Peter Auster, DMD, has spent 30 years in  private practice in Pomona, N.Y. He has long-term experience in high-end reconstructive and cosmetic dentistry, and completed 2 terms as a director of the American Academy of Cosmetic Dentistry (AACD) as well as a term as chairman of their leadership committee. Dr Auster is extremely proud to be a winner of the AACD Humanitarian of the Year Award. He has been named a “Top Dentist in the Hudson Valley” by his peers for the past 10 years from 

. He is the founder and past president of the Greater New York Academy of Cosmetic Dentistry, the New York affiliate of the AACD. He was named a Fellow of the prestigious American College of Dentists. He teaches dentists internationally and has given seminars on advanced dentistry from Portland, Maine to Portland, Oregon.

Peter Auster, DMD, FICD, FACD

Abstract

Those of us who have been in practice for more than a few years have recognized the need for, but also the awkwardness of pulp capping materials. For many years, only limited options were available for both indirect or direct techniques.

Throughout the past decade, a new array of products that show great potential for success and ease of use have been introduced, and recently a promising new product has been launched. However, prior to discussing new potential additions to the treatment arsenal, this article will review the ideal properties for a pulp capping material.

Pulp capping promotes the healing of a damaged pulp by creating a barrier over the pulp tissue to allow healing to take place without contamination. If inflammation and infection are present at the site of the treatment, we would ideally expect to see a reduction in both following the pulp cap placement. Providing this barrier of protection is one of the key functions required in a pulp capping material.

Just as important as the barrier is the need for a material that can help stop the decay process and stimulate pulp cells to form new dentin.

 With this in mind, bioactivity and biocompatibility are additional desirable properties in a pulp capping material.

Clearly, those characteristics are key to achieving product success. From a practitioner’s point of view, however, it is equally important to use a material that is easily applied but does not dissolve in the presence of saliva and overlaying restorative materials.

Catapult Education, LLC is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Approved PACE Program Provider. FAGD/MAGD Credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. 6/1/20 to 5/31/24. Provider ID 306446.

Catapult Education designates this continuing education activity for 1/2 credit.

For more info on this activity, or to take the quiz and obtain your continuing education credit follow the link from the QR code or visit 

www.catapulteducation.com/course/pulp-capping

The pulp capping agents discussed in this article can be used for indirect and direct pulp caps.

These are placed over very deep cavity preparations without pulp exposure. They are applied over noncarious dentin or dentin with some remaining caries. Historically, indirect pulp caps have been treated as either 2-step or single-step procedures.

In this case, pulp capping agents are placed directly over pulp tissue that is exposed due to decay, trauma, or mechanical damage.

The success of both techniques depends on the patient’s pretreatment condition. The state of pulp vitality, the amount of pulpal necrosis, and related periapical damage can all impact the outcomes of placing a pulp capping material.

Calcium hydroxide (Dycal; Dentsply Sirona)

Throughout many decades, calcium hydroxide was the predominant means of pulp capping for both direct and indirect procedures. Because it has been used so long, it is the most thoroughly researched pulp capping material.

During use, it dissociates into calcium and hydroxide ions. It has a high pH as well as antibacterial properties.

 However, it also has negative characteristics, including high solubility, lack of adhesion to the dentin, and poor physical properties.

 Many of us have frustratingly witnessed the material leaching off the tooth immediately after completing the next step in the clinical workflow.

MTA is derived from Portland cement. It was originally used as a root end sealer and as a repair material for root canal perforations.1 It improves upon the properties of calcium hydroxide by adding biocompatibility to the pulp exposure, better sealing to keep out contaminants, and lower solubility. It also may reduce levels of pulp inflammation, hyperemia, and necrosis.

Calcium in MTA reacts with phosphates in oral tissue to form hydroxyapatite, which helps create a seal and adds to the material’s biocompatibility. Success rates for carious and mechanical exposure have been shown to be 80% and 84%, respectively. MTA has been proven to be more successful in primary teeth as a pulpotomy agent than formocresol and other sealing materials.

One of the major drawbacks of using MTA as a pulp capping agent is its extraordinarily long setting time, which can be as long as 2 to 4 hours.

 Newer formulations for pulp capping materials featuring MTA often add other materials to help reduce the setting time.

