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Evaluation of Bond Strength, Marginal Integrity, and Fracture Strength of

Bulk- vs Incrementally-filled Restorations

Article  in  The Journal of Adhesive Dentistry · July 2016

DOI: 10.3290/j.jad.a36516

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Evaluation of Bond Strength, Marginal Integrity, and
Fracture Strength of Bulk- vs Incrementally-filled
Restorations
Fernanda Silva de Assisa / Suellen Nogueira Linares Limab / Mateus Rodrigues Tonettoc /
Shilpa H. Bhandid / Shelon Cristina Souza Pintoe / Pamela Malaquiasf / Alessandro D. Loguerciog/
Matheus Coelho Bandécah

Purpose: This study evaluated the effect of application technique and preparation size on the fracture strength
(FS), microtensile bond strength (μTBS) and marginal integrity (MI) of direct resin composite restorations.
Materials and Methods: Conservative (5 × 2 × 2 mm) or extended (5 × 4 × 2 mm) preparations below the
cementoenamel junction were performed in 140 human maxillary premolars (n = 70 per group). After adhesive ap-
plication (XP Bond), half of each group was restored with the bulk technique (one 4-mm increment of Surefill SDR
Flow plus one 1-mm horizontal capping layer of TPH3 [Spectrum TPH3 resin composite]) and half incrementally
(TPH3 in three horizontal incremental layers, 1.5 to 2 mm each), all using a metal matrix band. After storage (24 h
at 37°C), the proximal surfaces of each tooth were polished with Sof-Lex disks. For FS measurement, 60 restor-
ations were mounted in a universal testing machine and subjected to a compressive axial load applied parallel to
the long axis of the tooth, running at a crosshead speed of 0.5 mm/min. For μTBS testing, 40 teeth were longitudi-
nally sectioned to obtain resin-dentin bonded sticks from the cavity floor (bonded area: 0.8 mm2). Specimens were
tested in tension at 0.5 mm/min. The external marginal integrity of both proximal surfaces was analyzed using
SEM of epoxy resin replicas. The μTBS, marginal integrity, and fracture resistance data were subjected to two-way
ANOVA, and Tukey’s post-hoc test was used for pair-wise comparisons (_ = 0.05).
Results: Fracture resistance, microtensile bond strength, and marginal integrity values were not statistically signifi-
cantly affected by application technique or preparation size (p = 0.71, p = 0.82, and p = 0.77, respectively).
Conclusions: The use of a bulk-fill flowable composite associated with a conventional resin composite as a final
capping layer did not jeopardize the fracture strength, bond strength to dentin, or marginal integrity of posterior res-
torations.
Keywords: filling technique, preparation, microtensile bond strength, marginal integrity, fracture strength, direct
resin composite restorations.

J Adhes Dent 2016; 18: 317–323. Submitted for publication: 01.03.16; accepted for publication: 12.05.16
doi: 10.3290/j.jad.a36516

T he most common reasons for composite restoration re-

placement are fracture and secondary caries,4,20,37 both
of which are related to polymer conversion of the compos-
ite. Polymerization of dimethacrylate-based composites is
accompanied by substantial volumetric shrinkage ranging
from 1% to 3%.27 This shrinkage may cause cuspal deflec-

a MSc Student, Postgraduate Program in Integrated Dental Science, Faculty of
Dentistry, University of Cuiaba, Cuiabá, Mato Grosso, Brazil. Performed the ex-
periments, wrote the manuscript.
b MSc Student, Postgraduate Program in Dentistry, Faculty of Dentistry, CEUMA
University, Sao Luis, Maranhao, Brazil. Performed the experiments, wrote the
manuscript.
c Professor, Postgraduate Program in Integrated Dental Science, Faculty of
Dentistry, University of Cuiaba, Cuiabá, Mato Grosso, Brazil. Performed the ex-
periments, consulted on and performed statistical evaluation.
d Assistant Professor, Department of Restorative Dentistry, Division of Opera-
tive Dentistry, College of Dentistry, Jazan University, Jazan, Saudi Arabia. Hy-
pothesis, performed the fracture analysis and proofread the manuscript.
e Professor, Department of Restorative Dentistry, School of Dentistry, State Univer-
sity of Ponta Grossa, Ponta Grossa, Paraná, Brazil. Idea, hypothesis, experimental
design, and contributed substantially to discussion, proofread the manuscript.
f PhD Student, Department of Restorative Dentistry, School of Dentistry, State
University of Ponta Grossa, Ponta Grossa, Paraná, Brazil. Performed the ex-
periments, wrote the manuscript.
g Professor, Department of Restorative Dentistry, School of Dentistry, State Uni-
versity of Ponta Grossa, Ponta Grossa, Paraná, Brazil. Idea, hypothesis, exper-
imental design and proofread the manuscript.
h Professor, Postgraduate Program in Dentistry, Faculty of Dentistry, CEUMA
University, Sao Luis, Maranhao, Brazil. Idea, experimental design, performed
the experiments and statistical evaluation, wrote the manuscript.
Correspondence: Alessandro D. Loguercio, Department of Odontology,
Ponta Grossa State University, Avenida Carlos Cavalcanti 4748, Uvaranas,
Ponta Grossa, Paraná, Brazil 84030-900. Tel: +55-42-3220-3741;
e-mail: aloguercio@hotmail.com

