ACTA SCIENTIFIC DENTAL SCIENCES (ISSN: 2581-4893)

Volume 3 Issue 1 January 2019

Mini Review

Resin Composite Pre-Heating – A Literature Review of the Laboratory Results

Nikolaos-Stefanos Kampanas*
Department of Operative Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Greece
*Corresponding Author: Nikolaos-Stefanos Kampanas, Department of Operative Dentistry, School of Dentistry, National and
Kapodistrian University of Athens, Greece.
Received: November 13, 2018; Published: December 26, 2018

Abstract
Background: Resin composite pre-heating is a recent innovative method that could be clinically beneficial by improving handling
and marginal adaptation of the unset material paste.
Aim: The aim of this study was to gather all the laboratory trials regarding resin composite pre-heating and investigate how this
technique affects the material.
Materials and Methods: An electronic search was carried out in PubMed and Google scholar databases, covering the period from
January 2003 to May 2018. Specific criteria were set in order to define the relevance of each study.
Results: Eighteen articles were included. The most commonly studied variable was the degree of conversion. Five studies found it
increased and two not statistically significant different. Marginal adaptation, viscosity and polymerization shrinkage were higher.
Flexural strength found to be unaffected. The results varied about microhardness and polymerization shrinkage.
Conclusion: Preheating has positive effect on the degree of conversion, viscosity, marginal adaptation and microhardness of compos-
ite resins. The flexural strength remains unaffected, the polymerization shrinkage is worsened, while the results for the microleakage
are unclear. Further studies are needing to take place in order to assess the clinical significance of composite pre-heating.
Keywords: Composite Resins; Composite Pre-Heating; Pre-Heated Composite Resins; Pre-Heating; Pre-Heated

Introduction Polymers can present lower viscosity when they are warmed.
This is based on the theory that thermal energy forces the mono-
In the last decade, growing requests by patients for esthetic
mers or oligomers further apart, allowing them to slide by each
restorations have increased the use of direct resin composites in
other more readily [1,2]. Ideally, increased flow of pre-heated com-
restorative dentistry [1]. However, drawbacks of composites like
posite would improve adaptation of uncured resin to tooth walls
high viscosity and stickiness make them difficult for handling
and potentially reduce microleakage [9]. Recent literature shows
and manipulating, resulting in deficient marginal adaptation to
advantages in increasing the flowability of composite resins by
preparation walls [2-4]. Flowable composite could minimize the
raising their temperature. Better handling improved marginal ad-
gaps between the tooth and the restoration, due to their greater
aptation, higher degree of monomer conversion, better mechanical
flow ability. However, their low filler content may cause higher net
properties are some examples of the possible benefits of compos-
shrinkage, degrading the mechanical properties of restoration [5].
ite preheating, which made it a popular technique among clinicians
Another way to overcome this problem is to use a flowable liner in
[7,10].
combination with regular composites. One recent alternative inno-
vation is the use conventional composites that are pre-heated in a
The aim of this review is to collect the results of the laboratory
chairside warming device before polymerization [6-8].
trials which have studied resin composite pre-heating and find out
the effects of this procedure in the material.

Citation: Nikolaos-Stefanos Kampanas. “Resin Composite Pre-Heating – A Literature Review of the Laboratory Results”. Acta Scientific Dental Sciences 3.1
(2019): 133-137.
Resin Composite Pre-Heating – A Literature Review of the Laboratory Results

134

Materials and Methods

The review followed a process of locating articles through an
electronic search in the PubMed and Google scholar databases.
Searches were conducted covering the period from January 2003
to May 2018. The combination of the following terms was used to
identify the relevant publications: "pre-heating of resin compos-
ites", “pre-heated resin composites".

The criteria for the final inclusion of each article were:

1. Laboratory studies that studied one or more variables re-

lated to the effects of pre-heating of resin composites prior
to their placement in the cavity and their polymerization;
2. Sufficient data on the methodology of the laboratory ex-
periments;
3. Articles written in English.

