d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 928–935

Available online at www.sciencedirect.com

journal homepage: www.intl.elsevierhealth.com/journals/dema

Creep deformation of restorative resin-composites intended

for bulk-fill placement

S. El-Safty a,c , N. Silikas a , D.C. Watts a,b,∗

a Biomaterials Research Group, School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK
b Institute of Materials Science and Technology, Friedrich Schiller University, Jena, Germany
c Biomaterials Department, School of Dentistry, Tanta University, Tanta, Egypt

a r t i c l e i n f o a b s t r a c t

Article history: Objectives. To determine the creep deformation of several “bulk-fill” resin-composite formu-
Received 6 March 2012 lations in comparison with some other types.
Received in revised form Methods. Six resin-composites; four bulk-fill and two conventional were investigated. Stain-
30 April 2012 less steel split molds (4 mm × 6 mm) were used to prepare cylindrical specimens for creep
Accepted 30 April 2012 testing. Specimens were thoroughly irradiated with 650 mW cm−2 . A total of 10 specimens
for each material were divided into two groups (n = 5) according to the storage condition;
Group A stored dry at 37 ◦ C for 24 h and Group B stored in distilled water at 37 ◦ C in an
Keywords: incubator for 24 h. Each specimen was loaded (20 MPa) for 2 h and unloaded for 2 h. The
Resin-composites strain deformation was recorded continuously for 4 h. Statistical analysis was performed
Bulk-fill using a two-way ANOVA followed by one-way ANOVA and the Bonferroni post hoc test at a
Viscoelastic time-dependent creep significance level of a = 0.05.
Water storage Results. The maximum creep strain % ranged from 0.72% up to 1.55% for Group A and the
range for Group B increased from 0.79% up to 1.80% due to water sorption. Also, the perma-
nent set ranged from 0.14% up to 0.47% for Group A and from 0.20% up to 0.59% for Group B.
Dependent on the material and storage condition, the percentage of creep strain recovery
ranged between 64% and 81%. Increased filler loading in the bulk-fill materials decreased
the creep strain magnitude.
Significance. Creep deformation of all studied resin-composites increased with wet storage.
The “bulk-fill” composites exhibited an acceptable creep deformation and within the range
exhibited by other resin-composites.
© 2012 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

cavity preparations. Typically, this technique con-

1. Introduction sists of placing increments of resin-composite material
in thickness of 2 mm or less followed by exposure
Performing a trouble-free direct composite restoration with to light curing from an occlusal direction and then
care and in a reasonable time is a valuable technique that a repeating increments until the preparation is filled [2].
dentist must have if he or she desires a satisfying and success- One obvious advantage for this technique is the limitation
ful practice [1]. Incremental layering has long been accepted of the thickness of resin to be penetrated by light, as it has been
as a standard technique for placement of resin-composite in shown that light energy transmitted through resin-composite

∗
Corresponding author at: Biomaterials Research Group, School of Dentistry, University of Manchester, Higher Cambridge Street,
Manchester M15 6FH, UK.
E-mail address: david.watts@manchester.ac.uk (D.C. Watts).
0109-5641/$ – see front matter © 2012 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.dental.2012.04.038
 d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 928–935 929

