Easy and fast one quadrant restorations by bulk-fill composite

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.

styleitaliano style italiano old amalgam restoration

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.

styleitaliano style italiano teeth after removing old restorations with bleeding

Fig.2
After injecting the anesthesia, we removed the old restorations.

styleitaliano style italiano clean cavities after isolation with rubber dam

Fig.3
Full quadrant isolation is necessary in multiple teeth restorations.

styleitaliano style italiano selective etching in multiple cavity restoration

Fig.4
Selective etching of the enamel with orthophosphoric acid was performed for 30 seconds.

styleitaliano style italiano etched multiple cavities

Fig.5
Cavities were then rinsed for 30 seconds to be sure all of the acid was removed.

styleitaliano style italiano bonded multiple posterior cavities

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.

dmg banner style italiano styleitaliano
dmg banner style italiano styleitaliano
styleitaliano style italiano multiple cavity restoration with wedges and matrices

Fig.7
Bioclear matrices and diamond wedges were then placed to build-up the proximal walls.

styleitaliano style italiano multiple proximal build-ups in upper posterior

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.

styleitaliano style italiano ecosite universal bulk fill composite material

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.

styleitaliano style italiano finished composite restorations

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.

styleitaliano style italiano occlusal anatomy in multiple posterior direct restorations

Fig.11
Oblique view of the final restorations before rubber dam removal.

styleitaliano style italiano occlusal check after quadrant composite restoration

Fig.12
Immediately after rubber dam removal and bite check, some occlusal adjustments were needed.

styleitaliano style italiano polished composite fillings

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

1. Taübok TT, Attin T. Composites Bulk fill. Une mise à jour. Swiss Dent J. 2016;126(9):812-813.
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.

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