Fig.1
In this particular case, the patient’s main complaint was the complete lack of a contact point with the adjacent tooth, which led to food impaction and pain while chewing tougher food

Fig.2

Fig.3
After removal of the previous filling, a sectional matrix was used for the reconstruction of the proximal wall. The use of teflon tape was optimal for a perfect marginal adaptation of the matrix (watch the video).

Fig.4

Fig.5
After selective enamel etching, a universal adhesive was applied and cured for both dentin and enamel adhesion.
The first bulk composite resin mass was used to build the proximal wall and obtain a simple Class I cavity to fill.

Fig.6
In this case a new highly-filled bulk composite resin (DMG Ecosite Bulk-Fill) was used to build both the core and occlusal surface of the tooth.

Fig.7
After placing a small amount of flowable composite resin (0,5-1 mm) on the bottom of the cavity, a single mass of bulk composite resin was placed in the remaining cavity and after the marginal adaptation (watch the video) a simple modeling following Giuseppe Chiodera’s Essential Lines was performed (watch the video).

Fig.8

Fig.9
After polymerization of the bulk material, some stains were applied in order to enhance the anatomy. Then finishing and polishing were carried out with a carbide bur, a flexible contouring disc, a brown polisher and a silicone carbide brush.

Fig.10
After rubber dam removal, occlusion was checked with an 8 mm articulation paper and some small premature contacts were removed.

Fig.11
At one week check-up, we had a complete integration of the restoration with the tooth.

Fig.12

Conclusions

Modern Bulk composite resins are an easy and affordable material for posterior teeth reconstruction. They can be easily and quickly applied in cavities (up to 5 mm in height), easily shaped and polished as shown in this didactic case.

DMG Ecosite Bulk-Fill has a good handling and good optical properties thanks to its particular and natural opalescence. Furthermore, it’s an easy-to-model material, because it keeps its shape without collapsing inside the cavity before light-curing. As regards the polishing procedure and its result, it is similar to that obtained with a conventional composite resin.

For these reasons, this kind of material is ideal in all those situations in which we need to save time while obtaining ideal restorations without compromising on function and aesthetics.

Bibliography

1. Van Ende, J. De Munck, K.L. Van Landuyt, A. Poitevin, M. Peumans, B. Van Meerbeek. Bulk-filling of high C-factor posterior cavities: effect on adhesion to cavity bottom dentin. Dental Materials 29 (2013) 269-277.
2. Van Dijken JW, Pallesen U. 2016. Posterior bulk-filled resin composite restorations: a 5-year randomized controlled clinical study. J Dent. 51:29–35.
3. Hirata R, Kabbach W, de Andrade OS, Bonfante EA, Giannini M, Coelho PG. Bulk Fill Composites: An Anatomic Sculpting Technique. J Esthet Restor Dent. 2015 Nov;27(6):335-43.
4. 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.
5. 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.
6. Ilie N, Bucuta S, Draenert M. Bulk-fill resin-based composites: an in vitro assessment of their mechanical performance. Oper Dent. 2013 Nov-Dec;38(6):618-25.