Simple and Esthetic
Improved bulk fill composite offers alternative to crowns in the posterior
David Clark, DDS
Today, three trends are aligning in dentistry: dentists want to increase their clinical efficiency; patients are living longer and require stronger, long-term restorative solutions; and the demand for superior esthetics is greater than ever. Therefore, it is increasingly important to perform efficient procedures; however, saving time can be difficult when dealing with challenging posterior restorations.
Earlier formulations of bulk fill composites were less esthetically pleasing because of their translucency, which was a necessary part of their design. Manufacturers had to make bulk fills from more translucent resins because that was the only way that dentists would be able to penetrate 5 mm of material with a curing light. Providing a decided advantage over prior formulations, 3M™ Filtek™ One Bulk Fill Restorative (3M, 3m.com/filtekone) turns more opaque as it cures, which makes it significantly more esthetic.
In the past, crowns have been the go-to option for many dentists working in the posterior, but as composite materials have improved, so has the popularity of their use for these types of restorations. Filtek One Bulk Fill is a game-changing option among bulk fill composites, and when combined with the Bioclear BioFit HD Matrices (Bioclear, bioclearmatrix.com), it is the author’s preferred esthetic option for his patients, bar none.
A 45-year-old male patient presented to the office with a failing, 30-year-old amalgam restoration. The tooth had an incomplete fracture on the mesiobuccal cusp, and the amalgam was cracked (Figure 1). Additionally, the patient had a history of mild tooth sensitivity to cold and when chewing.
For a Class II restoration, Filtek One Bulk Fill Restorative relies on a three-point curing process, which involves using a light to cure from the occlusal, buccal, and lingual surfaces. Because it is clear, the Biofit matrix allows dentists to cure the buccal and lingual surfaces while it is in place, providing true three-point curing.
Using Filtek One Bulk Fill Restorative in combination with Bioclear Biofit is predictable, enjoyable, and profitable. In this case, the author was able to perform a step-by-step approach to modern composite dentistry using a completely engineered matrix system and modern bulk fill composite.
1. Creation of the infinity edge. After anesthesia was applied, the Bioclear Blaster was used to remove any biofilm present. This reduces stain and allows a much better bond on the infinity edge (ie, feathered edge). Creation of an infinity edge blends and camouflages the margins of the composite.
2. Pre-wedging. This step provides multiple benefits to the operator, as it not only creates some initial separation of the teeth, but also protects the interproximal tissue as well (Figure 2).
3. Cavity preparation. The pre-wedge was removed, and the interproximal area was sanded with a Lightning® Strip (Integra®, Miltex®). The cavity preparation area was then re-blasted to clean 360° around the tooth, and the Biofit matrix was placed.
4. Management of the matrix. To optimize the contact area, simply expand and appose the matrix (Figure 3).
5. Etching and bonding. Using a total etch technique, the etch was left on the enamel for approximately 20 seconds and on the dentin for approximately 10 seconds after rinsing and drying. Because it allows for one-step, one-coat application, 3M™ Scotchbond™ Universal Adhesive was selected. The adhesive was massaged into the dentin for 20 seconds, lightly air-dried, and then light-cured (Figure 4).
6. Injection molding. Next, the adhesive was reapplied as a wetting agent, then air-dried but not light-cured. A small amount of 3M Filtek Bulk Fill Flowable Restorative was then injected into the adhesive (also not light-cured). Filtek One Bulk Fill Restorative was then injected so that the material married with the flowable and together filled in all of the nooks and crannies (Figure 5). The Filtek One Bulk Fill Restorative material makes up the majority of the restoration, which creates a strong and smooth result.
7. Curing and sculpting. Three-point curing from the occlusal, buccal, and lingual is crucial for achieving true 5 mm depth of cure in the interproximal (Figure 6). The tooth structure was then sculpted with the 3M™ Sof-Lex™ XT course disc—a centerpiece tool in the Bioclear method and the author’s go-to disc.
8. Two-step polishing. Bioclear’s dual abrasive Magic Mix Pre-Polisher was then applied for the satin finish, followed by polishing with a diamond-impregnated high shine cup (Figure 7). The resultant brilliant shine is affectionately referred to as the “Rock Star Polish.”
9. Evaluation. The final step was to evaluate the occlusion. The procedure resulted in a natural looking and esthetically pleasing composite resin restoration (Figure 8 and Figure 9).
The world of dentistry now requires clinical efficiency as well as the ability to provide results that are long-lasting and beautiful. Overall, the bulk fill restoration process has become simpler and faster due to improvements in the materials that allow for easier handling and adaptability. This saves crucial time for both dentists and their patients. With these recent changes to the efficiency and esthetics of the modern bulk fill, it has become a tried-and-true technique for posterior restorations.
About the Author
David Clark, DDS
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