Calcium silicate includes much of the Portland cement formula of MTA but adds tricalcium silicate to provide the material with enhanced physicomechanical properties.

 The material must be prepared in a triturator prior to placement. It can be used as a dentin substitute under composite restorations and has demonstrated positive results in direct pulp cap procedures.

 Perhaps, the main drawback of this material can also be considered a benefit: The setting time has been reduced to 10 to 15 minutes with this calcium silicate/MTA formulation. Although this is clearly an improvement vs MTA on its own, it is still a relatively long time to wait before completing a restoration.

Resin-modified calcium silicate (TheraCal LC; Bisco Inc)

TheraCal LC has become one of the most popular pulp capping materials over the past decade. The resin-based formula has taken many of the advantages of MTA but added light curing technology, which creates a setting time measured in seconds rather than hours or minutes like the previously available pulp capping materials. TheraCal LC is a calcium silicate product like Biodentine but with a modified powder composition and particle size. It is a fourth-generation calcium silicate material.

 Additionally, TheraCal LC has been shown to release calcium ions in concentrations that can stimulate the pulp and odontoblasts to reform healthy tissue.

Although the properties of these materials have improved, studies have shown similar results when comparing effectively capping the pulp with TheraCal LC, Biodentine, and MTA.

 Further long-term studies of the latest materials will be necessary to determine a clear winner.

The Latest Trends in Dental Pulp Capping Materials

Resin-modified bioceramic (Ceramir Protect LC; Directa Dental Group)

Ceramir Protect LC, the newest Ceramir bioactive product, answers several problems that have plagued past pulp capping agents. As with other bioactive products, it dissolves and recrystallizes into nanocrystalline hydrates and creates a unique bond between the material and the tooth. This resin-modified bioceramic is useful for direct and indirect pulp capping. The product releases calcium, which helps stimulate the formation of hydroxyapatite and tertiary dentin.

The benefits of this new product include:

a highly alkaline pH that repels bacteria and creates an environment conducive to healing and hostile to bacteria;

moisture tolerance and thixotropy, which reduce the tendency of materials to dissolve on contact with bonding agents and saliva;

light curing for efficient placement and radiopacity for easier visibility on radiographs; and

twice as much calcium release as competing products.

Although previous improvements in pulp capping materials enhanced the biocompatibility and setting times for working with them, one issue continues to make most pulp capping materials less than optimal: Regardless of their classification and composition, pulp capping agents tend to exhibit an ineffectiveness at attaching to dentin, as well as the potential to debond from the dentin when a moist material is placed over the pulp capping material.

The modified ceramic resin formulation of Ceramir Protect LC seems to act as more of a “sealer” than previous pulp capping materials, and in the author’s experience, this type of material provides an extremely strong bond to the dentin that holds regardless of what is underneath and whatever material is placed over the top of the cap.

As with most categories of dental materials, newer pulp capping materials offer improvements vs previous generations. Although research shows similar effectiveness among materials at capping the pulp, newer materials are faster to place and improve on other physical and biocompatible properties.

With its high calcium release, hydroxyapatite creation, and ability to stay where it is placed, a bioceramic resin like Ceramir Protect LC is another step in this evolution toward making pulp capping procedures more effective and efficient.

Alex G. Direct and indirect pulp capping: a brief history, material innovations, and clinical case report. 

Islam R, Islam MRR, Tanaka T, Alam MK, Ahmed HMA, Sano H. Direct pulp capping procedures - evidence and practice. 

 2023;59:48-61. doi:10.1016/j.jdsr.2023.02.002

da Rosa WLO, Cocco AR, Silva TMD, et al. Current trends and future perspectives of dental pulp capping materials: A systematic review. 

 2018;106(3):1358-1368. doi:10.1002/jbm.b.33934

Nair PNR, Duncan HF, Pitt Ford TR, Luder HU. Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: a randomized controlled trial. 

. 2008;41(2):128-150. doi:10.1111/j.1365-2591.2007.01329.x

Marques MS, Wesselink PR, Shemesh H. Outcome of direct pulp capping with mineral trioxide aggregate: a prospective study.

2015;41(7):1026-1031. doi:10.1016/j.joen.2015.02.024

Tomson PL, Grover LM, Lumley PJ, Sloan AJ, Smith AJ, Cooper PR. Dissolution of bio-active dentine matrix components by mineral trioxide aggregate. 

