J Esthet Restor Dent - 2022 - Patussi - Preheating of Dental Composite Resins A Scoping Review

Received: 18 August 2022 Revised: 18 November 2022 Accepted: 21 November 2022
DOI: 10.1111/jerd.12991
REVIEW ARTICLE
Preheating of dental composite resins: A scoping review
Amanda F. C. Patussi DDS 1 | Juliana C. Ramacciato DDS, MSc, PhD 1 |

ria R. P. Nascimento DDS 2 |
João G. R. da Silva DDS 2 | Victo
Débora e Silva Campos DDS, MSc 3 | Isis de Araújo Ferreira Munizz DDS, MSc 3 |
Grace M. de Souza DDS, MSc, PhD 4 | Renally B. W. Lima DDS, MSc, PhD 2
1
Faculdade de Medicina e Odontologia São
Leopoldo Mandic, Campinas, Brazil Abstract
2
Faculdade Nova Esperança, João Pessoa, Objective: The aim of this scoping review was to analyze the available evidence on
Brazil
3
the preheating process and its effects on physicochemical properties of composite
Department of Restorative Dentistry,
Universidade Federal da Paraíba, João Pessoa, resins.
Brazil
Materials and Methods: A systematic search was performed in August 2021 using
4
Departament of Comprehensive Dentistry,
PubMed/Medline, Embase, Scopus, and ISI Web of Science databases and gray litera-
University Louisville, Louisville, Kentucky, USA
ture without language or date restriction. Inclusion criteria were in vitro studies that
Correspondence
assessed the physicochemical properties and marginal adaptation of preheated com-
Renally B. W. Lima, Faculdade Nova
Esperança, Av. Frei Galvão, 12 - Gramame, posite. Exclusion criteria were studies with experimental composite, literature
João Pessoa - PB, 58067-698, Brazil.
Email: [email protected]
reviews, clinical studies. Data from selected studies were qualitatively analyzed.
Results: In total, 104 studies were found from which 39 were included. The most
used composite resin was Filtek Z350 XT (3 M/ESPE), preheated at 68 C in a Calset
device (AdDent Inc., Danbury, CT, USA) for 5 or 15 min. Most studies showed
decreased viscosity, increased conversion degree and microhardness of composite
resins, and better marginal adaptation of direct and indirect restorations. Also, flex-
ural strength was not affected, and data about bond strength were inconclusive due
to heterogeneity among studies.
Conclusion: The parameters used for preheating composite resins are heteroge-
neous. Preheating decreased viscosity, increased the conversion degree and micro-
hardness of composite resins, and improved the marginal adaptation of direct and
indirect restorations.
Clinical Significance: The analysis of evidence showed a high heterogeneity among
preheating protocols. Preheating may benefit the handling and physicochemical prop-
erties of composite resins.
KEYWORDS
composite resin, conversion degree, marginal adaptation, microhardness, preheated composites,
review
1 | I N T RO DU CT I O N variations in the organic and inorganic matrix, which affect properties

