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TECHNIQUE

SCAN:

TeTric evoceram bulk fill Ȝ Single-layer placement up to 4mm for faster procedures

Ȝ low shrinkage and low shrinkage stress for superior margins

Ȝ Nano-filler technology for improved strength, high-gloss polish and low wear

Ivoclar Vivadent, Inc.ivoclarvivadent.com 800-533-6825

CIRCLE: RS No. xx

In today’s dental market, there’s a choice of many different composites. Some com-posites are universal, some indicated for anterior restorations, and others are made strictly for direct posterior restorations.1 Each composite category demonstrates advantages and disadvantages, and they often vary in terms of physical properties such as wear characteristics and compres-sive strength. Traditionally, direct com-posite restorations have required the use of a layering technique to minimize the negative effects associated with polym-erization shrinkage. This layering tech-nique is intricate, time-consuming and sometimes time-sensitive, depending on the amount of working time provided by the material.

To address the layering requirements of posterior restorations, several manu-facturers have developed new bulk f ill materials (i.e. Venus® Bulk Fill, Heraeus; SonicFill, Kerr Corp.) to eliminate the disadvantages associated with conven-tional composites. The goal of these new

PlaCe ComPosite in one layerivoclar Vivadent’s tetric evoCeram Bulk Fill helps improve performance and reliability

by C h r i t o p h e e r r a m s e y , D m D

Information provided by Ivoclar Vivadent, Inc.

aT a glaNce1. Pre-operative view of tooth No. 4.

2.  Tooth No. 4 prepared for restoration.

3. A band, sectional matrix and separation ring were placed.

4. Fuji Lining LC glass ionomer was applied.

5.  Total Etch was used to etch enamel and dentin.

6. Gluma desensitizer was replied as a re-wetting agent.

7. ExciTE F bonding agent was applied.

8. A 4-mm increment of bulk fill composite in shade IVW was placed into the preparation.

9. A conventional composite placement instrument was used to easily adapt the

bulk fill composites is to eliminate or min-imize the layering requirements, enabling clinicians to fill a cavity preparation with up to 4 mm in a single increment. Conven-tional direct posterior composites have required placing and curing incremental layers of 2 mm or less.2,3

New bulk fill materials also are help-ing to reduce shrinkage stress and ensure a complete depth of cure without the need for a final “capping” layer. Recent composite research and development has addressed such issues as polymer-ization shrinkage and shrinkage stress.1 Polymerization shrinkage and shrinkage stress can result in negative consequences for the tooth/composite interface and, subsequently, affect the longevity of the posterior restoration.1 Polymerization shrinkage is considered the primary negative characteristic of composites.3 It can contribute to marginal leakage and, ultimately, postoperative sensitivity and secondary caries.2

Among the newest bulk fill materials is Tetric EvoCeram® Bulk Fill, a nano-

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hybrid composite (Ivoclar Vivadent). This bulk f i l l composite contains a new patented photo initiator. The initiator, Ivocerin, a dibenzoyl geranium derivative facilitates the application and curing of posterior restorations in larger

increments without compromising the composite’s optical properties. In addi-tion, Ivocerin acts as a polymerization booster permitting the material to polymerize more rapidly allowing the material to cure in a 4mm increment in just 10 seconds (power intensity of the

curing light is >1,000mW/cm2). This bulk f i l l composite

also features a shrinkage stress reliever which is an additional f i l ler technolog y (e.g. pre-polymer) that is f lexible and relieves shrinkage stress during polymerization. This prevents the material from pulling away from cavity walls resulting in improved elasticity and marginal integrity of the restoration.

Tetric EvoCeram Bulk Fill also contains a light sensitivity f ilter, which increases the composite’s i m mun it y to a m bient operatory l ighting. As a result, cl inicians are prov ided w it h a mple work ing t ime to place the composite and sculpt the f inal anatomy of the restoration.4

Av a i l a b le i n t h r e e shades (e .g., I VA for

slightly reddish teeth; IVB for slightly yellowish teeth; and IVW for white or deciduous teeth), it allows clinicians to select the most esthetic alternative. IVW was chosen for this patient.

Using Tetric EvoCeram Bulk Fill composite to fill a posterior cavity eliminates the need for several composite increments,

reduces the chance of shr inkage induced failure,5-7 and eliminates the need for a final layer. As a result, direct posterior composites can be placed

composite to the preparation walls and contour the anatomy.

10.  The occlusion was verified with articulating paper.

11.  Gray finishing points were used to smooth the surface.

12. Green polishing points were used to polish the surface.

13. Pink polishing points were used to achieve a high-gloss.

14. Final postoperative view of the bulk fill restoration on tooth No. 4,

15.  The restoration demonstrates excellent ...

16. And seamless integration with surrounding natural tooth structure ...

17. As well as a prismatic effect.

with greater efficiency, resulting in a more predictable restoration.

