Dr. Robert Ritter

Technique in 2 Minutes: How to Increase Efficiency, Predictability, And Durability In Class I Restorations

How to Increase Efficiency, Predictability, And Durability In Class I Restorations

An 18-year-old female patient presented to the dental practice for a routine hygiene appointment and checkup. During a thorough clinical exam, probing detected “stickiness” on the occlusal surface of tooth No. 18, which was verified as isolated Class I occlusal caries.

The agreed-upon treatment plan involved removing the caries using a conservative and minimally invasive approach to maintain the integrity of the tooth structure and retain as much enamel as possible for a durable, long-lasting restoration.

The tooth would be restored using a tooth-colored composite material. The patient was anesthetized, and the site was isolated using a rubber dam.

A carbide bur was used to remove the carious lesion followed by a diamond bur to smooth and refine the angles of the preparation.

With the preparation design complete, the phosphoric acid, Total Etch from Ivoclar Vivadent, was applied to the enamel for 15 seconds and dried using the Warm Air Tooth Dryer from A-dec.

After the preparation was thoroughly rinsed, Adhese Universal was applied, using the Adhese Universal VivaPen single unit dose applicator.

The adhesive is then air dried using a warm air dryer.

Next the adhesive was light cured for 3 seconds using the Bluephase PowerCure, a highintensity LED curing light from Ivoclar Vivadent.

Now, the first layer of flowable direct composite—Tetric PowerFlow from Ivoclar Vivadent—in shade IVA was placed as a dentin replacement

It is then cured for 3 seconds using the Bluephase PowerCure. This flowable composite is used to coat the internal aspects of the cavity and to ensure a complete seal against microleakage and recurrent caries.

During polymerization, the initial visual high translucency gradually changes to a more opaque shade that is close to that of natural dentin in value. The material’s final opacity conceals the stained underlying tooth structure to optimize the esthetics of the final restoration.

After the flow layer is placed and cured, a layer of Tetric PowerFill bulk fill composite from Ivoclar Vivadent in shade IVW was placed in a single 4-mm increment. It is sculpted using a contouring instrument and light cured for the manufacturer-recommended 3 seconds.

Once curing and occlusal adjustments were made, the restoration was finished and polished using a silicone polisher to create the final occlusal restoration seen here.

Videos

A brief visual technique guide to a Class I case restored using Ivoclar Vivadent's Adhese Universal, Tetric PowerFill, Tetric PowerFlow, and Bluephase PowerCure.

Technique in 2 Minutes: How to Increase Efficiency, Predictability, and Durability In Class I Restorations

Reliable curing performance for all light-curing materials due to polywave LED

Short curing times starting from 3 seconds due to a high intensity up to 3,000 mW/Cm2

Wide 10 > 9-mm light guide for time-saving single-exposure curing procedures

With more patients demanding tooth-colored restorations, dentists face multiple choices and challenges in providing durable, functional, and esthetic solutions, especially when restoring large posterior class I and II lesions.

 The most common esthetic solution for posterior carious lesions involves light-cured, tooth-colored direct composite restorative materials.

 Using tooth-colored filling materials allows dentists to remove the carious lesion while preserving as much natural tooth structure as possible and seal the tooth from recurrent decay.

Although direct composite materials satisfy patient preference for esthetics, they often present dentists with a multitude of technique-sensitive and time-consuming protocols that require proper isolation of an operative site that is hard to access and hindered by poor visibility.

The use of efficient composite systems can limit this challenge. In addition, the key to restorative durability and functionality in direct posterior cases: proper photopolymerization of incrementally placed composite layers. Proper photopolymerization is critical for preventing material shrinkage, postoperative sensitivity, and marginal leakage.

Advances in direct composite monomer technology and LED curing technology provide dentists with more efficient and simplified direct composite restorative systems that optimize treatment time without sacrificing the final restoration’s predictability and long-term durability.

An 18-year-old female patient presented to the dental practice for a routine hygiene appointment and checkup. During a thorough clinical exam, probing detected “stickiness” on the occlusal surface of tooth No. 18, which was verified as isolated Class I occlusal caries 

. The agreed-upon treatment plan involved removing the caries using a conservative and minimally invasive approach to maintain the integrity of the tooth structure and retain as much enamel as possible for a durable, long-lasting restoration. The tooth would be restored using a tooth-colored composite material.

The patient was anesthetized, and the site was isolated using a rubber dam. A carbide bur was used to remove the carious lesion followed by a diamond bur to smooth and refine the angles of the preparation 

With the preparation design complete, the phosphoric acid, Total Etch from Ivoclar Vivadent, was applied to the enamel for 15 seconds 

 and dried using the Warm Air Tooth Dryer from A-dec. The self-etching technique takes advantage of the universal adhesive technology in Adhese Universal from Ivoclar Vivadent: Only the enamel is etched, creating maximum bond strength to enamel. The need to etch dentin is eliminated, which protects and minimizes the chances of hypersensitivity.

Clinical Case

After the preparation was thoroughly rinsed, Adhese Universal was applied 

, using the Adhese Universal VivaPen single-unit dose applicator, and air-dried 

. The adhesive was light cured for 3 seconds 

 using the Bluephase PowerCure, a high-intensity LED curing light from Ivoclar Vivadent.