such as consistency, surface finishing and opacity.1 For example, flow-
Composite resins (CR) are widely used for a variety of applications in able composite resins present lower percentage of inorganic filler and
direct and indirect restorations. The versatility of CR is due to greater amount of organic matrix than universal composites. Their
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PATUSSI ET AL. 647
organic matrix is also mainly constituted of low-molecular weight question was based on the PPC strategy (population, context, and con-
monomers such as triethylene glycoldimethacrylate (TEGDMA) and cept)32: “what is the effect of preheating on physicochemical properties
urethane dimethacrylate (UDMA). The proper ratio of low weight and marginal adaptation of CR in direct and indirect restorations?”
monomers and inorganic fillers results in a material with low viscos-
ity.2 In addition to variations in composition, alternative strategies
have been used to expand composite resin applicability, such as pre- 2.1 | Eligibility criteria
heating the material at a certain temperature range.
The preheating of conventional CR may enhance physicochemical Inclusion criteria were in vitro studies that assessed the physicochemi-
properties by increasing the conversion degree of monomers and the num- cal properties (viscosity, conversion degree, bond strength, flexural
ber of cross-linking in the polymer formation.3,4 Preheating also may strength, and microhardness) of preheated photoactivated CR and the
reduce CR viscosity, enabling its use as a luting agent. Additionally, marginal adaptation of direct and indirect restorations using pre-
increased flowability reduces the incorporation of air bubbles and facilitates heated light-cured CR. Exclusion criteria were studies with experimen-
the handling and adaptation of the material to cavity preparation walls.4–6 tal CR, letters to the editor, literature reviews, clinical studies, case
Preheated CR may be either used as direct restorative materials or reports, and studies that did not follow the recommendations of the
7,8
luting agents for indirect restorations. Superior mechanical perfor- manufacturer for CR use or handling.
mance, more color availability, higher filler content, lower polymerization
shrinkage stress and marginal degradation are some of the properties of
preheated CR when compared to resin cements commercially avail- 2.2 | Search strategy
9,10
able. Limitations are only related to cooling time, in which the temper-
ature decrease after preheating varies significantly among CR.11 PubMed/Medline, Embase, Scopus, and ISI web of science databases
There is only one material, CR VisCalor (Voco, Cuxhaven, were accessed in August 2021 without language or time restriction. Com-
Germany), that was developed to be used specifically with preheating. plementary searches were conducted in the OpenGrey, Google Scholar,
Overall, composite resins of regular viscosity and flowable composites and ProQuest databases. Two authors were previously calibrated for
have been used for the evaluation of preheating techniques. The study search and selection. The following keywords and text words were
response of different materials to preheating and their consequence used: “preheated composite resin,” “preheated composite,” “composite
clinical performance will vary according to the material's chemical com- resin preheating,” “preheated composites resin,” “preheated composites,”
position. Thus, dentists commonly do not have a clear criteria available “composites resin preheating,” “marginal adaptation,” “microhardness,”
for selecting conventional composite resin-based materials.12 “viscosity,” “conversion degree,” “flexural strength,” and “bond strength.”
Laboratory studies have been conducted to investigate the The following searches were conducted on each data-base: “pre-
impact of preheating on properties of CR. Nevertheless, results are heated composite resin” OR “preheated composite” OR “composite
controversial and often not conclusive. Some studies have reported resin preheating” OR “preheated composites resin” OR “ preheated
an increase in the degree of conversion, microhardness, flexural composites” OR “composites resin preheating” AND “marginal adapta-
strength, and marginal adaptation.13–17 In contrast, other studies tion” OR “microhardness” OR “ viscosity “ OR “ degree of conversion”
showed that those same properties were not improved.3,18–21 Fur- OR “flexural strength” OR “bond strength” using advanced option.
thermore, the proper preheating protocols investigated vary signifi-
cantly in terms of heating device, preheating time, and temperature.
Previous studies have used CR with different particle size (micro/ 2.3 | Study selection
nanohybrid or nanofilled), as well as, pre-heated device, such as the
Calset (AdDent Inc., Danbury, CT, USA),13,15,20,22–24 Hotset Titles and abstracts were included in the Mendeley reference manager
11,12
(Technolife, Joinville, SC, Brazil) and Ena Heat (Micerium SpA, to remove duplicates. The selected articles were exported to the
Avegno GE, Italy),21,25–30 using a large variation of time (10, 15 or Rayyan platform, and two authors independently read the titles and
30 min) and temperature (45 C, 55 C, or 68 C). abstracts to apply the eligibility criteria. Potential articles were fully
Thus, this scoping review aimed to assess the available evidence read for inclusion or exclusion. If there was any disagreement, it was
on preheating and their effects on physicochemical properties and resolved by consensus with a third author.
marginal adaptation of composite resin restorations.
2.4 | Data extraction

2 | MATERIALS AND METHODS
Two authors used a collection form to extract the most relevant
This scoping review was conducted and reported according to the Pre- methodological data from included studies. Main data were authors,
ferred Reporting Items for Systematic Review and Meta-Analyses year of the study, temperature, commercial brand of the CR and heat-
(PRISMA).31 The study protocol was registered in the Open Science ing device, physicochemical properties assessed, marginal adaptation
Framework (DOI number 10.17605/OSF.IO/NP74F). The research measurement, and main results.
648 PATUSSI ET AL.
FIGURE 1 PRISMA 2020 flow diagram summarizing identification and selection process
2.4.1 | Quality assessment 3 | RE SU LT S
The evaluation of the methodological quality of the included studies 3.1 | Study search and selection
was based on the previous systematic reviews of in vitro studies and
performed by two independent authors.33 If there was any disagree- Figure 1 shows the PRISMA search strategy. Of 104 articles found,
ment, then a third reviewer was consulted. The analysis verified 101 were from databases and 3 from the gray literature. The initial
whether studies reported randomization, sample size calculation, tem- screening removed 24 duplicates, and title and abstract analyses
perature, preheating time, information regarding measurements, sta- excluded 34 studies; 46 studies were selected for full-text reading.
tistical analysis, single operator, and operator blinding. If each specific From these studies, two were excluded for not meeting the inclusion
item was not mentioned in the methodology, then it was assigned criteria, and five were not available. The authors of unavailable full
“No”, if it was reported, it was assigned “Yes.” Then, each study was texts were contacted via e-mail but did not respond. Thus, 39 studies
classified based on the number of “Yes” into high (1–3), medium (4 or were considered eligible for the qualitative synthesis of this scoping
5), or low risk of bias (6–8). review.
2.4.2 | Data analysis 3.2 | Study characterization
A qualitative and detailed synthesis was conducted based on the out- Methodological aspects and main results are shown in Table 1. The
comes and data extracted from studies that met the inclusion criteria. included studies were published between 2007 and 2021. The
TABLE 1 Methodological data and main results
Physicochemical Marginal
Preheating property adaptation
PATUSSI ET AL.
Author CRa Temperature time Heating device assessedb measurementc Main results