 2007;35(8):636-642. doi:10.1016/j.jdent.2007.04.008

Stringhini Junior E, Vitcel ME, Oliveira LB. Evidence of pulpotomy in primary teeth comparing MTA, calcium hydroxide, ferric sulphate and electrosurgery with formocresol. 

2015;16(4):303-312. doi:10.1007/s40368-015-0174-z

Mente J, Hufnagel S, Leo M, et al. Treatment outcome of mineral trioxide aggregate or calcium hydroxide direct pulp capping: long-term results. 

2014;40(11):1746-1751. doi:10.1016/j.joen.2014.07.019

Formosa LM, Mallia B, Camilleri J. The effect of curing conditions on the physical properties of tricalcium silicate cement for use as a dental biomaterial. 

. 2012;45(4):326-336. doi:10.1111/j.1365-2591.2011.01980.x

Strassler HE, Levin R. Biodentine tricalcium-silicate cement. 

2011;7(10):98-100. Accessed June 8, 2023. https://www.aegisdentalnetwork.com/id/2011/11/biodentine-tricalcium-silicate-cement

Articles

Earn up to 1/2 Continuing Education Credit after reading this article about pulp capping materials.

Dentists often ask me when to avoid single- or limited-shade composites. My answer is quite simple: hardly ever. Single-shade composites have proven to be incredibly reliable and efficient products. Surprisingly, they are also economical. Compared with older formulas of 30 to 40 shades, they lessen supply costs. In the words of my dearly departed grandmother, “What’s not to love?”

The longer your dentistry journey, the wider the differential you have probably seen in the number of necessary shades within a composite system. Over the decades, I have seen my composites systems increase from 1 to 36 shades. An abrupt change in that trend occurred just prior to the pandemic when Tokuyama Dental America introduced a new single-shade composite called OMNICHROMA.

The huge success of this product created a cascading effect, changing the way many companies introduced or marketed their composites. In some cases, companies reinvented one of their many shades as a single universal shade. Some manufacturers reintroduced systems built around 3 to 5 limited shades, and others were satisfied with 6 to 11 shades. Other manufacturers have since developed their own niche materials with a single universal shade, offering optical properties to help it blend in with surrounding dentition.

What led to this change? Materials researchers started this process more than 20 years ago when looking into the use of structural color as opposed to chemical color. Earlier composites used dyes and pigments to mimic natural dentition, but the clinician needed to identify the proper shade or mix of shades to match the look of the surrounding teeth. Instead, the new structural approach to coloring materials is based on allowing light to move through the material in predictable ways, enabling the restoration to virtually absorb the color around it. New materials do a great job at this, but they allow darker, undesirable shades to show through. This is why most systems include an opaque shade to block out darker areas beneath or around a restoration. This blocking agent is engineered for this process and can be placed underneath the single shade composite in 1 mm or small increments with surprising effectiveness.

The introduction of single-shade composites led to an unintentionally well-timed improvement in composite efficiency as the pandemic began. Obviously, a single choice removes the need for shade tabs and shade guides and eliminates wasted material from incorrect shades being placed and removed.

What do these limited shade materials do for a practice? Clear benefits include:

Little or no wasted material due to expiration

Improvements in polishability, smoothness, and marginal integrity

A new option for making screw holes and post holes invisible

With the COVID-19 pandemic leading to global supply chain difficulties, we have all been forced to confront dental inflation. Few products are the same price they were prior to the pandemic. Although newer unishade composite systems can vary in price from brand to brand and seller to seller, purchasing materials from a system with fewer shade options means a practice can significantly cut materials expenses.

In March 2021, a dental consumer journal reported the cost of OMNICHROMA per mL was $33 less for the same amount of material than that of the leading composite brand, which has a total of 36 shades, and $10 less than that of the 2 other leading composite brands. Although those numbers have obviously changed in today’s inflationary times, consider the cost savings for single-shade composites in general: no overpaying for shades we seldom use or shedding of expired materials. These savings can amount to thousands of dollars per month and potentially tens of thousands or more depending on the size of your practice.

