Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

Posterior Composites and Universal Bonding Agent Applications in the Modern Dental Practice by Dr. Gary Radz, DDS

Start Discussion


Composite resins continue to increase in use and popularity over the past 30 years1. Class II composites are one of the most common restorations provided in today's general practice. Recent studies suggest that newer generations of composites and bonding agents provide the potential for composites to have a similar or even better long-term success rate than amalgams2. Newer composites now have nano-hybrid particles that are highly filled and have very low polymerization shrinkage. These improved physical properties could allow for even better longevity. Since 1955—after Dr. Michael Buonocore published his industry changing paper of how it was possible to increase the adhesion of dental materials to the enamel surface3—the dental industry has been working to create the perfect bonding system. For nearly 60 years we have certainly seen dramatic improvements in bonding technology with systems that provide better adhesion to enamel and dentin, that are also easier and faster to use clinically.

The recent introduction of universal bonding systems has provided dentists with the opportunity to decide whether a total-etch, a selective-etch, or a self-etch technique is best for any particular restoration. These bonding systems now allow dentists to reduce their bonding agent inventory to just one product that can be used in all situations. Even though research has demonstrated that both total-etch and self-etch bonding can have successful outcomes4, many dentists want to choose which technique they'd prefer in any given clinical situation based on his or her clinical experience.

The following case studies will demonstrate the use of the newest generation of composites in combination with a universal bonding system in different combinations based on the given clinical situation and the clinician's preference based on his experience.

Case Study #1
A patient presented with failing posterior restorations. #3 has a leaking Class I composite, two Class VI lesions, recurrent decay present radiographically under a Class II amalgam and recurrent decay noted radiographically under a Class II amalgam on #5 (Fig. 1). The patient is aesthetically aware and requests replacement with tooth-colored fillings.

The area is isolated with a rubber dam and the failing restorations and recurrent decay are removed. A caries detector is used to verify that complete removal of decay has been accomplished. A section matrix system (Composit-Tight 3D, Garrison) is placed on #5 (Fig. 2). These sectional matrices allow for excellent adaptation to the prepared tooth, development of anatomical contours and are very successful in the creation of desired interproximal contacts.

A self-etching universal bonding agent (Futurabond U, VOCO) is used for a selective-etch technique. Only the enamel is etched with phosphoric acid for 15 seconds and rinsed off and lightly air-dried. The bonding agent is then applied in a single application using the unidose delivery system for 20 seconds, air thinned for five seconds and light cured for 10 seconds. This next generation universal bonding agent can be used in either a total-etch, selective-etch, or no-etch mode. The selective-etch technique was used in this particular restoration to take advantage of the slightly higher bond strength to enamel that phosphoric etch can provide, while also eliminating the possibility of pulpal irritation that can happen when dentin is exposed to phosphoric etching solutions. The clinical reality is that any of the three techniques would work well for this particular restoration.

A thin layer of flowable composite (GrandioSO Flow, VOCO) is now placed at the apical portion of the proximal box (Fig. 3). The flow characteristics of this material allow for excellent composite adaptation at the most recurrent caries prone area of the restoration, where the composite meets the enamel in the interproximal area. This particular product also has non dripping syringe technology which allows for accurate material placement without excess material extruding from the syringe. This is critical in this step as only 1-1.5mm thickness of flowable composite is to be placed. Lastly—it is important for this particular technique—the flowable composite has excellent radiopacity for future radiographic evaluation.

The final fill of the restoration is completed with two layers of a highly filled (89%), low shrinkage (1.6%) A1 shade of a nano-hybrid composite. The two increments are placed in layers 2-3mm deep and each layer is light cured for 30 seconds each. Once the restoration is complete the initial anatomy is created using a composite finishing bur (R.A.P.T.O.R., Axis). The molar has four preparations to be restored. The Class II restoration is restored in exactly the same manner as the Class II restoration on #5.

