{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:37:48Z","timestamp":1793317068724,"version":"4.5.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002386","name":"Cairo University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002386","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Oral Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study assessed the fracture resistance of upper premolars based on the placement technique of giomer restoration in MOD cavities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Seventy sound maxillary premolars were divided into five groups (n=14). A standardized MOD cavity was prepared in each tooth (2 mm buccolingual width, 2\u00b10.2 mm central floor depth, and 4\u00b10.2 mm proximal depth).<\/jats:p>\n                    <jats:p>Teeth were assigned to four experimental groups: Group I received Packable material (Beautifil II LS, Shofu Inc, Japan) applied in 2mm increments; Group II received Injectable material (Beautifil Flow Plus X, Shofu); Group III received a packable bulk-fill variant (Beautifil-Bulk Restorative Packable); and Group IV received flowable bulk-fill material (Beautifil-Bulk Flowable, Shofu), each followed by a 2mm occlusal capping layer. A fifth group of intact premolars served as the control.<\/jats:p>\n                    <jats:p>All specimens were embedded in self-cure acrylic resin blocks with simulated periodontal ligaments at temperatures ranging from 5 to 55\u00b0C, utilizing a thermocycling machine (SD Mechatronic Thermocycler, Germany). Fracture resistance was assessed using a universal testing machine (Instron 3345 Series, UK) at 1 mm\/min crosshead speed. Data were analyzed using One-way ANOVA, followed by Tukey\u2019s post hoc test. The level of statistical significance was set at p&lt;0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The results indicated a significant difference in fracture resistance across groups (p&lt;0.001). The control group exhibited the highest strength (935.12\u00b1114.52 N), followed by the Packable (926.79\u00b1229.36 N) and Injectable groups (923.29\u00b1110.28 N), with no significant differences. In contrast, the Bulk-Restorative and Bulk-Flowable groups had the lowest strengths (684.20\u00b1163.60 N and 616.08\u00b1132.54 N, respectively). Post hoc comparison showed significantly lower fracture resistance values in the bulk-restorative and bulk-flowable groups (p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Incremental placement of packable or injectable giomers restored fracture resistance to levels comparable to sound teeth, while bulk-fill techniques yielded inferior outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical significance<\/jats:title>\n                    <jats:p>Clinicians frequently opt for bulk-fill restorative materials due to their efficiency and user-friendliness compared to traditional incremental layering techniques. However, evidence regarding the fracture resistance of giomers placed via different techniques remains limited. Injectable giomers represent a viable alternative, offering superior handling and precise adaptation while maintaining favorable mechanical properties. This study provides critical insights into optimizing placement strategies to balance clinical efficiency and biomechanical performance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-025-06790-w","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T13:53:00Z","timestamp":1758289980000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Influence of filling technique on fracture resistance of giomer-restored MOD-cavities"],"prefix":"10.1186","volume":"25","author":[{"given":"Ahmed","family":"Saad Naser","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dena","family":"Safwat Mustafa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7178-1065","authenticated-orcid":false,"given":"Dina","family":"Ezzeldin Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"6790_CR1","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1016\/j.dental.2023.10.009","volume":"39","author":"U Josic","year":"2023","unstructured":"Josic U, D\u2019Alessandro C, Miletic V, Maravic T, Mazzitelli C, Jacimovic J, et al. Clinical longevity of direct and indirect posterior resin composite restorations: an updated systematic review and meta-analysis. Dent Mater. 