small chipping of upper right incisor

Bubble-free flowable restoration in esthetic anterior composites

Facing the restoration of a small fracture is always complicated. Preserving sound tissue and avoiding preparation, controlling color, using very small amounts of composite, are just a few of the challenges that can turn an otherwise-successful restoration into a failed one.
Moreover, it is very common to create voids or bubbles in such small restorations. This depends mainly on the mixing of the composite material when injected into the syringes, and may destroy an aesthetic restoration by leaving a small defect.
Flowable composites are helpful in controlling the quantity of material, yet we all know that, paradoxically, we can find more bubbles inside the material itself when we push it out.
In this case, I tested the latest 3M system in flowable tecnology. According to the manufacturer, with this syringe, it’s impossible to have bubbles in a restoration, so I wanted to test it in the most difficult situation: a small and esthetic restoration of the incisal edge in a young patient after a trauma, without any preparation of the residual tissue.

incised view of enamel crown fracture

Fig.1

Palatal view of the fracture. A brush was used to clean up the tissue, and a silicone point to smooth a bit the irregularities, and to favour the penetration of the bonding agent.

enamel etching with orthophosphoric acid

Fig.2

Ortophosforic acid was applied for 20 seconds to prepare the enamel at the best for adhesion. After that, I thoroughly rinsed for 20 seconds, and dried carefully the entire tooth.

micrubrush applying bonding agent

Fig.3

Scotchbond Universal was applied carefully with a microbrush. After 10 seconds sitting, it was air-blown to eliminate excess.

flowable filtek syringe for bubble-free application

Fig.4

The 3M Filtek Flowable material was directly applied on the tooth surface. The syringe was easier to use, and the extrusion looked very well controlled while pressing.
Especially in such small restorations, controlling the quantity of composite is very helpful to manage material spacing.

Fig.5

The whole increment in the picture was done in one shot. You can appreciate the homogeneity of the material, and the translucence and its good esthetic appearance.

pop on abrasive disc for shaping of incisor

Fig.6

A pop-on disc was used to finalize the shape of the restoration.

finishing perio bur from styleitaliano finishing kit

Fig.7

A blue-handpiece-mounted bur from the Styleitaliano Finishing kit was used to delicately carve the surface with the aim of copying the shape of the adjacent tooth. Just this one bur for the macro- and micro-texture of the restoration. Low speed allows for perfect control of the small restoration in all their details.
TIP! Use it dry to better control the situation and to avoid touching sound tissue.

spiral wheel for composite polishing

Fig.8

The beige spiral wheel is ideal to polish the restoration: first slow and dry, rubbing the surface with slight pressure, and then, with a lighter touch, increase the speed and add water as well. If needed, repeat the same steps with the white wheel.

finished flowable composite restoration

Fig.9

Here is the final outcome. You can appreciate good color blending, and the perfect homogeneity of the restoration, even without any preparation.

surface texture of incised edge restoration

Fig.10

As you can see from this lateral view, controlling the shape during the finishing procedures is crucial for a satisfactory integration of the restoration material.

Conclusions

Very small edge restorations of the incised edge, and no prep, is one of the hardest esthetic challenges. No space to layer, difficult application of paste composite, difficult finishing manoeuvres. Although the use of a flowable composite in one shot could be the perfect solution, many of these materials on the market are full of bubbles inside the syringe, and not resistant enough in the long term.
My experience with the 3M Filtek flowable is very positive, and it keeps on proving itself at each follow up appointment. The new syringe looks very easy to handle, and the extrusion is very homogeneous. Bubbles seem not to be an issue anymore, and this is a big step forward with regards to the dentist’s needs. Also, the esthetic outcome in one application looks very good, as well as the easy management with 1 bur-1 wheel for finishing and polishing. Challenge accepted and won, then!

Bibliography

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Salat A, Devoto W, Manauta J. Achieving a precise color chart with common computer software for excellence in anterior composite restorations. Eur J Esth Dent. 2011;6(3);280-296.
Devoto W, Pansecchi D. Composite restorations in the anterior region: clinical and aesthetic performances. PPAD. 007;19(8):465-470
Devoto W, Manauta J, Paolone G. IN-OUT: a new concept in composite stratification. LABLINE. 2013;Summer:110-127.
Paolone G, Orsini G, Manauta J, Devoto W, Putignano A. Composite shade guides and color matching. Eur J Esthet Dent. 2014;9(2):2-20