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Inside Dentistry
June 2021
Volume 17, Issue 6

An Optimal Clinical Alternative to Amalgam and Composite

Alan Atlas, DMD, on Surefil one™

I maintain a full-time private practice dedicated to esthetic and comprehensive restorative dentistry located in Philadelphia, Pennsylvania. In addition to practicing and lecturing, I've been a professor at the University of Pennsylvania School of Dental Medicine for more than 20 years. My academic experience and private practice perspective are focused on applying evidence-based protocols to general and advanced clinical dentistry, and this has led me to become actively involved in the development and integration of research studies for dental materials.

The quest to find an alternative to amalgam for long-term, successful posterior restorations has been challenging for the dental profession. An ideal restorative material would be one that requires minimal preparation beyond removing the diseased tooth structure; creates an adequate seal with minimal to no gaps for bacterial colonization; bonds to all substrates without the requirement of additional materials and steps, minimizing time and placement errors; and can be successfully placed in compromising clinical situations where achieving isolation with a rubber dam may be difficult.

Surefil one, a novel material recently introduced by Dentsply Sirona, is being marketed as a self-adhesive, dual-cure, bulk-fill composite hybrid material that exhibits high mechanical strength paired with excellent adhesion to dental hard tissue for load-bearing posterior restorations. For its first issue of 2020, The Journal of Adhesive Dentistry published an edition on state-of-the-art, self-adhesive restorative materials, which included many articles evaluating Surefil one's adhesive performance regarding shear bond strength and micro-tensile bond strength in different C-factor situations, fatigue behavior for both bulk and adhesive applications, wear behavior, gap formation, and fracture susceptibility. In summary, Surefil one outperformed most of its self-adhesive amalgam alternatives, including highly viscous glass hybrids, in all categories tested and resin-modified glass ionomers in most categories tested with the understanding that these materials are used most frequently as liners and are not considered strong enough to be used on their own in load-bearing posterior restorations.

The uniqueness of Surefil one lies in its proprietary modified polyacid system (MOPOS) adhesive molecule as well as its dual-cure capability, which allows for adequate self- and light-curing in large restorations. These qualities, unseen in many other materials, enable full conversion and polymerization, particularly in deeper restorations where the efficacy of light polymerization is compromised. In addition, the dual-cure mode enables the material to optimally cure on its own before light curing is initiated, improving its mechanical and physical properties. This ability to "auto-cure" during initial placement slows down the velocity of polymerization in the high C-factor areas, enabling better adaptation.

Key Takeaways

1.  An extraordinary alternative to amalgam, glass ionomers, glass hybrids, and light-cure composites for compromised clinical situations and non-compliant patients

2. Excellent for core buildups and Class V restorations because it comes in a variety of shades from bleach white to A3.5 and is esthetic and highly polishable

3.  If an insufficient amount is extruded from the capsule to fill the cavity, clinicians can easily add more to the existing material

4.  Facilitates the preservation of tooth structure, reduces operator error by eliminating etching and bonding, and allows for optimal adaptation and a completely dark cure in deep subgingival preparations

Alan Atlas, DMD
Private Practice
Philadelphia, Pennsylvania

Manufacturer Information
Dentsply Sirona Restorative

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