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Inside Dentistry
February 2014
Volume 10, Issue 2

A Simple “Bulk-Fill” Technique for Posterior Esthetic Restorations

Reduced treatment time with highly esthetic results

Mark L. Pitel, DMD, FAGD, FACD

When it comes to restoring posterior teeth, nothing is easier to use than amalgam. Place a matrix retainer, pack the material with a bulk-fill technique, check the occlusion, and done! Since we started placing esthetic posterior restorations, everyone has been searching for a material or technique that would provide the same level of simplicity as amalgam. As the popularity of direct composites grew, it seemed natural to assume that they would eventually be improved so that they could be used like amalgam and perform similarly. But research and clinical experience have shown that composites are not well suited for bulk filling.

The search for a material with high esthetics and easy handling may have been realized in the surprising combination of a new high-viscosity, posterior-grade glass ionomer with a nanofilled, light-cured resin coating. Introduced commercially as EQUIA™ by GC America, it provides long-lasting, esthetic restorations and has the additional benefits of true hydrophilicity, reduced postoperative sensitivity, high fluoride release, and a simplified, rapid clinical placement. Long appreciated for the cementation of indirect restorations, for bases under composite, and for crown buildups, glass ionomers have now moved into the mainstream restorative arena with EQUIA.

The EQUIA Technique

When using EQUIA, the cavity is prepared with a minimally invasive approach. There is no need to provide mechanical retention. Place your matrix as you would for amalgam or composite. To ensure a good contact, the author takes a plastic instrument and adapts the matrix material to the adjacent proximal surface. Although no surface pretreatment is required with glass ionomers, it is normally a good idea to remove the smear layer with a cavity cleanser such as 20% polyacrylic acid. This is not like etching, and conventional phosphoric acid should not be used for this. EQUIA™ Fil in the proper shade is mixed for 10 seconds and then bulk filled into the cavity. It is an auto-curing material, so no layering or light curing is required. Within a few seconds of placement, you can shape or condense it without harm to the setting restoration. After 2 minutes and 30 seconds, you are ready to check the occlusion and smooth it to final contour. All that remains now is to apply and light cure a thin layer of EQUIA™ Coat. This provides a smooth surface appearance comparable to composite resin and increases the durability of the final restoration.


Bulk filling is an excellent way to simplify the placement of posterior esthetic restorations. If an esthetic restoration is desired, the EQUIA technique can offer reduced treatment time with numerous other clinical benefits.

About the Author

Mark L. Pitel, DMD, FAGD, FACD, is an associate clinical professor of operative dentistry at Columbia University College of Dental Medicine in New York, New York, and maintains a private general practice in Poughkeepsie, New York.

For more information, contact:
GC America

Key Takeaways

• High-viscosity, posterior-grade glass ionomer with a nanofilled, light-cured resin coating

• Long-lasting, esthetic restorations with a simplified, rapid clinical placement

• True hydrophilicity, reduced postoperative sensitivity, and high fluoride release

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