Making fillings fast and easy isn’t a dream anymore, as restoration of posterior teeth with bulk composites makes it possible compared to the traditional incremental technique. Bulk material in posterior restoration is now a reality accepted by clinicians and by Literature, hence should be considered as an affordable and time-saving procedure. We present a clinical case of our daily practice with composites in which we used the bulk-fill to restore a posterior tooth. We mention the advantages of using this material in micro-invasive cavities.
Initial picture shows the clinical aspect of a caries distal 1.4 that was detected thanks to an x-ray.
Rubber dam isolation from first molar to the central incisor with a 27N clamp. We always use a wedge before opening the cavity. A wedge will help us open the proximal space, determine the position of the cavity margin and squeeze down the papilla preventing us from perforating the dam with burs.
Aperture of the cavity is done with a cylindrical diamond bur, at high speed with water, until healthy enamel is detected. Now we will proceed to the deep cleaning of the cavity.
The micro-invasive cavity has margins outside the contact point, gingival margin at the level of the wedge and no carious debris. The carious lesion was cleaned with low-speed round bur and no water, delicately brushing the cavity without heating the dentin. After caries removal, aquaCare was used for a final cleaning.
Transparent matrix in place, the palatal side needed extra adaptation, which was achieved with a cotton pellet as it’s easy to use and extremely effective.
An extra strong NiTi ring (MyRingClassico, Polydentia) was used to achieve a strong contact point.
Due to the cavity geometry (very narrow, but very deep) a bulk fill material would be an optimal choice.
The bulk material (DMG Ecosite Bulk Fill, universal color) was placed in only one increment. The cavity is deep but narrow, making the conventional incremental technique difficult to perform. The single increment offered by the features of the bulk material, was an advantage in this case, as a 4-5 mm layer was placed in a short time.
After bulk filling of the cavity with a single increment, excess material was removed and modeling done thanks to the nice stiffness and sculpting properties of the material.
Color-wise, these kind of materials integrate very well in most cases in posterior teeth, sometimes better than some hybrid composites. The finishing and polishing protocol is the same as for hybrid materials and it is not difficult to make this composites shine.
The optical properties of this composites are very similar to some body masses of conventional hybrid composites. A control appointment will be scheduled and the control pictures will be uploaded.
Bulk fill composites are indicated in all type of posterior restorations, but bulk fill materials – as opposed to what one may think – are particularly advantageous for the mini-invasive restorations like the one of the presented clinical case. The limited accessibility of these micro-cavities makes the performance of the conventional stratification technique complicated. Instead, the bulk application (non incremental) offers technical advantages and is time-saving.
This more economical restorative approach, as compared to conventional resin composites, is very convenient in the current dentistry hard times.
DMG Ecosite Bulk Fill has a handling, optical properties and polishing similar 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.
1. Taübok TT, Attin T. Composites Bulk fill. Une mise à jour. Swiss Dent J. 2016;126(9):812-813.
2. 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.