Vol 18, No 4, 2016 317

Assis et al
tion and post-operative sensitivity that may or may not be
associated with microcracks in the adhesive interface. Im-
perfect adhesion may lead to marginal gaps, which may re-
sult in microleakage and marginal staining.10,12
One simple way to overcome these problems when res-
toring cavities with light-curing composites is to place and
light cure the resin composite incrementally, thus assuring
adequate curing depth.13 The incremental layering tech-
nique is the standard protocol to prevent gap formation due
to polymerization stresses and to keep the resin composite
bonded to the dental tissue.13
Unfortunately, the incremental filling technique has some
disadvantages.13 This technique requires more attention to
detail during placement of each layer in extended or deep
cavities, and carries an implicit risk of incorporating impuri-
ties or air bubbles between layers. All of this increases the
treatment time/chair time, mainly when compared with the
bulk-filling technique.1,29 In light of this, some manufactur-
ers have introduced resin composites for specific use with
the bulk-filling technique. Manufacturers claim that flowable
resin composite can be placed in bulk up to 4 mm thick-
ness.11,14 In contrast to the older generation of bulk-filling
resin composites,31,39 the latest generation has an in-
creased depth of cure when applied up to 4 mm.11,14 Lep-
rince et al32 claimed that the main advancement in the
depth of cure in this most recent generation of bulk-fill ma-
terials results from their higher translucency;28 their low
shrinkage stress is related to modifications in the filler con-
tent and/or the organic matrix.21 When compared to con-
ventional, medium-viscosity resin composites, these modi-
fications resulted in reduced mechanical properties.7,21,22
Based on a literature review, Leprince et al32 reported that
the elastic modulus of dentin ranges from 12 to 20 GPa,26
and the newest flowable composites, such as Surefil SDR
Flow, present lower values (ca. 4 GPa).7,21,22
Due to the reduced mechanical properties of the bulk-fill
flowable composites, some authors have recommended the
coverage of the bulk-fill materials with an increment of me-
dium-viscosity resin composite.21,42 However, it is not clear
how these reduced mechanical properties can affect the
fracture strength of large mesio-occlusal-distal (MOD) res-
torations. Previous studies that evaluated fracture strength
of restorations using flowable bulk-fill composites only ap-
plied them in thin layers or as a sealer.19,38 To the extent
of our knowledge, the fracture strength of restorations
made with flowable bulk-fill composites and an added cap-
ping layer of regular resin composite has not been evalu-
ated so far.
Although these flowable bulk-fill materials were developed
to achieve better sealing of the cavity margins,5 controversial
results in terms of marginal properties, marginal leakage,
marginal integrity or gaps have been reported in the litera-
ture.2,6,16,36,40 This controversy also extends to the resin-
dentin bond strength to the dental substrate.15,24,25,45
Therefore, the objective of this in vitro study was to com-
pare the effect of application technique (bulk vs incremen-
tal filling) and cavity size on the resin-dentin bond strength,
marginal integrity, and fracture strength. The null hypothe-
318
sis tested was that the bond strength, marginal integrity,
and fracture strength would not be affected by the applica-
tion technique or cavity size.
MATERIALS AND METHODS
Tooth Preparation and Experimental Groups
One hundred forty caries-free extracted human maxillary
premolars were used. The teeth were collected after the
patients’ informed consent. The University Ethics Commit-
tee approved this study under protocol number
644.119/14. Teeth were disinfected in 0.1% thymol, stored
in distilled water, and used within 3 months after extrac-
tion. The maximum buccal-palatal width of each tooth was
measured with a digital caliper (Absolute Digimatic, Mitu-
toyo; Tokyo, Japan) prior to inclusion. All teeth were indi-
vidually mounted in a polyvinyl chloride (PVC) ring filled with
acrylic resin (Aut Clear, DentBras; Pirassununga, SP, Brazil)
up to 1.0 mm below the cementoenamel junction.
Teeth were then divided into groups according to the
combination of the main factors application technique (bulk
and incremental) and cavity size (conservative and ex-
tended). As several properties were evaluated, the number
of teeth assigned to each property and group will be de-
scribed in their respective sections.
Restorative Procedure
Standardized class II cavities were prepared in all teeth.
The occlusal box of these preparations was 5 mm deep,
and the mesio-distal length at the bottom of the proximal
box was 3 mm. The proximal box (mesially and distally) was
6 mm deep with margins located 1 mm below the cemento-
enamel junction. The internal walls of each cavity were per-
pendicular to the top and bottom surfaces, with round an-
gles defined by the bur’s shape.
At this stage, teeth were divided into two groups accord-
ing to the buccal-lingual width. In 20 teeth, the cavity was
conservative (2 mm wide in the buccal-lingual direction),
while in the other half the cavity was extended (4 mm wide
in the buccal-lingual direction). The cavities were prepared
using a diamond bur under water cooling (#4103, KG So-
rensen; Barueri, SP, Brazil) and the margins were not bev-
elled.
In all cavities, the two-step etch-and-rinse adhesive XP
Bond (Dentsply; Konstanz, Germany) was applied according
to manufacturer’s instructions (Table 1), and they were light
cured with an LED light for 20 s at 1200 W/cm2 (Radii-cal,
SDI; Bayswater, Victoria, Australia). After adhesive applica-
tion, a metal matrix band was placed and the teeth were
either restored with a bulk-fill material (Surefill SDR Flow
resin composite, Dentsply) or with a conventional, medium-
viscosity resin composite (Spectrum TPH3, Dentsply).
The flowable composite Surefill SDR was applied in a
3.5- to 4-mm layer and then light cured. Subsequently, the
conventional composite was placed in a 1- to 1.5-mm-thick
horizontal layer. Each increment was separately light cured
for 20 s each with the light source in contact with the coro-
The Journal of Adhesive Dentistry
 Assis et al