Abdulmajed FBF and FSU 68 C 10 min HeatSync (Bioclear) FS and ME – Preheating the composite resin increased the values of the
et al., 202034 assessed properties for FBF.
Acquaviva VE 54 C – Calset (AdDentInc) DGC – An optimal conversion degree was achieved by preheating the
et al., 200928 light-activated composite.
Alvarado et al., EH 39 C to 30 s Ena Heat (Micerium) BS and MA SEM and CM The preheated composite resin presented lower bond strength
202035 55 C than resin cement. Preheated composite resin improved the
marginal adaptation for cementing indirect pieces.
Awliya, 200729 Z250 37 C – Calset (AdDentInc) MH – Microhardness increased proportionally according to
temperature, regardless of photoactivation.
Ayub et al., VLE, TCH, FSU, and 68 C 40 min Calset (AdDentInc) MH and VS – Preheating the composite resins increased microhardness and
201430 FLS decreased viscosity.
Calheiros et al., EX and HM 40 C and - Calset (AdDentInc) DGC and PS - Increasing the temperature of the composite resin increased the
201431 60 C conversion degree and polymerization stress.
Coelho et al., Z100, IED, and EO 69 C 5 min Hotset (Technolife) VS - Viscosity gradually decreased as temperature increased. The
201911 difference in viscosity between materials was smaller at 69 C.
D'Amario et al., HFO, HRI, and OP 45 C 12 min Ena Heat (Micerium) FS - Flexural strength was affected by the type of composite resin
201336 and the number of preheating cycles. A decrease in resistance
was observed with 40 cycles.
D'Amario et al., HFO, OP, and CXD 39 C 10 min Ena Heat (Micerium) FS, ME, and MH - Preheating up to 40 cycles did not affect the strength of
201521 composite resins.
Darabi et al., P60 and XTF 68 C – Calset (AdDent Inc) MA SEM Preheating decreased marginal cracks in both composite resins.
202032
Davari et al., P60 and Z250 37 C 30 min – BS – The increase in temperature to 37 C did not influence the bond
201437 strength for Z250. The P60 composite showed high bond
strength only at 37 C.
Deb et al., TPH, XRV, P60, 60 C - Calset (AdDent Inc) MA, FS, and PS SEM Preheating increased flowability and conversion degree of
201133 F2000, and WA composite resins but not to the level of flowable resins. A
higher conversion degree resulted in high linear
polymerization shrinkage, but flexural strength did not
change. Increasing the flowability of composite resins did not
decrease the incidence of marginal microleakage.
Demirbuga FSI and FSU 68 C – Calset (AdDent Inc) BS – Preheating composite resins increased microshear bond
et al., 201638 strength to dentin.
Dionysopoulos Z250 and GSO 37 C and – Ena Heat (Micerium) MH - Microhardness increased with the increase in composite
et al., 201539 55 C temperature.
El-Deeb et al., FLS 54 C and – Calset (AdDent Inc) BS – Resin preheating did not affect bond strength to dentin.
201522 68 C
(Continues)
649
TABLE 1 (Continued)
650

