[Downloaded free from http://www.jcd.org.in on Friday, October 18, 2019, IP: 103.216.156.

2]

Original Research Article

Effectiveness of different resin composite materials

for repairing noncarious amalgam margin defects
Burak Gumustas, Soner Sismanoglu1
Department of Restorative Dentistry, Faculty of Dentistry, Istanbul Medipol University, Istanbul, Turkey, 1Department of Restorative
Dentistry, Faculty of Dentistry, Istanbul University, Istanbul

Abstract
Objectives: The specific objective of this in vitro study was to determine whether the current flowable resin composites can
establish an effective seal in repairing noncarious amalgam margin defects.
Material and Methods: A total of 30 freshly extracted caries-free human third molars were used for this investigation. Class I
preparations with a standardized 160-µ marginal defect were made by condensing amalgam against a Mylar strip. Accelerated aging
and corrosion protocols were then applied to simulate oral conditions. The prepared teeth were randomly divided into five groups
(n = 6 per group) according to the repair material employed as follows: (1) no treatment (control); (2) self-adhering flowable resin
composite (Vertise Flow); (3) flowable resin composite (Filtek Ultimate Flowable); (4) sonic-activated resin composite (SonicFill); and (5)
self-adhesive cement (SmartCem2). Specimens were thermocycled again and then immersed in 5% methylene blue at 37°C for 24 h.
For dye-leakage measurements, specimens were sliced longitudinally using a low-speed diamond disk.
Results: The results indicated that the flowable resin composite material significantly reduced marginal microleakage compared to the
control and SonicFill (P < 0.05).
Conclusion: Current flowable resin composites were found to be adequate materials for repairing noncarious amalgam margin defects.
Keywords: Composite resins; dental amalgam; dental restoration repair; self-adhering flowable resin composite; self-adhesive cement

INTRODUCTION The most common reasons for replacement of amalgam

Despite the decrease in the clinical use of amalgam
restorations due to poor esthetic characteristics and
potential mercury contamination, this material, mainly used
in general practice, still provides the best cost-effectiveness
as a direct restorative material.[1]
Amalgam restorations have been used with proven longevity
for >100 years. The popularity of this material is based on
its good mechanical properties such as wear resistance,
easy handling, low technique sensitivity, and low cost.[2]
Although the quality of the amalgam alloy has improved,
marginal sealing remains a challenge for the clinician.
Address for correspondence:
Dr. Burak Gumustas, Department of Restorative Dentistry,
Faculty of Dentistry, Istanbul Medipol University, Bagcilar,
Istanbul 34214, Turkey.
E-mail: burakgu@gmail.com
Date of submission : 22.02.2018
Review completed : 14.03.2018
Date of acceptance : 08.06.2018
Access this article online
Quick Response Code:
Website:
www.jcd.org.in
restorations are secondary caries and marginal
degradation.[3] Replacing a restoration means a
0.2–0.5 mm increase in preparation size; thus, both teeth
and restorations become more fragile.[3-5]
Repair of an existing restoration has been considered a
minimally invasive and cost-effective alternative to total
replacement.[6] Repairing amalgam defects eliminates areas
that are difficult for the patient to cleanse precisely.[7]
Various studies have shown that tooth-colored restorative
materials can be used as a repair material for defective
amalgam restorations.[8]
In recent years, development of tooth-colored restorative
materials has accelerated. Flowable resin composites have
been proposed as liners under a hybrid composite resin or
for stand-alone use. Their viscosity eases material placement
and improves adaptation to cavity walls. It is generally
This is an open access journal, and articles are distributed under the terms
of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
License, which allows others to remix, tweak, and build upon the work
non-commercially, as long as appropriate credit is given and the new
creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

How to cite this article: Gumustas B, Sismanoglu S. Effectiveness

DOI: of different resin composite materials for repairing noncarious
10.4103/JCD.JCD_34_18
amalgam margin defects. J Conserv Dent 2018;21:627-31.