A recent search of costs of 1 bottle of 20 compules of A1 Body shade of the leading composite showed the cost as $135 for a box of each of 36 shades. Assuming potential expiration or lack of use of 25% of those compules, there is a waste cost of $1200. Compare that with the more economical cost of the single-shade product, and the savings can easily be $10,000 per year. And this is before considering the cost savings of the new OMNICHROMA FLOW composite.

www.catapulteducation.com/course/dental-composite-systems

Less Material Waste and Broken Dispensers

We have all experienced wasted compules and syringes—in many cases, practices discover they have full boxes of expired material in rarely used shades such as A5, A4, and WT. Even though they are rarely used, practices need to keep these shades on hand for patients who require them. They may be purchased as a part of a huge box set or on their own to make sure the practice has every shade available. But when material goes unused, it wastes both the composite itself and the practice’s financial resources.

If you are like me, you have experienced the aggravation of putting an A5 compule in your dispenser when you finally need it, only to find a solid material that won’t extrude. This causes part of the dispenser to snap and fly across the room. Since I began using single-shade composites, this once-familiar situation hasn’t happened at all.

The new generation of products is designed to deliver the esthetics clinicians and patients expect with a simple polishing protocol. In my experience of using unishade and similar materials, these composites make it easier to achieve nearly invisible margins. When these new materials are combined with the latest in finishing and polishing instruments, it is easier than ever to achieve great results. These materials handle as expected and can be shaped to provide great anatomy and smooth transitions, making margins virtually invisible.

Although unishade composites offer numerous benefits when it comes to practice and inventory management, they also solve some common challenges facing dentists today. Screw-retained implants continue to be the top choice for most tooth replacement situations, but in the past, covering the screw hole without residual grayness showing through was a difficult task. A unishade material placed atop a layer of a unishade opaque material such as OMNICHROMA Blocker makes the hole disappear like magic. This can be a lifesaver to cover metallic screws and implant crowns. There is nothing else like it.

The last benefit I’m going to mention is simple and sometimes overlooked. Using a unishade composite system means little or no time is required to choose the shade or shades you want for a specific case. Even if shade selection normally takes 1 minute, this can add up throughout the day. Even 10 minutes of saved time can make a difference at a busy office.

There are multiple benefits of unishade composites. They are a money-saver in several ways, allowing practices to reduce inventory overhead while streamlining treatment workflows. With only 1 shade needed for any procedure, the unishade system cuts down on set-up time and clinical decision-making. Additionally, there is less short- and long-term waste because most of the product is used soon after purchase. The fact these materials can deliver durable, esthetic outcomes makes them an ideal option for both patients and practice. Kudos to the single-shade composite companies for creating products that work extremely well.

[Continuing Education] Earn 1/2 free continuing education credit provided by Catapult Education by reading this article and following the link to complete the test on the Catapult website.

Novel Dental Composite Systems Can Help Practices Achieve Efficiency With a Single Shade

The dental industry constantly moves toward higher standards of care via decreasingly invasive treatments and workflows. Updated materials, instruments, and technologies improve the outcomes clinicians can achieve for their patients. Although the benefits of these advancements are easily recognized, the many steps to get there are not always seen.

Still, every innovation that helps drive dentistry forward is worth noting and even celebrating. One way to put these innovations in the spotlight is to take a look at what they replaced. It’s easy to get used to a comfortable and effective daily workflow, and sometimes it may even seem there’s no need for change. But once something new is brought in to save time, enhance results, or otherwise make things better, it’s easy to move forward from the way things were.

This article (and its online components at dentalproductsreport.com) puts some of those former favorites front and center a final time, as dental professionals share stories of things they once used day in and day out but no longer need due to innovations that make practicing dentistry better for everyone.

How Ameet R. Sachania, DDS found a better material for posterior composites when he tried VOCO's VisCalor Bulk.

Warming to a New Bulk Fill Composite

A simple design feature makes these posts suitable for almost any situation where a post is indicated.

Adaptable Post Becomes Core Part of Armamentarium

Using Simplifeye makes running the practice easier for patients and clinicians.

Simplify the Payment Process

How the Clio Prime intraoral sensor from SOTA Imaging solved one practice's imaging challenges.

The Perfect Digital Development

Adopting Stellalife's natural rinses impacts a practice and its patients.

Natural Rinse for Better Postop Care

Finding the best mill for his practice set this clinician on a new path.

Milling Made Easy

Necessity leads one clinician to find a faceshield that delivers on both comfort and convenience. 

Pandemic Leads to Face Shield Find

Sometimes the innovation doesn't seem that large, but the effects can still change a practice.

