Effect of composite insertion technique on cuspal deflection using an in vitro simulation model.

OBJECTIVE The objective of this study was to investigate, by simulation, the effect of conventional composite resin insertion techniques on cuspal deflection using bonded typodont artificial teeth. The deflection produced by a new low-shrinkage composite was also determined. MATERIALS AND METHODS Sixty standardized MOD preparations on ivorine maxillary premolars were prepared: group A at 4 mm depth and group B at 6 mm depth. Each group was further subdivided according to composite insertion technique (n=6), as follows: 1) bulk insertion, 2) horizontal increments, 3) tangential increments, and 4) a modified tangential technique. Preparations were microetched, acid-cleaned, and bonded with adhesive resin to provide micromechanical attachment before restoration with a conventional composite (Spectrum TPH( 3 ), Dentsply). Two additional subgroups at 4 mm and 6 mm depth (n=6) were restored in bulk using low-shrinkage composite (Filtek LS, 3M/ESPE). All groups received the same total photo-polymerization time. Cuspal deflection was measured during the restorative procedure using two Linear Variable Differential Transformers attached to a data acquisition system. RESULTS The average cuspal deflections for group A were 1) 40.17 ± 1.18 μm, 2) 25.80 ± 4.98 μm, 3) 28.27 ± 5.12 μm, and 4) 27.33 ± 2.42 μm. The deflections in group B were 1) 38.82 ± 3.64 μm, 2) 50.39 ± 9.17 μm, 3) 55.62 ± 8.16 μm, and 4) 49.61 ± 8.01 μm. Cuspal flexure for the low-shrinkage composite was 11.14 ± 1.67 μm (group A: 4 mm depth) and 16.53 ± 2.79 μm (group B: 6 mm depth). CONCLUSIONS All insertion techniques using conventional composite caused cuspal deformation. In general, deeper preparations showed increased cuspal deflection-except in the case of bulk insertion, which was likely affected by decreased depth of cure. Cuspal movement using low-shrinkage composite was significantly reduced.