2023;39:1085\u201394.","journal-title":"Dent Mater"},{"key":"6790_CR2","doi-asserted-by":"publisher","DOI":"10.1016\/J.IDENTJ.2024.06.012","author":"A Lehmann","year":"2024","unstructured":"Lehmann A, Nijakowski K, Jankowski J, Donnermeyer D, Ramos JC, Drobac M, et al. Clinical difficulties related to direct composite restorations: A multinational survey. Int Dent J. 2024. https:\/\/doi.org\/10.1016\/J.IDENTJ.2024.06.012.","journal-title":"Int Dent J"},{"key":"6790_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jdent.2016.08.003","volume":"54","author":"AMA da Veiga","year":"2016","unstructured":"da Veiga AMA, Cunha AC, Ferreira DMTP, da Silva Fidalgo TK, Chianca TK, Reis KR, et al. Longevity of direct and indirect resin composite restorations in permanent posterior teeth: A systematic review and meta-analysis. J Dent. 2016;54:1\u201312.","journal-title":"J Dent"},{"key":"6790_CR4","doi-asserted-by":"crossref","unstructured":"Pizzolotto L, Moraes RR. Resin composites in posterior teeth: clinical performance and direct restorative techniques. Dent J. 2022;10(12):222.","DOI":"10.3390\/dj10120222"},{"key":"6790_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.dental.2022.11.009","volume":"39","author":"FF Demarco","year":"2023","unstructured":"Demarco FF, Cenci MS, Montagner AF, de Lima VP, Correa MB, Moraes RR, et al. Longevity of composite restorations is definitely not only about materials. Dent Mater. 2023;39:1\u201312.","journal-title":"Dent Mater"},{"key":"6790_CR6","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1007\/s10266-023-00829-6","volume":"112","author":"RA Abdelfattah","year":"2024","unstructured":"Abdelfattah RA, Nawar NN, Kataia EM, Saber SM. How loss of tooth structure impacts the Biomechanical behavior of a single-rooted maxillary premolar: FEA. Odontology. 2024;112:279\u201386.","journal-title":"Odontology"},{"key":"6790_CR7","first-page":"99","volume":"25","author":"P Magne","year":"2023","unstructured":"Magne P, Milani T. Short-fiber reinforced MOD restorations of molars with severely undermined cusps. J Adhes Dent. 2023;25:99\u2013106.","journal-title":"J Adhes Dent"},{"key":"6790_CR8","doi-asserted-by":"crossref","unstructured":"Tsertsidou V, Mourouzis P, Dionysopoulos D, Pandoleon P, Tolidis K. Fracture resistance of class II MOD cavities restored by direct and indirect techniques and different materials combination. Polymers. 2023;15(16):3413.","DOI":"10.3390\/polym15163413"},{"key":"6790_CR9","doi-asserted-by":"publisher","first-page":"105","DOI":"10.21608\/asdj.2024.290204.1285","volume":"35","author":"MB Bertie","year":"2024","unstructured":"Bertie MB, Kamel MA, Niazi HAA. Effect of various types, placement techniques and aging of composite resin on the fracture resistance of upper premolars. Ain Shams Dent J. 2024;35:105\u201314.","journal-title":"Ain Shams Dent J"},{"key":"6790_CR10","doi-asserted-by":"publisher","first-page":"2281","DOI":"10.1007\/s00784-021-04337-1","volume":"26","author":"PVM Kunz","year":"2022","unstructured":"Kunz PVM, Wambier LM, Kaizer M da, Correr R, Reis GM, Gonzaga A. Is the clinical performance of composite resin restorations in posterior teeth similar if restored with incremental or bulk-filling techniques? A systematic review and meta-analysis. Clin Oral Investig. 2022;26:2281\u201397.","journal-title":"Clin Oral Investig"},{"key":"6790_CR11","doi-asserted-by":"crossref","unstructured":"Ferracane JL. A historical perspective on dental composite restorative materials.\u00a0J Funct Biomater. 2024;15(7):173.","DOI":"10.3390\/jfb15070173"},{"key":"6790_CR12","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1016\/j.dental.2005.04.018","volume":"21","author":"RR Braga","year":"2005","unstructured":"Braga RR, Ballester RY, Ferracane JL. Factors involved in the development of polymerization shrinkage stress in resin-composites: a systematic review. Dent Mater. 