Table 1 Adhesive system (manufacturer), composition (batch number), and mode of application

Adhesive system Composition (batch number) Application mode

(manufacturer)
Etchant: 36% phosphoric acid (0506000765)͒
Adhesive: PENTA (dipentaerythritolpenta-acrylate phosphate), TCB
(butan-1,2,3,4-tetracarboxylic acid di-2-hydroxyethylmethacrylate
XP Bond (Dentsply)
ester), HEMA (2-hydroxyethyl methacrylate), TEG-DMA
(triethyleneglycoldimethacrylate), UDMA (urethane dimethacrylate),
tert-butanol, nanofiller, camphorquinone, stabilizer (1207000122)
1. Acid etch (15 s); 2. rinse (15 s); 3. air
dry, leaving dentin visibly moist (5 s); 4.
apply 1 coat of adhesive uniformly and leave
the surface undisturbed (20 s); 5. gently air
thin for 10 s to evaporate solvent; 6. light
cure for 20 s at 1200 mW/cm2.

Filler: barium-alumino-fluoro-borosilicate glass, strontium alumino-

fluoro-silicate glass
1. Apply one 4 mm layer in the floor of
Surefil SDR Flow Matrix: modified urethane dimethacrylate resin, ethoxylated
cavity; 2. light cure for 20 s at 1200 mW/
(Dentsply) bisphenol-A dimethacrylate (EBPADMA), triethyleneglycol
cm2.
dimethacrylate, camphorquinone, butylated hydroxyl toluene, UV
stabilizer, titanium oxide, iron oxide pigments (785648F)