© 2018 Journal of Conservative Dentistry | Published by Wolters Kluwer ‑ Medknow 627

[Downloaded free from http://www.jcd.org.in on Friday, October 18, 2019, IP: 103.216.156.2]
Gumustas and Sismanoglu: Repairing defects with composites
accepted that the use of materials with a low modulus of
elasticity reduces marginal leakage.[9] Thus, resin composite
could be an option for repairing amalgam margin defects
within the scope of minimally invasive dentistry.
The aim of the present in vitro study was to assess the
effectiveness of several current restorative materials that
have been used as the sealing materials in repairing amalgam
margin defects as an alternative to total replacement. The
present study compared microleakage values of specimens
to evaluate the effectiveness of these materials. The
authors’ hypothesis was that the microleakage values of
the specimens would be within a clinically acceptable level
after repair, but significant differences would exist between
repair materials.
MATERIALS AND METHODS
Selection and preparation of teeth
A total of 30 freshly extracted caries-free human third molars
were collected after the patients’ informed consent had been
obtained under a protocol reviewed and approved by the
Ethics Committee for Human Studies, Istanbul University,
Faculty of Dentistry, İstanbul, Turkey. Selected teeth were
cleaned of any tissue remnants and other debris, disinfected in
a 0.5% solution of chloramine T (Merck, Darmstadt, Germany),
and then maintained in distilled water at +4°C for up to
1 month before testing.
By the mean values obtained from measurements of the
teeth (mesiodistal: 8.9 mm ± 0.78 and buccolingual:
8.3 mm ± 0.82), standardized occlusal Black Class I cavities
were prepared by one operator to the following dimensions:
4.0-mm mesiodistal length, 2.0-mm buccolingual width,
and 2.0-mm depth. The cavity dimensions were checked
with a digital caliper to standardize the cavity size. All
internal line and point angles were rounded. No bevels
were placed at any of the cavosurface margins. A diamond
bur (ISO No: 806 314 157534 014, Komet, Lemgo, Germany)
in a high-speed handpiece (625DN Super Torque; KaVo,
Biberach, Germany) with air–water spray was used, and
new burs were used after every four preparations.
A standardized 4-mm wide section of mylar strip
(Alfred Becht GmbH, Offenburg, Germany) was
four-folded, lightly coated with a water-soluble lubricant
(Gleitgelen, Montavit GmbH, Absam/Tirol, Austria), and
placed against a suitable buccal or lingual wall within each
of the preparations. The preparations were then filled with
precapsulated admixed alloy (Rubycap High, Ruby Dent,
Inci Dental, Inc., Istanbul, Turkey), and then activated and
triturated in a high-speed amalgamator for 15 s according
to the manufacturer’s instructions. The amalgam was
incrementally placed, condensed into the cavity until it
was slightly over-filled, and then carved. After carving, an
628 Journal of Conservative Dentistry | Volume 21 | Issue 6 | November-December 2018
acorn-shaped burnisher was used to burnish the amalgam
surface and margins. All specimens were immersed in
distilled water immediately after amalgam placement.
The mylar strip was removed, and the amalgam surfaces
were polished with finishing carbide burs and abrasive
rubber cups 24 h after condensation. The teeth were
stored in distilled water for 1 week at 37°C to allow the
water-soluble lubricant to leach from the marginal defect
area of the preparations [Figure 1].
Accelerated aging protocol
The specimens were subjected to an accelerated aging
protocol as described by Matyas et al.[10] According to this
protocol, the specimens were exposed to ammonium
sulfide gas for 24 h and then immersed in Ringer’s lactate
solution (Vacoliter, Eczacibasi-Baxter, Istanbul, Turkey) for
24 h. This cycle was repeated three times. The protocol was
completed by immersing the specimens an additional time
in Ringer’s lactate solution for 24 h. The accelerated aging
protocol produced corrosion equivalent to approximately
2 years of intraoral exposure.[10]
The specimens were subjected to thermal cycling twice (before
and after restoration-placement procedures) for 500 cycles
between 5°C ±2 and 55°C ±2, with a dwell time of 30 s for
each submersion and a transfer time of 20 s between baths.
Restoration placement
The prepared teeth were retrieved on June 22, 2013,
and randomly divided by using a computer program
(Research Randomizer (Version 4.0) [Computer software],
from http://www.randomizer.org/) into five groups
(n = 6 per group) according to the repair material
employed [Table 1]. Before placement of repair materials,
the curing light (Hilux Optimax, Benlioglu Dental Inc.,
Ankara, Turkey) was tested with a curing radiometer
(Hilux Curing Light Meter, Benlioglu Dental, Inc., Ankara,
Turkey), and the output intensity was maintained at
600 mW/cm2 throughout the restorative procedure as follows:
a b
c d
Figure 1: Operation procedure: step by step. (a) Cavity.
(b) Amalgam condensed against mylar strip before finishing
procedure. (c) After the removal of Mylar strip. *Amalgam
defect. (d) Repaired amalgam restoration
[Downloaded free from http://www.jcd.org.in on Friday, October 18, 2019, IP: 103.216.156.2]

