Julian Phan

January 31, 2021

Core Build-Up Materials

Upon completing my first core build-up with resin composite material, there was a major

discrepancy in material of choice for the build-up. The site of the core build-up was on the upper right

maxillary premolar region, with a previous defective resin core build-up with recurrent caries. After

removing the previous restoration, there was difficulty in placing traditional packable composite to

the metal post surface in order to avoid creating any voids; therefore, the next decision was to find a

resin material that allowed proper consistency and flow. Unfortunately, flowable composite should

not have been the material of choice and this paper will discuss my findings on why flowable

composite should not be used as a core build-up material.

As traditionally learned in restorative and prosthodontics class, there are common resin

restorative materials that come in different consistencies, fillers, and resins. The ones I am most

familiar with were the packable composite and flowable composite. Interestingly, during my research

I found that there are actually various forms of resin composite, some specifically tailored for core

build-up material, some with the hybrids of macrofills and microfills, dual-cure resin composites, and

even forms of composite that provide the strength of core build-up material in less viscous forms.

In this case, I initially reviewed the literature regarding flowable composites and its

advantages/disadvantages and uses. One of the major attributes of flowable is its consistency;

however, because its lower filler content, it is not recommended in high-stress occlusal areas due to

its low properties to wear resistance (Baroudi). This is something commonly taught in our traditional

lecture, and in retrospect I feel that is something I knew and should’ve known at the time of the

appointment yet made the judgement error to use flowable. Also reflecting o on what could’ve been

done differently, I should’ve asked managing faculty which composite to use so as not to create any
voids, but also maintain the integrity and strength of the restoration for a core buildup in a posterior,

high stress and occluding tooth It is obvious now and should have been before, flowable should not

be an option, but I realize too that asking the managing faculty I would’ve been presented with more

options of composites our dispensary has and would’ve been able to make a more informed and

competent selection.

Upon doing my research, I have discovered that there are other options to obtain more

flowable consistency of resin composites yet with the purpose of core build-up material. Aside from

the decreased fractured and wear resistance of flowable composite, a study compared various resin

composites as core build up materials and their bond strength. Although the study was testing glass

fiber posts rather than a metal post that I saw in my patient, I think the study did show something

important. The study found a significant difference in bond tensile strength between the core resin

composites and hybrid composites versus the flowable composite (Sadek). Although all bond

strengths were weak in adaptation to the post itself, it is the finding that the bond strength for flowable

was significantly inferior as a build-up material compared to the other forms. However, they did find

that flowable composite did provide the least number of voids and had best adaptation to the post

itself followed by hybrid composites. This led me to read up on also what kinds of materials would

allow larger restorations to be filled with resin and still provide fracture toughness, bond strength,

adaptability, and less shrinkage. I also discovered the advancements of dual-cure resins that allow bulk

fill. However, research showed that although fracture toughness was similar to traditional layered

composite, it did have significant polymerization shrinkage (Vandewalker). This leads to my

conclusions that traditional flowable composite with low filler amount is not the material of choice

for a core build- up. However, there are advances in resin composites tailored toward being used as

core build-up material that not only are in the packable form but in a less viscous form.
 In our dental school dispensary, there are a variety of resin composite materials used for

multiple purposes. When requesting to view the common composites used for core build-dup, I was

given various selections. The first two packable forms commonly used in clinic were the Premise and

Filtek brands, which were both nanofilled composites. The second two were a resin core build-up

materials EndoSequence and Compcore AF, which also had nanofilled reins included. The last one I

was given was actually a flowable composite from Surefil SDR Flow+. For packable composites,

nanofilled composites were made ideally to provide higher strength, wear resistance, and polishability

(Lavigne). Therefore, nanofill composites can be used for core buildups like Premise but our

dispensary only has them in packable form. Our dispensary also offers multiple shades of each brand,

and it a core buildup, I would use a bright white color in order to differentiate the natural tooth and

buildup if aesthetics is not an issue. However, if packable composite is difficult to manipulate in order

to avoid voids, our dispensary does have the core buildup material and the flowable bulk fill composite.

