The Effect of Gravity on Marginal Integrity of Different Flowable Bulk-Fill Resin Composites

Background and Objectives: The aim of this quantitative research was to investigate the effect of gravitational forces on the marginal integrity of different bulk-fill composites by micro-CT imaging. Materials and Methods: Fifty caries-free human third molars extracted for prophylactic purposes were used in this study. Each tooth was prepared with two proximal box cavities, with dimensions of 3 mm × 3 mm × 5 mm. Five distinct groups, each comprising 20 cavities, thus totaling 100 cavities for this study: (1, Group CON): Clearfil Majesty Flow + Clearfil Majesty Esthetic (as the control); (2, Group FBR): Filtek Bulk-fill Flowable Restorative + Clearfil Majesty Esthetic; (3, Group XTB): Voco Extrabase + Clearfil Majesty Esthetic; (4, Group SDR): SDR + Clearfil Majesty Esthetic; and (5, Group SNC): Sonicfill. When restoring the mesial cavities, the occlusal surfaces of the teeth in the mold were positioned upwards, counteracting the force of gravity. In contrast, for the restoration of the distal cavities, the occlusal surfaces were aligned downwards, to be parallel with the gravitational pull. After restorative procedures, each tooth was treated with 5000 thermal cycles. A solution of ammoniacal silver nitrate (AgNO₃) was employed as a tracing agent. The micro-CT scans were conducted and the total volume of silver nitrate and the total volume of restorations within the relevant region of interest were calculated in "mm³" with software. Two-way ANOVA and Tukey tests were performed at a significance level of p = 0.05 with Graphpad Prism v 8.2.1 software. Results: Both gravity effect and interaction showed no statistical differences (p > 0.05). Statistically significant differences were observed in the restorative materials (p < 0.05). Conclusions: Gravitational forces do not emerge as a major factor affecting the marginal integrity of flowable bulk-fill composites in class II restorations. The chemical composition of the composites plays a more crucial role, with the XTB composite showing higher microleakage ratios compared to the others.