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Bulk Fill Composites
Transcript of Bulk Fill Composites
September 14th, 2012 A - Why would I ever do that?
B - Of course I do, it saves time
C - I will when I cannot properly isolate
D - No, it causes too much stress on the teeth
E - Occasionally, on weekends and holidays
F - Only when I'm drunk Have you ever done a bulk fill composite restoration? Why bulk fill? Using a bulk fill technique SAVES US TIME!
Less time = easier to keep isolation
Less time = more productivity in the practice Disadvantages to Bulk Fill Increased stress on teeth
Marginal integrity compromised
Depth of cure not possible for polymerization Stress on teeth from polymerization shrinkage effects
According to Tatbirojn et. al. 2011 buccal and lingual surfaces were pulled inward even with significantly lower total shrinkage values
Shrinkage stress was not necessarily reduced within the composite, at the bonded interface, and the surrounding tooth structure Sonic Activated, Bulk Fill Composite SonicFill SonicFill is a nanohybrid composite that has great strength, low shrinkage, and high depth of cure
Nanohybrid refers to the filler particle size
Nanohybrid composites have shown to finish smoother and have no decreased physical properties (O'Brien 2008) Moorthy A, Hogg CH, Dowling AH, Grufferty BF, Benetti AR, Fleming GLP "Cuspal deflection and microleakage in premolar teeth restored with bulk-fill flowable resin-based composite base materials" Journal of Dentistry 40 pg 500-505, 2012.
Frauscher KE, & Ilie N "Degree of conversion of nano-hybrid resin-based composites with novel and conventional matrix formulation." Clin Oral Invest, May 2012.
Jafarpour S, El-Badrawy W, Jazi HS, McComb D. "Effect of composite insertion technique on cuspal deflection using an in vitro simulation model." Oper Dent. 2012 May-Jun;37(3):299-305.
Roggendorf MJ, Kramer N, Appelt A, Naumann M, Frankenberger, R. "Marginal quality of flowable 4-mm base vs. conventionally layered resin composite." Journal of Dentistry 39: 643-647, 2011.
Senawongse P, Pongprueksa P, Tagami J. "The effect of the elastic modulus of low-viscosity
Tantbirojn D, Pfeifer CS, Braga RR, Versluis A. "Do Low-shink Composites Reduce Polymerization Shrinkage Effects?" Journal of Dental Research 90(5): 596-601, 2011
Campodonico CE, Tantbirojn D, Olin PS, Versluis A. "Cuspal deflection and depth of cure in resin-based composite restorations filled by using bulk, incremental and transtooth-illumination techniques." JADA 2011;142(10):1176-1182.
Ilie N, Hickel, R. "Quality of curing in relation to hardness, degree of cure and polymerization depth measured on a nano-hybrid composite." American Journal of Dentistry 20: No 4, Aug 2007.
Souza-Junior E, Souza-Regis M, Alonso RC, Freitas A, Sinhoreti M, Cunha L. "Effect of the Curing Method and Composite Volume on Marginal and Internal Adaptation of Composite Restoratives." Operative Dentistry 36(2): 231-38, 2011.
X-tra fil website. http://www.voco.com/en/news/press/x-tra_fil/index.html. References We need to consider new materials as they are being developed
Dental Materials have come a long way since Dr. Snyder's mustache
We need to use our own clinical judgment with the materials we are using Conclusions According to Campodonico (2012).
Cuspal deflection was not significantly affected by placement technique within the same material.
Emphasizing depth of cure as apposed to the forces placed on the tooth by polymerization shrinkage. Compromised Marginal Integrity? Adequate depth of cure is commonly measured by the hardness at various depths using the Vickers Hardness Test.
80% bottom-to-top hardness is a commonly accepted value for adequate polymerization.
Degree of cure is strongly influenced by the depth, polymerization source, shade, and curing time. Depth of Cure? According to Moorthy A et. al. 2012
Bulk-fill flowable resin based composites were not associated with a change in cervical microleakage when compared to conventional resin based composites placed in incremental layers.
Traditional packable RBCs that are bulk filled do show cervical microleakage attributed to inadequate depth of cure. Frauscher (2012)
Novel monomers are being developed including dimer acid and tricyclodecane that show higher degrees of conversion at increased depths.
N'Durance and Venus Diamond used novel monomers and showed the least decrease in Degree of Conversion at 6mm depths Curing light technology has advanced over time from the first UV lights to modern Halogen and LED lights. Research has shown that Halogen lights show greater polymerization depths. LED lights can be used in three curing modes Fast, Ramped, and Pulse. The pulse method is most effective for deeper polymerization Campodonico (2012)
Filtec Supreme Ultra shows drop in hardness around 2mm, showing that the traditional notion of incremental fill is necessary with this material.
X-tra fil, a hybrid composite with new multi-hybrid filler technology and an innovative initiator system for photo-polymerization is designed for deeper bulk fill polymerization, was also researched.
Showed relative hardness values greater than 90% for all measured depths researched (0mm-3.5mm) for both incremental and bulk fill procedures. Filtec Supreme Ultra vs X-tra Fil
Depth of Cure When Selecting Dental Materials In Private Practice I will...
A. Buy whatever the Rep who throws the best tailgate recommends.
B. Ask Shad.
C. ASK KEVIN.
D. Compare some peer reviewed research and find a system that works for you Moorthy (2012)
SDR and X-tra base(bulk-fill flowable RBC bases) had less cuspal deflection than GrandioSO composite (compared to Filtek in the paper) that was used incrementally.
This decrease was attributed to constraining both cusps simultaneously during light curing which limits overall deflection.