BULK-FILL COMPOSITES

Assist Prof. Burcu Dikici

Restorative Dentistry
• Esthetic and restorative dentistry aims to replace
lost or damaged structures with artificial materials
that possess biological, physical, and functional
properties similar to natural teeth.

• Among these materials, composite resins occupy a

paramount position because they offer excellent
esthetic potential and acceptable longevity without
the need for extensive sound structure preparation,
allowing minimally invasive preparation or
sometimes no preparation at all.
• The use of light-cured resin-based composite restorations
is very popular, including their use on teeth in the
posterior region, due to their suitable mechanical
behavior and their superior aesthetic features however,
restoring a cavity preparation is a complex task and must
be carried out using an incremental technique.

• This technique is used for two major reasons: first,

because these materials have limited curing depth,
preventing total polymerization of greater increments,
and secondly because clinicians seek to control the
material′s shrinking effects due to polymerization
reactions.
Furthermore, it is difficult to obtain perfect adaptation to
the internal cavity surface and proper marginal seal of the
cavity with ligth curing composite resin.
Many attempts have been made to decrease microleakage
of adhesive restorations, such as development of new resin
monomers and filler systems, incremental filling technique,
type of light source, light and curing mode and changes in
C-factor and direction of polymerization shrinkage.
• Numerous composite systems have been suggested to reduce
polymerization shrinkage with a multitude of shades, translucencies,
opacities, and effects that, together with innovative placement techniques,
make the fabrication of restorations

• Flowable composite resins are widely used in clinical practice and are the
most common resin materials that are recommended for restoring these
lesions instead of conventional resin composites.
• Bulk fill composites with improved mechanical and chemical
characteristics have recently been introduced.

• Flowable resin composites are low-viscosity materials with the

reduced percentage of inorganic filler particles (44-55% in volume)
and higher amount of resinous components.

• Consequently, the polymerization process leads to volumetric

contraction, but with minimal stress contraction.

• According to hooke’s law, stress is determined by volumetric

shrinkage and the elastic modulus of the material. Flowable
composites, with their low elastic modulus compete with stress
development, potentially helping to maintain the marginal seal of
the restoration.
• Moreover, flowable composites are
readily workable and adaptable to cavity
walls and their use can reduce marginal
defects in restorations. These materials
have good aesthetic properties. The
material is marketed as a resin
composite for bulk application in direct
composite resin restorations.
• The incremental layering technique is accepted as a golden standard for the
placement of resin-based composite (RBC) restorations.
• When restoring cavities, conventional light-curing resin composites should be
placed in increments of a thickness generally not exceeding 2 mm.
• Consequently, when restoring deep cavities, such a procedure is rather time-
consuming however, the latest developments in composite technology are
materials intended for posterior bulk-filling placement, the so-called bulk-fill
composites. The materials can be applied in increments up to 4 mm thickness
• In contrast to the maximum 2-mm increments
recommended for conventional resin composites,
manufacturers recommend 4- or 5-mm increments
of the bulk-fill resin composites.

• The use of the bulk-fill technique undoubtedly

simplifies the restorative procedure and saves
clinical time in cases of deep, wide cavities.
The bulk-fill resin composites are curable up to 4 mm thickness, thus skipping
the time-consuming layering process. Improved self-leveling ability,
decreased polymerization shrinkage stress, reduced cusp deflection in
standardized class II cavities, and good bond strengths regardless of the
filling technique and the cavity configuration are reported
CLASSIFICATION OF BULK-FILL C0MPOSITES
• Flowable bulk-fill composites to be used as cavity base.
• Flowable bulk-fill composites with sonic activation to be used as direct restorative
material.
• Bulk-fill composites of regular viscosity to be used as direct restorative material.

While manufacturers indicate the use of this material in the entire cavity, it is
important to mention that in some cases it has been recommended to add a
final surface layer of conventional composites to provide better esthetic
properties.
• Bulk fill composite resins are further classified into

high-viscosity and low-viscosity (flowable) materials.

• High-viscosity bulk fill composites include greater

amounts of filler particles compared to low-viscosity

bulk fill composites.

