Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
DDS
MS
Definition
Light-cured composite materials that can
be placed and cured in bulk increments
of 4 5 mm thickness
MODES of FAILURE
#1 - secondary caries
#2 - fracture
Other reasons . . . .
- Marginal breakdown
- Wear
- Discoloration
- Pulpal death
- Tooth fracture
Volumetric Shrinkage
Not in my
hands !
C-Factor
2
1
# bonded surfaces /
# unbonded surfaces
Fundamental Concept
Composites must be adequately polymerized to function
properly in the mouth
Undesirable Consequences of
Inadequate Polymerization
- Inadequate physical properties
- Reduced bond strengths
- Increased breakdown at margins with use
- Decreased biocompatibility
- Potentially increased DNA damage due to leachates
- Increased bacterial colonization of resin
Laboratory Studies
Manufacturers Guidelines
0 mm tip-to-surface distance
BOTTOM
TOP
= 80%
Schattenberg et al, Dent Mater. 2008
PROBLEM
Calculations of energy density based on manufacturers
recommendations ASSUME intimate contact with composite
material is possible (< 1.0 mm)
This MAY be possible for some anterior teeth
Clinically Relevant Distance can be much greater:
7+ mm in Class II box
molar / premolar cusp tips on deep Class I
Class Vs second molars
SonicFill
Surefill SDR Flow
Filtek Bulk Fill
Venus Bulk Fill
X-tra base
X-tra Fil
Tetric EvoCeram Bulk Fill
QuiXfil
Kerr
Dentsply Caulk
3M ESPE
Heraeus Kulzer
VOCO
VOCO
Ivoclar Vivadent
Denstply Caulk
STATED INDICATIONS
Base Class I & II restorations
Class II box liner
www.surefilsdrflow.com
Contraction Stress *
SDR Flow
= 1.5 Mpa
Flowables
= 3-5 Mpa
Restoratives = 2-3 Mpa
Stress RATE
SDR Flow
= 4 MPa/min
Flowables
= 5-13 MPa/min
Restoratives = 3-10 MPa/min
Polymerization Modulation
www.surefilsdrflow.com
www.surefilsdrflow.com
www.surefilsdrflow.com
www.surefilsdrflow.com
www.dentaladvisor.com
www.dentaladvisor.com
Research
Investigations on a methacrylate-based flowable composite
based on the SDR technology
Ilie and Hickel. Dental Materials 27(2011)348-355
Shrinkage Stress
Shrinkage Rate
Micromechanical
Properties
RESULTS:
Shrinkage stress and stress rate were significantly lower for the SDR
Flow compared to flowables and conventionals.
Stress: SDR Flow (1.1 Mpa) EsthetX Flow (5.3 Mpa)
Silorane (3.6 Mpa)
Filtek Supreme Flow (6.5 Mpa)
Micromechanical properties of SDR Flow (and other flowables) were
significantly lower than the conventional composite materials
SIGNIFICANCE:
The effect on the interfacial stress build-up difficult to predict.
Research
Bulk filling of high C-factor posterior cavities: Effect on
adhesion to cavity-bottom dentin.
Van Ende et al. Dental Materials 29(2013)269-277
Microtensile Bond Strength to bottom of cavity
preparations of different C-factor configurations
Manuf.
4.0 mm
1.5 mm
2.5 mm
METHODS:
RESULTS:
solutions.3m.com
solutions.3m.com
4 mm
(4)
INDICATIONS
- Pit & Fissure Sealant
- PRR non-stress bearing
- Undercut blockout
- Repair small enamel defects
- Repair small defects in composites
- Repair resin temporaries
- Base under Class I / Class II
- Liner under direct restoratives (Class II box)
- Class III and V restorations
- Core build-up where at least half the
coronal tooth structure remains to provide
support
4 mm
(4)
2 shades - universal, A2
10 sec cure ( 1,000 mW / cm2)
Golf
courses
are scary
places
1 Universal shade
10 sec cure ( 1,000 mW / cm2)
20 sec cure ( 800 mW / cm2)
Load-bearing Class I and II,
Core build-up
10 m
Tech Manual - Tetric EvoCeram Bulk Fill
1 Universal shade
10 sec cure ( 800 mW / cm2)
20 sec cure ( 800 mW / cm2)
Load-bearing Class I and II,
Core build-up
10 m
Tech Manual - Tetric EvoCeram Bulk Fill
Questions?
www.sonicfill.com
Questions?
www.sonicfill.com
Questions?
www.sonicfill.com
SonicFill
Handpiece Technology
Side View
Top View
SonicFill
www.sonicfill.com
www.sonicfill.com
Depth of
Cure = 5 mm
Vol. Shrinkage
= 1.6%
Flexural Strength
= 187 MPa
PERFECTION
www.sonicfill.com
www.sonicfill.com
SonicFill
SonicFill
Cure Depth
97%*
= 80% or more
- Dental Advisor
- CR
- Reality
* Dental Advisor tested using: Bottom: Top hardness ratio. Data available upon request.
