Special Report: A new take on flowables

The take-aways

• G-ænial Universal Flo combines the best properties of a composite and a flowable composite.

• Finding the right nano particle was key to giving this material the strength and esthetics needed to create high-quality restorations.

After Dr. Patrick Broome finishes a restoration with GC America’s new G-ænial Universal Flo flowable composite, his patients are left trying to figure out which tooth he worked on.

Dr. Broome has been using G-ænial Universal Flo for a few weeks now, and said his patients have been “ecstatic” with the results.

“They see it right away. It literally is seamless and invisible,” Dr. Broome said. “I had a patient this week with carious Class V lesions on No. 8 and No. 9, and when we finished he could not tell where the composite ended and the tooth began.”

Dr. Broome is one of about 100 clinicians who evaluated this nano-hybrid composite, which is set to launch this month. But before G-ænial Universal Flo was ready for dentists like Dr. Broome to try clinically, the company put in a lot of time and research to create a material that is meant to take the flowable composite category to the next level.

How they got here

It all started in 2003, when GC America launched its first composite, GRADIA® DIRECT to the U.S. market. Since then, GC has introduced various composite resin products under the GRADIA Family name. With G-ænial Universal Flo, GC focused on further improving the company’s second generation of composite resin.

The G-ænial family, which also includes G-ænial Flo and G-ænial Bond, took four years to get to market. The research took place at the company’s R&D facility in Japan, where chemists and researchers work toward one common goal: improving dental materials.

“Very few, if any, dental companies have as many people as GC focused on research and development,” Product Manager Kelley Reinfelds said. “The composite group is working on developing products continuously. GC really has some R&D prowess.”

With G-ænial Universal Flo, the researchers focused on optimizing the composite’s handling and improving the physical properties, said Mizuki Nakayama, Chief Researcher in Polymer-based material section. Even though it features a consistency that is similar to that of a flowable composite, its 200 nm glass fillers give it a smooth surface void of bubbles or any other common problems associated with flowables. The strontium glass particles are silanated using a new proprietary technology and have a low refractive index for beautiful final restorations.

Finding the right nano-filler technology was key for developing this product, Nakayama said. According to advanced filler technology, nano-sized filler can be dispersed homogeneously, which means the polished surface can maintain a high gloss, even after the patient leaves your office and gets back to his or her normal brushing routine, Research Chemist/Liaison Kyosuke Hirano said. The pure 200 nm strontium glass powder enabled researchers to achieve that.

This nano-filler uses advanced technology, Reinfelds said, and really gives patients the glossy smile they’re after while providing clinicians with the material strength and durability they need for a successful restoration. The 69 percent filled flowable features gloss retention that is comparable to a microfill, Reinfelds said, and features increased flexural strength and is easy for the clinician to handle, all features that have been lacking in flowable composites.

“We’ve taken a product category that has been around for 15 or 20 years, and we’ve really improved the physical properties,” VP of Sales and Marketing John O’Neill said. “In the past, it was a compromise. This product category had a high level of shrinkage and they weren’t strong. We’ve taken a product category and raised the bar extremely high. Dentists can do a nice restoration and look the patient in the eye and say ‘I don’t have to worry about this product.’”

A clinician’s role

When GC develops a product, clinician feedback is a key part of getting it ready for the everyday dentist’s practice. Field evaluators work with the product in their practices and then report back about what went well and what could be improved.

Dr. Broome’s local GC sales rep encouraged him to evaluate the product. He does a lot of cosmetics in his practice, uses other GC products and even does some speaking and training, so he was excited to get his hands on the company’s latest development.

“It’s tremendously rewarding to be able to work with a dental manufacturer almost like a team,” Dr. Broome said. “We can give them feedback. You can do certain things in a lab or certain things on a model and think you have a great product, but the question is does it work clinically. These manufacturers need feedback from clinicians using the product on patients. It’s fun to contribute to what’s going on in the industry and help them market a better product to help dental professionals and their patients.”

What they’re saying

Many of the doctors who evaluated G-ænial Universal Flo liked the polishability and the polish retention, but did have some difficulty realizing it can be used as a regular restorative material and not just as a flowable, Nakayama said, but once they used the sample they saw it was easier to manipulate than a regular composite.

“One of the things we found in pre-market evaluation was that, despite all the data, clinicians are still hesitant. It’s a leap of faith to use a flowable differently,” Reinfelds said. “It won’t replace universal composites, but it’s better than other flowables when it comes to esthetics, handling and physical properties.”

Dr. Hal Stewart, who has evaluated products for GC in the past, was impressed with how the material handles. It stays where you put it, he said, and you can manipulate it very easily-something you can’t really do with other flowable composites. Dr. Stewart has been using G-ænial Universal Flo for a few months now and said it seems to become hard and enamel-like once it’s cured and polished. Not only that, the colors match (it comes in 15 shades), something he’s been very pleased with.