The exception criteria were:

1. Studies not related to the effects of pre-heating on resin

composites; Figure 1: PRISMA 2009 flow diagram.
2. Animal studies;
3. Articles related to the clinical handling of pre-warmed
composite resins; The laboratory tests and their results included in this study are
4. Studies with inadequate methodology data; presented in table 1.
5. Articles written in languages other than English.
The most commonly studied variable, from seven research
The relevance of each article was initially evaluated by scanning teams, was DC. Five of them concluded that pre-heating of resin
the title and then the summary. Articles found in all databases were composite led to an increase in DC while two contended that no
reviewed for duplicate printouts that were automatically blocked. statistically significant difference was found in the pre-heated res-
ins. Regarding marginal adaptation, flexural strength and viscos-
The information selected from each object related to the effect ity, the different research groups found unanimous results for each
of preheating of resin composite before its polymerization on the variable respectively. With pre-heating before polymerization MA
following variables: degree of monomer conversion (DC), marginal was increased, FS was unaffected, and viscosity was increased. In
adaptation (MA), flexural strength (FS), viscosity, microhardness contrast, for microhardness and microleakage the results of the
(KHN), microleakage and polymerization shrinkage (PS). laboratory tests vary. Especially, of the five laboratory tests that
dealt with microhardness, three supported that the variable in-
Results and Discussion creased with preheating and two that it was not affected. Of those
A total of 167 articles were identified from the above electronic studied the microleakage, two showed that it was decreased but
search. Due to the absence of duplicates, the same number re- only under certain conditions (immediate polymerization and
mained for title and summary review. At this stage, 144 titles were polymerization with a QTH lamp, respectively), one showed that
excluded, and 23 abstracts were selected for reading, resulting in it was unaffected and one that it was reduced. Finally, for polym-
23 full-text studies being evaluated for eligibility. The sample, fol- erization shrinkage two studies concluded that it was increased
lowing the inclusion and exclusion criteria, was ultimately formed while one that it was not statistically significant different after 24h.
at 18 articles (Figure 1).

Citation: Nikolaos-Stefanos Kampanas. “Resin Composite Pre-Heating – A Literature Review of the Laboratory Results”. Acta Scientific Dental Sciences 3.1
(2019): 133-137.
Resin Composite Pre-Heating – A Literature Review of the Laboratory Results

135

Effect of pre-heating on studied variables

Study Degree of monomer Marginal Flexural Viscosity Micro- Micro- Polymerization
conversion Adaptation strength hardness leakage shrinkage
Daronch., et al. (2005) ↑
Wagner., et al. (2008) ↓*
Uctasli., et al. (2008) —
Lohbauer., et al. (2009) — —
Saade., et al. (2009) —
El-Korashy., et al. (2010) ↑ ↑
Lucey., et al. (2010) ↓ ↑
Fróes-Salgado., et al. (2010) — ↑ —
Choudhary., et al. (2011) ↑
Nada., et al. (2011) ↑
dos Santos., et al. (2011) ↓*
Deb., et al. (2011) — ↓ — ↑
Karaarslan., et al. (2012) —
Ayeb., et al. (2014) ↓ ↑
Calheiros., et al. (2014) ↑
Tauböck., et al. (2015) ↑
Yang (2016) ↓
Theobaldo., et al. (2017) ↑ —
↑: increase, ↓: decrease, —: no statistically significant difference
*: under certain circumstances
Table 1: The laboratory tests and their results included in this study.

The degree of conversion is the rate of reacted C = C monomeric lision frequency of the active species and further monomer conver-
bonds, which are converted to C-C polymeric bonds. It expresses sion [9,10,12]. One study confirmed this higher DC on pre-heating
the extent of polymerization and is critical for the mechanical fea- temperature but pointed out that after 24 hours measurements the
tures, solubility, dimensional and color permanency and biocom- beneficial increase in DC is less distinguishing [7]. One study, on the
patibility of resin composites [7,9,11]. A higher degree of conver- other hand, concluded that composite pre-heating did not affect the
sion corresponds to increased microhardness, flexural strength DC. Τhe difference in this result could possibly attributed to the fact
and modulus, fracture resistance and tensile strength. However, that the experiment took place under a non-isothermal condition.
polymers with similar conversion percentages may exhibit differ- Furthermore, room-temperature composite can show an increase
ent cross-link density due to differences in the formation of their in DC up to 10% over time. This mechanism is unlikely to occur
polymer network. Cross-link density is associated with amplified with pre-heated composites, since a higher conversion is reached
mechanical properties and stability. Thus, conversion alone is immediately and so a further increase in the DC is dubious [13].
not enough for envisaging the performance of a resin composite
[9,11]. Five laboratory tests showed that DC was increased after Of the three papers studying polymerization shrinkage, the two
composite pre-heating. As the temperature rises, system viscosity found higher shrinkage in pre-heated resins. This conclusion was
is reduced, the mobility of the roots is boosted, and therefore ad- expected, as it has been detected that polymerization shrinkage
ditional polymerization and thus higher conversion is achieved. As increases correspondingly with the degree of conversion [5,10].
the heating continues, the additional free volume increases, giving However, one study showed no statistically important difference
increased mobility to the trailing roots, resulting in increased col- in shrinkage after 24h [7]. Despite the highest shrinkage that ap-