Elkaffass et al., Z350 68 C 5 min Therma-flo (Vista) MH – Preheating did not change microhardness.
20203
Elsayad, TCH 37 C, 54 C, 10 min Calset (AdDent Inc) MA SM Marginal adaptation improved at temperatures from 37 C to
200923 and 68 C 54 C. The temperature of 68 C deformed dental cusps and
did not improve marginal adaptation.
El-Korashy TCH 37 C, 54 C, 20 s and Calset (AdDent Inc) DGC, and PS - Preheating composite resin increased conversion degree and
et al., 201013 and 40 s shrinkage stress.
68 C
Fro
es-Salgado Z350 68 C - Calset (AdDent Inc) MA, DGC, and SEM Preheating did not increase the conversion degree and flexural
et al., 201024 FS strength. Better marginal adaptation of the material was
found when preheated, especially in the axial walls.
Kramer et al., TEC and FSU 37 C, 54 C, – Calset (AdDent Inc) FS – Preheated TEC showed higher flexural strength than the
201625 and 68 C unheated group (25 C). No difference in flexural strength
values for FSU was observed with increased temperature.
Lempel et al., Z250, FBF, EXP, 35 C and – Ena Heat (Micerium) DGC – Preheating positively affected the conversion degree of high
201940 FUF, SDR, and 55 C viscosity composite resins (especially at 55 C) and negatively
TSF affected the conversion degree of low viscosity resins.
Lohbauer et al., TEC 68 C 30 min – DGC and PS – Preheating the composite resins did not increase the conversion
200919 degree over time.
Loumprinis CMP, EE, FSU, GSO, 30 C, – – VS – Preheating reduced the viscosity of composite resins. Some
et al., 202141 VP, and VC 37 C, 45 C, commercial brands had similar viscosity to resin cement and
and flowable resins.
54 C
Lucey et al., TPH 60 C 15 min Dry oven VS and MH – Increasing the temperature decreased viscosity and increased
201014 the polymerization depth and microhardness.
Marcondes CD, IED, HRI, ES, 69 C 45 s Hotset (Technolife) VS – Preheating at 69 C reduced 47% to 92% of the viscosity of
et al., 202012 EO, Z100, Z350, composite resins compared to 37 C. Few composite resins
GR, TPH, and VC achieved the same flowability found in the resin cement and
flowable resins.
Mohammadi FSI and Z250 37 C and 15 min Thermostatically FS, ME, and MH – Preheating increased microhardness of Z250 and microhardness
et al., 201642 68 C controlled water and elastic modulus of FSI but did not affect their flexural
bath strength.
Mohammed Z350 and SF2 54 C 15 min Ena Heat (Micerium) MA DMC Cementing with resin cement provided better marginal
et al., 202043 adaptation than cementing with preheated composite resin or
sonic-activated composite. No difference was observed
between the last two techniques.
Mundim et al., TNC 60 C 30 s Calset (AdDent Inc) DGC – Preheating the composite resin increased the conversion
201026 degree, mainly at 60 C.
PATUSSI ET AL.
TABLE 1 (Continued)
PATUSSI ET AL.

