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Inside Dentistry
August 2022
Volume 18, Issue 8

An Innovative Composite That Behaves Like None Other

Dentsply Sirona’s SDR® flow+ provides uniquely seamless margins

Alan Atlas, DMD

Alan Atlas, DMD, does not take his responsibilities as an educator and a key opinion leader lightly. In addition to maintaining his private practice in Philadelphia, Pennsylvania, and having a dual appointment as a clinical professor in the departments of Preventive/Restorative Sciences and Endodontics at the University of Pennsylvania School of Dental Medicine, Atlas is widely published and lectures internationally on research and new techniques that he has developed. "I have been very blessed to be able to speak around the world," he says. "I never imagined in my life that I would ever do that, and I do not take it for granted, so every time that I speak, I am very evidence-based. I am a voracious reader of the literature. I try to figure out what works, what we can take from the evidence, and how we can put it in our hands in the operatory."

Atlas focuses his research and presentations on identifying etiologies of failures and determining how to avoid them in the future. "I am trying to perform the best dentistry that I possibly can for my patients," he says. "Ultimately, our profession comes down to successes and failures. If you have failures, it really hammers you stress-wise, and it also affects your profitability." One of Atlas's current projects involves teaching first-year dental students how to use a dental microscope to refine preparations. "Simply using microscopy for finishing can make a significant difference in the marginal fit of CAD/CAM ceramic crowns," he says. "Even with the precision of digital scanning and milling, good dentistry still requires excellent preparation skills." Atlas also notes that according to some clinical studies, composite restorations are failing approximately twice as fast as amalgam ones. "They are often failing within 5 years," he says. "However, for many dentists, improving those success rates really only requires some minor changes in technique. You need to prepare the tooth well, put the matrix down correctly, and use the right materials. I have developed a technique for putting composite in a tooth that is very scientifically sound. My passion and my purpose during what may be the last quarter of my career is to have an impact and try to make some changes to what we are teaching in dental schools."

The materials part of the equation is critical, and Atlas speaks particularly passionately about one flowable composite: SDR® flow+ from Dentsply Sirona. Despite initial skepticism based on the negative effects of shrinkage on margins exhibited by other flowable materials, Atlas was won over by the evidence that SDR flow+ was different. At an International Association for Dental Research meeting, the researcher who developed this product explained that the SDR technology utilizes a modulator to extend the dimethacrylate monomer, which makes the molecular chain more flexible and thus reduces volumetric shrinkage and stress during light polymerization. "He insisted that clinical trials would prove it, and they did," Atlas says. "Independent studies showed that this material was by far the biggest game-changer in dentistry during the past decade." Two years later, Atlas attended another meeting where two researchers associated with a different company said that they had tested every flowable composite on the market and that this material was unlike anything that they had ever examined. "It was the only composite resin that did not develop gaps at the margins when it was being light polymerized," Atlas says. "To this day, there is no material that behaves like this material. There have been many attempts to imitate it, but it has never been duplicated."

Atlas utilizes SDR flow+ in an "open sandwich" technique. "This is the best way to deliver a restoration at this point," he says. The first step is proper placement of a bonding agent, for which he often uses Prime&Bond elect® from Dentsply Sirona. "This is a multimode universal adhesive, so it can be used for self-etch, total-etch, or selective-enamel-etch techniques," Atlas says. "The evidence indicates that its bond strength and durability are better than many of the other multimode adhesives available." Regarding matrix bands, Atlas prefers the Palodent® Plus sectional matrix system from Dentsply Sirona. "When placed properly, this product can be utilized to create a really solid contact with no possibility of bacteria accumulating in the margin," he says. After properly preparing the tooth, Atlas places SDR flow+ as a dentin replacement. "In an increment of up to 4 mm, it really behaves beautifully on the margins," he says. At that point, Atlas places a cap layer on top using Dentsply Sirona's TPH Spectra® ST. "TPH Spectra ST is available in two different viscosities—high and low—which gives clinicians the option of choosing what works best in their hands," he says. "It is an excellent material. It adapts beautifully, it polishes beautifully, and it is highly durable. It has an amazing chameleon effect too, so you can use it in the esthetic zone. Predominantly, I am using the A2 shade." Finally, Atlas polishes with Dentsply Sirona's Enhance® PoGo® Polishing System. "The bottom line is that Dentsply Sirona has everything that you need in its product portfolio," he says.

The key to the entire process, however, is SDR flow+. "Whenever you have dentin exposed—regardless of the class of the restoration—this material should go down first, and it can be up to 4-mm thick," he says. "It levels very nicely in the preparation, so you do not need to tease it in. It is also very radiopaque, so it shows up clearly on radiographs. In addition, it covers up any discoloration very well." Spreading the word for the good of the profession is a responsibility that Atlas feels strongly about. "It amazes me that everybody isn't already using this material," he says. "My work comes down to helping everyone learn about what materials deliver the best results and how to use them properly. This material is absolutely, undoubtedly, one of the greatest materials ever developed for direct composite restorative dentistry."

Key Points

• SDR technology enables the formation of a more relaxed network, minimizing the buildup of polymerization stress.

• The unique chemistry of SDR flow+ helps ensure the longevity and overall quality of a bulk-fill restoration.

• The material may be applied in 4-mm increments without an additional liner, automatically decreasing procedural time and inventory.

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