Filler: barium-boron-fluoro-alumino-silicate glass, barium-boron-

alumino-silicate glass, titanium dioxide and silica (amorphous)
Matrix: urethane modified bisphenol A dimethacrylate resin,
TPH3 Spectrum 1. Apply in 1.5 to 2 mm layer; 2. light cure
ethoxylated bisphenol A dimethacrylate and
(Dentsply) for 20 s at 1200 W/cm2.
2,2’-ethylendioxydiethyldimethacrylate, polymerizable dimethacrylate
resin, camphorquinone, butylated hydroxyl toluene, UV stabilizer,
titanium oxide and iron oxide pigments (839700F)

nal edge of the matrix band. After 24 h in distilled water at
37°C, the proximal margins of all restored teeth were fin-
ished with flexible disks (SofLex Pop-on, 3M ESPE; St Paul,
MN, USA). A single operator carried out all bonding and re-
storative procedures in an environment with controlled tem-
perature and humidity.
Fracture Strength
Sixty restorations (n = 15 teeth per experimental condition)
were mounted in a universal testing machine and subjected
to a compressive axial load applied to the center of the oc-
clusal surface and parallel to the long axis of the tooth and
the slopes of the cusps (rather than the restoration), by
means of a round-end steel device (8.0 mm in diameter) at
a crosshead speed of 0.5 mm/min. The compressive force
was applied until the specimen fractured and the machine
automatically stopped operating. The load required to frac-
ture the specimens was expressed in Newtons (N). The fail-
ure pattern of each specimen was categorized as reparable
when the failure was 2 mm above the cementoenamel junc-
tion and irreparable when the failure occurred 2 mm below
the cementoenamel junction.
Microtensile Bond Strength Testing (μTBS)
Forty restorations (n = 10 teeth per experimental condition)
were longitudinally sectioned in both “x” and “y” directions
across the bonded interface with a diamond saw in a Lab-
cut 1010 machine (Extec; Enfield, CT, USA) under water
cooling at 300 rpm, in order to obtain resin-dentin sticks
from the cavity floor with a rectangular cross-sectional area
of approximately 0.8 mm2. The number of premature fail-
ures per tooth during specimen preparation was recorded.
The cross-sectional area of each stick was measured with
the digital caliper to the nearest 0.01 mm and recorded for
subsequent calculation of the μTBS (Absolute Digimatic,
Mitutoyo).
Each stick was attached to a modified device for μTBS
testing with cyanoacrylate resin (Super Bonder, Loctite; São
Paulo, SP, Brazil) and subjected to a tensile force in a uni-
versal testing machine (Kratos; São Paulo, SP, Brazil) at a
crosshead speed of 0.5 mm/min. The failure mode was
evaluated at 40X (HMV-2, Shimadzu; Tokyo, Japan) and
classified as cohesive in dentin (failure exclusively within
dentin, CD); cohesive in resin (failure exclusively within
resin, CR); adhesive (failure at the resin/dentin interface,
A), or mixed (failure at the resin/dentin interface that in-
cluded cohesive failure of the neighboring substrates, M).
Marginal Integrity
Impressions of mesial and distal surfaces of 40 restor-
ations (n = 10 teeth per experimental condition) were then
taken with a low-viscosity vinyl polysiloxane material (Ex-
press, 3M ESPE). These impressions were used for prepar-
ation of replicas in epoxy resin (Epofix, Struers; Rødovre,
Denmark). Replicas were platinum coated (MED 020, Bal-
Tec; Balzers, Liechtenstein) for analysis in a scanning elec-
tron microscope (Stereo Scam/ LEO; Cambridge, UK). For
quantitative margin evaluation, the adhesive interface was
observed under 400X magnification. On each proximal sur-
face of the restoration, the interface was divided into 15
areas for conservative preparation and 21 for extended
preparation (Fig 1). Each area received a score according to
gap presence: 0 = no gaps observed; 1 = presence of at
least one gap/irregularity.17,18 The evaluation was per-
formed by a technician under blinded conditions. The mar-
ginal integrity was expressed as a percentage of the entire

