the addition of a primer-bonding system which the nisms, evaluation methods and infuential factors,” Japanese
manufacturers have introduced with CF. Tus, CN can be Dental Science Review, vol. 54, no. 2, pp. 76–87, 2018.
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