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Inside Dentistry

October 2010, Volume 6, Issue 9
Published by AEGIS Communications


Low-Shrink Composite Technology

A new class of composite material with optimized mechanical properties is designed to reduce shrinkage stress.

Amanda Canto, DDS

Confused by all of the composite terminology over the past decade? Macrofill, microfill, hybrid, microhybrid, nanohybrid, low-shrink, etc; these materials have made important contributions to our industry and the manner in which we provide care. Yet, of all the different composite choices, nothing has garnered more excitement in recent years than the promise of "low-shrink" composites. Low-shrink composite materials have promised to make posterior adhesive dentistry easier, safer to use, and more appealing to the masses of dentists concerned about placement methodology and long-term clinical results. In fact, for more than a decade, achieving low-shrink has been the Holy Grail in adhesive dentistry for composite manufacturers and dentists alike. Dental material companies are finding, however, that low-shrink does not achieve all that they and others believed it would.

Today, we are beginning to see a new class of composite material with optimized mechanical properties designed to reduce shrinkage stress as opposed to merely addressing the issue of shrinkage. This fact is significant given that a lower-shrink material does not necessarily offer a low-shrinkage stress value. The result of using a low-shrink, higher-stress building composite can be just as deleterious and harmful to the tooth as placing an older composite material using a bulk-placement technique.

Thankfully, these new low-stress materials allow for simpler, faster, and fewer steps in placing composite, making placement safer and more time efficient than ever before.

The Technique

The technique used in the case presented in this article began by using a self-etch adhesive (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6). iBOND® Self Etch adhesive (Heraeus Kulzer, http://www.heraeusdentalusa.com) was chosen because of its high bond strength to both enamel and dentin, simple one-coat technique, and proven clinical efficacy.

After placement of the self-etch adhesive, a low-shrink, flowable composite material (Venus® Bulk Fill, Heraeus Kulzer) was used to fill up all but approximately 1.5 mm of the occlusal surface (Figure 7 and Figure 8). The approximate total depth of the low-shrink, flowable material was 4 mm. Venus® Diamond Bulk Fill material was chosen because it can be placed up to 4 mm deep. In the author's opinion, this bulk-flow flowable allows for fast, safe, and efficient placement without compromising the clinical result (Figure 9 and Figure 10).

After placement of Venus® Bulk Fill, a final layer and single shade of Venus® Diamond Universal Composite (Heraeus Kulzer) was chosen specifically because of its durability, high wear resistance, and color-adaptive qualities. Primary, secondary, and even tertiary anatomy is simple to carve and create with the wax-like consistency of Venus® Diamond (Heraeus Kulzer) (Figure 11, Figure 12, Figure 13, Figure 14, Figure 15).

After gross reduction, the Venus Supra finishing and polishing system (Heraeus Kulzer) was used to create a lasting polish (Figure 16 and Figure 17).

Conclusion

Venus® Bulk Fill base/liner flowable composite material allows for fast, simple, and safe clinical application of composite in a posterior restorative situation. Heraeus' entire Venus Esthetic Solution System provides for a complete solution to what has historically been a difficult task: Restoring posterior teeth to proper function and esthetics using a system that provides simplicity, repeatability, and the promise of long-term success.

About the Author

Amanda Canto, DDS
Private Practice
Houston, Texas


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Image Gallery

Figure 1  The patient, a 36-year-old man, presented with the need and desire to replace a leaking amalgam restoration on tooth No. 30.

Figure 1

Figure 2  After anesthetizing, rubber-dam isolation was achieved and the amalgam restoration was removed. Recurrent decay was found and removed buccolingually, yielding a class I preparation of moderate size.

Figure 2

Figure 3  The enamel at the cavosurface margin was roughened in preparation for application of iBOND® Self Etch adhesive. This adhesive was chosen specifically because of its consistently high bond strengths and low occurrence of postoperative hy

Figure 3

Figure 4  A copious amount of iBond was applied to the preparation and then agitated with a microbrush for 20 seconds to improve demineralization and diffusion.

Figure 4

Figure 5  A light stream of air was used to dry the adhesive, leaving a visibly glossy surface before light-curing.

Figure 5

Figure 6  The adhesive was then cured with an LED light for 20 seconds.

Figure 6

Figure 7  Chosen for its low shrinkage stress and exceptional ease of use, a single dose of Venus® Bulk Fill Universal Shade was used to fill approximately 4 mm of the pulpal floor of the preparation.

Figure 7

Figure 8  Because flow and self-leveling properties of Venus® Bulk Fill are exceptional, there was no need for manipulation with an instrument and the material was light-cured for 20 seconds with an LED light.

Figure 8

Figure 9  The one-step, 4-mm increment had great adaptability to the preparation walls, leaving the final 1.5 mm of the preparation to be restored with Venus Diamond Universal Composite.

Figure 9

Figure 10  A final layer of Venus Diamond Universal Enamel Shade A2 was applied and adapted to the margins of the restoration with an anatomical burnisher that was used to reproduce the cavosurface anatomy.

Figure 10

Figure 11  The restoration was then light-cured with an LED light for 20 seconds.

Figure 11

Figure 12  The primary, secondary, and even tertiary anatomy was easily sculpted, and an incredible chameleon effect was created using just one shade of Venus Diamond Universal Composite.

Figure 12

Figure 13  Occlusion was adjusted with a carbide finishing bur and then finished and polished using the Venus Supra polishing system.

Figure 13

Figure 14  Occlusion was adjusted with a carbide finishing bur and then finished and polished using the Venus Supra polishing system.

Figure 14

Figure 15  This view shows the buccal preparation also restored with the bulk-fill technique described.

Figure 15

Figure 16  The rubber dam was removed and the final restoration is shown to be imperceptible and accomplished in just a matter of minutes.

Figure 16

Figure 17  Venus Bulk Fill also has excellent radiographic properties, giving a clear radiopaque image on x-ray for identification of the restoration. The patient reported no postoperative discomfort and was thrilled with his new restoration.

Figure 17