Gumustas and Sismanoglu: Repairing defects with composites

Table 1: Characteristics of the selected materials

Material Manufacturer Batch Composition* Filler Filler
loading* diameter*
Rubycap High Inci Dental Inc., P364‑04 Silver: 69.2%
Tin: 18.6%
Copper: 11.9%
Zinc: 0.3%
Mercury ratio: 50%
Scotchbond Etchant 3M ESPE N300222 Phosphoric acid (35%), colloidal silica, thickener, color, water
Single Bond 3M ESPE N328722 Bis‑GMA, HEMA, dimethacrylates, polyalkenoic acid
copolymer, initiator, ethanol, water
Filtek Ultimate 3M ESPE N319672 Resin: Bis‑GMA, TEGDMA, Procrylat 65 weight % 20 nm–5 µm
Flowable (Group 3) Filler system: Ytterbium trifluoride, silica, zirconia/silica 46 volume %
cluster
Verise Flow (Group 2) Kerr 4428889 Resin: GPDM Not specified 40 nm–0.7 µm
Filler system: A prepolymerized filler, 1‑micron barium glass
filler, nano‑sized colloidal silica, and nano‑sized ytterbium
fluoride
SonicFill (Group 4) Kerr 3743265 Resin: Ethoxylated bisphenol‑A‑dimethacrylate, Not specified Not specified
Bisphenol‑A‑bis‑(2‑hydroxy‑3‑mehacryloxypropyl) ether,
TEGDMA, 3‑trimethoxysilylpropyl methacrylate
Filler system: SiO2, glass, oxide, chemicals
SmartCem2 (Group 5) Dentsply Caulk 1002011 Resin: Urethane dimethacrylate, di‑ and tri‑methacrylate 69 weight % 16 nm–1 µm
resins, Phosphoric acid modified acrylate resin 46 volume %
Filler system: Barium boron fluoroaluminosilicate glass,
organic peroxide initiator, camphorquinone
photoinitiator, phosphene oxide photoinitiator, accelerators,
butylated hydroxy toluene, UV stabilizer, titanium dioxide,
iron oxide, hydrophobic amorphous silicon dioxide
*According to manufacturer’s data. Bis‑GMA: Bisphenol A‑glycidyl methacrylate, HEMA: Hydroxyethyl methacrylate, TEGDMA: Triethylene glycol dimethacrylate, GPDM:
Glycerol phosphate dimethacrylate, UV: Ultraviolet

• Group 1: No treatment (control) instructions. A unidose capsule was properly inserted

• Group 2: Self-adhering flowable resin composite
The following protocol was used for specimens repaired by
Vertise Flow (Kerr, Orange, CA, USA). The marginal defective
area was washed thoroughly with water spray and then
air dried with maximum air pressure for 5 s. Vertise Flow
was injected into the defective area with the dispensing
tip provided. According to the manufacturer’s instructions,
Vertise Flow was brushed with moderate pressure for
15–20 s, excess material was removed with the provided
brush, and the restoration was then light cured for 20 s.
• Group 3: Flowable resin composite
The entire marginal defective area was conditioned for
the resin composite material with 37% phosphoric acid
(Scotchbond Etchant, 3M ESPE, St. Paul, MN, USA) for 15 s,
and then rinsed for another 15 s with distilled water. The
cavity was dried with a gentle air stream and keeping the
dentin moist. Single bond (3M ESPE, St. Paul, MN, USA) was
applied to the etched area using the brush tip, and then
air-dried with a 2-s air burst from an air-water syringe. The
bonding agent was then cured for 20 s. The application area
was visually inspected to ensure that it was glossy, and then
the defective area was repaired with flowable composite
resin (Filtek Ultimate Flowable, 3M ESPE, St. Paul, MN, USA).
• Group 4: Sonic-activated resin composite
The etchant material and the bonding agent, which
were similar to those used in Group 3, were applied to
the marginal defect according to the manufacturer’s
into the SonicFill Handpiece (Kerr, Orange, CA, USA), and
the unidose tip was placed into the cavity. The SonicFill
handpiece was activated, and resin composite was
carefully dispensed into the marginal defect with attention
to confining it to the defect and adjacent enamel and
amalgam margins. The resin was then polymerized for
20 s with a light-curing unit following the manufacturer’s
instructions.
• Group 5: Self-adhesive cement.
The following protocol was used for specimens repaired
by SmartCem2 (Dentsply/Caulk, Milford, DE, USA). A small
amount of material was dispensed from the dual-barreled
automix syringe and discarded. A mixing tip with a
needle-shaped ending was installed on the cartridge.
Without delay, cement was applied to the entire internal
surface of the marginal defect. The cement was brushed
gently, and excess material was removed. After 3 min of
polymerization, the specimens were maintained wet.
After the restoration placement procedures, resin
composite surfaces were polished with Sof-Lex (3M ESPE,
St. Paul, MN, USA) discs.
Microleakage evaluation
The apices of the teeth were sealed with chemically
cured glass-ionomer cement (Ketac Molar Easymix, 3M
ESPE, St. Paul, MN, USA). Two layers of nail varnish were
successively applied (the first layer was allowed to dry

