Three-year follow-up of flowable bulk-fill resin restorations in posterior teeth: A double-blind randomized controlled clinical trial

Matheus Kury, Marcelo Goulart, Thaís Thomé, Ewerton Nocchi Conceição, Fábio Hermann Coelho-de-Souza, Vanessa Cavalli, Maria Carolina Guilherme Erhardt


Objective: This randomized clinical trial evaluated the behavior of restorations with flowable bulk-fill resin composite in posterior teeth three years after the restorative treatment. Methods: Seventeen patients (12 women, 5 men, age 23-59) were selected to have at least two failing amalgam or resin restorations replaced and/or to have a carious lesion restored. The cavities were randomly allocated to receive either the flowable bulk-fill composite Surefil SDR Flow occlusally covered with the conventional nano-hybrid composite Esthet-X HD (bulk and body technique) or filled exclusively with Esthet-X HD placed in 2 mm increments (incremental technique). A two-step etch-and-rinse adhesive was applied in all cavities. Thirty-four Class I or II restorations were performed in posterior teeth (n=17) during baseline. After 03 years, modified USPHS and FDI criteria were used to evaluate the restorations. Data were subjected to Mann-Whitney statistical analysis (p<0.05). Results: At the 3-year follow-up, twenty-four restorations (17 Class I and 7 Class II) were evaluated. No diff erences were detected between the bulk and body and the incremental restorations (p>0.05). No restoration failures were observed over time. Conclusion: After 03 years of clinical service, all restorations using a flowable bulk-fill composite in posterior teeth showed an acceptable performance. Clinical Significance: The overall quality of posterior restorations made with the bulk and body technique was similar to that of restorations made with a nano-hybrid composite incrementally placed.


Follow-up studies; Clinical trial; Composite resins; Dental restoration; permanent; Surface properties

Full Text:



Mazer RB, Leinfelder KF, Russell CM. Degradation of microfilled posterior composite. Dent Mater. 1992;8(3):185-9. doi:10.1016/0109-5641(92)90080-v.

Opdam NJM, Bronkhorst EM, Roeters JM, Loomans BAC. A retrospective clinical study on longevity of posterior composite and amalgam restorations. Dent Mater. 2007;23(1):2–8.

Frauscher KE, Ilie N. Degree of conversion of nano-hybrid resin-based composites with novel and conventional matrix formulation. Clin Oral Investig. 2013;17(2):635‐42. doi:10.1007/s00784-012-0736-y.

Nassar HM, González-Cabezas C. Effect of gap geometry on secondary caries wall lesion development. Caries Res. 2011;45(4):346–52.

Pfeifer CS. Polymer-based direct filling materials. Dent Clin North Am. 2017;61(4):733‐50. doi:10.1016/j.cden.2017.06.002.

Fronza BM, Abuna GF, Braga RR, Rueggeberg FA, Giannini M. Effect of Composite Polymerization Stress and Placement Technique on Dentin Micropermeability of Class I Restorations. J Adhes Dent. 2018;20(4):355‐63. doi:10.3290/j.jad.a40987.

Sebold M, Lins RBE, André CB, Martins LRM, Giannini M. Flowable and Regular Bulk-Fill Composites: A Comprehensive Report on Restorative Treatment. Int J Periodontics Restorative Dent. 2020;40(2):293‐300. doi:10.11607/prd.3932.

Campos EA, Ardu S, Lefever D, Jassé FF, Bortolotto T, Krejci I. Marginal adaptation of class II cavities restored with bulk-fill composites. J Dent. 2014;42(5):575‐81. doi:10.1016/j.jdent.2014.02.007.

Zorzin J, Maier E, Harre S, Fey T, Beli R, Lohbauer U, et al. Bulk-fill resin composites: polymerization properties and extended light curing. Dent Mater. 2015;31(3):293‐301. doi:10.1016/

Van Ende A, De Munck J, Lise DP, Van Meerbeek B. Bulk-Fill Composites: a review of the current literature. J Adhes Dent. 2017;19(2):95‐109. doi:10.3290/j.jad.a38141.

