Purpose

A systematic review was conducted to determine whether there were any alternative technique or additional step strategies available to reduce and control polymerization shrinkage stress development in dental resin-based restorative materials.

Data sources

This report followed the PRISMA Statement. A total of 36 studies were included in this review. Two reviewers performed a literature search up to December 2016, without restriction of the year of publication, in seven databases: PubMed, Web of Science, Scopus, SciELO, LILACS, IBECS, and BBO.

Study selection

Only in vitro studies that evaluated polymerization shrinkage stress by direct testing were included. Pilot studies, reviews and in vitro studies that evaluated polymerization shrinkage stress by indirect methods (e.g., microleakage or cuspal deflection measurements), finite elemental analysis or mathematical models were excluded. Of the 6.113 eligible articles, 36 studies were included in the qualitative analysis, and the meta-analysis was performed with 25 studies. A global comparison was performed with random-effects models (α = 0.05). The strategies were subdivided as follows: the use of an alternative technique protocol of placing the material inside the tooth cavity; the modification of the irradiation intensity or total energy delivered to the material; the use of an alternative light-curing source; or the use of an alternative photo-activation mode. All alternative strategies showed statistically significant differences when compared with their respective controls (p < 0.05).

Conclusion

The use of alternative light-curing sources contributed more to minimizing stress development than placing the material by means of an alternative technique protocol or by modifying the irradiant intensity or total energy delivered to the material during photo-activation. Moreover, the use of an alternative photo-activation mode (intermittent light, exponential, soft-start or pulse delay modes) was shown to be an effective strategy for reducing and controlling stress development in resin-based dental materials.

中文翻译：

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树脂基牙科材料的聚合收缩应力：技术方案和光活化策略的系统综述和荟萃分析

目的

进行了系统的评估，以确定在牙科树脂基修复材料中是否有其他替代技术或其他步骤策略可用于减少和控制聚合收缩应力的发展。

数据源

该报告遵循PRISMA声明。该评价共纳入36项研究。截止到2016年12月，两名审稿人在七个数据库中进行了文献检索，不受出版年份的限制：PubMed，Web of Science，Scopus，SciELO，LILACS，IBECS和BBO。

研究选择

仅包括通过直接测试评估聚合收缩应力的体外研究。排除了通过间接方法（例如，微渗漏或骨挠度测量），有限元分析或数学模型评估聚合收缩应力的试验研究，综述和体外研究。在6.113篇符合条件的文章中，定性分析包括36项研究，并且对25项研究进行了荟萃分析。使用随机效应模型（α= 0.05）进行全局比较。这些策略细分如下：使用另一种技术方案将材料放置在牙齿腔内；改变辐照强度或传递给材料的总能量；使用替代的光固化光源；或使用其他的光激活模式。与其他对照相比，所有其他策略均显示出统计学上的显着差异（p <0.05）。

结论

与通过替代技术方案放置材料或通过更改光活化过程中传递给材料的辐照强度或总能量来放置材料相比，使用替代性光固化源在最大程度地减少应力发展方面起到了更大的作用。此外，使用替代的光活化模式（间歇光，指数，软启动或脉冲延迟模式）被证明是减少和控制树脂基牙科材料应力发展的有效策略。