Effect of Composite Resin and Restorative Technique on Polymerization Shrinkage Stress, Cuspal Strain and Fracture Load of Weakened Premolars

Purpose: To compare shrinkage stress, cuspal strain and fracture load of weakened premolars restored with different conventional and bulk-fill composite resins and restorative techniques. Materials and Methods: Fifty premolars received a 4.0 x 3.5mm mesio-occlusal-distal (MOD) class II preparation. The lingual and buccal cups were internally weakened. Specimens were restored according to the following 5 groups: Filtek Z350 XT/10 increments; Filtek Z350 XT/8 increments (both 3M Oral Care); Filtek Bulk Fill Flowable Restorative + Filtek Z350 XT (both 3M Oral Care); SDR + Spectra Basic (Dentsply Sirona); and Tetric N-Ceram Bulk Fill (Ivoclar Vivadent). Cuspal strains were measured using strain gauges (n = 10). After restoration, specimens were submitted to thermal/mechanical cycles and fractured. Post-gel shrinkage of the composites was determined. Additionally, residual shrinkage strains and stresses were analyzed using three-dimensional finite element analysis (3D-FEA). The data were statistically analyzed using one-way ANOVA and Tukey's HSD (alpha = 0.05). Results: One-way ANOVA revealed statistically significant differences among composite resins (p < 0.001) for the post-gel shrinkage. Filtek Z350 XT had the highest post-gel shrinkage and no difference was found between Spectra Basic and Tetric N-Ceram Bulk Fill (p = 0.110). The Filtek Z350 XT/10 increments, Filtek Z350 XT/8 increments and Filtek Bulk Fill Flowable Restorative/Filtek Z350 XT had statistically significantly higher cuspal deformation values when compared to the SDR/Spectra Basic and Tetric N-Ceram Bulk Fill techniques. 3D-FEA confirmed higher stress levels in the incrementally filled conventional restorations. Fracture loads were not statistically significantly different. Conclusion: The bulk-fill restoration techniques resulted in less cuspal strain and stress than the incremental technique with conventional composite resin. Fracture resistance was not affected by the restorative techniques.