The Class I and two Class VI restorations are completed with a slightly different technique and material. Because of the minimal exposed dentin, a total-etch technique is used. All three preparations are etched and the universal bonding agent is applied at the same time, then light cured for 10 seconds. The restorative material chosen for these restorations is a highly filled (83%) flowable composite (GrandioSO Heavy Flow) that has high viscosity characteristics. This allows for all three restorations to be filled quickly and at the same time while having excellent adaptation to the preparation. The high filler content will provide good wear characteristics over time.

Figure 4 shows the final restorations after occlusal adjustments, final contouring and polishing.

Case Study #2
This patient presented with a “filling that fell out last night.” Upon clinical examination there is a fractured, old composite restoration that shows evidence of recurrent decay (Fig. 5). The area is isolated with a cotton roll and an Isolite system and the old restoration is removed. Upon removal of the old restoration, a significant amount of recurrent decay is noted. Using a slow speed electric handpiece, a #4 round bur and caries detection solution, the decay is carefully removed around the periphery. This set is repeated until all decay has been removed.

The decay is successfully removed without exposing the pulp, but the proximity of the pulp is such that a pink hue of the dentin is observed. Such proximity to the pulpal tissue necessitates placement of a base material. A light cured calcium hydroxide paste (Calcimol LC, VOCO) is placed to protect the pulpal tissue as well as stimulate the formation of secondary dentin (Fig. 6).

A sectional matrix system (Composit-Tight 3D, Garrison) is placed with an appropriate interproximal wedge. Due to the proximity to the pulp and the large amount of dentin present within the preparation, it was decided to use a universal bonding agent (FuturaBond U, VOCO) in a self-etching mode so as to minimize the potential of irritating the pulpal tissue (Fig. 7).

Next, a layer of flowable composite is used in a 1-1.5mm increment to layer the apical portion of the proximal box to provide a better seal and minimize the risk of leakage and potential recurrent decay (Fig. 8). Lastly the restoration is completed using a highly filled (89%), low shrinkage (1.6%) nano-hybrid composite. The low shrinkage will minimize the potential for leakage, sensitivity and recurrent decay. The high fill composition will provide excellent wear resistance and a high polish.

The occlusion is then adjusted and a final polish applied using single step diamond impregnated silicone polishing system (Fig. 9).

Figure 10 is the immediate post-operative view. The final treatment plan is to wait a minimum of six months and check vitality of #13. To date #13 is now four months post-treatment and the patient has experienced no symptoms.

Conclusion
Recent advancements in composite resins, bonding agents and matrix systems allow dentists to have the best opportunity to provide his or herpatients excellent posterior composite restorations that have the potential to provide the patient with a restoration that can last a long time.

Technique and attention to detail will still remain critical for long-term success. Understanding this new generation of materials will allow the dentist to use his or her clinical experience and knowledge to choose which material and technique to use as the situation dictates.

References
  1. Lynch CD, McConnell RJ, Wilson NHF. Trends in the placement of posterior composites in dental schools. J Dent Ed. 2007;71(3):430-4.M
  2. Opdam NJ, Bronkhorst EM, Loomans BA, Huysmans MC. 12-year survival of composite vs amalgam restorations. J Dent Res. 2010 Oct;89(10):1063-7.
  3. Buonocore MG. A simple method of increasing the adheasion of acrylic filling materials to enamel surfaces. J Dent Res. 1955;34:849-53.
  4. Strassler HE. Self-etch adhesives. Inside Dentistry 2006;3(6)


Dr. Gary Radz maintains a private general dentistry practice in downtown Denver. He is on faculty of the University of Colorado School of Dental Medicine and has published more than 150 articles. In addition, Dr. Radz is on the editorial board of seven different dental journals and has lectured internationally for the past 18 years on restorative, aesthetic dentistry as well as sleep apnea. He is a founding member of the Catapult Group and in 2014 he became the chief dental officer for Somnia, a sleep wellness store in Colorado. In 2003, 2011 and 2013 he was the program co-chair for the American Academy of Cosmetic Dentistry's annual scientific meeting.

Dentaltown Magazine
September 2025
Dentaltown Magazine September 2025 Read Current Issue Read Archived Issues
Sponsors
Townie Perks
Townie® Poll
Who or what do you turn to for most financial advice regarding your practice?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds Dental News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2025 Dentaltown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450