Next, the first layer of flowable direct composite—Tetric PowerFlow from Ivoclar Vivadent—in shade IVA was placed 

 as a dentin replacement and cured for 3 seconds using the Bluephase PowerCure. This flowable composite coats the internal aspects of the cavity and ensures a complete seal against microleakage and recurrent caries. During polymerization, the initial visual high translucency gradually changes to a more opaque shade that is close to that of natural dentin in value. The material’s final opacity conceals the stained underlying tooth structure to optimize the esthetics of the final restoration.

After the flow layer was placed and cured, a layer of Tetric PowerFill bulk fill composite from Ivoclar Vivadent in shade IVW was placed in a single 4-mm increment 

, sculpted using a contouring instrument and light-cured for the manufacturer-recommended 3 seconds. Once curing and occlusal adjustments were made, the restoration was finished and polished using a silicone polisher 

Using a single coordinated system of durable restorative materials and efficient, streamlined protocols for Class I restorations helps clinicians save chair time without compromising the integrity, predictability, and long-term durability of the final restoration.

Shortened 3-second cure times for 4-mm layers of composite materials minimize the risk of error, and the Bluephase PowerCure curing light’s ability to detect movement away from the occlusal surface and alert the user to the potential of an inadequate result ensures restorative predictability and the proper depth of cure.

In this case, the patient was pleased with the treatment outcome and impressed with the short procedure time.

1. Nashan FP, Mondelli RF, Franco EB, et al.Clinical strategies for esthetic excellence in anterior tooth restorations: understanding color and composite resin selection. 

2. BS, Ye Q, Misra A, Sene F, Spencer P. Posterior composite restoration update: focus on factors influencing form and function. 

3. Jadhav S, Hegde V, Aher G, Fajandar N. Influence of light curing units on failure of direct composite restorations. 

4. Giachetti L, Scaminaci Russo D, Bambi C, Grandini R. 

A review of polymerization shrinkage stress: current techniques for posterior direct resin restorations

5. Rodrigues Junior SA, Pin LF, Machado G, Della Bona A, Demarco FF. Influence of different restorative techniques on marginal seal of class II composite restorations. 

6. Versluis A, Douglas WH, Cross M, Sakaguchi RL. Does an incremental filling technique reduce polymerization shrinkage stresses

7. Van Ende A, De Munck J. Van Landuyt KL, Poitevin A, Peumans M, Van Meerbeek B. Bulk-filling of high C-factor posterior cavities: effect on adhesion to cavity-bottom dentin. 

Bulk-fill materials: simplify restorations, reduce chairtime

Articles

A coordinated system of materials and light-curing technology optimizes chair time without sacrificing restorative integrity and esthetics.

How to increase efficiency, predictability, and durability in Class I restorations

How new Imprint 4 VPS impression material from 3M ESPE can help you create accurate impressions in less time.  

Impression taking is one daily procedure that has the potential to throw a wrench in office efficiency. Between the minutes spent waiting for material to set and the possibility of discovering (after removing an impression) that there are voids or bubbles, there are many opportunities for wasted minutes.

For the patient, the time spent waiting for the material to set can feel uncomfortably long.

3M™ ESPE™ Imprint™ 4 VPS Impression Material

 can cut minutes from the impression taking procedure and help ensure accuracy, increasing the odds of success in one quick take.

The Super Quick version of this material has a set time of just 75 seconds, the shortest intraoral setting time of any precision impression material.

This incredibly fast setting time can help minimize patient discomfort during the impression procedure and also keep appointments flowing efficiently.

While the Super Quick variety - with a 75-second working time and 75-second setting time - is ideal for 1- or 2-unit impressions, regular-setting versions are also available with longer working times, making them a great choice for large unit cases.

Fig. 1 Imprint 4 Penta™  Heavy body tray material and Imprint 4 Light wash material.

The material’s fast setting time is made possible by a proprietary 

, a new feature that is only found in Imprint 4 impression material.

After the material’s working time has passed, a chemical reaction causes the material to quickly warm up to body temperature, which accelerates its setting in the mouth.

However, the material’s working time is not impacted, so the dental team still has adequate time to prepare for the impression and follow proper technique.

Fig. 2 The color combinations of the material make it easy to read margins.

Whether dentists use the Super Quick or Regular setting version of Imprint 4 impression material, its chemistry helps it perform to high standards. The material’s 

, which is better than any other VPS material in its unset state, helps it flow into moist areas and capture very precise details.

This falls in line with the strong record of hydrophilicity for Imprint materials, which many dentists are already familiar with after using Imprint 3 or Imprint 2.

I have also found that it has an ideal density. When I remove impressions from the mouth, there are no air bubbles.

Fig. 3 Imprint 4 Penta Super Quick Heavy body tray material and Imprint 4 Super Quick Light wash material.

An additional feature of the material that I find helpful is the variety of colors. The contrasting colors of the tray and wash materials are excellent for showing details at the margins, and the colors are pleasing on the eye.

The color options in some other materials can sometimes make it difficult to read margins, but Imprint 4 impression material has refreshed its colors for enhanced readability.

Fig. 4 This excellent detail is captured after a setting time of just 75 seconds.

Beyond making the process more comfortable for patients with a shorter setting time, Imprint 4 also has a pleasant mint taste.

These patient- and user-friendly features, combined with superior accuracy, make Imprint 4 impression material a great tool for improving impression taking efficiency. This gives dentists a new, faster way to capture precise details and ensure great fitting restorations.