Case Presentations Using X-Tra Fil Composite
Kaitlin C. Small, DMD
A new posterior direct composite has been introduced that has advantages over other available materials. This case report will discuss the uses of this light-cured posterior composite, X-tra fil by VOCO America, Inc.
In the dental literature there has been a difference of opinion about whether or not to bulk fill or layer a direct composite. Quellet1 has tested both methods and stated that, “Contemporary adhesive and composite technology now allow for bulk filling or directed shrinkage techniques.” More recently Loquercio2 et al reported that there was no difference in polymerization shrinkage between one, two, or three increments. In some cases where speed is important (pediatric and geriatric patients) bulk filling may be an advantage when compared to amalgam placement or layering of the resin. One of the advantages of X-tra fil is that it can be bulk filled and consequently economical with a savings in time. Fleming3 et al recently tested the properties of X-tra fil after a curing of 4 mm. They found that in terms of flexural strength, water uptake, and biocompatibility, X-tra fil performed analogously to conventional resin-based composites. This decreases the time each restoration takes by half because of the ability to bulk fill. It also has a low shrinkage of 1.7% through a multi-hybrid filler technology. In addition, it has great wear resistance because it is 87% filled by weight. Lastly, it has one universal shade that truly has a chameleon effect for good esthetics.
The following are three cases in which X-tra fil has been used.
A 13-year-old presented with occlusal decay on tooth No. 30. This is ideal for a composite restoration because the tooth was easily isolated. The patient was anesthetized and a rubber dam was applied to isolate the tooth (Figure 1). Hitmi4 et al found that the use of a rubber dam is necessary for adhesive dentistry. The cavity was prepared to ideal depth and resistance form (Figure 2).
The bonding agent used was Futurabond NR (VOCO America). It is a single-step, self-etch adhesive. The advantages of this adhesive are that there is very low postoperative sensitivity and it is easy to use. It is fast and simple in a one-coat application (Figure 3). The adhesive is applied to the tooth with a microbrush for 20 seconds, gently dried for 5 seconds, then cured for 10 seconds according to the manufacturer’s instructions. It also has fluoride within the adhesive. The X-tra fil was condensed into the tooth and then finished and polished (Figure 4).
A 30-year-old female presented with two failing class II mesio-occlusal composites on teeth Nos. 5 and 12. The initial cavity preparation was extended to the buccal, so material choice was limited. Amalgam and gold were not an option because they would be too visible. Direct composites were decided upon because of the cost for the patient (Figure 5 and Figure 6).
To facilitate operations, a rubber dam was applied from first molar to first molar (Figure 7 and Figure 8). Note the improper proximal contour and leaking on the occlusal surface. The teeth were prepared to remove recurrent decay, etched with a phosphoric acid for 10 seconds, and rinsed with air-water spray for 10 seconds. The teeth were then dried, leaving the enamel frosty and the dentin glossy. A bonding agent was applied and cured. X-tra fil was then condensed, cured, finished, and polished (Figure 9). Note the exceptional color match.
A 45-year-old female presented with a failing mesial-occlusal-distal amalgam restoration. A porcelain-fused-to-metal crown was treatment planned for the tooth because of several undermining cracks. The previous restoration as well as recurrent decay was removed (Figure 10). The cavity was etched with phosphoric acid for 10 seconds and rinsed with air-water spray for 10 seconds. The bonding agent was applied and cured. X-tra fil was placed as the build-up material and light-cured (Figure 11). The tooth was then ready to be prepared for the crown.
X-tra fil is a new high-tech composite with excellent physical properties and acceptable esthetics. It has exceptional handling characteristics, and can be fast and reliable to use. Clinically, this new direct composite would be an ideal restorative material for pediatric and geriatric patients where time and budget are concerns. It also is well-suited for core build-ups.
1. Quellet D. Considerations and techniques for multiple bulk fill direct posterior composites. Comp Cont Educ Dent. 1996;17;(2):146.
2. Loquercio AD, Reis A, Schroeder M, et al. Polymerization shrinkage: effects of boundary conditions and filling technique of resin composite restorations. J Dent. 2004;(6):459-470.
3. Fleming GJ, Awan M, Cooper PR, Sloan AJ. The potential of a resin-composite to be cured to a 4 mm depth. Dent Mater. 2008;24(4):522-529.
4. Hitmi L, Attal JP, Degrange M. Influence of the time-point of salivary contamination on dentin shear bond strength of 3 dentin adhesive systems. J Adhes Dent. 1999;1(3):219-232.
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VOCO America, Inc
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About the Author
Kaitlin C. Small, DMD
Lawrenceville, New Jersey