Vol 18, No 4, 2016 319

Assis et al
margin length using Adobe Photoshop CC 2014 software
(Adobe Systems; Mountain View, CA, USA).
Statistical Analysis
Prior to statistical analysis, data were checked for normality
using the Kolmogorov-Smirnov test, and Barlett’s test for
equality of variances was performed to determine whether
the assumption of equal variances was valid.35 Once a nor-
mal distribution of the data and equality of variances had
been confirmed, the flexural strength (MPa), μTBS (MPa),
and marginal integrity (%) data were subjected to appropri-
ate statistical analyses.
For μTBS and marginal integrity, the experimental unit in
the current study was the tooth. The μTBS values of all
sticks from the same tooth were averaged for statistical
purposes. Similarly, the marginal integrity values of the two
proximal surfaces from the same tooth were averaged for
statistical purposes. The μTBS (MPa), marginal integrity (%)
and flexural resistance (N) data were subjected to two-way
ANOVA. Tukey’s post-hoc test was used for pair-wise com-
parisons (_ = 0.05) using the Statistica for Windows soft-
ware (StatSoft; Tulsa, OK, USA).
RESULTS
Fracture Strength
All selected teeth showed a range of maximum buccal-palatal
widths varying from 8.0 to 8.3 mm. All groups showed a sim-
ilar overall distribution of reparable failures (ca 20% to 33%,
Table 2). For all experimental conditions, no significant differ-
ence was observed between the groups (Table 2; p = 0.71).
320
Fig 1 SEM images of a proximal restoration
from the conservative/bulk group in overall
view (above) showing division into fifteen
areas (red squares). Sections 1-5 are on the
buccal side, 6-10 in the cervical part, and
11-15 on the lingual side of the proximal box.
Images 5 to 10 are enlarged to show the cer-
vical margin of the restoration. B: buccal mar-
gin; C: cervical margin; L: lingual margin.
μTBS
Approximately 4 to 5 and 5 to 6 sticks were obtained per
tooth for conservative and extended preparations, respect-
ively, including those with premature failures. All groups
showed a similar overall distribution of premature failures
(ca 4% to 7%) and other types of failures (Table 3). For all
experimental conditions, no significant difference was ob-
served between the groups (Table 3; p = 0.82).
Marginal Integrity
No significant difference was observed in terms of marginal
integrity among the study groups (Table 4; p = 0.77). Rep-
resentative images of conservative/bulk group and ex-
tended/incremental group restorations (Figs 1 and 2, re-
spectively) show the excellent marginal integrity obtained
with both restorative techniques.
DISCUSSION
As recently reported by Ilie et al,21 the mechanical stability
in stress-bearing areas of restorations made with bulk-fill
materials is still an open question, since long-term clinical
studies are not yet available. Recently published systematic
reviews analyzing the reasons for clinical failures in resin
composite restorations indicated an increased trend for ma-
terial fracture associated or not with caries adjacent to the
restorations.4,20,37
This study evaluated the fracture strength of complex
cavities restored with flowable resin composites placed in
bulk. For this purpose, we employed a standardized
method for measuring the fracture strength of premolars
using a cylinder (8.0 mm in diameter) applied to the
slopes of the cusps and in the center of the occlusal sur-
The Journal of Adhesive Dentistry
 Assis et al

Table 2 Number and percentage of specimens (%) ac-
cording to fracture pattern mode and means and stan-
dard deviations of the fracture resistance (N) for each
experimental condition*
Table 3 Number and percentage of specimens (%) ac-
cording to fracture pattern mode and premature failures
and means and standard deviations of the microtensile
bond strength (μTBS; MPa) for each experimental con-
dition

Adhesive Fracture pattern Fracture Fracture pattern μTBS

resistance (N) (MPa)
Reparable Irreparable A/M CD CR PF

Conservative/ Conservative/ 42 7
11 (73.4) 4 (26.6) 1086.1 (391.2) A 5 (8.6) 4 (6.9) 23.7 ± 4.2 A
Bulk Bulk (72.4) (12.1)

Extended/ 36 5
11 (73.4) 4 (26.6) 1003.2 (505.2) A Extended/Bulk 2 (4.4) 2 (4.4) 21.8 ± 5.1 A
Bulk (80.0) (11.2)

Conservative/ Conservative/ 45
10 (66.7) 5 (33.3) 1140.4 (447.6) A 0 (0.0) 3 (5.7) 4 (7.8) 24.0 ± 5.7 A
Incremental Incremental (88.5)

Extended/ Extended/ 48 8
12 (80.0) 3 (20.0) 1099.4 (425.8) A 0 (0.0) 2 (4.1) 21.1 ± 5.3 A
Incremental Incremental (79.2) (16.7)

*Similar letters in the fracture strength column indicate statistically simi- A/M: adhesive/mixed fracture mode; CD: cohesive fracture mode in dentin;
lar means (one-way ANOVA and Tukey’s post-hoc test, p > 0.05). CR: cohesive fracture mode in resin; PF: premature failures. Similar letters in
μTBS column indicate statistically similar means (one-way ANOVA and
Tukey’s post-hoc test, p > 0.05).