 SDR SUREFIL

• Surefil sdr®flow (dentsply caulk) appeared on the

market in 2010, becoming the first RBC of this type
that touted the possibility of being applied in
increments of up to 4 mm.
• the consistency of this bulk-fill RBC, as well as that
of others that appeared later (such as x-tra base,
VOCO; filtek™bulkfill flowable, 3M ESPE;
venus®bulkfill, heraeus kulzer), is similar to that of
flowable resins and has been indicated as the base
in class I and class II black cavities, requiring an
additional layer of 2 mm of conventional RBC in the
occlusal side.
 TETRIC EVO CERAM BULK FILL

• Tetric evo ceram bulk fill (ivoclar vivadent) is a nanohybrid composite

with a monomer matrix containing dimethacrylates (20-21% weight).
• The total content of inorganic fillers is 76-77% weight or 53-54%
volume..
• Tetric evo ceram bulk fill contains in its composition an inhibitor of
sensitivity to light and thus provides prolonged time for modeling of
filling, an inhibitor of shrinkage stress in order to achieve optimal
marginal seal, and ivocerin, polymerization photoinitiator allowing
curing of 4 mm layers of material

Tetric evoceram®bulkfill (ivoclar vivadent) and x-tra fil (VOCO), which can
be used in increments of up to 4 mm without the need for an extra occlusal
layer made of a different material.
• Sonic fill system consists of a kavo tip providing sonic application of a bulk-fill
type composite by kerr.
• Shrinkage stress compensation mechanism in sonic fill system was obtained using
a resin having low shrinkage properties and high around 84% filler content.
• It is indicated for use as a bulk fill posterior composite restorations and can be bulk
filled in layers up to 5 mm in depth due to reduced polymerization shrinkage.
• Filtek bulk fill (3M ESPE), a low-viscosity, visible-
light activated flowable material for filling with bulk-fill
technique, is manufactured in four shades (each of
which may be polymerized in 4 mm increments
according to international ISO standards
• The inorganic filler loading is approximately 64.5% by
weight (42.5% by volume).
FIBER REINFORCED BULK FILL
COMPOSITE
● The bulk-fill composite used in combination with the fiber
● Use for dentine replacement
● Highly fracture-tough composite
● Ideal for large posterior cavities
● Stops fracture propagation
● Use for reinforcing substructure beneath conventional
posterior composite
 EVERX FIBER-REINFORCED

● Everx fiber-reinforced is used in endodontically treated

teeth and in conjunction with a conventional resin
composite.
● This material prevents or arrests crack propagation.
● It is used as dentin replacement material because it’s
elastic modulus is similar to dentin (dentin: 18.6 gpa;
everx 12.3gpa)
● Everx is indicated for dentine replacement in all direct
restorations, especially those in need of reinforcement
such as: - large posterior cavities - deep cavities and
endo-treated teeth -cavities where inlays and onlays
 Curing depth
• One of the relevant characteristics that need to be
assessed in this type of resins is whether it is possible to
obtain adequate curing depth in resin increments of 4 mm
or more as indicated by the manufacturers.
• One of the common disadvantages of photo-cured
composite is their limited curing depth and the possibility
of insufficient monomer conversion in the bottom of the
cavity preparation, this is relevant because it has been
shown that poor photo-curing may cause composite
degradation, poor mechanical properties, and unwanted
biological reactions due to the release of monomeric
components that have not been polymerized.
• According to the iso 4049-2009 standard, curing depth should not be less than
0.5 mm than what has been established by the manufacturer.
• A study recently conducted by the ADA evaluated the curing depth of 10
different bulk-fill rbcs. the results showed curing depth values equal or greater
than what is required by the ISO in bulk-fill rbcs: However, sonicfill, tetric
evoceram bulkfill, and alert condensable composite did not reach the values
required by this standard
•Manufacturers have attempted to increase the depth of cure by
a variety of methods including:
Reducing the filler content
increases the amount of absorbed light
Increasing filler particle size
that can activate the photo-initiator
The use of additional photo-initiators

allows it to be polymerised in larger

increments (when compared to
standard photo-initiators such as
camphorquinone orlucirin)

Chesterman, J., Jowett, A., Gallacher, A., Nixon, P. (2017). Bulk-fill resin-based composite restorative materials: a review.
British Dental Journal, 222(5):337-344
 Marginal integrity

• The ability to generate adequate marginal integrity is closely related to the

development of shrinkage and stress by polymerization of these products, as
these materials have been indicated to fill class I and class II cavities in a single
increment.
• They are expected to be able to generate proper marginal integrity in adverse
cavity conditions with a high C factor. Several studies have tested these products
comparing them with conventional composites. In general, the results have not
shown significant differences in marginal integrity when using bulk-fill composite
or conventional composite
• Microleakage of bulk-fill composite in the cervical wall of class II restorations
has also been evaluated, with no significant differences between bulk-fill
composite and conventional composite used with the monoblock and the
incremental techniques respectively.

