Dr. Margeas received his DDS from the University of Iowa College of Dentistry in 1986 and completed an AEGD residency in 1987. He is an adjunct professor in the Department of Operative Dentistry at the University of Iowa. He is board-certified by the American Board of Operative Dentistry and is a fellow of the Academy of General Dentistry. He has authored numerous articles on implant and restorative dentistry and lectures on those subjects. He is the director of The Center for Advanced Dental Education and maintains a private practicein Des Moines, Iowa.

Robert Margeas, DDS

	When it comes to running a dental practice, time is money. Working efficiently, without compromising high-quality clinical results, is one of the main keys to achieving success.

	This can be especially true when it comes to performing posterior restorations, which are typically time-consuming procedures. In these cases, I prefer to use bulk fill composites, which are specifically designed to shorten procedure time and provide a strong restoration with high fracture resistance that is also long-lasting and durable.

	In the past, bulk fill materials have not been as esthetic as other composites. Fortunately, the world of bulk fill composites has been evolving over the course of the last several years as the popularity of these procedures has increased year after year. This rise in the popularity of bulk fills has led to drastic improvements in the materials that are on the market, which not only save time and decrease patient sensitivity, but also provide impressive esthetics, which means that both myself and my patients are pleased with the final result!

	Another main goal that I have in my practice is to be as efficient as possible. Bulk fill composites provide the efficiencies that I require to keep my practice running smoothly. Performing the bulk fill technique allows me to place the composite all in one increment and avoid using multi-layer techniques, which saves time and helps me to complete more restorations.

	In the past, bulk fill composites were more translucent, which provided a result that was less esthetic than their counterparts. For the light to reach all the way to the bottom of the restoration, bulk fill material was required to be somewhat translucent to ensure a full cure. Fortunately, 

3M’s Filtek™ One Bulk Fill Restorative

 has an updated formula that turns more opaque as it cures, which means that the final result is not only wear-resistant and durable, but is also extremely esthetic.  

	In this case, a 42-year-old male patient presented with decay in the upper left first molar, extending from the distal pit to the central pit. I typically use bulk fill composites when doing posterior restorations, so the treatment plan included my recommendation of using 3M™ Filtek™ One Bulk Fill Restorative. 

	The first step was to prep the cavity by completely isolating the tooth. Complete isolation is critical to achieving a successful posterior restoration. If moisture or contamination comes in contact with the tooth while the procedure is taking place, there is a chance that the cavity will be compromised and the restoration will not be successful. Typically, I use rubber dams to provide isolation during posterior restoration procedures.

	However, if I am unable to use a rubber dam, my next choice is to use an isolation device, such as the DryShield™ Isolation System. DryShield aides in isolation by combining a high-suction evacuator, saliva ejector, bite block and tongue shield in one device. This product isolates well and is easy to use, and it is a great backup for those who do not want to use a rubber dam. After achieving complete isolation and opening the distal pit, the cavity was prepped and a liner/base material (Vitrebond™ Light Cure Glass Ionomer Liner/Base, 3M) was placed in the deepest area.

Fig. 1: Pre-operative decay on distal pit of upper left fist molar. Fig. 2: Rubber dam placed around tooth. Fig. 3:Initial opening of the distal pit showing the decay and extension of decay.

	Next, it is time to choose which etching technique will work best for each specific restoration. When using 3M™ Scotchbond™ Universal Adhesive, I recommend a selective etch. Although total etch is an option with this product, Scotchbond Universal can be effective without the application of the phosphoric acid to the dentin. Etching the dentin may open up the dentinal tubules, which can cause sensitivity. To avoid the possibility of sensitivity in the tooth, I prefer to use a selective etch technique as often as possible. The enamel was then etched for 15 seconds.

Fig. 4: Cavity was prepped. Fig. 5: 3M™ Vitrebond™ Light Cure Glass Ionomer Liner/Base was placed in deepest area. Fig. 6: Enamel was etched for 15 seconds (dentin was not etched).

	After completing the etch, adhesive was applied to the entire cavity, scrubbed for 20 seconds and air-dried until there was no fluid movement. Next, it was light cured for 10 seconds (Elipar™ DeepCure-S LED Curing Light, 3M). It is critical to make sure the light is positioned close to the surface and that the tooth has been cured completely.

Fig. 7: 3M™ Scotchbond™ Universal was applied to the entire cavity, scrubbed 20 seconds and air-dried until there was no fluid movement. Fig. 8: Tooth was light cured for 10 seconds using 3M™ Elipar™ DeepCure-S LED Curing Light. Fig. 9: 3M™ Filtek™ One Bulk Fill Restorative was placed in tooth. 

	Step 4: Placement of bulk fill composite

	After light curing the adhesive, I placed 3M™ Filtek™ One Bulk Fill Restorative into the cavity. One of the key benefits of Filtek One is the ability to place it in one increment, up to 5 mm. Eliminating the need to use a multi-layer technique when performing bulk fill restorations not only saves time and increases efficiency, but it is also more comfortable for my patients.

