Essential Flow – Elevate (3 of 8)

Clinical Case in collaboration with Dr. Paulo Monteiro.

Clinical Applications of Flowable Composite Resins: A Comprehensive Series

Deep margin elevation with composite resin is a reliable technique in dentistry that has revolutionized adhesive restorative treatments, particularly in cases of extensive carious lesions or tooth fractures extending to sub-gingival areas. This approach offers several significant advantages, especially when using flowable resins. Firstly, flowable resins provide excellent marginal adaptation due to their reduced viscosity, allowing for more effective sealing and minimizing bacterial infiltration. Additionally, this technique facilitates moisture control and improves accessibility during the restoration, resulting in a more predictable and durable procedure. Deep margin elevation also contributes to the preservation of tooth structure, avoiding the need for excessive removal of healthy tissue to achieve accessible margins.

styleitaliano style italiano fractured premolar with deep caries essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.1
Initial situation. A lower premolar with deep caries and an infra-gingival distal/lingual margin.

styleitaliano style italiano isolation of infagingival fracture line essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.2
After cleaning the all affected dentin, the tooth is ready to proceed with the deep margin elevation.

styleitaliano style italiano selective enamel etching essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.3
The Selective Enamel Etch technique was used for the deep margin restoration. This approach reduces the risk of post-operative sensitivity by utilizing a universal adhesive without etching the deep dentin.

styleitaliano style italiano bonding of cavity essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.4
After the application and light curing of the adhesive system (3M Scotchbond Universal Plus, Solventum).

styleitaliano style italiano wedge placed for deep margin elevation essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.5
A large Polydentia plastic wedge was used to seal the interproximal space, allowing for margin elevation. After applying the wedge, 3M Filtek Bulk Fill Flowable (Solventum) was placed on top of the dentin, extending to the top of the wedge, and light-cured for 20 seconds.

styleitaliano style italiano bul flowable composite resin essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.6
The chemistry of the 3M Filtek Bulk Fill Flowable (Solventum) composite resin, combined with the innovative design of the syringe and tips, ensures the absence of internal bubbles and allows for easy, smooth material extrusion. The smoothness and anatomic shape of the Polydentia wedges provide the perfect tool for adapting to the proximal margin of the tooth, creating a smooth composite wall and a seamless transition margin.

3M filtek bulk flowable banner style italiano styleitaliano
3M filtek bulk flowable banner style italiano styleitaliano
styleitaliano style italiano scheme for deep margin elevation essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.7
Illustration of the deep margin elevation in this particular clinical case.
Orange – The Polydentia plastic wedge.
Red – The 3M Scotchbond Universal Plus (Solventum).
Green – The 3M Filtek Bulk Fill Flowable (Solventum).

styleitaliano style italiano onlay buildup and preparation essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.8
After the deep margin elevation, the tooth was prepared for an indirect posterior partial restoration (Onlay).

styleitaliano style italiano polyether impression for onlay restoration essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.9
Impression of the onlay preparation taken with Impregum (Solventum).

styleitaliano style italiano resin provisional restoration essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.10
The short term provisional restoration was preformed using Telio-Temp (Ivoclar Vivadent).

styleitaliano style italiano try in of onlay restoration essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.11
Try in of the Ceramic Onlay.

styleitaliano style italiano cavity being cleaned by aquacare essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.12
Cleaning and sandblasting the internal tooth structure with the Aquacare Twin.

styleitaliano style italiano etching before cementation of onlay essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.13
On the internal tooth surface, after cleaning and sandblasting, phosphoric etching was applied for 30 seconds and then rinsed with water for another 30 seconds.

styleitaliano style italiano brushing adhesive agent essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.14
Adhesive was applied to the internal surface of the tooth using 3M Scotchbond Universal Plus (Solventum).

styleitaliano style italiano cementation of ceramic onlay restoration essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.15
The internal surface of the onlay was prepared with hydrofluoric acid etch, thoroughly cleaned with a water spray, treated with silane, and then coated with adhesive (3M Scotchbond Universal Plus, Solventum) without light curing. After cementing the onlay with RelyX Universal resin cement in dual-cure adhesive mode and removing the main cement excess, the margins were covered with glycerin and light cured for 20 seconds.

styleitaliano style italiano onlay restoration after rubber dam removal essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.16
Final outcome of the indirect restoration bonded after the deep margin elevation procedure.

styleitaliano style italiano before and after xray essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.17
X-ray images from the initial and final situations (after deep margin elevation and indirect restoration adhesion) reveal perfect adaptation between the flowable composite resin used for the deep margin elevation and the remaining tooth structure.

styleitaliano style italiano 6 months follow up after indirect restoration essential flow elevate deep margin elevation technique solventum 3M filtek bulk fill flowable composite indirect posterior restoration onlays

Fig.18
6 months follow-up of the indirect restoration bonded after the deep margin elevation procedure.

Conclusions

In conclusion, deep margin elevation (Elevate) with composite resin, particularly utilizing flowable resins such as 3M Filtek Bulk Fill Flowable (Solventum), offers significant advantages that enhance the effectiveness and durability of dental restorations. These flowable resins excel in marginal adaptation and sealing, crucial for preventing bacterial infiltration and maintaining restoration integrity. The technique’s ease of application and effective moisture control ensure predictability and minimal invasiveness, preserving healthy tooth structure. Furthermore, the creation of accessible and cleanable restorative margins supports periodontal health, lowering the risk of gingival inflammation.

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3M filtek bulk flowable banner style italiano styleitaliano

Bibliography

  1. Attar N. Influence of flowable composite lining on the microleakage and adaptation of composite restorations. Journal of Dentistry. 2016 Mar;44:14-20.
  2. Poitevin A, De Munck J, Van Ende A, Suyama Y, Mine A, Peumans M, Van Meerbeek B. Bonding effectiveness of self-adhesive composites to dentin and enamel. Dental Materials. 2013 Feb;29(2):221-30.
  3. David JR, Gomes OM, Gomes JC, Loguercio AD, Reis A. Bond strength of self-adhesive flowable composite resins to dental tissues: A systematic review and meta-analysis of in vitro studies. Journal of Adhesive Dentistry. 2022 Jun;24(3):193-208.
  4. Hikita K, Van Meerbeek B, De Munck J, Ikeda T, Van Landuyt K, Maida T, Lambrechts P, Peumans M. Bonding effectiveness of adhesive luting agents to enamel and dentin. Dental Materials. 2007 Jan;23(1):71-80.
  5. Karaman E, Ozgunaltay G.  A two-year comparative evaluation of clinical performance of a nanohybrid composite resin to a flowable composite resin. Journal of Functional Biomaterials. 2021 Sep;12(3):53.
  6. Alqabas AA, Mously HA, Alkhurays MA, Alhumaidan HJ, Alnassar AS. The effect of gravity on marginal integrity of different flowable bulk-fill resin composites. Medicina. 2024 Feb;60(2):230.
brain boost style italiano styleitaliano hands-on lectures styleitaliano tv 3M Solventum
brain boost style italiano styleitaliano hands-on lectures styleitaliano tv 3M Solventum

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