Chemical Bonding Means Better Endo Temps

With the right tools, creating restorations with lifelike anatomy can be simplified.

A Better Shape for Shaping Anatomy

A new material selection helps eliminate postop sensitivity.

Eliminate Sensitivity and Toxicity

Using VoIP phones can change the way a dental practice and its patients connect and interact.

Move Beyond the Phone to Connect With Patients

A new option for sealing root canals helps this clinician perform at his best.

Enhanced Endodontic Chemistry Means Better Seals

3D printing leaps forward with printed, long-term crowns.

Permanent Crown Resin Replaces Conventional Restorations

Shifting from a scalpal to a laser makes treatment easier on patients and for clinicians.

Why I Tabled My Scalpel for a Dental Laser

Find out why the author believes every practice should be using an electric handpiece.

It’s Time to Upgrade to Electric Handpieces

Why Gary Radz, DDS, believes he's found an "easy button" for creating temporary crown matrices. 

Pressing the Button on a Better Temporary Crown Matrix

The dental mirror will always be essential, but it doesn't need to be limited by the past.

Reflections on the Dental Mirror

A pre-exam rinse is a good prophylactic step for many practices, and finding the best rinse is a key to success.

Replacement Rinse Leads to Better Results

Oral probiotics show favorable results for enhancing oral health in both lab testing and clinical use.

Out With Bad Bacteria, In With the Good

Why a new technology, and its fresh approach to treating xerostomia, might be the best approach for some dry mouth patients.

A New Technology to Manage Xerostomia

The Vivos sleep system aims to treat patients with sleep apnea rather than help them manage their condition.

Treating Sleep Issues at the Root Cause

Finding a system for automatic shade matching can save a practice time, improve relationships between clinics and labs, and enhance restorative outcomes.

Shade System Reduces Miscommunication

Using tooth morphology as a guide, one clinician designed an instrument set to make it easier to mimic the details of a natural tooth.

Let the Tooth Design the Instrument

One clinician is excited about the possibilities of moving his clinical imaging to the cloud.

Add Security and Convenience With Cloud Imaging

The Dental Products We’ve Left Behind (and What’s Replaced Them)

Dental professionals share stories of dental products they’ve stopped using and innovations that are their new favorites.

Flowable and injectable composites have become all the rage in dentistry. It seems as if a new one is released every week. Very few of these materials have characteristics that make them significantly different from others on the market. Catapult Educators evaluated a new injectable product that appears to be unique: everX Flow™ by GC America, a short fiber-reinforced flowable composite for dentin replacement.

Instances of bruxism have increased during the coronavirus disease 2019 (COVID-19) pandemic, which led to tooth cracking and weakened dentition.

Newspaper articles, message boards, and social media posts by dental health professionals demonstrated a considerable increase in fractured and previously unrestorable teeth because of increased clenching and grinding habits. There is a mandate for dentists to look for products that help decrease this trend.

But dental health professionals can now use everX Flow to reinforce cracked teeth and help stop crack propagation in these situations. The short glass fibers in everX Flow increase the strength and fracture toughness of the material, just as rebar adds to the strength of highway construction cement.

GC America’s G-ænial™ line of injectable composites is renowned for its excellent handling characteristics, strength, and polishability. everX Flow shares the comfortable handling characteristics of the company’s other injectable composites but adds more strength, making it an ideal core material, with or without a post.

 The glass fibers that give it the added strength necessitate that it be veneered 1 to 2 mm with a light-cured composite to cover the fiber layer.

Designed to work similar to rebar in a construction project, everX Flow is a composite substructure material that incorporates glass microfibers and full silane coverage technologies to reportedly strengthen both restorations and weakened tooth structure from within. It is suited for use as a dentin replacement in bulk fill and core buildup procedures. It can also be applied to help prevent or repair cracked dentition in endodontic cases.

The material comes in bulk and dentin shades. The bulk shade allows for a 5.5-mm depth of cure, making it ideal for use with a fiber post, and it is ideal for bulk-fill situations. The thixotropic viscosity of the material allows it to flow and adapt well to the cavity floor without slumping, even on maxillary posterior teeth. The dentin shade cures to a depth of 2.0 mm and is suited for both core buildups and when esthetic results are important to the case outcome. Once this material is placed and cured, it is designed to be covered with a layer of conventional composite.