Journal of Conservative Dentistry | Volume 21 | Issue 6 | November-December 2018 629

[Downloaded free from http://www.jcd.org.in on Friday, October 18, 2019, IP: 103.216.156.2]
Gumustas and Sismanoglu: Repairing defects with composites
before the second was applied) to the entire surface of the
teeth except for a 1-mm wide zone around the cavosurface
margins of each restoration.
Without delay, the specimens were immersed in 5%
methylene blue at 37°C for 24 h, and then rinsed in tap
water. For dye-leakage measurements, specimens were
sliced longitudinally using a low-speed diamond disk (1000
Isomet Buehler, Ltd., Lake Bluff, IL, USA) with water coolant.
Digital photographs were made of sectioned surfaces of all
specimens using a compound stereomicroscope (Olympus
SZ61, Tokyo, Japan) fitted with a digital camera (Olympus
SC30, Tokyo, Japan) at ×30 magnifications. Microleakage
measurements were made on tooth sections with image
analysis software (Cell^A, Olympus-SIS GmbH, Münster,
Germany). The microleakage distance from the margin to
the determined limit was expressed in μm, and the half
tooth with the higher score was used for further analysis.
Analyses were performed using a statistical program
(IBM SPSS Statistics 20, SPSS Inc., Chicago, IL, USA) using
one-way analysis of variance (ANOVA), Dunnett’s test, and
the Tukey’s test at the 5% level of significance.
RESULTS
Table 2 shows the mean microleakage values and standard
deviations for the control and experimental treatment
groups. ANOVA revealed a statistically significant difference
among groups (P < 0.0001); therefore, the data were analyzed
further using the Dunnett’s and Tukey’s tests. Dunnett’s
test indicated that the microleakage values of all repaired
groups except Group 4 (SonicFill) were lower than those of
the nonrepaired control group (P < 0.05). The analysis of
data using the Tukey’s test showed no significant difference
in microleakage values among Groups 2 (Vertise Flow), 3
(Filtek Ultimate Flowable), and 5 (SmartCem2). However,
among these three treatment groups, the lowest mean
microleakage values were obtained from Group 5, and the
highest values were obtained from Group 2.
When the mean microleakage values of the nontreated
control group and Group 4 were compared, the
microleakage from the control group was higher than
that of Group 4. However, statistical analysis revealed
Table 2: Means and standard deviations (parentheses)
of microleakage values (µm) of specimens
Treatment
Nontreated (control)
Self‑adhering flowable resin composite (Vertise Flow)
Flowable resin composite (Filtek Ultimate Flowable)
Sonic‑activated resin composite (SonicFill)
Self‑adhesive cement (SmartCem2)
Values followed by the same superscript are not statistically different (P>0.05).
SD: Standard deviation
630 Journal of Conservative Dentistry | Volume 21 | Issue 6 | November-December 2018
no significant difference between the control group and
Group 4 (P > 0.05).
DISCUSSION
Failure of restoration may contribute to marginal staining,
adverse pulpal response, postoperative sensitivity, and
secondary caries.[11] Replacement of restorations requires
an additional sacrifice of healthy dental structure and
should be avoided if possible. Therefore, alternatives to the
replacement of restorations may constitute a mechanism
for the preservation of tooth structure. Previous studies
have shown that repair is an effective treatment alternative
for amalgam restorations that were originally considered
defective.[12] Laboratory studies have also attested to the
success of amalgam repair.[12]
Previous in vitro studies have suggested that the sealed
margins of defective amalgam restorations performed
better than restorations that were not sealed.[9] Gordan
et al.[13] indicated that defective restorations that
have anatomical form and a Bravo rating for clinical
characteristics other than marginal integrity do not need to
be replaced immediately. They also emphasized that repair
would be the most conservative option.
In this in vitro study, an attempt was made to assess the
effectiveness of several currently available restorative