decreases exponentially with resin-composite thickness [3]. approach to accomplish this is by being translucent i.e.,
Therefore, limiting increment thickness to 2 mm or less highly conducive to light transmission. The translucency of
provides adequate light penetration and subsequent poly- tooth-colored restorative materials is considered a crucial
merization. Adequate polymerization results in enhanced optical property, comparable in importance to color, as the
physical properties [4,5], improved marginal adaptation [6] translucency will strongly affect the appearance of the com-
and decreased cytotoxicity of the resin-composite. Inade- posite material [22]. The transmission of the curing light
quate polymerization may result in reduced conversion of through the composite material is mainly influenced by the
the various components of the resin-composite and there- size of the filler particles and the matching between the
fore a higher residual monomer content remains in the refractive indices of the resin matrix and the filler particles
material [7]. This residual monomer, in addition to other [9,23]. Matching the refractive indices of filler and matrix
drawbacks in the materials like poor mechanical properties is essential for improving the translucency and the opti-
[8], increases the cytotoxicity of the resin-composite [7,9–11]. cal properties of the resin-composit material [24–26]. If the
A second reason to use the incremental technique is to filler and matrix have mismatched refractive indices, the filler
decrease the amount of shrinkage occurring during poly- will increase light scattering in the resin–filler interface and
merization. The reduction of polymerization shrinkage is produce opaque materials [27,28]. The use of filler particles
beneficial because the developing stress can cause cus- (≤400 nm) has many advantages. One of these advantages
pal deformation with resulting sensitivity or microcracks is the superior esthetic properties of the resin-composite
in resin or tooth structure. The stress can also cause due to excellent translucency [27]. Also, the pigments can
adhesive failure at the tooth/resin interface resulting in affect the light transmission and translucency of the material.
marginal gaps, microleakage, and secondary caries [6,12–14]. In darker composite shades, there might be light scatter-
Despite these benefits, the incremental technique has ing, reduced translucency and attenuation of the curing
disadvantages. These may include (i) the possibility of incor- light which may result in inadequate polymerization [29–31].
porating voids or contamination between composite layers, There are a number of recent studies that evaluated dif-
(ii) bond failures between increments, (iii) difficulty in place- ferent sets of conventional direct resin-composites placed
ment because of limited access in conservative preparations, with bulk-fill method and compared it with the conventional
and (iv) the increased time required to place and polymerize incremental method. This evaluation included polymeriza-
each layer [15,16]. In addition, as the bonding and filling steps tion shrinkage [32], hardness [4], microleakage [15], marginal
are the most crucial, perfect isolation during these steps must adaptation [33] and interfacial stresses [34]. However, these
be maintained to guarantee a successful restoration. However, studies compared conventional hybrid composites used in
when the patient salivates and moves the tongue constantly bulk or in increments. The introduction of resin-composites
during the placement of composite layers, this could poten- specifically intended for bulk-fill use renews the argu-
tially compromise the accuracy of the filling. Every additional ment. These materials need to be thoroughly evaluated and
increment increases the likelihood of failure [1]. As reported the claims made about their performance substantiated.
by Blank and Latta [17], techniques for internally stratified As reported by many authors [35–37], the creep deforma-
direct resin restorations are highly dependent on the clini- tion is a significant aspect of the mechanical performance
cian’s skills, and care must be taken to ensure that the exact of polymer-based materials. It has been reported that if a
thickness and shape of each layer is accurately predicted. resin-based material has high creep strain, this will adversely
Recent studies have suggested that fewer increments and affect its resistance to mechanical stress and thus influ-
even bulk-filling could be equally successful [15,16,18,19]. ence the long-term clinical durability of the restorations
Moreover, some clinicians challenge the concept that the [38]. Therefore, this study will be conducted to evaluate
incremental-fill technique produces improved results in the the creep deformation of some newly introduced resin-
restoration and use instead a bulk placement method in composites intended for bulk-fill placement. The specific
which the entire preparation is filled in one increment and objectives were to measure: (a) maximum creep strain; (b)
is then exposed to light [3]. However, concern about the maximum creep recovery; (c) percentage of creep recovery;
results or the lack of a suitable bulk-fill material has discour- and (d) permanent set for the investigated composites. The
aged most clinicians from implementing such techniques [16]. null hypotheses tested were: (i) there is no significant differ-
Lately, there is a direction to decrease the number of incre- ence in the creep deformation and recovery behavior of the
ments for direct composite restoration and encourage the use composite resins investigated; (ii) the storage condition has
of a bulk-fill technique. Several manufacturers have developed no effect on the creep parameters of the resin-composites.
“bulk-fill” resin-composites that can be applied to the cavity
in thickness of 4 mm with enhanced curing and controlled
shrinkage [20]. Consequently, dentists can save themselves 2. Materials and methods
and their patients’ significant chairside time, and make
the restorative process less stressful and more comfortable. The materials selected in this study, lot numbers
Several authors [1,21] recommended that the “bulk-fill” and manufacturers’ information are listed in Table 1.
composite materials must possess some important charac- Stainless steel split molds (4 mm in diameter × 6 mm in
teristics. These include low polymerization shrinkage, more length) were used to prepare the specimens. A total of 10
flowability to allow for better cavity adaptation, easy to specimens were prepared from each material at room tem-
dispense with minimal handling, enhanced physical char- perature 23 ◦ C. Glass microscope slides were positioned at the
acteristics and improved depth of cure, at least 4 mm. One upper and lower surfaces of the cylindrical specimen. Each
930 d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 928–935