Seventeen members of Catapult Education reviewed everX Flow. The product was used in various clinical situations including Class I to V direct restorations and core buildups. A variety of composite formulations were stated with resin-modified glass ionomers and glass ionomers. The everX Flow’s performance reflected the multiple options for direct restorative dentistry and posed the first question to ponder: Will everX Flow fit into an armamentarium of such product offerings? Jumping to the answer, 70% of the group members said they would purchase this product, and over 50% stated they would use this product multiple times a day.

Other notable results from the evaluation showed that:

66% of the group covered everX Flow with a capping composite;

over 75% used a traditional paste/pack composite material;

Handling was rated: excellent 40%; very good 26%; and good 26%;

75% of the group rated the dentin shade’s opacity and shade after light curing as optimal;

71% of the group rated the bulk shade’s opacity and shade after light curing as optimal;

overall evaluation of everX Flow was 35% excellent, 47% very good, and 12% good.

Although it is difficult for any composite to gain a foothold considering the multitude of flowable and injectable products on the market, GC America has garnered a reputation for creating high-end, quality injectable products. The evaluators at Catapult Education concluded that everX Flow could become another game changer in the industry. Any product that can lead to fewer fractured teeth, with good marginal adaptation and added strength, is something that should be considered for every dental practice.

1. Garoushi S, Tanner J, Keilemans, Bell-Ronnlof AML, Lassila L, Vallittu PK. Fiber reinforcement of endodontically treated teeth: what options do we have? Literature review. 

. 2020;28(2):54-63. doi:10.1922/EJPRD_2002Garoushi10

Catapult Education evaluators test out this flowable composite, then award it the Catapult Vote of Confidence.

GC America’s everX Flow Composite Grades Out Well

Once you have spearheaded a paradigm shift, what is next? That is a classic question in the corporate world and an interesting question in dentistry. Much as Apple changed an industry with the introduction of the iPhone, Tokuyama Dental America has rocked the dental composite world with the introduction of OMNICHROMA—the world’s first 1-shade universal composite. Suddenly, it appears that every dental products company is introducing composites that require 5, 3, or 1 shade. This is a huge reversal of the 30-year-long trends of introducing products with 15 to 36 shades.

OMNICHROMA FLOW is part 2 of this groundbreaking trend initiated by Tokuyama Dental. This innovative product brings the same benefits of convenience, time-saving, inventory control, and reduction of composite waste as 1-shade universal OMNICHROMA. Like OMNICHROMA, the flowable version matches every tooth shade from A1 to D4. In fact, it is the world’s first single-shade flowable composite. OMNICHROMA FLOW uses Tokuyama Dental’s Smart Chromatic Technology and uniformly sized spherical fillers to create highly esthetic, easily polished, and durable restorations.

This material is designed to treat all types of direct restorations as a complete restoration or as a base under a veneered filling. OMNICHROMA FLOW is particularly useful as a repair for almost any shade temporary crown, veneer, or composite restoration. Virtually every other flowable composite on the market comes in 10 or more shades. The ability to use a single-shade flowable composite results in a diminished need for shade decisions and less cross-contamination, a huge benefit in today’s dental world. It also drastically controls expenses for the practice, as does OMNICHROMA.

Like its predecessor, OMNICHROMA FLOW relies on structural color instead of chemical color. This implies that both materials do not rely on dyes or pigments to create the color of the restoration. The structural color of the tooth itself is reflected by the filler particles in the material to create a seamless tooth shade. The material manifests extremely high glossiness that leads to a great shine, higher than all other flowable composites tested.*

An interesting study soaked OMNICHROMA FLOW in coffee for 24 hours and noted that this material showed less staining than other flowable products on the dental market.* Flexural strength, wear, and abrasion are among the best of all flowable products as well.* Viscosity level falls in the middle of flowable spectrum as shown by Tokuyama Research and Development.

The technique for incorporating this material into your dental world will feel familiar for most dentists. It is virtually identical to using shade-specific flowable composites. Curing depth is 2 mm. A bevel (like 1-shade universal OMNICHROMA) is highly recommended as a 347895means of making the margin disappear. OMNICHROMA FLOW appears quite opaque white when placed. It matches the surrounding shade after light curing is completed.