Mutlu et al., HRI 55 C – Ena Heat (Micerium) BS – Preheated composites showed similar shear strength to resin
202044 cement and flowable resins.
Oskoee et al., Z250 and P90 55 C 12 min Water bath (Teledyne MA SM Gap formation at the gingival margins of Class V cavities
201745 Hanau) decreased due to preheating of both composite resins.
Sabatini et al., Z250 37 C, 5 min Calset (AdDent Inc) MA SEM No improvement was observed in the marginal adaptation of
201020 54.4 C, class II restorations after preheating.
and
68.8 C
Shahin et al., Z350 55 C – Ena Heat (Micerium) BS – Bond strength was high for the preheated composite resin
202146 before aging. However, no significant difference between
materials was observed after aging.
Sharafeddin Z250 and P90 45 C 15 min Incubator FS, and ME – The temperature of 45 C improved the properties of materials
et al., 201547 compared with 25 C. P60 showed a higher elastic modulus
than Z250 with increased temperature.
Tauböck et al., TEC, XTF, QF, and 68 C 5 min Calset (AdDent Inc) DGC and PS – Preheating the composite resin before light-curing reduced
201515 SF polymerization shrinkage stress without compromising
conversion degree.
Theobaldo SDR 54 C 1h Incubator Model DGC, MH, and – Preheating composite resin increased conversion degree and
et al., 201748 502 (Fanem) DP microhardness.
Theodoridis FSI and Z250 55 C – Ena Heat (Micerium) MH – Microhardness was higher for Z250 after preheating to 55 C.
et al., 201616
Thyab et al., GP, Z350, and TNC 40 C, 50 C, 40 min Foshan (Stardent) MH – Preheating increased the surface hardness of composite resins.
202017 and 60 C The temperature of 60 C was considered the most suitable.
Uctasli et al., GSO and Z250 40 C, 45 C, – EASE-IT FS and ME – No significant differences between the properties tested after
200818 and 50 C (Roving Dental) preheating.
Wagner et al., EX 54.4 C – Calset (AdDent Inc) MA OM Treatment with preheated composite effectively reduced
200827 microleakage at the cervical margins.
a
Brand names of composite resin materials cited: CD, Charisma Diamond (Kulzer); CMP, Clearfil Majesty Later (Kuraray); CXD, Ceram X Duo (Dentsply); EE, Ecosite Elements (DMG); EH, ENA HRi (Micerium);
EO, Omega Stelite (Tokuyama); ES, Essentia (GC); EX, Esthet-X (Dentsply); EXP, Ever X Later (GC); F2000, F2000 (3 M/ESPE); FBF, Filtek One Bulk Fill (3 M/ESPE); FLS, Filtek LS (3 M/ESPE); FSI, Filtek Silorane
(3 M/ESPE); FSU, Filtek Supreme XT (3 M/ESPE);FUF, Filtek Ultimate Flow(3 M/ESPE); GP, G-aenial Posterior (GC); GR, Gradia (GC); GSO, GrandioSO (VOCO); HFO, Enamel Plus HFO (Micerium); HM,
Heliomolar (Ivoclar Vivadent); HRI, Enamel Plus HRi (Micerium); IED, IPS Empress Direct (Ivoclar Vivadent); OP, Opallis (FGM); P60, Filtek P60 (3 M/ESPE); P90, Filtek P90 (3 M/ESPE); QF, QuixFil (Dentsply);
SDR, Surefil SDR (Dentsply); SF, SonicFill (Kerr); SF2, SonicFill 2 (Kerr); TCH, Tetric Ceram HB (Ivoclar Vivadent); TEC, Tetric EvoCeram (Ivoclar Vivadent); TNC, Tetric N-Ceram (Ivoclar Vivadent); TPH, TPH
Spectrum (Dentsply); TSF, Twinky Star Flow (VOCO); VC, VisCalor (VOCO); VE, Venus (Kulzer); VLE, Vit-l-escence (Ultradent); VP, Venus Pearl (Kulzer); WA, Wave (SDI); XRV, Herculitis XRV (Kerr); XTF, X-Tra
Fil (VOCO); Z100, Filtek Z100 (3 M/ESPE); Z250, Filtek Z250 XT (3 M/ESPE); Z350, Filtek Z350 XT (3 M/ESPE).
b
Physicochemical properties assessed: BS, bond strength; DGC, degree of conversion; DP, depth of polymerization; FS, flexural strength; MA, marginal adaptation; ME, modulus of elasticity; MH, microhardness;
PS, polymerization shrinkage; VS, viscosity.
c
Method for analysis of marginal adaptation: CM, confocal microscopy; DMC, digital microscopy; OM, optical microscopy; SEM, scanning electron microscopy; SM, stereomicroscopy.
651
652 PATUSSI ET AL.
preheating temperature ranged from 30 C to 69 C, and the predomi- Seven out of nine studies showed high conversion degree after
nant temperatures were 68 C5,13,15,22–24,27,35,36,38–40,43 (n = 13), preheating the CR,13,15,28,34,46–48 but two studies showed that pre-
37 C13,20,22,27,36,39,44,49,50 (n = 10), and 54 C13,23,24,34,39,44,46,49 (n = 8). heating did not increase the conversion degree.23,34 In most studies,
3,11,15,20
Preheating time varied significantly from 20 s to 1 h; 5 min increased temperature also increased microhardness of
(n = 4), 15 min13,29,36,41 (n = 4), and 10 min21,23,35 (n = 3) were the CR.3,14,16,17,21,27,34,36,40,44
most frequently reported. Microhardness3,14,16,17,21,27,34,36,40,44 The studies that assessed flexural strength18,21,24,26,36,39,41,42
(n = 10) was the most assessed property, followed by marginal adapta- (n = 9) also presented diverging results. Most authors (n = 6) did not