Table 1 – Resin-composites investigated; product codes, filler loadings, resin systems and manufacturers’ information.
Code Product Type Manufacturer Lot no. Resin system Filler system
VB Venus bulk fill Bulk-fill Heraeus Kulzer 10028 UDMA, EBADMA Ba–Al–F silicate
GmbH, Hanau, glass, YbF3 and SiO2
Germany (65% by wt and 38%
by vol)
SF Surefil SDR flow Bulk-fill Dentsply Caulk, 1003011 EBPADMA, TEGDMA Barium/strontium-
Milford, DE, USA alumino-fluoro-
borosilicate glass
(68% by wt and 44%
by vol)
TE Tetric EvoCeram Bulk-fill Ivoclar Vivadent, PM0213 Dimethacrylate Ba glass, YbF3 ,
bulk fill Schaan, co-monomers oxides and
Liechtenstein prepolymers (80% by
wt and 60% by vol)
EX X-tra base Bulk-fill Voco, Cuxhaven, V 45252 MMA, Bis-EMA Inorganic fillers (75%
Germany by wt and 58% by
vol)
BE Beautiful flow plus Flowable Shofu Inc., Kyoto, 041008 Bis-GMA, TEGDMA Fluoro-borosilicate
Japan glass (67.3% by wt
and 47% by vol)
FS Filtek supreme XTE Nanohybrid 3M ESPE, St. Paul, N214152 Bis-GMA,UDMA, Zirconia/silica fillers
MN, USA TEGDMA, PEGDMA, particles (78.5% by
Bis-EMA wt and 63.3% by vol)

specimen was thoroughly irradiated from multiple directions. in Fig. 2. When a polymer is loaded below its elastic limit,
Light curing was performed using a visible light curing unit there is an immediate rapid elastic deformation (R). This is fol-
(Optilux 501, Kerr, USA) with light irradiance of 650 mW cm−2 lowed by a slower, time-dependent, viscoelastic deformation
as measured with the incorporated calibrated radiometer. A (S), which is known as creep. When the load is removed, an
separating medium (a thin film of petroleum jelly) was placed immediate recovery will take place (X). This is also followed by
inside and around the edges of the mold cavity to facili- a further time-dependent, viscoelastic recovery (Y), which may
tate removal of the specimens. After curing, specimens were or may not be complete within the given time limit of a test,
finished flush with the ends of the mold by hand-grinding and then there would be a permanent set (Z) [38–40]. In this
with 800 grit silicon carbide paper. They were then separated investigation, the following measurements were considered:
from the mold to be stored. The 10 specimens for each mate-
rial were divided according to the storage condition into two (1) Maximum creep strain (R + S).
groups (n = 5); Group A: stored dry at 37 ◦ C for 24 h and Group (2) Maximum creep recovery (X + Y).
B: stored in distilled water at 37 ◦ C in an incubator for 24 h. (3) Percentage of creep recovery ([X + Y/R + S] × 100).
A creep measurement apparatus was used to determine the (4) Permanent set (Z).
creep of the selected resin-composites (Fig. 1). It consisted of a
lever, which was pivoted at one end via a bearing pin, in a ver-
Data were statistically analyzed using a two-way ANOVA
tical pillar bolted to a steel U-section base [38]. A loading pin
followed by one-way ANOVA and the Bonferroni post hoc
(1 cm diameter) contained in a reduced friction bearing was
test, at a significance level of 5%. Linear regression and
located vertically and the specimen was placed on a raised
correlation analysis were performed to investigate corre-
platform, which was mounted in a small water bath, in an
lation between the maximum creep strain of the wet
axial alignment with the loading pin, so that a force could be
group of the “bulk-fill” composites and the filler loading.
directed to the end faces by the application of loading weight
to the free end of the lever. A linear variable displacement
transducer (LVDT) (type GTX 2500; RDP Electronics, Wolver- 3. Results
hampton, UK) was used to monitor the strain changes in the
specimens in units of voltage, where the LVDT was mounted Upon fitting the two-way ANOVA model to the data for
on an outrigger clamped to the loading pin. A signal from the outcome measurement CREEP, there was a statistically
the LVDT was transferred to an analog-to-digital converter significant interaction (P < 0.05) between the two factors
(Pico Technology, Hardwick, Cambridge, UK) and recorded via MATERIAL and CONDITION. This meant that the data for
a computer data recorder (PicoLog data acquisition software). each material or condition had to be considered separately.
Each specimen was subjected to a cycle of constant com- Mean values of maximum creep strain, permanent set,
pressive stress of 20 MPa for 2 h followed by 2 h of strain maximum creep recovery and percentage of creep recov-
recovery after load removal. The dimensional changes of the ery are listed in Table 2. Standard deviations are shown in
specimens were monitored during both stress application and parentheses.
its removal over a total of 4 h. Creep strain data were processed Statistically significant differences in the mean creep strain
using Sigma Plot Software Version 8.0. A schematic represen- were found between the investigated composites in both
tation of the typical constant load creep behavior is illustrated groups (P < 0.05). The lowest creep strain values in both groups
 d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 928–935 931