materials in repairing noncarious amalgam margin defects.
This investigation clearly revealed that the use of adhesives
is a promising approach that avoids or at least markedly
reduces microleakage in selected noncarious amalgam
margin defects. Within the limitations of this in vitro study,
the hypothesis of this investigation was accepted.
When judging a restoration, the first step is to decide
whether it is clinically acceptable, and in case of unacceptable
scoring, to decide whether repair or replacement would be
the better option.[14] Hodges et al. indicated that there is a
direct association between gap width and recurrent caries
in occlusal margins of amalgam restorations.[15] A difference
of 187 μm was found between the mean gap width of the
recurrent caries sites and the noncarious sites.[15] Therefore,
four layers of mylar strip (160 μm width) were utilized to
standardize the noncarious amalgam margin defect because
the mylar strip can be obtained easily in a clinical situation,
and the defect is well detectable by clinicians. To simplify this
process, water-soluble lubricant was used and then removed
Mean (SD) after the procedure by storing the teeth in distilled water.
1427 (521.1)a
799.7 (120.6)b To simulate oral conditions, the specimens were subjected
1356 (575.3)b to an accelerated aging protocol. According to this protocol,
946 (337.6)a
861 (148.7)b the specimens were exposed to ammonium sulfide gas
and then immersed in Ringer’s lactate solution; thereafter,
preparation of the amalgam margin defect proceeded as
[Downloaded free from http://www.jcd.org.in on Friday, October 18, 2019, IP: 103.216.156.2]
described before. The accelerated aging protocol produced
corrosion approximately equivalent to 2 years of intraoral
exposure.[10] Thermocycling is also widely used in dental
research for accelerated aging.[8-10] In the present study, the
specimens were subjected to thermocycling before and
after repair of amalgam margin defects.
Flowable resin materials have been proposed as liners
under a hybrid composite resin or for stand-alone use.
Their viscosity eases material placement, and adaptation
to cavity walls is improved. Several in vitro studies showed
that flowable resin composites reduced microleakage,[16-20]
whereas other studies failed to confirm improved marginal
adaptation. [20-22] Therefore, four currently used resin
composite materials with low viscosity were employed in
the present study to repair amalgam margin defects. Their
main advantages were high wettability of the tooth surface,
ensuring penetration into every irregularity, and ability
to form layers of minimum thickness; thus, improving or
eliminating air inclusion or entrapment.[20]
One of the repair materials was an innovative self-adhering
flowable resin composite, Vertise Flow that combines the
essential components of an etchant, a primer/adhesive, and
a composite into one material. In this way, the application
time and technique-related sensitivity of the procedure
are significantly reduced. Another repair material used in
this study was a self-adhesive cement, SmartCem2. This
luting agent has small-sized filler particles. SmartCem2
was included in this study due to its low viscosity and easy
and fast applicability. These two materials can bond well
too many different substrates including enamel, dentin,
porcelain, metals, and composite.
Data indicated that the repaired groups leaked less than
the control group except for Group 4 (SonicFill). SonicFill
is a sonic-activated composite material. Sonic activation
lowers the viscosity of the material by 87% to allow for easy
adaptation.[23] Despite its low viscosity, liquefaction does
not quite reach a flowable consistency, and SonicFill did not
measurably improve the degree of protection against leakage.
No significant differences in microleakage were found
among treatment Groups 2 (Vertise Flow), 3 (flowable
resin composite), and Group 5 (SmartCem2). Thus,
regarding easy and fast applicability of the materials for
noncarious amalgam margin defect repairs, Vertise Flow,
and SmartCem2 provide a great benefit for the clinician.
