Using an Injectable Bulk Fill for an Efficient, Quality Restoration
New Products | Product Spotlight | Tried & True | Clinical Practice
Dory Stutman, DDS, AAACD, FICOI
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 fi x 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 efficiently.
Strength & Adaptability
The patient presented with recurrent decay in tooth No. 3 and a large existing restoration. 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. 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. The sectional matrix system helped me maintain a better curved contour in the contact areas compared to other matrix systems. The preparation was then acid etched 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. While injecting, the tip was slowly 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.
Excess material was then removed, occlusion checked, and final polish achieved. Proper contacts were checked with floss to complete the restoration. The final bitewing, compared to the preop radiograph, showed an excellent, densely filled restoration.
Go-To Product Used in this Case
G-ænial BULK Injectable: handling, and adaptation characteristics for use as a 1-step application for bulk filling the occlusal surface (up to 4 mm) without capping or veneering with another composite. It provides high flexural strength and wear resistance for a durable and long-lasting restoration that retains its gloss for many years after placement. Easy to manipulate, G-ænial BULK Injectable is also highly adaptable to the cavity for reduced porosities and air bubbles.
About the Doctor
A Long Island native, Dr. Stutman earned his dental degree from the School of Graduate Dentistry at Case Western Reserve University. He completed his general practice residency at MetroHealth Medical Center in Cleveland, OH, and a postgraduate program in esthetic dentistry at the University of Buffalo. Dr. Stutman has been in private practice since 1991 and opened the doors of South Shore Dental Care in 1995. He attends more than 100 hours of advanced dentistry seminars each year, concentrating on cosmetic dentistry, dental implants, and full-mouth reconstruction. Dr. Stutman is a member of several professional organizations, including the American Dental Association. He is also an accredited member of the American Academy of Cosmetic Dentistry.