Fig. 1 – Diagram of creep strain instrument.

Table 2 – Mean values of the maximum creep strain, permanent set, maximum creep recovery and percentage of creep
recovery of the resin composites investigated. Different superscript letters and numbers indicate statistically significant
differences between the creep and permanent set of dry and wet groups respectively.
Code Condition Max. creep strain (%) Permanent set (%) Max. creep Percentage of
recovery (%) creep recovery (%)
VB Dry 1.39 (0.17)a 0.32 (0.17)a 1.07 77
Wet 1.80 (0.15)1 0.59 (0.10)1 1.21 67
SF Dry 1.55 (0.07)a 0.47 (0.05)b 1.08 70
Wet 1.70 (0.13)1 0.49 (0.15)1 1.21 71
TE Dry 1.05 (0.07)c 0.35 (0.10)a 0.70 67
Wet 1.17 (0.12)2 0.41 (0.09)2 0.76 65
EX Dry 0.84 (0.10)b 0.26 (0.05)c 0.58 69
Wet 1.03 (0.10)3 0.37 (0.08)2 0.66 64
BE Dry 0.90 (0.05)b 0.24 (0.07)c 0.66 73
Wet 1.10 (0.15)3 0.32 (0.04)2 0.78 71
FS Dry 0.72 (0.09)b 0.14 (0.06)d 0.58 81
Wet 0.79 (0.07)3,4 0.20 (0.08)3 0.59 72

were exhibited by FS (0.72% and 0.79% respectively). The higher than the maximum creep strain of the rest of
lowest permanent set values in both groups were recorded the studied materials (P < 0.05). No statistically significant
for FS (0.14% and 0.20% respectively). The highest creep difference was shown between VB and SF (P > 0.05). FS exhib-
strain and permanent set in the dry group was exhib- ited statistically significant differences with VB, SF and
ited by SF (1.55% and 0.49% respectively) and in the wet TE but not with BE or EX. No significant difference was
group by VB (1.80% and 0.59% respectively). The highest recorded between BE and EX. The same pattern of signif-
percentage of creep recovery in both groups was recorded icance between investigated composites of the dry group
for FS (81% and 72%) and the lowest percentage of creep was demonstrated by the wet group with the exception
recovery for the dry group was exhibited by TE (67%) and of FS exhibiting a statistically significant difference with
for the wet group by EX (64%). All the studied composites BE (P < 0.05). Figs. 3–8 show the creep strain curves of the
exhibited higher creep strain, higher permanent set and studied materials. Fig. 9 is a bar chart showing the mean val-
lower creep recovery in the wet testing compared to the dry ues and standard deviations of creep strain of investigated
testing. composites. Regression and correlation analysis revealed a
With regard to the statistically significant differences strong significant and negative correlation (r2 = 0.94) between
between the investigated composites, for the dry group the maximum creep strain of the wet group of the “bulk-
the maximum creep strain of VB and SF was significantly fill” composites and the filler loading as shown in Fig. 10.
932 d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 928–935

Fig. 2 – Schematic representation of a typical creep strain

curve. Fig. 5 – Creep deformation and recovery of TE. Each plot is
the mean of five measurements.

