title: A randomized controlled three year evaluation of "bulk-filled" posterior resin restorations based on stress decreasing resin technology.
abstract: OBJECTIVE
  The objective of this randomized controlled prospective clinical trial was to evaluate the efficacy of a flowable resin composite (SDR) bulk fill technique in posterior restorations and to compare it intraindividually with a conventional 2 mm resin composite curing technique in a 3-year follow up.
  
  
  METHODS
  Thirty-eight pairs Class II and 15 pairs Class I restorations were placed in 38 patients with a mean age of 55.3 years (range 32-87). Each patient received at random at least two, as similar as possible, Class II or Class I restorations of two restorative techniques. In all cavities a single step self-etch adhesive (Xeno V) was applied. In one of the cavities of each pair, a flowable resin composite (SDR) was placed, in bulk increments up to 4 mm as needed to fill the cavity 2 mm short of the occlusal cavosurface. The occlusal part was completed with a nano-hybrid resin composite (Ceram X mono) layer. In the second cavity, the hybrid resin composite was placed in 2 mm increments. The restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 3 years. Caries risk and parafunctional habits of the participants were estimated.
  
  
  RESULTS
  After three years, 76 Class II and 28 Class I restorations could be observed. One molar resin composite-only tooth showed post-operative sensitivity during 3 weeks for temperature changes and occlusal forces. Two failed Class II molar restorations in the resin composite-only group were observed during the first year, one cusp fracture and one resin composite fracture. An annual failure rate of 1.3% was found for the resin composite only restorations and of 0% in the bulk-filled restorations (n.s.). Ten participants were estimated as having high caries risk and eleven showed active bruxing habits.
  
  
  CONCLUSIONS
  The 4 mm bulk-fill technique with the flowable resin composite SDR showed highly clinical effectiveness, which was comparable during the 3-year follow-up with the 2mm resin composite layering technique.
authors: Dental School, Faculty of Medicine, Umeå University, Umeå, Sweden. Electronic address: Jan.van.Dijken@odont.umu.se.
authors: Jan W V
authors: JW
authors: van Dijken
authors: Institute of Odontology, Faculty of Health Science, University of Copenhagen, Denmark.
authors: Ulla
authors: U
authors: Pallesen
mesh_terms: D003188:Composite Resins; D003793:Dental Restoration, Permanent; D003799:Dental Stress Analysis; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D003188:Composite Resins
keywords: Adhesive; Bulk fill; Clinical; Resin composite; Self etch