2005;21:962\u201370.","journal-title":"Dent Mater"},{"key":"6790_CR13","doi-asserted-by":"publisher","first-page":"3085","DOI":"10.21608\/edj.2023.218074.2606","volume":"69","author":"F Ahmed","year":"2023","unstructured":"Ahmed F, Safwat Mustafa D. Effect of cavity optimization on the fracture resistance of Inlay-Restored molars (An In-Vitro Study). Egypt Dent J. 2023;69:3085\u201393.","journal-title":"Egypt Dent J"},{"key":"6790_CR14","doi-asserted-by":"publisher","first-page":"1991","DOI":"10.1007\/s00784-013-1177-y","volume":"18","author":"S Bucuta","year":"2014","unstructured":"Bucuta S, Ilie N. Light transmittance and micro-mechanical properties of bulk fill vs. conventional resin based composites. Clin Oral Investig. 2014;18:1991\u20132000.","journal-title":"Clin Oral Investig"},{"key":"6790_CR15","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1016\/j.jdent.2015.04.009","volume":"43","author":"N Ilie","year":"2015","unstructured":"Ilie N, Fleming GJP. In vitro comparison of polymerisation kinetics and the micro-mechanical properties of low and high viscosity Giomers and RBC materials. J Dent. 2015;43:814\u201322.","journal-title":"J Dent"},{"key":"6790_CR16","doi-asserted-by":"crossref","unstructured":"Arbildo-Vega HI, Lapinska B, Panda S, Lamas-Lara C, Khan AS, Lukomska-Szymanska M. Clinical effectiveness of bulk-fill and conventional resin composite restorations: systematic review and meta-analysis. Polymers. 2020;12(8):1786.","DOI":"10.3390\/polym12081786"},{"key":"6790_CR17","doi-asserted-by":"publisher","first-page":"e43310313413","DOI":"10.33448\/rsd-v10i3.13413","volume":"10","author":"A Rodrigo","year":"2021","unstructured":"Rodrigo A, Da Silva J, Feitosa VG, Pereira R, Muniz D, Alves MC, et al. Mechanical properties of composites with bioactive technology giomer: a literature review. Res Soc Dev. 2021;10:e43310313413\u201343310313413.","journal-title":"Res Soc Dev"},{"key":"6790_CR18","doi-asserted-by":"crossref","unstructured":"Al-Ibraheemi ZA, Abdullah HA, Jawad NA, Haider J. Assessing fracture resistance of restored premolars with novel composite materials: an in vitro study. Int J Dent . 2021;2021(1):5512708.","DOI":"10.1155\/2021\/5512708"},{"key":"6790_CR19","doi-asserted-by":"publisher","first-page":"360","DOI":"10.4103\/JCD.JCD_198_17","volume":"20","author":"V Hegde","year":"2017","unstructured":"Hegde V, Sali A. Fracture resistance of posterior teeth restored with high-viscosity bulk-fill resin composites in comparison to the incremental placement technique. J Conserv Dent. 2017;20:360\u20134.","journal-title":"J Conserv Dent"},{"key":"6790_CR20","doi-asserted-by":"publisher","first-page":"175","DOI":"10.3758\/BF03193146","volume":"39","author":"F Faul","year":"2007","unstructured":"Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175\u201391.","journal-title":"Behav Res Methods"},{"key":"6790_CR21","doi-asserted-by":"publisher","first-page":"1903","DOI":"10.21608\/edj.2020.33292.1151","volume":"66","author":"D Al-Sherbini","year":"2020","unstructured":"Al-Sherbini D, Hamza H, Aly A. Fracture resistance of premolars restored with bulk fill resin composite versus incrementally packed resin composite: in vitro study. Egypt Dent J. 2020;66:1903\u201313.","journal-title":"Egypt Dent J"},{"key":"6790_CR22","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1590\/S1806-83242005000100003","volume":"19","author":"CJ Soares","year":"2005","unstructured":"Soares CJ, Pizi ECG, Fonseca RB, Martins LRM. Influence of root embedment material and periodontal ligament simulation on fracture resistance tests. Braz Oral Res. 2005;19:11\u20136.","journal-title":"Braz Oral Res"},{"key":"6790_CR23","first-page":"281","volume":"35","author":"CJ Soares","year":"2004","unstructured":"Soares CJ, Martins LRM, Pfeifer JMGA, Giannini M. Fracture resistance of teeth restored with indirect-composite and ceramic inlay systems. Quintessence Int. 2004;35:281\u20136.","journal-title":"Quintessence Int"},{"key":"6790_CR24","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing. 2023."