tion20,23–25,29,37,42,43,45 (n = 9), conversion degree13,15,19,24,28,34,46–48 find significant differences between preheated and unheated
(n = 9), and flexural strength18,21,24,26,35,36,39,41,42 (n = 9). Scanning CR,18,21,24,26,36,39 even in bulk-fill CR.34 In two studies, preheated CR
electron microscopy20,24,25,42,43 (n = 5) was the most used marginal showed higher flexural strength than those unheated, but these
adaptation measurement, followed by stereomicroscopy 23,45
(n = 2) results were material-dependent.41,42
and confocal microscopy 25
(n = 1), digital microscopy 29
(n = 1), and
optical microscopy37 (n = 1).
4 | DI SCU SSION
3.3 | Quality assessment Thirty-nine studies were included in this scoping review. Most of
them showed that physicochemical properties and marginal adapta-
Methodological quality assessment outcomes are shown in Table 2. All tion of CR were influenced by preheating in temperatures ranging
studies met the criteria for detailed information on measurements and from 30 C to 69 C. Overall, preheating decreased viscosity,
adequate statistical analysis. The parameters least described in increased the conversion degree and microhardness of CR, and
the methodology were operator blinding and sample size calculation. improved the marginal adaptation in direct and indirect restorations.
Most studies were classified as medium risk of In most of the studies, preheating did not affect the flexural
bias 3,11–15,17,19,21,24,26,29,30,36,37,39,41,45,46,48,50
(n = 21), followed by strength of CR. Only in two studies,41,42 flexural strength increased
low 16,20,23,25,27,28,33–35,39,43,47
(n = 13) and high risks 18,22,44,46,49
(n = 5). after preheating. Results regarding bond strength were heteroge-
neous, material-dependent, and inconclusive. Two studies38,50
showed increase in bond strength after preheating. Most of the
3.4 | Summary of results included studies evaluated the use of preheated CR for direct resto-
ration (n = 35), and only four manuscripts studied this resin as a lut-
Important methodological heterogeneity was found among included ing agent. Therefore, it was not possible to assess potential
studies, especially in terms of tested materials, preheating tempera- advantages of preheated CR for the cementation of indirect restora-
ture and time, types of heating device. The variability made it inappro- tions, an indication that the use of preheated CR in clinical practice
priate to carry out a meta-analysis. is not a common procedure.
CR preheated between 45 C and 69 C showed lower viscosity The data collected indicated heterogeneity among preheating
than unheated CR.2,40,49 Preheated CR showed similar or higher vis- protocols. However, some parameters were applied more frequently,
cosity than flowable CR.11,12 such as the brand of CR (Filtek Z350 XT/Filtek Supreme XT,
The methodology and results of marginal adaptation of preheated 3 M/ESPE), heating device Calset (AdDent Inc., Danbury, CT, USA),
CR were heterogeneous among the nine studies included. Of these, five temperature (68 C), and preheating time (5 and 15 min). The CR com-
studies assessed the marginal adaptation of direct class II restorations, position affects how the material reacts to a heating protocol, since
two assessed indirect restorations, and two assessed direct class V res- thermal conductivity can be affected by filler content, spatial arrange-
torations. Compared with the unheated group, preheating the CR at a ment of filler within the CR, and particle type, shape, and size.12,52,53
temperature between 37 C and 68 C improved marginal adaptation in Despite being less thermally conductive than the filler content, the
direct and indirect restorations in all studies.20,23–25,28,37,42,43,45 For one organic matrix may react more to preheating, increasing the mobility
study, thermoset CR resulted in worse marginal adaptation values com- of monomers, degree of conversion and decreasing viscosity of com-
pared to resin cement and flowable CR.29 posite resin.24,42
Of six studies that assessed bond strength using preheated CR, The heating device Calset (AdDent Inc., Danbury, CT, USA), intro-
four analyzed bonding to dentin,22,25,38,50 and two the bonding to lith- duced to the market in 1999, was developed to preheat dental mate-
ium disilicate ceramics.30,51 In two studies, preheated CR showed rials at 37 C, 54 C, or 60 C before placement in the cavity
38,50
higher bond strength to dentin than unheated CR, only one study preparation. The manufacturer recommends preheating for 30 s,
did not report significant differences.22 In addition, higher bond which is sufficient to significantly increase monomer conversion of