Fig. 3 – Creep deformation and recovery of VB. Each plot is

Fig. 6 – Creep deformation and recovery of EX. Each plot is
the mean of five measurements.
the mean of five measurements.

4. Discussion

This study investigated the creep deformation of several

recently introduced “bulk-fill” and conventional resin-
composites. As the studied resin-composites exhibited
statistically significant differences of the mean creep strain
% (P < 0.05), the first null hypothesis was rejected. Resin-
composites with high filler loadings exhibit lower creep
deformation than those with lower filler loading [41]. The
addition of inorganic fillers improves the resistance of
resin-based restorative materials against mechanical degra-
dation. In our study, the mean maximum creep strain
of the “bulk-fill” composites significantly decreased with
increasing the filler loadings (Fig. 10). Also, the incorpora-
tion of structurally rigid base monomer, such as bisphenol
glycidyl dimethacrylates (Bis-GMA) or urethane dimethacry-
Fig. 4 – Creep deformation and recovery of SF. Each plot is lates (UDMA) within the resin-based material enhances
the mean of five measurements. the ability of this material to resist deformation when
 d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 928–935 933

Fig. 7 – Creep deformation and recovery of BE. Each plot is Fig. 9 – Mean maximum creep strain % of both groups (dry
the mean of five measurements. and wet).

subjected to high stresses [42,43]. The low creep strain

exhibited by FS and the relatively higher creep strain demon- conventional resin-composites. Though SF exhib-
strated by VB and SF may be explained on this basis. ited the highest creep strain and permanent set in
All the investigated resin-composites exhibited higher the dry group, VB exhibited the highest creep strain
creep strain, higher permanent set and lower creep recovery and permanent set in the wet group which indicates
in the wet group than in the dry group; therefore the second more susceptibility of VB to water deteriorating effect.
null hypothesis was rejected. The absorption of moisture by In preparing resin-composite specimens for creep testing,
the resin-composites leads to the degradation of both strength it is essential from the creep behavior that the specimen is
and stiffness of composites [44]. The effect of water on creep thoroughly irradiated. If there were a central zone of poorly
behavior in terms of plasticization is evident in the literature. cured resin, the specimen would give an immediate defor-
The presence of water and other fluids has the potential to mation and very high permanent set. In this study, the low
induce swelling and peeling stress in the structure, in addi- values of permanent set observed confirm that the speci-
tion to a plasticizing effect on the polymer matrix as well as mens were thoroughly cured. Our investigation was mainly
debonding of the filler from the matrix, all of which can lead focusing on evaluating the creep deformation of some newly
to increased creep formation [38,45]. The highest increase introduced resin-composites to be used as “bulk-filling” mate-
in creep strain and permanent set with water storage was rials. The creep results showed that these materials exhibited
demonstrated by VB and the lowest values were for FS. The acceptable range of creep strain and recovery when compared
“bulk-fill” resin-composites showed more influence of water with other resin-based materials and other published studies
storage over the creep strain and permanent set than the [38,46,47]. The creep can range from 1 to 6% depending upon

Fig. 8 – Creep deformation and recovery of FS. Each plot is Fig. 10 – Correlation between the maximum mean creep
the mean of five measurements. (wet group) and the filler loading of the bulk-fill composites.
934 d e n t a l m a t e r i a l s 2 8 ( 2 0 1 2 ) 928–935

the volume fraction of the filler [38]. The creep strain of FS, EX, [4] Poskus LT, Placido E, Cardoso PEC. Influence of placement
BE and TE composites was approximately 1% in both groups. techniques on Vickers and Knoop hardness of class ii
Along with our findings in this study about the creep composite resin restorations. Dental Materials
2004;20:726–32.
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[5] Kovarik RE, Ergle JW. Fracture toughness of posterior
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