Posterior restorations. Which consistency to choose?

Composites nowadays have reached great performances both from a mechanical and an esthetic point of view. Almost any brand could work very well, but we usually have a first personal choice because of one main reason, the handling. In these terms different brand composites show huge differences from one another, and it’s up to each dentist to choose the one that’s closest to his/her own comfort at handling.

style italiano styleitaliano occlusal caries

Fig.1
A male patient came to my clinic showing caries on 36 and a marginally infiltrated filling on 37 that needed to be replaced. I placed the rubber dam as usual. In this specific case I chose a vey elastic latex dam by Ivory – Kulzer.

style italiano styleitaliano clean sandblasted cavities

Fig.2
Once I cleaned both cavities, I sandblasted the preparations with 29micron Aluminum Oxide (Aquacare) to enhance the adhesion.

style italiano styleitaliano selective enamel etching

Fig.3
Selective etching strategy combined with the right adhesive system is winning, especially when the cavity is deep in dentine as in 3.7.

style italiano styleitaliano brushing universal bonding agent

Fig.4
The perfect pairing with a selective etching strategy is a Universal adhesive. iBond by Kulzer has a durable and reliable bond strength when used in self etching mode, which allows us not to etch the dentine, therefore reducing post operative hypersensitivity. The bonding agent should be brushed for 30 seconds.

style italiano styleitaliano light curing

Fig.5
Light curing each cavity for 20 seconds.

style italiano styleitaliano flowable composite layering

Fig.6
The last step of adhesion consists in placing a layer of a flowable composite. Immediate Dentine Sealing is crucial to reduce hypersensitivity, but in this case, since the cavity on 37 was 5mm deep, a flowable bulk fill composite (Venus Bulk Flow ONE) was used both to seal the dentine and to quickly fill the cavity in order to leave approximatively 1.5- 2 mm to sculpt the occlusal anatomy. The Fissura instrument (LM Dark Diamond) with its thin tip is ideal to spread the flowable composite on the bottom of a cavity.

style italiano styleitaliano kulzer venus Bulk flow ONE one-shade bulk filling composite
style italiano styleitaliano kulzer venus Bulk flow ONE one-shade bulk filling composite
style italiano styleitaliano sculpting composite with LM Applica Dark Diamond

Fig.7
I decided to restore the two cavities with two different one shade composites in order to exploit the usage indications of each one. Due to larger cavity of 37, I chose Venus Diamond ONE because it is firmer and allows for thicker (yet not more than 2 mm) increments of composite to fill the cavity faster. The Applica instrument (LM Dark Diamond) due to its flexibility adapts very well to the residual anatomy.

style italiano styleitaliano layering buccal cusps

Fig.8
This reduces overlapping on the margins of the cavity which means a significant reduction in finishing time.

style italiano styleitaliano finished composite filling on second molar

Fig.9
Following the residual anatomy, the restoration was performed in a few minutes with an increment of composite for each cusp. Venus Diamond ONE keeps the shape very well, so we can simultaneously sculpt secondary anatomy (if required) with a micro brush or a rounded instrument.

style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano layering small composite increments

Fig.10
Cavity on 36, due to its smaller size, required little and more precise increments. Venus Pearl ONE has a softer consistency because of a lower filler content and a narrower filler size range.

style italiano styleitaliano filled class I cavities

Fig.11
In a few minutes, the occlusal surface of 36 was restored in a very natural shape. The ease of use and handling in small increments make Venus Pearl ONE perfect for small cavities because a softer composite makes it easier to remove excess and acquires a more sinuous shape. No stain was used for the grooves since the adjacent teeth weren’t naturally stained.

style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano polishing occlusal composites

Fig.12
Polishing was carried out with Venus Supra (Kulzer) two-step polishing system consists of pre- and high-gloss rubs at 5.000 – 8.000 rpm on handpiece.
They are made of highly filled silicone with microfine diamond powder and are tailor-made for Venus composites (Venus Diamond ONE and Venus Pearl ONE).
Twist brushes are ideal because their bristles can be bent for easy access to fissures.

style italiano styleitaliano polished occlusal restorations

Fig.13
Result after finishing and polishing procedures.

style italiano styleitaliano occlusal check after direct composite restoration

Fig.14
The final check revealed a pretty perfect function and occlusion on the restored teeth so no further correction was required. Even before rehydration, color matching and the blending of the composite were already impressive.

style italiano styleitaliano check up of composite restorations

Fig.15

Conclusions

After 3 months nothing’s changed in the patient’s mouth. Fillings are fully integrated from an esthetic point of view, even at the margins, where no infiltration or plaque retention were found.
The new one shade by Kulzer, both Venus Diamond and Pearl, blend seamlessly into the surrounding dentition, regardless of the tooth shade, enabling restorations to simply disappear. Moreover it saves time as no shade selection is needed.
Remember that increasing thickness leads to increasing chroma and opacity of the ONE shade. This effect is caused by the light scattering within the filling material. That’s why the filling on 37 is more chromatic then the one on 36 where it takes the shade of the surrounding tooth because, the ONE Shade has a low chroma and high translucency.
The dentist can choose his/her preferred consistency depending on the indication and his/her personal habit.
This article has the aim of sharing a personal opinion about the indications either of the Venus Diamond ONE and Venus Pearl ONE. Venus Diamond ONE is firm, keeps its shape allowing for more time to sculpt it. This features make it ideal when the cavity is wide as you don’t care about being fast to avoid collapsing of the composite.
Venus Pearl ONE is creamy. Its softer consistency makes it suitable to be used in narrow cavities, when you need to put small, rightly sized increments that are easier to be handled and you take less time to shape the occlusal anatomy.
Regardless of their consistency, both composites show excellent sculptability, low-stickiness and long working time to create proper functional surfaces.

Bibliography

  1. Kwon Y, Ferracane J, lee IB. “Effect of layering methods, composite type, and flowable liner on the polymerization shrink- age stress of light cured composites.” Dent Mater 2012;28:801–809.
  2. Demarco FF, Corrêa MB, Cenci MS, Mo- raes RR, Opdam NJ. longevity of posterior composite restorations: not only a matter of materials. Dent Mater 2012;28:87–101.
  3. Kwon Oh, Kim Dh, Park Sh. The influ- ence of elastic modulus of base material on the marginal adaptation of direct composite restoration. Oper Dent 2010;35:441–447.
  4. Hirata R, Clozza E, Giannini M, et al. Shrinkage assessment of low shrinkage composites using micro-computed tomog- raphy. J Biomed Mater Res B appl Biomater 2015;103:798–806.

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