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Using an Injectable Bulk Fill for an Efficient, Quality Restoration

Categories: Restorative Dentistry

Author(s): Dory Stutman, DDS, AAACD, FICOI

Date: 03-05-2020 10:57:19 am

In the past, providing a long-lasting direct posterior restoration was hampered due to the issue of microleakage, which often led to recurrent decay and breakdowns. Possible causes of microleakage included uncured composite at the base of the restoration, material shrinkage during curing, and voids from improper condensing and layering.
To overcome these restorative obstacles, the dental profession now has a new category of materials called injectable bulk-fill composites. One advantage of using a bulk-fill composite is its ability to restore teeth with large defects in one quick step. The injectable delivery system—as well as the material’s ability to flow and cling to the walls of the preparation while providing a complete, void-free filling—makes the process more efficient. Its translucency allows for complete curing at the base of the restoration, and the increased strength enables clinicians to fix teeth in need of more complex restorative care.
The following case demonstrates the ability of injectable bulk-fill composite material to help clinicians deliver quality restorative care in an efficient way.

Strength & Adaptability

The patient presented with recurrent decay in tooth No. 3 and a large existing restoration (Figure 1). A large composite restoration was chosen as the most appropriate treatment for this case. After using local anesthesia (Septocaine, Septodont) and isolating the area (Isolite, Zyris), the previous
restoration was removed along with recurrent decay. An electric handpiece with copious amounts of water was used to make a smooth preparation while removing a minimal amount of tooth structure Figure 2). Some minor bleeding was controlled with Astringedent (Ultradent).
The Composi-Tight 3D XR sectional matrix (Garrison Dental Solutions) was then used to adapt and form the walls of the cavity preparation (Figure 3). The sectional matrix system helped me to maintain a better curved contour in the contact areas as opposed to other matrix systems. The preparation was then acid etched (Figure 4) and rinsed, leaving a slightly moist dentin surface for the bonding step. OptiBond Solo Plus (KaVo Kerr) was brushed on the surface and air-thinned to avoid liquid pooling. The bonding agent was then cured for 10 seconds.
Next, G-ænial BULK Injectable (GC America) was flowed on and around the preparation floor, in all the internal corners and crevices (Figure 5). While injecting, the tip would slowly be withdrawn upward as the material flowed over and around it until the preparation was completely filled. An explorer was then dragged lightly over the unset composite, pulling it toward all the margins for adaptation. Finally, the restoration was light cured for 20 seconds from the occlusal, and then 20 seconds buccal and lingual after the matrix was removed (Figure 6).
Excess material was then removed, occlusion checked, and final polish achieved (Figure 7). Proper contacts were checked with floss completing the restoration. The final bitewing, as compared to the preop radiograph (Figure 8), showed an excellent, densely filled restoration (Figure 9).

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