John Isherwood. Clinical photography provided by Marcos Vargas, DDS, MS, professor, Department of family Dentistry, University of Iowa College of Dentistry

 for direct posterior restorations has provided a simple and efficient alternative to conventional composites. Prior to bulk fill composite materials, to achieve successful direct posterior restorations the layering technique was the necessary procedure, requiring competence, proficiency and dexterity.

A complex and technique sensitive procedure, one inadequately placed layer could result in an otherwise successful restoration developing microleakage, causing post-operative sensitivity, and leading to secondary caries. However, the enhanced material characteristics demonstrated by bulk fill composites eliminate the technique sensitivity and other disadvantages associated with conventional resin composite.

Direct posterior restorations with traditional composites were time-consuming, costly and wrought with room for error. Bulk fill composites benefit both dentists and patients by providing easy and predictable restorations in half the time, and with less anxiety due to a simplified technique. The bulk fill procedure is faster and more comfortable for the patient because chair time is reduced, allowing patients more free time to pursue personal interests and allowing dentists to perform more treatments, and therefore, increase their profitability.


	While featuring numerous advantages, Ivoclar Vivadent’s Tetric EvoCeram® Bulk Fill demonstrates two particularly important beneficial characteristics: viscosity and handling, both of which facilitate placement and sculptability. The composite possesses a smooth, creamy consistency that allows increased marginal adaptation to the walls and floor of the preparation. Marginal integrity is enhanced because of the shrinkage stress reliever technology, which also decreases polymerization shrinkage and the likelihood of post-operative sensitivity, micro-leakage and secondary caries.

The material also contains a patented “polymerization booster.” This newly developed photo initiator is added to the material in conjunction with today’s traditional photo initiators. The “booster” is much more reactive to curing light than the standard initiators. This allows the composite to achieve a 4 mm depth of cure without compromising esthetics or working time, like some bulk fill composites.

The resin-bonded composite can be placed in single increments up to 4 mm in depth. Because of the patented light-sensitivity filter technology, which prevents the composite from quickly curing under ambient light, it A sectional matrix band, separation ring and wooden wedge were placed to ensure proper tight proximal contact and sealed margins (Fig. 4).

The preparation was etched with 37% phosphoric acid. The etchant was applied to enamel first, then applied to dentin, with the goal of etching the enamel for more than 15 seconds and the dentin for less than 15 seconds (Fig. 5). OptiBond FL primer and adhesive were then applied according to the manufacurer’s instructions (Fig. 6).

An increment of Tetric EvoCeram Bulk Fill composite (of up to 4 mm) was placed to fill the preparation (Fig. 7).

Anatomical contouring was performed using a football burnisher (Fig. 8). The increment was then light cured for 10 seconds.

The increment was polymerized for 40 seconds (Fig. 9).

Upon completion of the restoration, the occlusion was verified.


	Tetric EvoCeram Bulk Fill composite not only saves patients and dentists time by providing quick, predictable, and long-lasting direct posterior restorations, it also blends with the natural surrounding tooth structure, ensuring a highly esthetic outcome (Fig. 10). The bulk fill composite is a much needed advancement to composite materials, providing dentists with an easy, less time consuming, more predictable, and highly esthetic procedure. By eliminating the traditional complex procedure, dentists can deliver durable and esthetic posterior restorations in half the time.

Articles

The development of bulk fill composites for direct posterior restorations has provided a simple and efficient alternative to conventional composites. Prior to bulk fill composite materials, to achieve successful direct posterior restorations the layering technique was the necessary procedure, requiring competence, proficiency and dexterity.