OMNICHROMA BLOCKER FLOW is an additional portion of the OMNICHROMA FLOW. It works similarly to OMNICHROMA BLOCKER and should be used in very deep, discolored Class lll and Class lV restorations beneath the flowable. The effect is to block out stains as well as to keep OMNICHROMA FLOW from mimicking shades from the tongue, lips, and other oral structures. OMNICHROMA BLOCKER FLOW is recommended to be used in 0.5 to 1.0 mm thickness, depending on the case. OMNICHROMA FLOW should take up the bulk of the space so the surrounding tooth surface can be matched.

The new flowable is truly a utility material. The author has had the opportunity to use it for Class I, Class II, and Class V restorations and as a base under 1-shade universal OMNICHROMA. The material is an excellent option for repairing temporary crowns, veneers, and onlays. This single shade system will easily bond to any resin temporary material and match the shade beautifully.

A female patient age 49 presented with decay and brown stain at the gingival margin of tooth #29 

. The tooth shade was a B2 shade. One-half carpule of Mepivacaine HCl 3% and one-half carpule of Articaine 4% were administered by infiltration. A DryShield was used to reduce aerosol generation. Decay was excavated and removed with a #330 carbide bur and a #4 low-speed round bur. The enamel was beveled using a #1923c football diamond bur (Microcopy). Consepsis Scrub (Ultradent Products) was administered as an antibacterial slurry. Ultra-Etch 35% phosphoric acid solution (Ultradent) was placed on the bordering enamel in a selective etch technique. The enamel and dentin were treated with Tokuyama Universal Bond. This product is a unique self-cured bonding agent that does not require light curing or additional activators. The bonding agent does not have to be agitated when applied to the tooth. OMNICHROMA FLOW was applied and contoured with an explorer. The restoration was subsequently light cured using the Bluephase Style curing light from Ivoclar Vivadent for 10 seconds. The Class V restoration was then polished using a flame-shaped NeoDiamond #863 from Microcopy. Final polishing was completed using A.S.A.P. All Surface Access Polishers and D-Fine Diamond Polishers both from Clinician’s Choice. Note the excellent shade match with single-shade OMNICHROMA FLOW 

Tokyama OMNICHROMA FLOW

A male patient age 54 presented with a failing Class I composite on tooth #20 with distal marginal ridge fractures 

. The initial shade was Vita A1. One-half carpule of Mepivacaine HCl 3% was administered by infiltration followed by one-half carpule of Articaine 4% (the author prefers initial norepinephrine anesthesia placed for comfort reasons, to be followed by epinephrine-containing anesthetic). The amalgam restoration was removed using a #556 carbide bur and the fractured tooth structure was obliterated. The tooth was contoured for a Class II restoration with the same bur. To eliminate decay, #2 and #4 low-speed carbide burs were used. Finally, a #1923c football-shaped diamond from Microcopy created bevels on the D Fusion sectional matrix band was placed along with Composi-Tight 3D Fusion wedges from Garrison Dental Solutions to create excellent contacts. The cavity preparation was treated with Consepsis Scrub from Ultradent. Enamel was etched using Ultra-Etch 35%, also from Ultradent and dentin and enamel surfaces were treated with Tokuyama Universal Bond without agitation. OMNICHROMA BLOCKER FLOW was placed in a 0.5-mm increment over a dark stain. OMNICHROMA FLOW was then applied in 2-mm increments and light cured using the Bluephase Style Curing Light for 10 seconds. The final layer was manipulated with the back end of an explorer and a contouring instrument. At this point, this layer was cured for 10 seconds with the Bluephase Style.

Anatomy was established using a fine football diamond 1923f from Microcopy and polished using A.S.A.P. All Access Polishers and D-Fine Diamond Polishers from Clinician’s Choice. Note the material’s ability to correctly match the A1 premolar shade 

OMNICHROMA FLOW and OMNICHROMA BLOCKER FLOW are perfect companions to OMNICHROMA. The single-shade option makes our dentistry easier, less costly, and more hygienic. The ability to place a single shade in the operatory is perfect for today’s disinfection protocols. There are no other shades exposed to contamination and there is no need to open drawers or containers during the procedure, which could result in contamination of everything in the drawer.

It is no wonder that many companies are suddenly downplaying their multishade composite products in favor of materials with few shade options. Many have a long way to go to meet the quality and reliability of the Tokuyama Dental America’s OMNICHROMA product family.

