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Using Tetric EvoCeram Bulk Fill to Easily and Predictably Place Direct Posterior Restorations by Jason Olitsky, DMD

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Introduction

Traditionally, the procedure for placing large direct posterior restorations has been complex and problematic. In order to guarantee success of the restoration, dentists had to meticulously place composite material by layering and curing 2mm increments. 1 The marginal leakage and polymerization shrinkage commonly associated with resin composites were causing clinical failures. In order to address these challenges, flowable composite material was introduced. This new material enhanced marginal adaption and reduced micro-leakage,2 although an additional "capping" layer of composite was needed to create suitable anatomical form.

Trend Toward Better Bulk Fill Composites

A growing demand from dentists and patients emerged for an advanced bulk fill material that would be simpler to place and provide the required strength and aesthetics. As a result, bulk fill materials demonstrating an improved depth of cure, greater shrinkage resistance and incorporating shrinkage stress relievers were developed. Today's bulk fill composites demonstrate marginal integrity, adequate resistance to chewing forces in the posterior region, ample working time in ambient light, sufficient radiopacity, good polishing properties, sculptability and aesthetics.3 As a result, modern bulk-fill composites enable dentists to place restorations more efficiently and confidently. These contemporary composites are available in multiple shades, including opaque and translucent options for enhanced color-matching with surrounding dentition.5

About Tetric EvoCeram Bulk Fill

Now there's Tetric EvoCeram Bulk Fill for the simple and quick placement of predictable and aesthetic direct posterior composite restorations. Tetric EvoCeram Bulk Fill demonstrates many advantages over previous composite and bulk fill materials, including decreased polymerization shrinkage, high-quality sculptability and premium aesthetics for restorations that are indistinguishable from the patient's natural dentition.4

Tetric EvoCeram Bulk Fill is a nano-hybrid composite containing Ivocerin, a patented-germanium-based light initiator that raises the composite's reactivity to curing lights providing an efficient and greater depth of cure. An additive ingredient in the composite serves as a light-sensitivity filter that delays the effects of ambient light, thereby extending dentists' working time past three minutes.4

With Tetric EvoCeram Bulk Fill, dentists can confidently place and completely cure material in a single placement of 4mm increments within 10 seconds, eliminating the need for a flowable composite. The material adapts well to cavity walls and surfaces, and can be easily placed using conventional dental instruments. The smooth consistency and adaptability make contouring easy, and the single application process decreases chairtime.4

The integrated shrinkage stress reliever diminishes the shrinkage stress placed along cavity walls and surfaces, reducing the total shrinkage volume experienced during polymerization. This prevents restorations from debonding, thereby preventing the possibility of micro-leakage, marginal white lines, post-procedure sensitivity, recurrent caries and failure of the composite restoration.4

Tetric EvoCeram Bulk Fill is available in three universal shades (IVA for slightly reddish teeth; IVB for slightly yellowish teeth; and IVW for quick deciduous fillings and/or lightlycolored teeth) with an enamel-like translucency of 15 percent for seamless blending with surrounding dentition.4

Case Presentation

A 46-year-old male patient presented for removal of defective Class I amalgam restorations on tooth #31 and tooth #32. After the patient received anesthesia, a hygienic rubber dam was placed to isolate the selected teeth for treatment. The amalgams and old bases on tooth #31 and tooth #32 were removed in their entirety with a carbide bur. The depth of the preparation was measured with a probe to be 4mm.

The teeth were prepared for bonding. First, the teeth were cleaned with a chlorhexidine antibacterial solution (Consepsis 2%, Ultradent), after which the dentin and enamel surfaces were etched with a 35 percent phosphoric acid gel. The enamel was etched first, then the dentin, ensuring the proper contact time. The phosphoric acid gel was then thoroughly rinsed off, and the teeth were dried with an A-dec Warm Air Tooth Dryer (Patterson Dental). A rewetting and desensitizing agent (Telio CS Desensitizer) was used to close the dentin tubules with protein plugs. The teeth were air dried with a light stream of air from the A-dec Warm Air Tooth Dryer, then coated with two coats of fifth-generation adhesive total-etch adhesive (ExciTE F VivaPen, Ivoclar Vivadent) for ten seconds. The adhesive was air dried with the A-dec Dryer to remove the solvent and light cured each for ten seconds.

Next, Tetric EvoCeram Bulk Fill Shade IVA was selected to color match the patient's existing dentition. Because of 4mm of preparation depth, cavity was restored in one increment of Tetric EvoCeram Bulk Fill with an OptraSculpt modeling instrument and was contoured to the desired anatomy. These steps were repeated for the second restoration.

Each restoration was light-cured for 10 seconds with an LED curing light (Bluephase Style, Ivoclar Vivadent). The rubber dam was removed, and the patient's occlusion was checked with 40 micron articulating paper and adjusted with a #7801 carbide polishing bur (Brasseler). The restorations were polished for 30 seconds with a one-step diamond polishing system (OptraPol NG, Ivoclar Vivadent).

The patient was very pleased with both the enhanced speed and efficiency of the visit and the natural aesthetic appearance of his new fillings. The next day, the patient reported that he was not experiencing any sensitivity from the new fillings.

Conclusion

Tetric EvoCeram Bulk Fill composite simplifies the placement of direct posterior restorations. This advanced material contains improved strength characteristics, low shrinkage stress values, optimal aesthetics and superior marginal integrity, eliminating the requirement for multiple layering and decreasing the risk for shrinkage-related failures. The material's Ivocerin technology, physical and optical properties and straightforward application enable dentists to provide patients with long-term, predictable and aesthetically pleasing restorations in a faster and more efficient manner.


References
  1. Wieczkowski G Jr, Joynt RB, Klockowski R, Davis EL. Effects of incremental versus bulk fill technique on resistance to cuspal fracture of teeth restored with posterior composites. J Prosthet Dent.1988;60(3):283-287.
  2. Wagner WC, M. N. Aksu, MN, Neme AM, J. B. Linger, JB, Pink FE, Walker S. (2008) Effect of Pre-heating Resin Composite on Restoration Microleakage. Oper Dent: 2008 Jan-Feb; 33 (1):72-78.
  3. Radz M. Gary. Direct Composite Resins. The most critical improvements have come in the filler particles. Inside Dent. 2011:108-114.
  4. Tetric EvoCeram Bulk Fill: The bulk composite without compromises. Scientific Documentation. Schaan, Liechtenstein: Ivoclar Vivadent; 2011:1-20.
  5. Denehy GE. Composite resins. Compend Cont Educ Dent. 2009;30(6):366-367.
Author's Bio
Dr. Jason Olitsky, The Smile Stylist, is an accredited member of the AACD, as well as president of the Florida Academy of Cosmetic Dentistry. He was a clinical mentor with the Hornbrook Group and is currently faculty with the Gold Dust Clinical Mastery Series. Jason currently works three days a week with his wife and partner, where 80 percent of their production is based off large cosmetic cases. They started Wallsmiles.com, a site that sells wall art for the dental office and teaches dentists how to get their own patients' pictures on their walls. They created Smile Stylist, a brand committed to promoting, providing and maintaining beautiful smiles for the fashion-forward customer. He is also co-author of The Naked Tooth: What Cosmetic Denists Don't Want to Know. Check out Olitsky's technique via his OnDemand Webinar on Dentaltown.com
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