The idea of bulk fill composite was to allow for hopefully less polymerization shrinkage without the

time consumption of incremental fill; however Surefil is a flowable. The manufacture indicates SDR

Flow+ can be used in smaller cavity preparations as well as core buildup materials. There is evidence

to show that SDR application as a bulk fill in Class I preparations can have reduced microgaps that

were issues with bulk fills and that there was less polymerization shrinkage and better marginal

adaptation for smaller cavities was achieved. However, because of the new technology of this type of

flowable, I think there needs to be more evidence to show whether or not Surefil is successful as a

core buildup, and not necessarily only in larger class I preparations. However, I do think that Surefil

might be a possible application for filling right around a post because of its good adaptation and

flowability and seal into the micro anatomy of a post, followed by a separate core buildup material

overlaid. When reviewing the indications and properties of CompCore AF and EndoSequence,

CompCore AF seems to be the more popular brand of choice for CompCore AF (Christensen).
Though I was not able to find any evidence as to why that is the case, based on my previous findings,

dual cure resin core buildup materials like these two can provide a less viscous alternative to the

nanofilled packable composites we have in our dispensary. Their color is also distinctive enough in

order to tell the difference between natural tooth structure and the resin itself. Also, these types of

materials provide the strength needed for a core buildup. Therefore, I think the most appropriate

choice would be a nanofilled packable composite with a bright white shade in Filtek or Premise or if

a less viscous material is needed for better flow, than a core build up resin with nanofillers like

CompCare AF would be a good option. Possibly if a post was used by EndoSequence, I may use the

EndoSequence Core Build Up Material to go along with the system. I would also consider using SDR

possibly around the post itself to avoid voids around the post, but I would use the packable or core

buildup resin after to build up the rest of the restoration.

Considering the research, there are other possibly comparable options to packable forms of

resin composite, especially in the situation where packable composite may not lead to proper

adaptation to posts of a core build-up like in the case I had with my patient. In the future, I can

consider other options like these dual-cured resin composites or even resin core materials that come

in a lower viscous form.

Baroudi, K., & Rodrigues, J. C. (2015). Flowable Resin Composites: A Systematic Review and

Clinical Considerations. Journal of clinical and diagnostic research : JCDR, 9(6), ZE18–ZE24.

https://doi.org/10.7860/JCDR/2015/12294.6129

Bruna Marin Fronza, Frederick Allen Rueggeberg, Roberto Ruggiero Braga, Borys Mogilevych, Luis

Eduardo Silva Soares, Airton Abrahão Martin, Gláucia Ambrosano, Marcelo Giannini.

(2015). Monomer conversion, microhardness, internal marginal adaptation, and shrinkage

stress of bulk-fill resin composites. Dental Materials, 31(12), 1542-1551.

https://doi.org/10.1016/j.dental.2015.10.001.

CompCore™ AF Dual-Cure Core Build-up Material. (2020, September 25). Retrieved January 22,

2021, from https://www.premierdentalco.com/product/restorative/compcore-af-dual-cure/

Christensen, G. The Forgotten Retention: Core, Posts, and Pins. (2018, August). Retrieved January

22, 2021, from https://www.cliniciansreport.org/uploads/files/1324/0818-RT-addendum-

post-core-survey.pdf

EndoSequence Core Build-up Material. Retrieved January 22, 2021, from

https://shop.brasselerusa.com/product/5013884u0?_ga=2.197264685.346908430.161134553

5-482890489.1611345535

Lavigne, C. (2020, May 22). Dental Composites: Types and Recommendations. Retrieved January

22, 2021, from https://www.speareducation.com/spear-review/2017/01/dental-composites-

in-2017-what-to-look-for-and-what-to-get
Mehler, S. (2018). Tips from practicing dentists on using products to the best advantage. ADA

Dental Product Guide, 6(6)..

Ramkumar Yadav, Mukesh Kumar. (2019). Dental restorative composite materials: A review, Journal

of Oral Biosciences, 61(2), 78-83. https://doi.org/10.1016/j.job.2019.04.001.

Sadek, F. T., Monticelli, F., Goracci, C., Tay, F. R., Cardoso, P. E., & Ferrari, M. (2007). Bond

strength performance of different resin composites used as core materials around fiber

posts. Dental materials : official publication of the Academy of Dental Materials, 23(1), 95–99.

https://doi.org/10.1016/j.dental.2005.12.005

SDR flow+ Procedurally versatile. Clinically accomplished. (n.d.). Retrieved January 22, 2021, from

https://www.dentsplysirona.com/en-us/categories/restorative/sdr-flow-plus.html

Vandewalker, J. P., Casey, J. A., Lincoln, T. A., & Vandewalle, K. S. (2016). Properties of dual-cure,

bulk-fill composite resin restorative materials. General dentistry, 64(2), 68–73.