Title	Limited Evidence to Support the Incremental fill Technique is More Effective Than the Bulk fill Technique
Clinical Question	In composite resin restorations, is the incremental fill technique more effective than bulk fill technique in regards to depth of cure as measured by hardness?
Clinical Bottom Line	There is not sufficient data to adequately support the incremental fill technique is more effective than the bulk fill technique in regards to depth of cure in composite resin restorations.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 21965491 Campodonico/2011 5 extracted teeth per study group In vitro study Key results There was no significant difference in hardness values at any depth between the bulk and incremental techniques for X-tra fil (P > 0.05). There were also no significant differences in hardness values at any depth between the bulk and incremental techniques for Filtek Supreme Plus (P > 0.05). Although there were no significant differences among the filling techniques within the same composite material, when comparing the two different composite materials, X-tra fil had higher hardness values than Filtek Supreme Plus at all measured depths in incremental and bulk techniques. 15302453 Poskus/2004 5 extracted teeth per study group In vitro study Key results There was no significant difference in the hardness values for the cervical and occlusal surfaces when the incremental technique was used (P > 0.05). However, hardness values for the cervical surfaces were lower than the occlusal surfaces when the bulk technique was used (P < 0.001). Additionally, hardness values significantly varied among each composite material when comparing each placement technique.
Evidence Search	("Incremental-fill"[Mesh] AND "Bulk-fill"[Mesh]) AND "Composite"[Mesh])
Comments on The Evidence	Validity: Both studies provided adequate level of evidence and conducted in vitro, however, the sample size for each study group was very limited. Results indicate that the evidence regarding the topic is extremely limited. Other factors besides placement technique seem to influence the depth of cure of composite resin restorations. No systematic review has been done on the topic as of yet.
Applicability	Results of both studies indicate that other factors besides placement technique may influence the depth of cure of composite resin restorations. Clinicians should take into consideration a thorough cure of a restoration, the composition of the resin composite material, a lighter shade vs. a darker shade of composite material, and the opacity/translucency of a resin composite influencing the depth of cure of composite resin restorations. More research should be conducted to determine the effectiveness of placement technique on the depth of cure of composite resin restorations.
Specialty	(General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords	Restorative materials, resin composite, incremental-fill, bulk-fill
ID#	2728
Date of submission	05/09/2014
E-mail	phamo@livemail.uthscsa.edu
Author	Oanh Hutson
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Joseph A. Bartoloni, DMD
Faculty mentor e-mail	Bartoloni@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available