The Combination of CQ-amine and TPO Increases the Polymerization Shrinkage Stress and Does Not Improve the Depth of Cure of Bulk-fill Composites.

OBJECTIVES: To evaluate the effect of combining camphorquinone (CQ) and diphenyl(2,4,6-trimethylbenzoyl)phosphine oxide (TPO) on the depth of cure and polymerization shrinkage stress of bulk-fill composites. METHODS AND MATERIALS: Experimental bulk-fill composites were produced containing equal molar concentrations of either CQ-amine or CQ-amine/TPO. The degree of in-depth conversion through each millimeter of a 4-mm-thick bulk-fill increment was evaluated by Fourier transform near-infrared microspectroscopy using a central longitudinal cross section of the increment of each bulk-fill composite (n=3). Light-transmittance of the multi-wave light-emitting diode (LED) emittance used for photoactivation (Bluephase G2, Ivoclar Vivadent) was recorded through every millimeter of each bulk-fill composite using spectrophotometry. The volumetric shrinkage and polymerization shrinkage stress were assessed using a mercury dilatometer and the Bioman, respectively. The flexural modulus was also assessed by a three-point bend test as a complementary test. Data were analyzed according to the different experimental designs (α=0.05 and β=0.2). RESULTS: Up to 1 mm in depth, adding TPO to CQ-based bulk-fill composites increased the degree of conversion, but beyond 1 mm no differences were found. The light-transmittance of either wavelengths emitted from the multi-wave LED (blue or violet) through the bulk-fill composites were only different up to 1 mm in depth, regardless of the photoinitiator system. Adding TPO to CQ-based bulk-fill composites did not affect volumetric shrinkage but did increase the flexural modulus and polymerization shrinkage stress. CONCLUSION: Adding TPO to CQ-based bulk-fill composites did not increase the depth of cure. However, it did increase the degree of conversion on the top of the restoration, increasing the polymerization shrinkage stress.