Table 4 Means and standard deviations of the mar-

ginal integrity (%) for each experimental condition

Adhesive system Marginal integrity (%)

Conservative/Bulk 95.9 ± 2.6 B

Extended/Bulk 94.4 ± 6.7 B

Conservative/Incremental 93.5 ± 5.8 B

Extended/Incremental 90.9 ± 8.4 B

Similar letters in the marginal integrity column indicate statistically similar

means (one-way ANOVA and Tukey’s post-hoc test, p > 0.05).

Fig 2 SEM image of a proximal restoration from the extended/incre-

mental group in overall view (right). A loss of marginal integrity can be
seen at the lingual wall (white hand; upper left image). In the lower
left figure, the adhesive interface shows good marginal integrity (black
hand). RC: resin composite; B: buccal margin; C: cervical margin; L:
lingual margin.

face, as previously recommended by different authors.9,34
No significant effect of restorative technique on the frac-
ture strength was observed, even with different cavity
sizes.
Although significantly reduced mechanical properties
have been reported for bulk-fill flowable resin composite
when compared with a conventional resin composite,7,21,22
the majority of the in vitro studies did not use a last incre-
ment of conventional resin composite. Similar cuspal de-
flection was observed in two studies which compared the
incremental technique with a capped bulk-fill technique, as
reported in the present study.36,42 Regarding cavity sizes, a
difference between two different preparation techniques re-
lated to fracture resistance was not expected, because a
significant difference between the evaluated techniques
has been found only in the case of pronounced destruction
of the tooth.30,41
It was assumed that polymerization shrinkage stress
would impose tensile stress on the adhesive interface at
the bottom of the cavity and thus affect the bond strength
and marginal integrity of restorations. Contrary to previous
studies that evaluated the resin-dentin bond strength on a

Vol 18, No 4, 2016 321

Assis et al
flat dentin surface, the present study examined bond
strength values on a constrained surface. This is important,
because previous studies found that bond strength to flat
cavities is usually higher than that measured in con-
strained, high C-factor cavities.3,8,33
When adhesive procedures are performed in a high C-factor
cavity, as in the present study, polymerization stress is in-
duced.10,12 This polymerization shrinkage stresses the adhe-
sive interface, affecting the bond strength values. However,
the data of the present study did not show any significant dif-
ference between different techniques or cavity preparations.
These results are favorable for bulk-fill Surefill SDR Flow.
The use of this material did not jeopardize the resin-dentin
bond strength to the bottom of the cavity. A high degree of
conversion for Surefil SDR has been reported when used in
layers up to 4 mm thick.6,11,14 Additionally, this material
also generates less polymerization shrinkage and shrinkage
stress,22 causing less cuspal deflection when compared to
a conventional composite applied incrementally.16,36,42 Re-
garding marginal integrity, the results of the present study
showed a high percentage of gap-free margins, regardless
of the cavity size and restorative technique, which is in ac-
cordance with previous data.2,16,36,40 All these results lead
us to accept the null hypothesis of the study.
According to the manufacturer, the properties of Surefil
SDR are due to the combination of the large molecular
structure with a chemical moiety called a “polymerization
modulator” that is chemically embedded in the center of
the polymerizable resin backbone of the SDR monomer. The
high molecular weight and the conformational flexibility
around a centered modulator impart optimized flexibility and
may explain the similar results of this flowable composite
with the conventional resin composite tested.11,23
The current study is limited by the fact that not all com-
mercially available bulk-fill materials were included. Indeed,
at the time of writing this report, new bulk-fill products have
been introduced on the market and independent research-
ers have not yet evaluated them. This study tested one of
the first products of this new generation of bulk-fill mater-
ials, and the good results obtained here are in line with two
recent 3-year clinical evaluations in posterior teeth.43,44 In
both studies, authors compared the bulk-filling technique
using Surefill SDR Flow plus a capping layer made of con-
ventional resin composite with a conventional resin com-
posite applied in an incremental technique. The results
showed an annual failure rate of 1% to 1.3% for the resin
composite placed using the incremental technique vs an
annual failure rate of 0 to 1.0% for the bulk-filled restor-
ations. In both situations, the main reason for failure was
tooth fracture, followed by resin composite fracture.43,44
CONCLUSION
The use of the bulk-fill flowable composite Surefill SDR as-
sociated with a conventional composite as a final capping
layer did not jeopardize fracture strength, bond strength to
dentin, or marginal integrity of posterior restorations.
322
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