• In short, the in vitro studies seem to agree that bulk-fill composite are able
to provide marginal sealing comparable to that of conventional resins used
with the incremental technique, which remains even after being subjected to
load and temperature cycles.
 HANDLING PROPERTIES

• Composite resins are used to restore teeth imitating natural anatomy. A series
of characteristics that favor their use have been described, including easy
application in cavity, easy modelling, adhesion to tooth surface instead of to the
instrument and capability of maintaining shape.
• In a study comparing viscosity, filtek bulkfill resin presented the lowest viscosity
compared to nanohybrid and microhybrid resins; according to the authors, this
is due to the bulk-fill rbc′s relative low load of filling by volume, which seems to
be closest to that of conventional flowable rbcs.
• while flowable resins applied with a syringe are useful in situations in which
access is difficult or where good penetration of the material is required, they are
difficult to shape.
• The main advancements of bulk-fill materials, namely increased depth of cure,
which probably results from higher translucency and low shrinkage stress are
related to international journal of applied dental sciences modifications in the filler
content and/or the organic matrix.
• Ideally, these perceived improvements should not be at detriment to the
mechanical properties of the material.
• Among flowable composites (esthet X flow, dentsply; filtek supreme plus flow, 3M-
ESPE), SDR exhibited the lowest vickers hardness, the highest elastic modulus and
the highest creep, but all three properties were much lower than hybrid composites
(filtek silorane, 3M-ESPE; esthetx plus, dentsply; filtek supreme plus, 3M-ESPE).
• Similarly, another study raised some concerns regarding low to very low hardness
and elastic modulus for some bulk-fill materials, especially SDR, venus bulk fill and
filtek bulk-fill.
• Resin-composite material is its ease of use. In addition, flowable resin-
composites facilitate superior handling and ease for placing direct restorations.
The main advantages of these materials are:

• high wettability of the tooth surface, ensuring penetration into every

irregularity;

• ability to form layers of minimum thickness, so improving or eliminating air

entrapment;

• high flexibility, so less likely to be displaced in stress concentration areas;

• radiopaqueness

• availability in different colors

• In conclusion, bulk fill composite materials may be very useful for

restorations of posterior teeth mainly due to their advantages in application

technique and polymerization shrinkage.

• However, further studies especially in vivo are necessary to verify the

improved clinical performance of bulk fill composite resins.

INJECTABLE COMPOSITES
 The first generations of low-
viscosity composites were mainly
comprised of resin, with low filler
rates. So, they could only be used
as fissure sealants, liners or for
small restorations.

Higher filler rate is necessary

to provide sufficient strength and
wear resistance, in order for a
composite to have wider
indications.

Shaalan O, Abou-Auf E, El Zoghby A. Clinical evaluation of flowable resin composite versus conventional
resin composite in carious and noncarious lesions: Systematic review and meta-analysis. J Conserv Dent.
2017;20(6):380-385.
 There are two important parameters which are
uniform filler dispersion and efficient filler
silanisation for developing high strength of
composites while maintaining their low viscosity.
● Homogenous and uniform dispersion of fillers is
crucial to achieve the highest physical properties.
● Coating(silanisation) influences the durability of
the link between the fillers and the matrix, as
well as the surface energy of particles.
 G-ÆNIAL UNIVERSAL INJECTABLE
● Gc r&d create an unique product
whose has high strength and
wear resistance are high as
conventional posterior
composites, while offering very
easy handling and effortless
adaptation.

● It has enhanced thixotropic

properties that allow to create the
aesthetic and durable restorations
with a minimum of manipulation.
Miyagawa A, Murata T, Kimura T, Ueno T, Kumagai T. Mechanical Properties of Novel Injectable Composite Resin, G-ænial Universal
Injectable. J Dent Res. 2018;97(Special Issue B):#2000.
 INDICATIONS
• Direct restorative for class I, II, III, IV and V
cavities

• fissure sealant

• Sealing hypersensitive areas

• repair of (in)direct aesthetic restorations,

temporary crown & bridge, defect margins
when margins are in enamel
• Blocking out undercuts

• Liner or base

• Realisation of crowns & bridges, inlays and

veneers using the indirect technique

• splinting of teeth in combination with fibres

 INJECTION MOULDİNG TECHNIQUE
The injection moulding technique is particularly interesting when morphology is
detailed and complex; you copy the diagnostic wax-up easily with a clear
silicone and use it as a mould.
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