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.
This young patient showed a dental caries on the first molar, while the second molar presented an old infiltrated restoration to replace.
The rubber dam placement highlights the two molars to be treated.
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.
Therefore, for the second molar, a sectional metal matrix was placed with wedge and ring to transform class II in class I.
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.
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.
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.
Subsequently, the enamel was selectively etched for 20 seconds.
The mesial wall of second molar was performed and now it is possible to restore the two class I.
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.
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.
Final result of two restorations after finishing and polishing procedures.
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.
Before and after.
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.
- 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.
- 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.
- 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.