Incremental versus bulk-fill techniques in Class I restorations using Smart Dentin Replacement Plus and Tetric N-Ceram: A prospective randomized split-mouth clinical trial.

BACKGROUND

Polymerization shrinkage and postoperative sensitivity remain significant concerns in posterior composite restorations. Although bulk-fill composites simplify clinical procedures, their long-term clinical performance compared with incremental techniques remains controversial.

AIM: The aim of this study was to evaluate the clinical performance of Smart Dentin Replacement Plus (SDR+) and Tetric N-Ceram composites when placed using incremental and bulk-fill techniques in Class I pit and fissure cavities over a 6- and 12-month follow-up period.

MATERIALS AND

METHODS

This prospective randomized split-mouth clinical trial included 44 patients (18-35 years) with Class I pit and fissure caries. Teeth were randomly allocated into four groups (n = 11): SDR+ bulk-fill, SDR+ incremental, Tetric N-Ceram bulk-fill, and Tetric N-Ceram incremental. Restorations were evaluated at 6 and 12 months for postoperative sensitivity and secondary caries using clinical examination, caries detector dye under ×6, and bitewing radiographs. Data were analyzed using the Chi-square test (α = 0.05).

RESULTS

At 6 and 12 months, the incremental technique groups demonstrated significantly higher clinical success (90.91%) compared with the bulk-fill groups (SDR+ - 45.45% and Tetric N-Ceram - 54.55%) (P < 0.05). No statistically significant difference was observed between SDR+ and Tetric N-Ceram when identical placement techniques were used.

CLINICAL SIGNIFICANCE: Placement technique plays a more decisive role than composite material selection in the long-term success of posterior restorations.

CONCLUSION

Incremental placement technique showed superior clinical performance compared to the bulk-fill technique in Class I restorations, irrespective of the composite material used.