The Flowable Bulk Fill Composite SDR flow+ Now In Shades: First-Class Aesthetics For Class II Restorations

13-11-2017

The treatment of Class II cavities demands a high level of skill and concentration from dentists. Just the reconstruction of the tooth's natural shape is a real art. Whilst aesthetic perfection in the posterior region is not as important as in the anterior region, patients are nevertheless becoming increasingly demanding and a truly impressive Class II restoration is seen as an optional, complex extra. In order to master this challenge, an approach which embraces complete dental treatment systems is required.

 

SDR flow+ adapts reliably to the floor of the cavity and the matrix band given its unique self-leveling properties – for simple, quick and safe bulk filling. In addition to the universal shade, it is now also available in shades A1, A2 and A3 for improved aesthetics.

The "Class II Solution" treatment concept from Dentsply Sirona promises a high degree of success. It provides answers to all challenges associated with filling Class II cavities. Questions relating to aesthetics arise during different phases of treatment, frequently in combination with other aspects. These involve, for example, the production of an anatomically natural contour and the broad issue of handling the composite used (e.g., adaptation, modeling properties and slump resistance).

 

A challenge at many levels

Following Black's definitions, Class II fillings affect the interproximal as well as the occlusal surfaces of posterior teeth [1]. From a mechanical perspective alone, the treatment of such cavities is challenging. Depending on the patient, the practitioner can be faced with treating deep proximal boxes and restoring extensive occlusal surfaces! In order to achieve the desired level of long-term stability, filling materials are required to withstand considerable occlusal stress (fracture resistance, fatigue strength). Furthermore, the restoration must be adequately sealed both at the cavity floor and the margins.

The dentist may also have to cope with limited access and visibility, depending on the cavity size and positioning. A safe and reliable sequence of treatment steps therefore is particularly important. Each step has to reliably fulfil its intended purpose and needs to effectively drive the overall result towards long-term success.

The "Class II Solution" is based on precisely this philosophy. It is outlined step by step, with particular emphasis placed on aesthetic aspects. After all, Class II fillings are not only among the most frequent dental treatments, they are also classed as particularly challenging in terms of achieving a natural-looking appearance.

 

The "tooth shape" challenge

70% of dentists consider the creation of the contact point as the most difficult part of a Class II restoration [2]. After all, an open proximal contact is a gateway for numerous risks: food residues can build up and potentially pathogenic microorganisms offer a starting point for the bacterial colonisation of the surrounding oral tissue. This increases the risk of periodontal inflammations and secondary caries.

If the anatomical design of a contact point is not correct, it also looks unnatural. To prevent this from happening, it is recommended to use a suitable sectional matrix system which adapts to the natural contour of the tooth. This results in reliably correct contacts and a tight gingival seal with only very little excess material. Thus, an aesthetically appealing tooth shape is achieved virtually automatically. An additional bonus of the "Class II Solution" sectional matrix system Palodent V3 is that less finishing is required, due to the limited amount of excess material. The dentist can quickly create the desired smooth surface and give the restoration a beautiful look.

 

The "adhesive bond" challenge

In terms of bonding, the bond strength and robustness of the product used are of primary importance; however, aesthetic aspects also have a role to play. For example, there is a belief that when it comes to esthetics in particular, phosphoric acid should always be applied on enamel to enhance marginal quality and prevent from marginal discolouration [3].

The nature of the specific procedure depends, of course, on the clinical situation and is at the discretion of the practitioner. What is beyond dispute, however, is that it is advantageous if the adhesive used supports all techniques: etch & rinse, self-etch and selective enamel etching. Within the scope of the "Class II Solution", the universal adhesive Prime&Bond active does just that and also offers another key benefit: this adhesive works even on overly dry or moist dentin and actively spreads to form a thin, homogeneous layer inside the cavity. Yet the major advantage here is not in aesthetics but in avoiding postoperative sensitivities.

 

The "tight marginal seal" challenge

In addition to the good adhesive bond, the special properties of the composite or composites are responsible for ensuring the tightness of the filling. 82% of all dentists use a liner to improve the seal along the cavity margins [4]. Within the scope of the "Class II Solution", the bulk fill composite SDR flow+ ensures excellent adaptation to the proximal margins, even on the floor of the prepared cavity and to the matrix band. This reduces the risk of voids and gaps and thus postoperative hypersensitivity and secondary caries.

From an aesthetic perspective, this composite's flowability also supports the prevention of marginal discolouration. The prerequisites for visually appealing restorations have been further improved with the new SDR flow+ as it adds three additional shades (A1, A2 and A3). This enables a closer match to the patient's natural tooth colour.

The bulk fill composite SDR flow+ can be applied in up to 4 mm bulk fill layers; the enamel cap is then added with the nano-ceramic filling material ceram.x universal. With just five CLOUD shades of medium translucency, this offers a streamlined shade concept to cover the entire VITA range and enables "invisible" restorations to be achieved thanks to the outstanding chameleon effect. For particularly demanding cases, ceram.x duo offers a two-layer concept with just four dentin and three enamel shades.

The "handling" challenge

74% of dentists still consider their composite's processing properties to be restricted [5]. After all, what use is theoretically good shade matching and a correct anatomical tooth shape if they cannot be achieved in practice, or only with additional time and labor, because the material has poor modeling properties or sticks to thehand instrument?

With ceram.x universal the special SphereTEC filler technology ensures that the material adapts well to the cavity walls while at the same time having excellent stability and good modeling properties. Designing the form and shade of the restoration is child's play and even final polishing to achieve a high-gloss finish is completed quickly.

 

Mastered challenges

The interplay of the four components in the "Class II Solution" concept – the sectional matrix system, universal adhesive, bulk fill flowable and nano-ceramic composite – enables a safe proximal marginal seal. Furthermore, the system ensures a smooth workflow, with excellent chances of success. The focus remains on aesthetic aspects throughout the treatment process. The dentist benefits from the various system advantages in a multitude of ways. This means the achievement of a natural-looking shape and shade when working with the concept described here for Class II fillings is both simple and quick.

 

Bibliography

1. G. V. Black: A work on special dental pathology, Medico-dental Publishing Company, Chicago 1915

2. DentalTown: Restorative Dentistry. Monthly Poll: What is the most challenging part of a Class II Restoration? 2015

3. B. Zimmerli: Adhäsive Techniken in der Zahnerhaltung. https://www.zwp-online.info/fachgebiete/endodontologie/grundlagen/adhaesive-techniken-der-zahnerhaltung (Accessed May 19, 2017)

4. Council on Scientific Affairs of the American Dental Association. Spring 2009;4(2)

5. Dentsply Sirona Restorative, user survey 2015 (297 dentists in Europe)