Benetti AR, Havndrup-Pedersen C, Honoré D, Pedersen MK, Pallesen U. Bulk-fill resin composites: polymerization contraction, depth of cure, and gap formation. Oper Dent. 2015;40(2):190‐200. doi:10.2341/13-324-L.

Alshali RZ, Salim NA, Sung R, Satterthwaite JD, Silikas N. Qualitative and quantitative characterization of monomers of uncured bulk-fill and conventional resin-composites using liquid chromatography/mass spectrometry. Dent Mater. 2015;31(6):711–20.

Ilie N, Hickel R. Investigations on a methacrylate-based flowable composite based on the SDR??? technology. Dent Mater. 2011;27(4):348–55.

Heintze SD, Monreal D, Peschke A. Marginal Quality of Class II Composite Restorations Placed in Bulk Compared to an Incremental Technique: Evaluation with SEM and Stereomicroscope. J Adhes Dent. 2015;17(2):147–54.

de Assis FS, Lima SNL, Tonetto MR, Bhandi SH, Pinto SCS, Malaquias P, et al. Evaluation of Bond Strength, Marginal Integrity, and Fracture Strength of Bulk- vs Incrementally-filled Restorations. J Adhes Dent. 2016;18(4):317–23.

Cidreira Boaro LC, Pereira Lopes D, de Souza ASC, Nakano EL, Perez MDA, Pfeifer CS, et al. Clinical performance and chemical-physical properties of bulk fill composites resin -a systematic review and meta-analysis. Dent Mater. 2019;35(10):e249-64. doi:10.1016/

Canali GD, Ignácio SA, Rached RN, Souza EM. One-year clinical evaluation of bulk-fill flowable vs. regular nanofilled composite in non-carious cervical lesions. Clin Oral Investig. 2019;23(2):889‐97. doi:10.1007/s00784-018-2509-8.

Ehlers V, Gran K, Callaway A, Azrak B, Ernst CP. One-year Clinical Performance of Flowable Bulk-fill Composite vs Conventional Compomer Restorations in Primary Molars. J Adhes Dent. 2019;21(3):247‐54. doi:10.3290/j.jad.a42519.

Astvaldsdottir A, Dagerhamn J, van Dijken JW, Naimi-Akbar A, Sandborgh-Englund G, Tranaeus S, et al. Longevity of posterior resin composite restorations in adults - A systematic review. J Dent. 2015;43(8):934–54.

Dentsply. Surefil SDR [Internet]. [cited 2019 Jun 22]. Available from: http:/

Bucuta S, Ilie N. Light transmittance and micro-mechanical properties of bulk fill vs. conventional resin based composites. Clin Oral Investig. 2014;18(8):1991–2000.

Kim E, Jung H, Hur B, Kwon H, Park K. Effect of resin thickness on the microhardness and optical properties of bulk-fill resin composites. Restor Dent Endod. 2015;40(2):128–35.

Ilie N, Keßler A, Durner J. Influence of various irradiation processes on the mechanical properties and polymerisation kinetics of bulk-fill resin based composites. J Dent. 2013;41(8):695–702.

Alrahlah A, Silikas N, Watts DC. Post-cure depth of cure of bulk fill dental resin-composites. Dent Mater. 2014;30(2):149–54.

Furness A, Tadros MY, Looney SW, Rueggeberg FA. Effect of bulk/incremental fill on internal gap formation of bulk-fill composites. J Dent. 2014;42(4):439–49.

Roggendorf MJ, Krämer N, Appelt A, Naumann M, Frankenberger R. Marginal quality of flowable 4-mm base vs. Conventionally layered resin composite. J Dent. 2011;39(10):643–7.

Rosatto CMP, Bicalho AA, Veríssimo C, Bragança GF, Rodrigues MP, Tantbirojn D, et al. Mechanical properties, shrinkage stress, cuspal strain and fracture resistance of molars restored with bulk-fill composites and incremental filling technique. J Dent. 2015;43(12):1519–28.

Leprince JG, Palin WM, Vanacker J, Sabbagh J, Devaux J, Leloup G. Physico-mechanical characteristics of commercially available bulk-fill composites. J Dent. 2014;42(8):993–1000.