strength was reported between resin cement and indirect restoration light-activated composite resin prior to polymerization, as reported by
25
than between heated CR and indirect restoration. Two studies ana- Daronch et al.54 Some studies have evaluated the effect of repeated
lyzing bond strength to lithium disilicate reported similar values when heating of the composite resin on their physical properties. They
preheated CR, resin cement and flowable CR were compared.30,51 observed no detrimental effect on flexural strength,26 but some color
PATUSSI ET AL. 653
TABLE 2 Risk of bias classification
Detailed
Sample information Proper
size Time of regarding statistical Single Operator Risk
Author Randomization calculation Temperature heating measurements analysis operator blinded of bias
Abdulmajed et al., 202034 Yes Yes Yes Yes Yes Yes Yes Yes Low
Acquaviva et al., 200928 No No Yes No Yes Yes No No High
35
Alvarado et al., 2020 Yes Yes Yes Yes Yes Yes Yes Yes Low
Awliya, 200729 No No Yes No Yes Yes No No High
30
Ayub et al., 2014 No No Yes Yes Yes Yes Yes No Medium
Calheiros et al., 201431 Yes No Yes No Yes Yes Yes No Medium
11
Coelho et al., 2019 Yes No Yes Yes Yes Yes No No Medium
D'Amario et al., 201336 No No Yes Yes Yes Yes No No Medium
21
D'Amario et al., 2015 No No Yes Yes Yes Yes No No Medium
Darabi et al., 202032 Yes Yes Yes Yes Yes Yes Yes Yes Low
37
Davari et al., 2014 Yes No Yes Yes Yes Yes No No Medium
Deb et al., 201133 Yes No Yes No Yes Yes No No Medium
38
Demirbuga et al., 2016 Yes No Yes No Yes Yes No No Medium
Dionysopoulos et al., 201539 Yes Yes Yes Yes Yes Yes Yes No Low
22
El-Deeb et al., 2015 No No Yes No Yes Yes No No High
Elkaffass et al., 20203 No No Yes Yes Yes Yes No No Medium
23
Elsayad, 2009 Yes Yes Yes Yes Yes Yes Yes Yes Low
El-Korashy et al., 201013 No No Yes Yes Yes Yes Yes No Medium
es-Salgado et al., 2010
Fro 24
Yes No Yes No Yes Yes Yes No Medium
Kramer et al., 201625 Yes No Yes No Yes Yes Yes Yes Low
40
Lempel et al., 2019 Yes Yes Yes Yes Yes Yes Yes No Low
Lohbauer et al., 200919 No No Yes Yes Yes Yes No No Medium
41
Loumprinis et al., 2021 No No Yes No Yes Yes No No High
Lucey et al., 201014 No No Yes Yes Yes Yes Yes No Medium
12
Marcondes et al., 2020 Yes No Yes Yes Yes Yes No No Medium
Mohammadi et al., 201642 No No Yes Yes Yes Yes No No Medium
43
Mohammed et al., 2020 No No Yes Yes Yes Yes No No Medium
Mundim et al., 201026 Yes No Yes Yes Yes Yes Yes No Low
44
Mutlu et al., 2020 Yes No Yes No Yes Yes No No Medium
Oskoee et al., 201745 Yes No Yes Yes Yes Yes No No Medium
20
Sabatini et al., 2010 Yes No Yes Yes Yes Yes Yes Yes Low
Shahin et al., 202146 Yes Yes Yes No Yes Yes No Yes Low
47
Sharafeddin et al., 2015 No No Yes Yes Yes Yes No No Medium
Tauböck et al., 201515 No No Yes Yes Yes Yes No No Medium
48
Theobaldo et al., 2017 Yes No Yes Yes Yes Yes Yes No Low
Theodoridis et al., 201616 Yes Yes Yes Yes Yes Yes Yes No Low
17
Thyab et al., 2020 No No Yes Yes Yes Yes No No Medium
Uctasli et al., 200818 No No Yes No Yes Yes No No High
27
Wagner et al., 2008 Yes No Yes No Yes Yes Yes Yes Low
change was observed.55 Another study reported that the re-heating mobility of a CR. In most of the studies, CR viscosity decreased after
56
of unused composite might not affect its degree of conversion. preheating,2,6,10,27,49 due to thermal agitation of monomers and high
The effect of preheating on viscosity depends on CR composition molecular movement.24,42 Thermal energy forces monomers of the
11
and commercial brand. Viscosity determines the degree of molecular matrix further apart and allow them to slide beside each other more
654 PATUSSI ET AL.
easily, which lowers the internal friction.37 Some studies reported that the real impact of elevated temperatures on polymerization shrinkage
preheated CR failed to reach flowability and marginal adaptation simi- and its critical clinical consequences.
25,29,55
lar to resin cements and flowable CR, probably because of the This scoping review showed that the success of preheated CR res-
higher filler content in CR composition. torations relies on several factors, such as composite resin composition,
In general, the viscosity increased with increasing filler volume temperature, and heating time. The heterogeneity among results and
fraction.57 Most studies showed that increased flowability improved preheating protocols hindered formulating an effective and adequate
marginal adaptation due to better contact with the substrate sur- protocol. Most studies showed a medium risk of bias in the methodo-
face.23–25,27,29,37,42,43,55 Less viscosity after preheating may also logical quality analysis, while operator blinding and sample size calcula-
enhance the penetration of CR in micro-retentive areas of the sub- tion parameters were the least cited. Also, this review included only
