How to simplify direct posterior composite restorations with Adhese Universal

Direct posterior composite restorations are among the most common dental procedures currently performed. However, their location in the mouth requires precise placement, complete isolation of the preparation and thorough polymerization to ensure longevity and adequate function.¹ 

Furthermore, these restorations have traditionally required composite materials to be placed incrementally to mitigate polymerization shrinkage and any resulting post-operative sensitivity.^2-6 This layering process may be time-consuming and/or difficult⁵, and if incremental placement leads to polymerization shrinkage that results in gaps or voids, the bond between the tooth and the restoration could break, or the cusps could flex, leading to severe post-operative sensitivity and/or marginal leakage.^1,3,7-9

There are two products that streamline the restorative process while ensuring predictability and efficiency: Tetric EvoCeram Bulk Fill (Ivoclar Vivadent), a bulk fill direct composite, and Adhese Universal (Ivoclar Vivadent), a single-component adhesive bonding system.

Tetric EvoCeram Bulk Fill is an advanced nano-hybrid composite that can be easily placed, sculpted and polymerized in one 10-second increment.¹⁰ Additionally, the material contains pre-polymer shrinkage stress relieving filler technology, a light sensitivity filter, and a light initiator that enhances polymerization, all of which enable the material to be placed and cured in increments of up to 4 mm.¹⁰

Adhese Universal is a single-component adhesive system that saves clinicians and patients valuable time. Used for both dentin and enamel, it is indicated for light-cured direct composite restorations and indirect restorations, according to the manufacturer. Its high bond strength makes it an ideal adhesive system for posterior restorations, where strong mastication forces are a concern. Additionally, Adhese Universal is a truly versatile adhesive that can be used with all etching techniques: self-etch, selective enamel-etch, and total-etch. 

When used together, Tetric EvoCeram Bulk Fill and Adhese Universal provide clinicians with the opportunity to place direct composite restorations with ease, without sacrificing quality. By placing composite restorations in bulk, they can also ensure they will save time for themselves and for patients, and enhance the predictability of the procedure.^4,11 The following case demonstrates the capabilities of these two materials for delivering a high-quality direct posterior composite restoration.   

Case Presentation

A patient presented with a failing amalgam restoration on tooth No. 14 (Fig. 1). Although the restoration was located in the posterior region, the patient expressed a desire for a more natural looking treatment that required minimal tooth preparation. It was decided a direct bulk fill composite (Tetric EvoCeram Bulk Fill) would be placed in combination with a universal adhesive system (Adhese Universal) to provide an esthetically pleasing and conservative restoration to meet the patient’s requests. The following technique describes the protocol for achieving this clinical outcome:

Step 1: The failing restoration was removed and caries were excavated (Figs. 1 and 2).

Step 2: The enamel was etched for 15 seconds followed by etching of the entire cavity for an additional 15 seconds each (Figs. 3 and 4).

Step 3: The etchant was rinsed and air dried according to the manufacturer’s instructions (Fig. 5).

Step 4: A bonding agent (Adhese Universal) was applied, scrubbed into tooth structure for 20 seconds, then dispersed with air until an immobile film layer developed (Figs. 6 and 7).

Step 5: The adhesive was then light cured with an LED curing light (Bluephase Style, Ivoclar Vivadent) for 10 seconds (Fig. 8).

Step 6: A bulk fill composite (Tetric EvoCeram Bulk Fill, shade IVB) was placed, sculpted, and contoured using a contouring instrument (OptraSculpt Pad, Ivoclar Vivadent) (Figs. 9 and 10).

Step 7: The composite material was light cured for 10 seconds (Fig. 11).

Step 8: Empress Direct Color (Ivoclar Vivadent) in shades ochre and brown were applied to the occlusal surface of the new restoration to impart a natural look that blended with the surrounding dentition (Figs. 12 and 13).

Step 9: After the restoration was cured, the occlusion was verified (Figs. 14 and 15).

Step 10: The restoration was polished (OptraPol Next Generation, Ivoclar Vivadent) (Fig. 16).

Step 11: A fluoride varnish system (Fluor Protector S, Ivoclar Vivadent) was applied to protect against erosion and caries development (Fig. 17).

Step 12: The restoration was evaluated one week after placement, and the patient was pleased with the outcome (Fig. 18). 

Conclusion

Since direct posterior composite restorations represent many of the dental procedures performed each day, it is imperative that clinicians avail themselves of advanced materials that will ensure an esthetic, predictable outcome. Tetric EvoCeram Bulk Fill and Adhese Universal are two products that enable practitioners to provide the highest quality, esthetic restorations to their patients while saving valuable chair time.