Tantbirojn D, Pfeifer CS, Braga RR, Versluis A. Do low-shrink composites reduce polymerization shrinkage effects? J Dent Res. 2011;90(5):596–601.

van Dijken JWV, Pallesen U. Posterior bulk-filled resin composite restorations: A 5-year randomized controlled clinical study. J Dent. 2016;51:29-35.

van Dijken JWV, Pallesen U. Bulk-filled posterior resin restorations based on stress-decreasing resin technology: a randomized, controlled 6-year evaluation. Eur J Oral Sci. 2017;125(4):303-9. doi:10.1111/eos.12351.

Demarco FF, Corrêa MB, Cenci MS, Moraes RR, Opdam NJM. Longevity of posterior composite restorations: Not only a matter of materials. Dent Mater. 2012;28(1):87–101.

Opdam NJ, Bronkhorst EM, Roeters JM, Loomans BA. Longevity and reasons for failure of sandwich and total-etch posterior composite resin restorations. J Adhes Dent. 2007;9(5):469-75.

Frascino S, Fagundes TC, Silva U, Rahal V, Barboza ACS, Santos PH, et al. Randomized Prospective Clinical Trial of Class II Restorations Using Low-shrinkage Flowable Resin Composite. Oper Dent. 2020;45(1):19‐29. doi:10.2341/18-230-C.

Demunck J, Van Landuyt K, Peumans M, Poitevin A, Lambrechts P, Braem M, et al. A critical review of the durability of adhesion to tooth tissue: methods and results. J Esthet Restor Dent. 2010;84(2):72–3.

Loguercio AD, Rezende M, Gutierrez MF, Costa TF, Armas-Vega A, Reis A. Randomized 36-month follow-up of posterior bulk-filled resin composite restorations. J Dent. 2019;85:93‐102. doi:10.1016/j.jdent.2019.05.018.

Correia A, Jurema A, Andrade MR, Borges A, Bresciani E, Caneppele T. Clinical evaluation of noncarious cervical lesions of different extensions restored with bulk-fill or conventional resin composite: preliminary results of a randomized clinical trial. Oper Dent. 2020;45(1):E11‐E20. doi:10.2341/18-256-C.

Yazici AR, Antonson SA, Kutuk ZB, Ergin E. Thirty-Six-Month Clinical Comparison of Bulk Fill and Nanofill Composite Restorations. Oper Dent. 2017;42(5):478‐85. doi:10.2341/16-220-C.

Sahadi BO, Price RB, André CB, Sebold M, Bermejo GN, Palma-Dibb RP, et al. Multiple-peak and single-peak dental curing lights comparison on the wear resistance of bulk-fill composites. Braz Oral Res. 2018;32:e122. doi:10.1590/1807-3107bor-2018.vol32.0122.

Shimokawa CAK, Turbino ML, Giannini M, Braga RR, Price RB. Effect of light curing units on the polymerization of bulk fill resin-based composites. Dent Mater. 2018;34(8):1211‐21. doi:10.1016/

Soto-Montero J, Nima G, Rueggeberg FA, Dias C, Giannini M. Influence of Multiple Peak Light-emitting-diode Curing Unit Beam Homogenization Tips on Microhardness of Resin Composites. Oper Dent. 2020;45(3):327‐38. doi:10.2341/19-027-L.

André CB, Nima G, Sebold M, Giannini M, Price RB. Stability of the Light Output, Oral Cavity Tip Accessibility in Posterior Region and Emission Spectrum of Light-Curing Units. Oper Dent. 2018;43(4):398‐407. doi:10.2341/17-033-L.

Kim RJ, Son SA, Hwang JY, Lee IB, Seo DG. Comparison of photopolymerization temperature increases in internal and external positions of composite and tooth cavities in real time: Incremental fillings of microhybrid composite vs. bulk filling of bulk fill composite. J Dent. 2015;43(9):1093-8. doi:10.1016/j.jdent.2015.07.003.


Licença Creative Commons

e-ISSN 2177-0018 / ISSN 0566-1854.

descrição da foto descrição da foto descrição da foto descrição da foto descrição da foto descrição da foto descrição da fotodescrição da foto