Citation: Nikolaos-Stefanos Kampanas. “Resin Composite Pre-Heating – A Literature Review of the Laboratory Results”. Acta Scientific Dental Sciences 3.1
(2019): 133-137.
Resin Composite Pre-Heating – A Literature Review of the Laboratory Results

136

pears to be present, it may not be clinically significant, as it can The above bibliographic review met two key constraints. Firstly,
be offset by a better marginal adaptation [5]. Indeed, the labora- the literature extent was limited. The number of studies that have
tory results concluded that preheating of resins composites leads assessed this issue is small, which, due to the fact that each study
to better marginal adaptation and lowers the total gap area [2,13]. dealt with a different combination of variables, resulted in fewer
This could be explained by the reduced viscosity of pre-heated res- research data for each variable. Therefore, in order to evaluate
ins, as confirmed by the laboratory tests [5,14,15]. As the tempera- the result of pre-heating for optimum clinical advantage, more tri-
ture rises, the flow capacity of the resin is improved, resulting in a als should be done, which will provide the necessary data for the
better adaptability to the walls of a cavity [2]. This is an important compilation of clinical studies and meta-analyzes [2]. Secondly,
finding, from a clinical point of view, since perfect sealing is crucial difficulties came up in comparing the results due to the different
to expand restoration longevity [13]. conditions under which each study was conducted. The heating
temperature, the isothermal or non-isothermal conditions, the
It would be expected that the better marginal adaptation of pre- polymerization time, the specimens’ thickness and the resin type
heated resins will be associated with a reduced microleakage. This were factors that varied between the studies. Some studies carried
is confirmed by one study [16]. Two studies resulted in the same out their trials under isothermal situation, maintaining the mate-
conclusion, but only when polymerization occurs immediately after rial temperature constant, which does not correspond in clinical
preheating [6] and only with the use of QTH lamp [17], respective- conditions. In the time since it is removed from the device until
ly. The first limitation could be explained by the fact that delaying polymerized, heated composite cools quickly. It is expected that
polymerization gives the time to the material to be removed from the material temperature reduces 50% after 2 min and 90% after
the walls due to viscoelastic behavior [6]. The second one happens 5 min. Consequently, the composite temperature when is photo-
probably due to the fact that the QTH lamp offers lower polymer- activated, is reduced to around 360C to 380C. Thus, it is essential
ization energy, which creates less shrinkage in the resin used in the to estimate the effect of preheating in non-isothermal conditions,
experiment [17]. The lesser microleakage is not confirmed by two simulating the realistic clinical scenario [9,12,13,19]. In addition,
studies [4,5]. This may be due to the non-isothermal conditions of the effect of preheating appears to vary from brand to brand and
the experiments, namely the abrupt drop in composite tempera- from shade to shade [8,9]. According to the above, in order to have
ture during placing [4]. However, these studies have concluded no more safely comparable results between surveys, in the future,
undesirable effect on microleakage. Thus, even if microleakage is laboratory tests should take place under similar conditions, using
not improved, it is at least not negatively affected [5]. a larger variety of resin composites.

Regarding the flexural strength of composite resins, studies Conclusion

have unanimously shown that it is not statistically significant dif- Within the limitations of this study, it is concluded that pre-
ferent in pre-heated composites [3,5,13]. In contrast, the results of heating of composite resins positively affects the degree of con-
three laboratory tests showed that pre-heating led to an increase version, viscosity, marginal adaptation and microhardness. The
in microhardness [8,14,15]. Τhis could be explained from the high- flexural strength remains unaffected, the polymerization shrink-
er rates of monomer conversion and the development of a highly age is adversely affected, while the results for the microleakage
crosslinked network. Contrary to these results, two studies have are unclear. However, in order to assess the clinical significance of
showed that temperature increase had no significant interference pre-heating, further studies with larger sample size and analogous
in microhardness values [11,18]. This effect can be attributed to experimental conditions are required
the fillers of resins used in these studies. Lower filler loading of
these materials may cannot give adequate support to the highly
Conflict of Interest
crosslinked network formed by pre-heating, in order to improve
The author declares no conflicts of interest.
microhardness.

Citation: Nikolaos-Stefanos Kampanas. “Resin Composite Pre-Heating – A Literature Review of the Laboratory Results”. Acta Scientific Dental Sciences 3.1
(2019): 133-137.
Resin Composite Pre-Heating – A Literature Review of the Laboratory Results

137

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Citation: Nikolaos-Stefanos Kampanas. “Resin Composite Pre-Heating – A Literature Review of the Laboratory Results”. Acta Scientific Dental Sciences 3.1
(2019): 133-137.