Bulk&Go and BIOBulk & Body

A clinical case by our Community member Dr Vincenzo Tosco

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

Nowadays, bulk-fill composites (BFCs) are one of the resin-based materials most widely used for the restoration of posterior teeth. They can be placed and cured in increments of up to 4–5 mm in thickness, in order to eliminate the need for layering, shortening the clinical procedure, and simplifying handling. Furthermore, the introduction of bioceramic materials with high-performance properties as a replacement for dentin makes their application possible for the bulk filling of deep cavities.
This clinical case presents two direct restorations in the posterior sector based on the Bulk and Go technique proposed by Style Italiano and a second new one based on the BIOBulk and Body concept.

  • The “Bulk and Go” technique allows a one-step procedure, taking full advantage of the favorable chemical–physical characteristics of the high-viscosity BFCs. Therefore, when providing the cavity that does not exceed a depth of 4 mm, its restoration can be realized in a single mass application.
  • The “BIOBulk and Body” technique is a two-step procedure based on the positioning of a first layer of bioceramic material, which acts as a dentin substitute, instead of BFC. Subsequently, the second cover layer consisting of an enamel-like composite using a Body Shade composite with low translucency and high value.
style italiano styleitaliano initial situation old infiltrated restoration

Fig.1
This young patient showed a dental caries on the first molar, while the second molar presented an old infiltrated restoration to replace.

style italiano styleitaliano isolation

Fig.2
The rubber dam placement highlights the two molars to be treated.

style italiano styleitaliano Cavities preparation

Fig.3
With the cavities open, the carious lesions found were cleaned first with the aid of high-speed burs, and then with manual instruments such as vanadium excavators. Once all the infected dentin had been removed, a class I on first molar and a class II on the second one were obtained.

style italiano styleitaliano Matrix, wedge, and ring placement on the second molar

Fig.4
Therefore, for the second molar, a sectional metal matrix was placed with wedge and ring to transform class II in class I.

style italiano styleitaliano Verification of a proper contact point

Fig.5
It is essential to check the closure of the matrix on the preparation margin of the cavity. Furthermore, it is important to verify and provide a proper contact point.

style italiano styleitaliano Biodentine XP placement

Fig.6
After that, the Biodentine XP biomaterial was applied inside the cavity in a single mass up to 1.5 mm from the occlusal surface, thus leaving space for the final layer of composite enamel. Once applied, it is necessary to wait at least 15 minutes for the material to harden before proceeding with the adhesion procedure.

septodont biodentine XP style italiano styleitaliano
septodont biodentine XP style italiano styleitaliano
style italiano styleitaliano Enamel margin of the cavity preparation

Fig.7
Furthermore, it is imperative to keep the enamel margin of the cavity preparation free in order to perform the mesial wall with the composite to transform class II into class I.

style italiano styleitaliano Selective-etch on enamel

Fig.8
Subsequently, the enamel was selectively etched for 20 seconds.

style italiano styleitaliano Restoring the mesial wall of the second molar

Fig.9
The mesial wall of second molar was performed and now it is possible to restore the two class I.

style italiano styleitaliano Essential lines technique

Fig.10
In the first molar Bulk and Go technique was provided, while in the second molar, the last layer of enamel shade composite using a Body shade was used to complete the restoration. For the modeling, Essential Lines technique was applied.

style italiano styleitaliano Drawing the lines on the the first and the second molars

Fig.11
After filling the cavity and condensing the composite in a proper way, the essential lines were drawn to reproduce the occlusal anatomy of each posterior tooth.

style italiano styleitaliano final situation direct composite restoration with biodentine XP

Fig.12
Final result of two restorations after finishing and polishing procedures.

style italiano styleitaliano follow up control x-ray

Fig.13
The control x-ray shows different radiopacities of the BFC and Biodentine XP. Furthermore, the entire cavity was filled and sealed, without the presence of gaps or voids within the restorations. After 9 months of follow-up, no radiographic signs of periodontal lesions were evident and no symptoms were reported by the patient.

style italiano styleitaliano before and after direct composite restoration

Fig.14
Before and after.

Conclusions

Biodentine has multiple applications. Considered a dentin substitute due to its similar physical-mechanical characteristics, it can be used to fill the cavity up to 1.5 mm from the occlusal surface in bulk mode, following the BIOBulk and Body concept. The combination of Biodentine for filling the cavity and the Essential Lines technique for modeling the occlusal surface, simplify and save time for the direct posterior restoration.

Bibliography

  1. Falakaloğlu S, Yeniçeri Özata M, Plotino G. Micro-shear bond strength of different calcium silicate materials to bulk-fill composite. PeerJ. 2023 Mar 29;11:e15183. doi: 10.7717/peerj.15183. PMID: 37013141; PMCID: PMC10066686.
  2. Putignano A, Tosco V, Monterubbianesi R, Vitiello F, Gatto ML, Furlani M, Giuliani A, Orsini G. Comparison of three different bulk-filling techniques for restoring class II cavities: μCT, SEM-EDS combined analyses for margins and internal fit assessments. J Mech Behav Biomed Mater. 2021 Dec;124:104812. doi: 10.1016/j.jmbbm.2021.104812. Epub 2021 Sep 3. PMID: 34500356.
  3. Chiodera G, Orsini G, Tosco V, Monterubbianesi R, Manauta J, Devoto W, Putignano A. Essential Lines: a simplified filling and modeling technique for direct posterior composite restorations. Int J Esthet Dent. 2021 May 10;16(2):168-184. PMID: 33969973.

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