SonicFill
10 m
X-tra base
Clinical Case
SonicFill #28-29
Filtek P-60 3M
SonicFill
http://www.afms.af.mil/decs/
http://www.afms.af.mil/decs/
http://www.afms.af.mil/decs/
Recommendations SonicFill
Promising product, but limited studies
Utilized to enhance internal adaptation and
have less voids
Recommend 2-3 mm increments
It may cure adequately to 6+ mm, but that
doesnt solve the volumetric shrinkage issue
Research
Microleakage in Class II composite restorations below the
CEJ: In vitro evaluation of different restorative techniques.
Poggio et al Med Oral Patol Oral Cir Bucal. 2013 Sep
1;18(5):e793-8.
Evaluate microleakage Class II box below CEJ
Filtek Flowable (1mm) + Filtek Supreme incremental
GrandioSO Heavy Flow (1mm) + GrandioSo incremental
Surefill SDR Flow (4mm) + Esthet-X HD
SonicFill (4+ mm) bulk
Grandio Layered incremental [CONTROL]
SDR flow +
capping
layer
Sonic Fill
Bulk fill
entire prep
Flowable
1-mm
Liner
flowable
liner
CONTROL
layered
hybrid
3 2
NO
leakage
Within
enamel
< 2/3 to
axial wall
> 2/3 to
axial wall
To and up
axial wall
Score 0
Score 1
Score 2
Score 3
Score 4
4 (20%)
3 (15%)
10 (50%)
1 (5%)
2 (10%)
GrandioSO
4 (20%)
Heavy Flow +
GrandioSo
9 (45%)
4 (20%)
1 (5%)
2 (10%)
Surefill SDR
Flow +
EsthetX HD
3 (15%)
10 (50%)
4 (20%)
2 (10%)
1 (5%)
SonicFill
12 (60%)
5 (25%)
2 (10%)
1 (5%)
0 (0%)
Grandio
Layered
CONTROL
11 (55%)
7 (35%)
1 (5%)
1 (5%)
0 (0)%)
Filtek Flow +
Filtek
Research
Bulk-fill resin-based composites: an in vitro assessment of
their mechanical performance. Ilie et al Oper Dent. 2013
38-5,000-000, electronic .
Research
A randomized controlled three year evaluation of bulk-filled
posterior resin restorations based on stress decreasing
resin technology. Van Dijken JWV & Pallesen U. Dental
Materials 2014 (30):e245-e251.
METHODS:
3-year follow up 76 Class II and 28 Class I paired restorations
RESULTS:
Annual Failure Rates:
SDR + nanohybrid
Nanohybrid layered
= 0%
= 1.3% (1 tooth fx, 1 comp fx)
Research
Physico-mechanical characteristics of commercially
available bulk-fill composites. Leprince JG et al. Journal of
Dentistry 2014 (42):993-1000.
Product
Venus Bulk Fill
Surefil SDR Flow
X-tra base
Filtek Bulk Fill Flow
Coletene Dual-cure Bulk-Fill
Category
Flowable
Flowable
Flowable
Flowable
Flowable - Dual Cure
Paste
Paste
Paste - Sonic HP
Paste glass fibers
Grandio Flow
Grandio
Hybrid - flowable
Hybrid - paste
METHODS:
2mm X 2mm X 25mm samples
Macromechanical properties tested
Flexural strength
Elastic modulus
Micromechanical properties tested
Vickers microhardness
Vickers microhardness [24 hours ethanol immersion]
Polymer Network Density = VHN/dry VHN
Degree of conversion
Filler Content Wt %
Flexural Strength
Dentin = 12-20
Elastic Modulus
Degree of Conversion
RESULTS:
Filler mass fraction [60.7 Filtek BF 85.3 Grandio]
Flexural Strength [76 MPa Venus BF 140.3 SonicF]
AND
Elastic Modulus [3.3 Gpa Venus BF 15.3 Grandio]
CONCLUSIONS:
Filler content important parameter for mechanical
properties
RECOMMENDATIONS
We should be using the BEST materials we have
access to
filler = better properties
IF you do NOT have problems with adaptation or
voids, may not be necessary
Questions ?