Case Presentation: Natural-Looking Restorations Using a Supra-Nano Filled Composite

Published Date 01/09/2019
Figure 1—Occlusal caries
A 22-year-old male patient presented with caries in the lower right first molar, tooth No. 30. The patient demonstrated no symptoms and had no history of sensitivity or pain. On examination, the area had a large cavity on the occlusal surface, very deep and close to the pulp.

Composite Restoration
I isolated the tooth with a rubber dam and removed the caries using a carbide round bur (Darby Dental) as well as a slow-speed handpiece (Midwest Shorty Two Speed, Dentsply Sirona) and high-speed handpiece (StarDental 430 Series, Dental EZ).

After cleaning and drying the tooth, I placed a resin-modified calcium silicate-filled liner (TheraCal LC, BISCO) and light-cured the material. The tooth was selectively etched with 35% phosphoric acid solution and then air-dried.

A self-cured adhesive (Universal Bond, Tokuyama) was then placed, and after allowing for further drying, a universal, supra-nano filled composite (Estelite Sigma Quick, Tokuyama) shade A3 was placed on the occusal surface. After a complete cure of 20 seconds for each area, a flowable composite (Filtek Supreme Ultra, 3M) was placed on the facial surface (shade A4) and on the occlusal surface (shade A3) between the margin of the prepped tooth and the paste area to make sure that all occlusal margins were sealed.

Finishing Treatment
I used a contouring and polishing disc (Sof-Lex, 3M) to produce a smooth facial surface, and also used finishing diamond and carbide burs (Brasseler) on the facial surface. On the occlusal surface, I used an acorn-shaped burnisher (Hu-Friedy) for anatomy before light-curing and made adjustments with pointed FG shaped diamond burs (Kerr Rotary and Brasseler). After all the adjustments were complete and the occlusal was done, I used an FG shape white stone (White Arkansas Stones, Dedeco) to smooth all the composite.

Photography was taken throughout with a digital intraoral camera (CS 1200, Carestream).
The patient was pleased with the outcome.
Figure 2—Rubber dam isolation
Figure 3—Large caries into the dentin
Figure 4—Soft caries removal with carbide round bur (Darby Dental) using slow-speed handpiece (Midwest Shorty Two Speed)
Figure 5—Clean and neat cavity preparation
Figure 6—Placement of TheraCal LC liner (BISCO)
Figure 7—Placement of Estelite Sigma Quick (Tokuyama) with a condenser (Darby Dental)
Figure 8—Occlusal anatomy with an acorn-shaped burnisher (Hu-Friedy)
Figure 9—More defined occlusal anatomy with a pointed composite instrument (Blue Titanium, Pioneer Solutions)
Figure 10—Final composite restoration after adjustments with burs (Kerr Rotary and Brasseler) and polishing with FG shape White Arkansas Stone (Dedeco)
Estelite Sigma Quick is a universal supra-nano filled, low shrinkage composite with a patented spherical filler technology that represents a uniform diffusion of light for a forgiving shade match. This universal resin composite is for both anterior and posterior restorations including occlusal surfaces.
Universal Bond is a 2-component self-cured universal bonding agent for both direct and indirect restorations that can be used with self-etch, selective-etch, and total-etch techniques. Universal Bond has been designed to be fully compatible with light-cured, self-cured, and dual-cured composite materials.
Dr. Chae has been practicing general and cosmetic dentistry in Diamond Bar, CA, since graduating from the University of California at San Francisco School of Dentistry in 2000. He is a member of the American Academy of Cosmetic Dentistry, American Dental Association, and California Dental Association. You can find Dr. Chae on Instagram @diamondbardentalgroup sharing his work and answering questions to his more than 27,000 followers worldwide.
Filtek Supreme Ultra Flowable Restorative - Capsule Refills, 20/Pkg - Shade A1
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