An innovative product from Tokuyama Dental America adds convenience while reducing composite waste.

How to Use A GroundBreaking 1-Shade Flowable Composite

	You are going to your first dental convention. Rows and rows of booths catch your eye, but the large, splashy ones seem more exciting and more inviting. Dental ads designed by large advertising companies have the same effect. But the best marketing doesn’t necessarily represent the best materials. 

	Some lesser-known companies have great research teams and extraordinary products. COLTENE has been creating quality products globally for the past 30 years. Their latest bonding agent, ONE COAT 7 UNIVERSAL, is a truly universal adhesive. Its distinctive triangular bottle or single-dose capsules hold a liquid agent that bonds to all surfaces using all techniques, without the need for silane or a ceramic primer. 

	ONE COAT 7 UNIVERSAL is a light-cured, single-component bonding agent for self-etch, selective-etch, or total-etch techniques. The material bonds to enamel, dentin and ceramics, and it seals sensitive dentin as well. Dual-cure needs are answered when its One Coat 7.0 Activator is added. No primer or silane needs to be used, even when bonding composite to zirconia, titanium and gold. 

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	Product testing has displayed excellent results. ONE COAT 7 UNIVERSAL was shown to have the best self-etch adhesion values when compared to five current bonding agents

). The material also showed excellent shear bond strength values using the total-etch technique

	The product’s triangular bottle contains 300 applications per bottle and has a unique no-leakage dropper system. ONE COAT 7 UNIVERSAL received a good/excellent rating from Catapult Educators. Post-op sensitivity levels are virtually non-existent, and it has an excellent marginal seal and anti-bacterial properties.

	The product is a great match with COLTENE’s unique new composite system, BRILLIANT EverGlow

	ONE COAT 7 UNIVERSAL is an eighth-generation adhesive, despite the “seven” in its name. As such, it has many of the benefits of eighth-generation materials as well as its own special qualities. 

	MDP, included in the adhesive, is a wetting agent with a hydrophobic group that works like silane to keep water from the bonded area. This adds to the bond strength between composite and zirconia, gold and other metals.

	There are different requirements for the material for total-etch, selective-etch and self-etch. While total-etch continues to have its proponents for all cases, many dentists now limit etchant to enamel to decrease potential post-op sensitivity. Enamel etching should be limited to 15-20 seconds and rinsed off with a full water spray to keep the tooth hydrated.

 Over-drying can lead to post-op sensitivity. Total-etch is best limited to 34 percent phosphoric acid and used in cases with little dentin exposed (minimal thickness veneers, sealants, fissurotomy bonds). On the other hand, self-etch can be used in fully dentin areas (crown preps, extremely deep restorations and core buildups) where total-etch could cause major sensitivity issues. 

	A 28-year-old female shattered the mesial corner of tooth #10 (

). Impressions were taken to evaluate bite issues and allow for the production of a mockup and prep guide. The mockup was created by adding BRILLIANT EverGlow to the correct mesial/incisal margin of tooth #10. A prep guide was made using Virtual

( Ivoclar Vivadent). It was determined that a single shade would work well after trying a few shades on the tooth without a bonding agent (

	Fig. 3                                                                                                Fig. 4

Scrub (Ultradent Products). Ultra-etch 34 percent phosphoric acid etch was placed in a total-etch technique on the labial bevel and lingual chamfer and all surfaces to be bonded. A VariStrip™ (Garrison Dental Solutions) was used to keep the etchant and bonding agent away from tooth #9, and ONE COAT 7 UNIVERSAL was applied lingually and facially to all exposed margins as well as to the bevels (

). A small amount of BRILLIANT EverGlow shade A1/B1 was added to the lingual of the prep guide and the template was placed in the mouth. More composite was added until final margins were created and cured using a Bluephase Style curing light (Ivoclar Vivadent). The composite was contoured using Super-Snap polishing discs (Shofu Dental Corporation) and Groovy Diamond

How COLTENE’S ONE COAT 7 UNIVERSAL offers one bond for all application techniques.

You are going to your first dental convention. Rows and rows of booths catch your eye, but the large, splashy ones seem more exciting and more inviting. Dental ads designed by large advertising companies have the same effect. But the best marketing doesn’t necessarily represent the best materials. 