strate, improving adhesion between CR, enamel, dentin, and restor- in vitro studies since the literature lacks clinical studies. Thus, clinical
50,58 25,30,51
ative material and bonding of indirect restorations. studies are needed to provide new information, confirm our results,
However, a rapid reduction in temperature when the CR is removed and standardize an effective and safe preheating protocol.
from the heating device can immediately increase viscosity.54 A study
showed that clinicians have between 10 and 15 s of working time
with preheated CR before significant changes in temperature and vis- 5 | CONC LU SION
cosity occur.12
As previously mentioned, some included studies reported pre- Within the limitations of this scoping review of in vitro studies, it was
heating composite resins for the cementation of indirect restora- possible to conclude that:
25,29,30,51
tions. Using heated light-activated composites as a luting
agent seems to be easier than resin cement, because resin composites 1. Preheating parameters (e.g., temperature, preheating time, and
maximize the range of shades available. Also, preheating appears to composite resin composition) are still heterogeneous, hindering
reduce cement line thickness and increase the degree of conversion the standardization of a preheating protocol for CR.
59,60
of composites resin. Overall, the few studies included on the topic 2. Most studies revealed that preheating decreased viscosity,
indicated that preheating composite resin may be more recommended increased conversion degree and microhardness of CR, and
for the cementation of indirect restorations not exceeding a 2-mm improved the marginal adaptation in direct and indirect restorations.
thickness over to dual-cured resin cements. 3. The included studies presented high methodological heterogene-
Increased conversion degree and microhardness were reported for ity, which hindered the quantitative analysis of results reported.
most preheated CR3,13–17,21,27,28,34,36,40,44,46–48 without any significant 4. Methodological quality assessment outcomes showed moderate
effect on flexural strength.18,21,24,26,35,36,39 Temperature is important evidence from included studies, since they were in vitro studies
for the polymerization of dimethacrylate monomers.56,61 The polymeri- and presented medium risk of bias.
zation rate of CR is accelerated by the Trommsdorf effect, which is a
decrease in the mobility of monomeric radicals due to an increase in
the material viscosity.61 Elevated temperatures increase radical mobil- ACKNOWLEDGMENTS AND DISCLOSURE
ity, resulting in additional polymerization before self-deceleration,
which enhances conversion degree.62,63 The higher incidence of cross- The authors would like to gratefully thank to all authors of included
linking this leads to better physicochemical properties.48,54,56,64,65 studies for providing the data for qualitative analyses. The authors do
Volumetric shrinkage of composites resin was not one of the not have any financial interest in the companies whose materials are
properties assessed by this scoping review. Studies have reported that included in this article.
13,19,42
polymerization shrinkage increases as temperature increases.
This may be attributed to a rapid stress buildup within the composite DATA AVAILABILITY STAT EMEN T
due to a faster rate of polymerization as a result of preheating and The data that support the findings of this study are available from the
rapidly reaching the gel point. Moreover, the higher degree of conver- corresponding author upon reasonable request.
sion due to preheating leads to an increase in volumetric shrinkage
and elastic modulus of the material.66–69 Another study demonstrated OR CID
that increasing composite resin temperature allows lower polymeriza-
tion stress while maintaining or increasing the degree of conversion.48 Grace M. de Souza https://orcid.org/0000-0002-7521-9723
This lower polymerization stress will happen if the reduction in viscos- Renally B. W. Lima https://orcid.org/0000-0003-4477-7850
ity due to heating would allow for increased viscous flow and chain
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Received: 18 August 2022 Revised: 18 November 2022 Accepted: 21 November 2022

Preheating of dental composite resins: A scoping review

Amanda F. C. Patussi DDS 1 | Juliana C. Ramacciato DDS, MSc, PhD 1 |

1 | I N T RO DU CT I O N variations in the organic and inorganic matrix, which affect properties

2.4 | Data extraction

2.4.1 | Quality assessment 3 | RE SU LT S

2.4.2 | Data analysis 3.2 | Study characterization

TABLE 2 Risk of bias classification

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