},{"key":"6790_CR25","doi-asserted-by":"crossref","unstructured":"Moosavi H, Zeynali M, Pour ZH. Fracture resistance of premolars restored by various types and placement techniques of resin composites. Int J Dent. 2012;2012(1):973641.","DOI":"10.1155\/2012\/973641"},{"key":"6790_CR26","first-page":"503","volume":"22","author":"LC Martins","year":"2020","unstructured":"Martins LC, Oliveira LRS, Braga SSL, Soares CJ, Versluis A, Borges GA, et al. Effect of composite resin and restorative technique on polymerization shrinkage stress, cuspal strain and fracture load of weakened premolars. J Adhes Dent. 2020;22:503\u201314.","journal-title":"J Adhes Dent"},{"key":"6790_CR27","doi-asserted-by":"publisher","first-page":"130","DOI":"10.4103\/ijds.ijds_129_22","volume":"15","author":"S Goyal","year":"2023","unstructured":"Goyal S, Choudhary M, Jindal N, Aggarwal R. An in vitro comparative evaluation of the fracture resistance of teeth with Mesio-Occluso-Distal preparations restored with different esthetic materials by Bulk-Fill and incremental methods. Indian J Dent Sci. 2023;15:130\u20135.","journal-title":"Indian J Dent Sci"},{"key":"6790_CR28","first-page":"389","volume":"15","author":"PHP Dalpino","year":"2002","unstructured":"Dalpino PHP, Francischone CE, Ishikiriama A, Franco EB. Fracture resistance of teeth directly and indirectly restored with composite resin and indirectly restored with ceramic materials. Am J Dent. 2002;15:389\u201394.","journal-title":"Am J Dent"},{"key":"6790_CR29","doi-asserted-by":"crossref","unstructured":"Basheer RR, Hasanain FA, Abuelenain DA. Evaluating flexure properties, hardness, roughness and microleakage of high-strength injectable dental composite: an in vitro study. BMC Oral Health. 2024;24(1):546.","DOI":"10.1186\/s12903-024-04333-3"},{"key":"6790_CR30","doi-asserted-by":"publisher","first-page":"153","DOI":"10.5114\/jos.2024.143582","volume":"77","author":"PM Gerges","year":"2024","unstructured":"Gerges PM, Labib ME, Nabih SM, Moussa M. Fracture resistance of injectable resin composite versus packable resin composite in class II cavities: an in vitro study. J Stomatology. 2024;77:153\u201360.","journal-title":"J Stomatology"},{"key":"6790_CR31","doi-asserted-by":"publisher","first-page":"205","DOI":"10.4012\/dmj.2016-131","volume":"36","author":"A Tsujimoto","year":"2017","unstructured":"Tsujimoto A, Barkmeier WW, Takamizawa T, Latta MA, Miyazaki M. Depth of cure, flexural properties and volumetric shrinkage of low and high viscosity bulk-fill Giomers and resin composites. Dent Mater J. 2017;36:205\u201313.","journal-title":"Dent Mater J"},{"key":"6790_CR32","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1016\/j.dental.2018.05.002","volume":"34","author":"CAK Shimokawa","year":"2018","unstructured":"Shimokawa CAK, Turbino ML, Giannini M, Braga RR, Price RB. Effect of light curing units on the polymerization of bulk fill resin-based composites. Dent Mater. 2018;34:1211\u201321.","journal-title":"Dent Mater"},{"key":"6790_CR33","first-page":"4021","volume":"12","author":"LC Burtea","year":"2019","unstructured":"Burtea LC, Prejmerean C, Prodan D, Baldea I, Vlassa M, Filip M, et al. New Pre-reacted Glass Containing Dental Composites (giomers) with Improved Fluoride Release and Biocompatibility. Materials 2019. 2019;12:4021.","journal-title":"Materials 2019"},{"key":"6790_CR34","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/j.dental.2019.01.020","volume":"35","author":"J Hayashi","year":"2019","unstructured":"Hayashi J, Espigares J, Takagaki T, Shimada Y, Tagami J, Numata T, et al. Real-time in-depth imaging of gap formation in bulk-fill resin composites. Dent Mater. 2019;35:585\u201396.","journal-title":"Dent Mater"}],"container-title":["BMC Oral Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-025-06790-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12903-025-06790-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-025-06790-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T13:53:07Z","timestamp":1758289987000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcoralhealth.biomedcentral.com\/articles\/10.1186\/s12903-025-06790-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,19]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6790"],"URL":"https:\/\/doi.org\/10.1186\/s12903-025-06790-w","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-5714699\/v1","asserted-by":"object"}]},"ISSN":["1472-6831"],"issn-type":[{"value":"1472-6831","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,19]]},"assertion":[{"value":"26 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"For In-Vitro Study: Ethical approval for the use of Extracted Teeth.\u201cEthics Committee at Faculty of Dentistry, Ain Shams University, Cairo, Egypt\u201d. Verify the review process and acceptance with a number. (FDASU-Rec EM072411)","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1415"}}