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New Bulk-Fill Material Simplifies Restorations to One Step
Filtek™ Bulk Fill posterior restorative for efficient, esthetic restorations
Now that amalgam is no longer the standard material used for bulk-filling posterior restorations, the dental industry has been continually seeking methods and materials that offer a similar ability to quickly and easily complete these restorations, which are performed on a daily basis in the typical general restorative practice.
Composite restorations are a vast improvement on amalgam in terms of esthetics. As manufacturers endeavor to increase the amount of fillers in their resins to improve mechanical and physical properties such as compression strength, flexural strength, elastic modulus, coefficient of thermal expansion, water sorption, and wear resistance, several classification systems have been developed. These systems are based on particle size, distribution, and quantity of fillers incorporated.1 Classifications include hybrid, microhybrid, microfill, and the newer nanofill, as well as bulk fill. The descriptions of these classifications can vary from system to system. Composite is also preferred over amalgam because of its ability to conserve tooth structure, as there is no need for the outline or undercuts to retain the filling. The process involved in the incremental layering of composites is technique-sensitive as well as time-consuming, due to the many steps and the amount of material required.
As shown in the case report highlighted here, a new posterior bulk-fill material from 3M ESPE can be light-cured to a depth of 5 mm without layering for Class II restorations and 4 mm for Class I restorations. Because it is a highly-filled composite, not a flowable, there is no need for a separate capping layer. The product, which can be dispensed without special equipment, eliminates steps while still offering excellent adaptation, strength, sculptability, and wear resistance. Without the need for layering, the clinician saves time without compromising patient care, and the chance of contamination between layers is eliminated.
An 18-year-old male patient presented to the author’s practice complaining of sensitivity on the occlusal surface of tooth No. 3, where a clinical exam revealed the presence of decay requiring removal and restoration (Figure 1). The tooth was isolated with a rubber dam (Figure 2), after which the decay was removed using a #557 bur (Figure 3).
The author then selectively etched only the enamel (Figure 4), taking care to keep as much of the etchant off the dentin as possible. Scotchbond™ Universal Adhesive (3M ESPE, www.3mespe.com) was then applied with a microbrush and scrubbed vigorously for 20 seconds (Figure 5). Although used by the author in a selective-etch technique, that product also offers the options of being used in total-etch or no-etch modes. The composite chosen for this case, 3M™ ESPE™ Filtek™ Bulk Fill posterior restorative in shade A1B, was then placed into the prepared cavity according to the manufacturer’s capsule procedure kit instructions, although a routine composite-dispensing gun can be used (Figure 6). The restoration was then light cured for a single 20-second cure on the occlusal surface. Finally, finishing and polishing were completed using first a coarse then a fine spiral finishing wheel (3M™ ESPE™ Sof-Lex™ Spiral Finishing and Polishing Wheels) (Figure 7 and Figure 8) with the rubber dam in place (Figure 9). The entire procedure was completed in less than 30 minutes, thereby offering the patient an esthetic and functional restoration as well as convenience (Figure 10).
As a majority of restorations are placed in the posterior, a product that offers the ability to provide these restorations more quickly and easily without compromising patient care is a valuable addition to the clinician’s armamentarium. Although incremental technique may be preferred in some clinical situations, its disadvantages include the possibility of trapping voids between layers and the time required to place the restoration. Bulk application technique is simpler and faster, with a reduced number of clinical steps.2
Filtek Bulk Fill posterior restorative is a brand-new product selected by the author for this procedure because it is fast and efficient, has an attractive chameleon effect, and polishes well. It was chosen in this case over a flowable that, at minimum, requires placement of a base layer and capping layer—both of which require etching and light curing.
As described above, this procedure can be quickly completed using a one-step placement technique, inserting up to 4 mm of Filtek Bulk Fill posterior restorative into a Class I restoration. It is formulated with two methacrylate monomers that act in combination to lower polymerization stress, so its use for bulk placement can be achieved without sacrificing strength or wear resistance. The product enables high strength, wear resistance, surface smoothness, and gloss retention. Additionally, the material’s excellent adaptation and sculptability contribute to its ease of use and fast placement.
Although the author always prefers to etch enamel, the product can be used with any self-etch or total-etch bonding system. The product was dispensed according to the manufacturer’s capsule procedure kit instructions, requiring no special dispensing equipment. Its chameleon effect enables it to blend with the surrounding dentition.
In this author’s opinion, clinicians who want to maintain practice profitability while also maintaining high-quality patient care must focus on efficiency in completing the treatments indicated for their patients. Materials that serve this goal help them provide better care as well as more treatments to their patients. For everyday practice, today’s newer composite resins offer many benefits. They enable clinicians to follow a predictable, conservative, and reliable chairside protocol for restoring worn and decayed tooth structure with excellent esthetics.
Such is the case with 3M ESPE Filtek Bulk Fill posterior restorative, which gives dentists the ability to place up to 5 mm in one increment while offering excellent wear resistance and stress relief. By eliminating additional layers and multiple steps, Filtek Bulk Fill posterior restorative provides dentists with a fast and easy option for direct posterior restorations. Designed for durability, Filtek Bulk Fill posterior restorative utilizes the same true nanofiller technology of other Filtek restoratives, which enables high strength, wear resistance, surface smoothness, and gloss retention.
Being able to complete a posterior restoration in less than 30 minutes using this product as described limited chairtime for both patient and clinician, which was a win-win situation for both.
1. Leinfelder KF. Composite resins. Dent Clin North Am. 1985;29(2):359-371.
2. Coli P, Brännström M. The marginal adaptation of four different bonding agents in Class II composite resin restorations applied in bulk or in two increments. Quintessence Int. 1993;24(8):583-591.
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About the Author
Robert C. Margeas, DDS
Iowa Dental Group
Des Moines, Iowa