Case PresentationA 23-year-old female presented with caries on tooth No. 4 (Fig. 1). After the initial examination and consultation, the patient agreed to have the cavity filled with direct composite. The cli-nician recommended this nanohybrid composite in order to streamline the restorative procedure and provide a predictable and esthetic result.7-11

STEP

01After a rubber dam was placed and the tooth prepared to isolate the gingival and

interproximal areas from saliva or blood contamination (Fig. 2). All caries were removed and the tooth prepared for a direct composite restoration.

STEP

02A sectional matrix band was placed (Fig. 3). Fuji Lining LC glass ionomer was applied (Fig.

4). Total Etch 37% phosphoric acid gel (Ivoclar Vivadent) was applied to the prepared dentin for 10-15 seconds and the prepared enamel for 15-30 seconds. The etchant was rinsed with a vigorous water spray for 5 seconds and then air-dried (Fig. 5).

STEP

03Gluma desensitizer was applied as a re-wett ing agent (Fig. 6).ExciTE F adhesive bonding

agent (Ivoclar Vivadent) was applied for 10 seconds onto the dentin and enamel (Fig. 7) using an VivaPen applicator pen (Ivoclar Vivadent). The adhesive was then air-dried to evaporate any remaining solvent. The preparation was then light-cured for 10 seconds.

STEP

04A 4-mm increment of Tetric EvoCeram Bulk Fill composite was placed into the preparation

(Fig. 8).

STEP

05Using a standard Optrasculpt composite placement instru-ment (Ivoclar Vivadent), the

bulk fill composite was packed, con-toured and sculpted to the preparation walls. The final anatomy was created (Fig. 9). The restoration was cured to a

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DENTALPRODUCTSREPORT.COM  |  March 20134

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complete depth of cure in 10-to-20 seconds.

STEP

06Occlusion and articulation were verified using articulation paper (Fig. 10).

STEP

07Final f inishing and polishing were completed using appropri-ate f inishers and a ser ies of

Astropol f inishing and polishing points (Ivoclar Vivadent) were used to complete the restoration. and brushes. Gray finish-ing points were used to smoth the surface. (Fig. 11). Green polishing points were used to pol-ish the surface (Fig. 12). Pink polishing points were used to achieve a high-gloss (Fig. 13). Because the optical properties of this mate-rial are designed specifically to match the refractive index of the fillers and polymer matrix, the restoration appeared impercep-tible from the surrounding tooth structure. It also demonstrated an enamel-like trans-lucency of 15% .

ConclusionBulk fill composites allow clinicians to pro-vide patients with fast and easy direct pos-terior restorations, without compromising marginal integrity, esthetics or long-term predictability. Additionally, the innovative light-intiator, Ivocerin of Tetric EvoCeram Bulk Fill composite allows clinicians to confidently place posterior restorations, without concern for time sensitivity, the need for intricate layering, or using time consuming techniques (Figs. 14-17). ●

RefeRenCes

1. Ferracane JL. Resin composite--state of the art. Dent Mater. 2011 Jan;27(1):29-38. Epub 2010 Nov 18.

2. Cheung GS. Reducing marginal leakage of posterior composite resin restorations: a review of clinical techniques. J Prosthet Dent. 1990 Mar;63(3):286-8.

3. Giachetti L, Scaminaci-Russo D, Bambi C, Grandini R. A review of polymerization shrinkage stress: current techniques for posterior direct resin restorations. J Contemp Dental Pract. 2006;7(4):79-88.

4. Tetric EvoCeram Bulk Fill: The bulk composite without compromises. Scientific Documentation. Schaan, Liechtenstein: Ivoclar Vivadent; 2011: 1-20.

5. Roggendorf MJ, Krämer N, Appelt A, Nau-mann M, Frankenberger R. Marginal quality of flowable 4-mm base vs. conventionally layered resin composite. J Dent. 2011 Jul 27. [Epub ahead of print] .

6. Kuijs RH, Fennis WM, Kreulen CM, Barink M, Verdonschot N. Does layering minimize shrink-age stresses in composite restorations? J Dent Res. 2003 Dec;82(12):967-71.

7. Souza-Junior EJ, de Souza-Régis MR, Alonso RC, de Freitas AP, Sinhoreti MA, Cunha LG. Effect of the curing method and composite volume on marginal and internal adaptation of composite restoratives. Oper Dent. 2011 Mar-Apr;36(2):231-8. Epub 2011 Jun 24.

8. Quellet D. Considerations and techniques for multiple bulk-fill direct posterior composites. Compend Contin Educ Dent. 1995;16(12):1212, 1214-6, passim; quiz 1226.

9. Utterodt A, Rist AC, Eck M, Schaub M. Polym-erization shrinkage stress and flexural strength of nano-composites. 42nd annual meeting of IADR-Continental: 2007.

10. Lowe RA. The search for a low-shrinkage direct composite. Oral Health Journal. March 2010.

11. Van Ende A, De Munck J, Mine A, Lambre-chts P, Van Meerbeek B. Does a low shrinking composite induce less stress at the adhesive interface? Dent Mater. 2010;26(3):215-22.

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