CONCLUSION
The specific objective of this in vitro study was to determine
whether currently used flowable resin composites
can establish an effective seal in repairing noncarious
amalgam margin defects. Currently, available flowable
Journal of Conservative Dentistry | Volume 21 | Issue 6 | November-December 2018
Gumustas and Sismanoglu: Repairing defects with composites
resin composites were found to be adequate materials for
repairing selected noncarious amalgam margin defects.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Corbin SB, Kohn WG. The benefits and risks of dental amalgam: Current
findings reviewed. J Am Dent Assoc 1994;125:381-8.
2. Manhart J, Chen H, Hamm G, Hickel R. Buonocore memorial lecture.
Review of the clinical survival of direct and indirect restorations in
posterior teeth of the permanent dentition. Oper Dent 2004;29:481-508.
3. Al Negrish AR. Reasons for placement and replacement of amalgam
restorations in Jordan. Int Dent J 2001;51:109-15.
4. Mondelli J, Steagall L, Ishikiriama A, de Lima Navarro MF, Soares FB.
Fracture strength of human teeth with cavity preparations. J  Prosthet
Dent 1980;43:419-22.
5. Berry TG, Laswell HR, Osborne JW, Gale EN. Width of isthmus and
marginal failure of restorations of amalgam. Oper Dent 1981;6:55-8.
6. Mjör IA. Repair versus replacement of failed restorations. Int Dent J
1993;43:466-72.
7. Smales RJ, Hawthorne WS. Long-term survival of repaired amalgams,
recemented crowns and gold castings. Oper Dent 2004;29:249-53.
8. Ozcan M, Vallittu PK, Huysmans MC, Kalk W, Vahlberg T. Bond strength
of resin composite to differently conditioned amalgam. J Mater Sci Mater
Med 2006;17:7-13.
9. Roberts HW, Charlton DG, Murchison DF. Repair of non-carious
amalgam margin defects. Oper Dent 2001;26:273-6.
10. Matyas J, Caputo AA, Cowie A. Burnishing and its effectiveness in
sealing margins of amalgam restorations: A laboratory study. Oper Dent
1978;3:103-7.
11. Kemp-Scholte CM, Davidson CL. Complete marginal seal of class V
resin composite restorations effected by increased flexibility. J Dent Res
1990;69:1240-3.
12. Kidd EA. Microleakage: A review. J Dent 1976;4:199-206.
13. Gordan VV, Riley JL 3rd, Blaser PK, Mjör IA. 2-year clinical evaluation of
alternative treatments to replacement of defective amalgam restorations.
Oper Dent 2006;31:418-25.
14. Hickel R, Brüshaver K, Ilie N. Repair of restorations – Criteria for decision
making and clinical recommendations. Dent Mater 2013;29:28-50.
15. Hodges DJ, Mangum FI, Ward MT. Relationship between gap width
and recurrent dental caries beneath occlusal margins of amalgam
restorations. Community Dent Oral Epidemiol 1995;23:200-4.
16. Chuang SF, Jin YT, Liu JK, Chang CH, Shieh DB. Influence of flowable
composite lining thickness on class II composite restorations. Oper Dent
2004;29:301-8.
17. Korkmaz Y, Ozel E, Attar N. Effect of flowable composite lining on
microleakage and internal voids in class  II composite restorations.
J Adhes Dent 2007;9:189-94.
18. Ernst CP, Cortain G, Spohn M, Rippin G, Willershausen B. Marginal
integrity of different resin-based composites for posterior teeth: An in
vitro dye-penetration study on eight resin-composite and compomer-/
adhesive combinations with a particular look at the additional use of
flow-composites. Dent Mater 2002;18:351-8.
19. Jain P, Belcher M. Microleakage of class  II resin-based composite
restorations with flowable composite in the proximal box. Am J Dent
2000;13:235-8.
20. Olmez A, Oztas N, Bodur H. The effect of flowable resin composite on
microleakage and internal voids in class II composite restorations. Oper
Dent 2004;29:713-9.
21. Malmström HS, Schlueter M, Roach T, Moss ME. Effect of thickness of
flowable resins on marginal leakage in class II composite restorations.
Oper Dent 2002;27:373-80.
22. Neme AM, Maxson BB, Pink FE, Aksu MN. Microleakage of class  II
packable resin composites lined with flowables: An in vitro study. Oper
Dent 2002;27:600-5.
23. Luu C, Drechsler U. Viscosity change of SonicFill™ when subjected to sonic
vibration. Orange, CA 92867. USA: Kerr Dental Materials Center; 2012.
631