Fig. 10: Restoration after placement of composite prior to finishing. Fig. 11: Carbide was used to begin finishing restoration. Fig. 12: Pe-polishing using 3M™ Sof-Lex™ Spiral Finishing Wheel (beige).

	Finally, a carbide bur was used to sculpt and shape the restoration. Filtek One is highly adaptable to the cavity, so it fits the tooth anatomy very closely and allows minimal finishing. Once the material had been shaped properly, I used the 3M™ Sof-Lex™ Spiral Finishing and Polishing Wheels to polish the restoration. This two-step system is easy to use because it includes both a spiral finishing wheel to smooth and remove scratches, as well as a spiral polishing wheel that provides complete gloss-like restorations in a re-usable rubberized system.

Fig. 13: Polishing using 3M™ Sof-Lex™ Spiral Polishing Wheel (white). Fig. 14: Final restoration with rubber dam placed. Fig. 15: Final restoration without rubber dam placed.

	The overall result of this case is a reliable restoration that took minimal time and effort, while also satisfying the patient. As bulk fill composite procedures continue to grow in popularity, it is more important than ever to use efficient and esthetic products that will keep both you and your patients happy. 3M™ Filtek™ One Bulk Fill Restorative is my top choice of composite for most of my posterior restorations, as long as it is not deeper than 5 mm. Filtek One can be placed in one increment, is easy to handle and the final result is an esthetically pleasing posterior composite. 

Articles

How to save time and provide improved esthetics with 3M’s latest bulk fill composite.   

How to get better bulk fill results

	In dentistry, there’s no such thing as a one size fits all approach to treatment. Even in every day procedures like deep caries restorations, some patients will have a better outcome with a full coverage crown and others may be just fine with a direct composite procedure. What may be a great option for one patient could be disastrous for another, so it’s important to always consider what the patient goals are for treatment.

	
	Nowhere is this more prevalent than in a full-mouth reconstruction case. I could fill pages with the number of options dentists have for full-mouth restorations, but the most important factor to consider in these cases is the patient. Specifically, one should consider the patient’s diagnosis, their age, their financial situation, and their desired final esthetic outcome.

	Since procedures like these require deep commitment by the patient, we would be doing them a disservice by not planning each case around their specific situation and only providing options that are easier to complete or will take the least amount of time.

	In the following case, I could have chosen any number of different treatment options, from full-mouth crowns to reshaping each tooth with composite. The patient could have also chosen a number of treatment options, as he visited several different dentists to ensure he was receiving the care he felt comfortable moving forward with. In the end, he elected to move forward with my office because we came to a mutual understanding of what was desired and I was able to offer a treatment plan that fit within his comfort level.

	Continue to the next page for the case study.

	The patient, a 26-year-old male, had severe bruxing and over the course of eight years had worn his teeth down to 5 mm (

). After an initial consultation, our team determined that given his young age, we wanted to be as conservative as possible. We felt confident we could achieve long-lasting, esthetic results by minimally prepping the teeth. We would only need to round the incisal edges and then bond veneers onto the upper and lowers. 

	The patient was excited to move forward with this option because it allowed him to reverse treatment at any point without the negative consequences of crown preparations. By considering the patient’s age and a myriad of options, we were able to come up with a treatment plan that the patient was comfortable with and that we were confident would provide him everything he wanted for his smile.

	The teeth were left untreated and a preliminary impression was taken and sent to the lab. The lab created a wax up with new vertical dimensions and milled a continuous top and bottom temporary restoration out of PMMA (

) and a minor rounding was done to prepare each tooth (

). This was done without any anesthetic, as the preparations were minimal.

	The temporaries were then air abraded and the teeth were spot etched. A thin layer of 3M™ ESPE™ Scotchbond™ Universal Adhesive was placed on the intaglio surface of the restoration and on the teeth (

	The patient wore the temporaries for 12 weeks (Fig. 7) to ensure comfort with tooth size and shape.

	Based on a prior impression, the lab created final restorations using IPS eMax for the upper arch (

). The patient returned and after a try-in, the intaglio surface of the restoration was salinated and the entire preparation was etched (3M™ ESPE™ Scotchbond™ Universal Etchant). Scotchbond Universal Adhesive was then applied to the restoration and preparation. The final restoration was cemented using 3M™ ESPE™ RelyX™ Veneer Cement. Upon placement, excess cement was extruded from the restoration and was easily cleaned up. The same process was completed for the remaining teeth.

) provided the patient with a smile he was proud to show off and it was completed using an extremely conservative treatment. The margins were supragingival due to the minimal preparation and undercut of the teeth and a very minor esthetic compromise was made in order to preserve tooth structure. This was augmentation, not amputation of the teeth. If the patient wants to reverse treatment in the future, he can do so without the negative consequences that would have occurred when bonding and cementing to dentin and the more aggressive preparations needed for crowns. The patient is planning to complete treatment on the lower arch at a future date.

Offering treatments plans that fit patient comfort levels can be the key to successful treatment.