When Dr. Broome talked with his sales rep and Reinfelds about the product, he had similar feedback. The product’s properties create a “unique opportunity” because the material is thicker than a flowable yet thinner than other types of composites you sculpt with an artist brush, he said. It will require a technique to control the material, but that’s apparent once you start using it clinically. Multiple color layering on the facial aspect of teeth has an excellent color match, and he described the gloss he could obtain and the ability to blend as outstanding. There’s no graininess or pitting visible under high magnification.

Benefits to the patient

The new syringe features longer, flexible tips, which makes the material easier to place in tight spots, Reinfelds said. Not only that, flowables simply are easier to use, and that means patients are in and out of your office faster and back to their busy lives.
But saved time isn’t the only benefit. The material allows for a minimally invasive approach, and any time you can conserve natural tooth structure that is a good thing, Dr. Stewart said.

“It will give dentists another tool for more conservative preps,” Dr. Stewart said. “In my case, I’m able to offer them another option restoratively rather than doing crowns everywhere. If we can just build the anatomy up with the technique I use, it allows patients to enjoy being rehabilitated without having to spend the money for major prosthetics. I can rebuild anatomy with the material and give patients a few more years before they have to start doing crowns. It opens up a whole new avenue for patients who can’t afford crowns. They can afford this.”

And the restoration feels and looks like enamel, Dr. Stewart said. Too many people know what a composite that doesn’t polish well feels like once it’s in their mouth, and it doesn’t feel natural. That is something GC wanted to address with this material, and from Dr. Stewart’s experiences, it looks like they’ve done that successfully.

And, of course, when it’s all done, the patient will walk away with a beautiful smile.
“Esthetics is so important in dentistry nowadays, and this will hold its gloss better than other flowables,” Reinfelds said. “It’s so quick and easy to place. The restoration will retain its beauty, and the patient will like having a glossy smile.”

How they’re letting you know about it

A product launch like this involves a variety of departments working closely together, from R&D to Professional Relations, to Sales to Customer Service to Quality Assurance. Everything has to be in place before the product is ready for your practice. But once it is, marketing plays a key role in making sure you know about a product and what it can do for you and your patients. GC is officially launching the G-ænial family of products at this month’s Yankee Dental Congress in Boston. Show activities will be scheduled around the launch. Key Opinion Leaders who have been using G-ænial in their practices also will be lecturing about their experiences at Yankee and upcoming meetings.

National ads, direct mail pieces, Web banners and e-blasts also are part of the marketing plan, as is featuring all the information you need to know about G-ænial on the company website (gcamerica.com).

To encourage dentists to try the new product, GC also will include one free syringe of G-ænial Universal Flo with the G-ænial Bond, Reinfelds said. That puts the material in the hands of dentists who may be hesitant to try it. Sales reps also will be talking the product up, and later this year results from the field evaluations will be published.

What it means for the industry

In the U.S., GC America is best known as an expert in glass ionomers, but with this product, the company plans to increase its strength in the composite area as well, Reinfelds said. G-ænial Universal Flo follows GRADIA and KALORE and brings yet another brand to GC’s composite family, adding to a presence in the industry that will continue to grow.

“In America, people don’t realize to what extent we have an extremely strong foundation of R&D capability in dentistry,” O’Neill said, noting that the research is focused on material science. “When they see new product innovation after new product innovation they’ll realize we are serious about raising the bar in all main categories in dentistry. Our goal is to improve oral health care throughout the world. We are a large dental company and have one mission: improving dental oral care.”
This product is a big departure from what’s already available, O’Neill said, and the first time clinicians will be able to use a flowable as a universal restorative.

Why you should give it a try

For Dr. Broome and Dr. Stewart the reasons you should try it go on and on. It provides excellent esthetics and wear resistance. It’s minimally invasive. It’s easy to handle. It’s a combination between a nano-hybrid composite and a flowable composite, giving you options you never really had before. It may be a little different from what you’re used to, but that gives you all the more reason to try it.

And, above all else, it will make your patients happy when they leave with a restoration that didn’t take a lot of time to complete, that was placed conservatively and that gave them the beautiful smile they’re after.

“It’s going to help clinicians provide more esthetic restorations, especially in challenging areas like Class Vs,” Dr. Broome said. “We have a lot of products we can use that give nice results, but to  have a product that has some adaptability to cavity preps or has the characteristics where you can drag and pull and sculpt it in an easier manner is going to allow clinicians to be more artistic. It’s really another tool in the tool box we’re going to have as clinicians, or artists per say, in creating really beautiful restorations.”