Bulk and Go

The restoration of posterior teeth is a diary clinical treatment that presents, in most of cases, a difficult challenge for clinicians. The bulk-fill composites have recently revolutionized restorative dentistry, being supported by the scientific literature and highly accepted by clinicians. Bulk-fill composites make possible to realize a successful restoration in terms of aesthetic and function in a relatively short time, since it is performed placing one single layer of material up to the occlusal surface, without using the traditional layering technique.

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Fig.1
This clinical case presents a patient, Roberto, 45 years-old, that came to the clinic for his annual oral hygiene recall. During the visit, thanks to x-ray and clinical examination, secondary decays on the previously restored 1.6 and 1.7 and a generally unaesthetic appearance of the old composites were evident, thus requiring their immediate replacement.

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Fig.2
A silicon molde guide was realized to reproduce the occlusal anatomy of the teeth.

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Fig.3
The silicon Molde adaptation in the posterior area to be restored.

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Fig.4
After rubber dam isolation, starting from tooth 1.7 and the distal proximal wall of 1.6, the old composites and the caries were removed and cavities prepared.

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Fig.5
Using one mass of Filtek™ One Bulk Fill Restorative (3M, ESPE) composite, the restoration of 1.7 and the distal proximal wall of 1.6. were performed.

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Fig.6
View of the restorations after finishing and polishing procedures on 1.7. and distal surface of 1.6.

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Fig.7
After, the removal of the rest of old restoration on tooth 1.6 was realized and a occluso-mesial cavity prepared.

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Fig.8
Step-by-step procedure to restore 1.6. Selective enamel etching using 3M™ Scotchbond™ Gel for 20 seconds.

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Fig.9
Application of 3M™ Scotchbond™ Universal Adhesive, which is a crucial step to obtain a strong and durable adhesion between dental hard tissues and composites. Double layers of the bonding agent ensure a great interdigitation into the etched enamel and an ideal penetration into dentinal substrate, which is also increased using a gentle blow air before polymerization.

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Fig.10
The ring with plastic tips allows to reproduce a good anatomy of the proximal wall with a correct point of contact.

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Fig.11
Filtek™ One Bulk Fill Restorative (3M, ESPE)  gives the possibility to directly place 4 mm and fill the cavity up to the occlusal surface, without losing the mechanical properties using only one mass of composite, as confirmed by the in vitro study of Monterubbianesi et al. (2016). At this stage, the modeling and sculpting of the occlusal morphology of 1.6. can be performed.

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Fig.12
First, the sulcus to demarcate the central fossa has to be drawn. With simple lines, it is possible to correctly recreate a perfect tooth anatomy.

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Fig.13
View of the second and third lines: the way to go for an easy and very fast modeling and sculpting.

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Fig.14
Final result after finishing and polishing procedures.

Conclusions

The Bulk fill composite technique is indicated in all type of posterior direct restorations, above all is particularly advantageous in term of simplicity and time-saving, if compared to the conventional layering technique, as evidenced by
Loguercio et al. (2019). Moreover, it offers good modeling and sculpting options: with simple lines it is possible to reproduce the exact anatomy of any tooth. The use of one single layer of  Filtek™ One Bulk Fill Restorative (3M, ESPE) leads to an aesthetic and functional restoration, meeting the expectations of both the clinician and the patient.

Bibliography

-Loguercio AD, Rezende M, Gutierrez Reyes MF, Costa TF, Armas-Veja A, Reis A. Randomized 36-month Follow-up of Posterior Bulk-Filled Resin Composite Restorations. Journal of Dentistry [Internet]. 2019 May 14 [cited 2019 May 21]; Available from: http://www.sciencedirect.com/science/article/pii/ S0300571219301010
– R. Monterubbianesi, G. Orsini, G. Tosi, C. Conti, V. Librando, M. Procaccini, A. Putignano, Spectroscopic and Mechanical Properties of a New Generation of Bulk Fill Composites, Front. Physiol. 7 (2016). doi:10.3389/fphys.2016.00652.
– R. Hirata, W. Kabbach, O.S. de Andrade, E.A. Bonfante, M. Giannini, P.G. Coelho, Bulk Fill Composites: An Anatomic Sculpting Technique, J. Esthet. Restor. Dent. Off. Publ. Am. Acad. Esthet. Dent. Al. 27 (2015) 335–343. doi: 10.1111/jerd.12159.

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