Molar cusp deformation evaluated by micro-CT and enamel crack formation to compare incremental and bulk-filling techniques.

Objectives: To describe a method of measuring the molar cusp deformation using micro-computed tomography (micro-CT), the propagation of enamel cracks using transillumination, and the effects of hygroscopic expansion after incremental and bulk-filling resin composite restorations.

Methods: Twenty human molars received standardized Class II mesio-occlusal-distal cavity preparations. They were restored with either a bulk-fill resin composite, X-tra fil (XTRA), or a conventional resin composite, Filtek Z100 (Z100). The resin composites were tested for post-gel shrinkage using a strain gauge method. Cusp deformation (CD) was evaluated using the images obtained using a micro-CT protocol and using a strain-gauge method. Enamel cracks were detected using transillumination.

Results: The post-gel shrinkage of Z100 was higher than XTRA (P < 0.001). The amount of cusp deformation produced using Z100 was higher compared to XTRA, irrespective of the measurement method used (P < 0.001). The thinner lingual cusp always had a higher CD than the buccal cusp, irrespective of the measurement method (P < 0.001). A positive correlation (r = 0.78) was found between cusp deformation measured by micro-CT or by the strain-gauge method. After hygroscopic expansion of the resin composite, the cusp displacement recovered around 85% (P < 0.001). After restoration, Z100 produced more cracks than XTRA (P = 0.012).

Conclusions: Micro-CT was an effective method for evaluating the cusp deformation. Transillumination was effective for detecting enamel cracks. There were fewer negative effects of polymerization shrinkage in bulk-fill resin restorations using XTRA than for the conventional incremental filling technique using conventional composite resin Z100.

Clinical Significance: Shrinkage and cusp deformation are directly related to the formation of enamel cracks. Cusp deformation and crack propagation may increase the risk of tooth fracture.