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A New-Generation Bulk-Fill composite for Direct Posterior Restorations
Material characteristics and ease of use eliminate challenges and enable dentists to quickly provide their patients with long-lasting, predictable, and esthetically pleasing restorations.
Many composite materials on the market today perform well and are reliable. However, the process of performing direct posterior restorations can be challenging and time-consuming using conventional composites that leave little or no margin for error. Because posterior restorations are among the most performed treatments in dentistry, the advantages associated with advanced material characteristics and streamlined procedures are too significant to ignore.
To ensure the success of a direct posterior restoration with conventional composite materials, several steps need to be meticulously performed, following a series of procedures and techniques the dentist must master.1 Cavity preparation, isolation, and bonding aside, the placement method requiring incremental layering to reduce polymerization shrinkage and marginal leakage2,3 is time-consuming and inherently associated with the potential for error. To save time and deliver predictable direct posterior restorations, materials with a number of specific characteristics eliminate numerous challenges and benefit both patient and practitioner. These characteristics include ease-of-use, adaptability, sculptability, form retention, strength, predictability, esthetics, and the ability to withstand ambient light conditions for an extended period of time.1
Bulk Fill Composite
Advanced composite technology allows for directly placed posterior restorations with bulk-fill resin-bonded composite in a single increment. Engineered with a smooth and creamy consistency, bulk-fill composite (eg, Tetric EvoCeram® Bulk Fill, Ivoclar Vivadent, www.ivoclarvivadent.com) can achieve high marginal adaptation to the floor and walls of cavity preparations, eliminating the need for a flowable liner. The patented shrinkage stress reliever technology increases marginal integrity and decreases polymerization shrinkage due to a low shrinkage stress of 1.13 MPa and a low shrinkage volume of 1.9%.4 Good marginal integrity and low polymerization shrinkage can result in a decreased probability of tooth deformation,5-7 postoperative sensitivity,8 microleakage, and secondary caries.5
The patented light-sensitivity filter technology provides expanded working time by acting as a protective shield against operatory lighting. Because the composite material will not quickly polymerize under ambient light, it is easier to place than conventional composite and allows ample opportunity to sculpt and mold,4 saving the practitioner valuable time adjusting the occlusion. The material can also be immediately contoured, eliminating the need for a final composite layer.4 In addition to easy and extended handling, the bulk composite retains its shape and is manufactured with a polymerization booster for fast curing of up to 4 mm in 10 seconds.4
With three universal shades featuring an enamel-like translucency of 15%, the color assortment ensures seamless blending with surrounding dentition; and the well-balanced filler composition allows the clinician to achieve a fast, easy, high-gloss polish for an esthetically pleasing restoration.4 Each added advantage of this bulk-fill composite material complements the others by providing a faster and easier option for delivering strong, predictable, and esthetic direct posterior restorations with one material in one increment and in half the time.
A 23-year-old man presented with old amalgam restorations that he found displeasing. He requested that they be refilled with white composite fillings for a more esthetic appearance. A careful clinical evaluation revealed defective amalgam restorations with marginal leakage, buccal decay on tooth No. 18 and buccal discoloration of tooth No. 19 (Figure 1).
A hygienic non-latex cheek retractor was placed (OptraGate®, Ivoclar Vivadent) (Figure 2), and a conservative preparation began with the removal of the old amalgam restorations using a high-speed electric dental handpiece and a 557 carbide bur. Round carbide burs were then used on slow speed to remove all soft dentin and any remaining stain resulting from the old amalgam fillings (Figure 3). To eliminate any sharp edges, a soft bevel was placed using a coarse or fine round diamond bur (Figure 4).
The preparations were then polished with pumice to eliminate any plaque, then cleansed with a 2% chlorhexidine scrub (Consepsis® scrub, Ultradent Products, Inc., www.ultradent.com). Using a total-etch technique, a 37% phosphorus acid-etch (Total Etch, Ivoclar Vivadent) was applied to the enamel for 15 to 30 seconds, then to the dentin for 10 to 15 seconds.
Next, a fifth-generation adhesive (ExciTE® F, Ivoclar Vivadent) was applied using a VivaPen® (Ivoclar Vivadent), agitating the surface for 10 seconds and ensuring the cavity walls were completely covered. Excite F was the adhesive of choice because it has been proven to virtually eliminate postoperative sensitivity. The bonding agent was dispersed into a thin layer, and the remaining solvent evaporated with a warm-air dryer, then light-cured (bluephase®, Ivoclar Vivadent) for 10 seconds.
Bulk-fill composite (Tetric EvoCeram®, Ivoclar Vivadent) in shade IVB was injected in a single bulk increment of less than 4 mm to fill the preparations (Figure 5) and adapted accordingly with suitable modeling instruments (OptraSculpt®, Ivoclar Vivadent) (Figure 6), prior to light-curing for 10 seconds. Excess material was removed using a series of fine and ultra-fine diamond burs (Figure 7). After a final check of the patient’s occlusion and articulation, a final polishing was performed (Astropol®, Ivoclar Vivadent) (Figure 8 through Figure 11).
Although there are numerous available composite materials—each of which is reliable for specific indications—the material characteristics of Tetric EvoCeram Bulk Fill have provided a breakthrough in the placement of direct posterior composite restorations. While possessing the requirements of a posterior composite to withstand the daily masticatory forces, this bulk-fill composite also provides dentists with a straightforward yet reliable procedure while eliminating the challenges associated with conventional composites. Its material properties and easy application allow dentists to provide long-lasting, predictable, and esthetically pleasing restorations quickly and easily.
1. Mackenzie L, Shortall AC, Burke FJ. Direct posterior composites: a practical guide. Dent Update. 2009;36(2):71-80.
2. Wieczkowski G Jr, Joynt RB, Klockowski R, Davis EL. Effects of incremental versus bulk fill technique on resistance to cuspal fracture of teeth restored with posterior composites. J Prosthet Dent. 1988;60(3):283-287.
3. Giachetti L, Scaminaci Russo D, Bambi C, Grandini R. A review of polymerization shrinkage stress: current techniques for posterior direct resin restorations. J Contemp Dent Pract. 2006;
4. Tetric EvoCeram Bulk Fill: The bulk composite without compromises. Scientific Documentation. Schaan, Liechtenstein: Ivoclar Vivadent; 2011:1-20.
5. Jensen ME, Chan DCN. Polymerization shrinkage and microleakage. In: Vanherle G, Smith DC, editors. Posterior composite Resin Dental Restorative Materials. Utrecht, The Netherlands: Peter Szulc Publishing Co;1985:243-262.
6. Suliman AH, Boyer DB, Lakes RS. Polymerization shrinkage of composite resins: comparison with tooth deformation. J Prosthet Dent. 1994;71(1):7-12.
7. Meredith N, Setchell DJ. In vitro measurement of cuspal strain and displacement in composite restored teeth. J Dent. 1997;25(3-4):331-337.
8. Pashley DH. Clinical considerations of microleakage. J Endod. 1990;16(2):70-77.
About the Author
Daniel Vasquez, DDS