Making fillings fast and easy is not a dream anymore, as bulk composites make results as good as the traditional incremental technique possible. Bulk materials in posterior restoration are now a reality accepted by clinicians and by literature, hence should be considered as an affordable and time-saving procedure. We are presenting a clinical case of our daily practice with composites, in which we used the bulk-fill to restore posterior teeth. We will mention the advantages of using this material.
Fig.1
This 18-years-old patient presented restorations with secondary caries in correspondence with the mesial and distal areas, overhanging fillings and food impaction.
Fig.2
After injecting the anesthesia, we removed the old restorations.
Fig.3
Full quadrant isolation is necessary in multiple teeth restorations.
Fig.4
Selective etching of the enamel with orthophosphoric acid was performed for 30 seconds.
Fig.5
Cavities were then rinsed for 30 seconds to be sure all of the acid was removed.
Fig.6
A universal adhesive (DMG Ecosite Bond) was applied on the dried cavity, in a selfetching mode, using a microbrush for 20 seconds. Excess was removed and the solvent evaporated by blowing air.
Fig.7
Bioclear matrices and diamond wedges were then placed to build-up the proximal walls.
Fig.8
A thin layer of flowable composite was used as a liner. The interproximal walls were layered using a bulk material (DMG Ecosite Bulk Fill, universal shade), in order to reproduce a more natural anatomy.
Fig.9
The bulk material (DMG Ecosite Bulk Fill, universal color) was then placed in just one increment. The single increment offered by the features of bulk materials was an advantage in this case, as a 4-5 mm layer could be placed at once.
Fig.10
After bulk filling the cavity with a single increment, excess material was removed and modeling done thanks to the nice stiffness and sculpting properties of the material. Brown stain was used to enhance the occlusal anatomy.
Fig.11
Oblique view of the final restorations before rubber dam removal.
Fig.12
Immediately after rubber dam removal and bite check, some occlusal adjustments were needed.
Fig.13
Final situation of the restorations. Thanks to the high mimicry and the easy polishability, the final aesthetic outcome is very good, even if only a universal shade was used.
Conclusions
Bulk fill composites are indicated in large posterior restorations, yet, as opposed to what one may think, these materials are particularly advantageous also for miniinvasive restorations.
DMG Ecosite Bulk Fill has handling, optical properties and polishing comparable to the conventional hybrid, making it easy to obtain similar results to those obtained with hybrid conventional composites, especially when we use a single body mass for posteriors, the most used approach in our daily practice with direct restorations.
Bibliography
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2. Hirata R, Clozza E, Giannini M, Farrokhmanesh E, Janal M, Tovar N, Bonfante EA, Coelho PG. Shrinkage assessment of low shrinkage composites using micro-computed tomography. J Biomed Mater Res B Appl Biomater. 2015 May;103(4):798-806.
3. Leprince JG, Palin WM, Vanacker J, Sabbagh J, Devaux J, Leloup G. Physico-mechanical characteristics of commercially available bulk-fill composites. J Dent. 2014 Aug;42(8):993-1000.
