Case Presentation: Faster, Easier Posterior Restorations Using a Dual-Cure Composite

Published Date 01/14/2019
There better be some very compelling reasons for me to consider changing the composite I use for posterior restorations. Several years ago, I was using the layering technique when placing direct posterior composites to control shrinkage and curing depth. This layering technique made the placement of the restorative material an arduous, multistep process. But after learning about Bulk EZ dual-cure, bulk-fill composite (Zest Dental Solutions), I was compelled to make a change. Since then, my posterior composite restorations have been much easier, faster, and more predictable.

Bulk EZ is a dual-cure material, so it has an unlimited depth of cure that cures toward the tooth, creating amazingly well-sealed and adapted gingival floor margins (a weakness of most light-cured restorations). And, unlike some other bulk-fill materials, Bulk EZ does not require placement of another composite over the top of it due to its low wear and proven durability. It is compatible with adhesive systems from the 4th generation on, so you can use it in tandem with your favorite adhesive system without worry.

Case in Point
In this case, the patient presented with an old DO amalgam restoration in tooth No. 4 that had failing margins (Figure 1). Upon removal of an old restoration, I will sometimes use Caries Finder (Zest Dental Solutions) to ensure the infected dentin is removed. The tooth was isolated with a rubber dam and the Mega V sectional matrix system (Zest Dental Solutions) was placed and burnished against the adjacent tooth so that a nice, tight contact without gingival margin flash could be created using Bulk EZ, which has a consistency similar to a flowable composite.
Figure 1—Preoperative photo of DO amalgam on tooth No. 4
Figure 2—Selective-etching on the enamel, with Sure Etch, for 15 seconds
Figure 3—Scrubbing Prelude One into the preparation, which is then dried with air and cured
The tooth was selectively etched with Sure Etch (Zest Dental Solutions), a 37% phosphoric acid gel etchant, on the enamel for 15 seconds, and then thoroughly rinsed off (Figure 2). Prelude One adhesive (Zest Dental Solutions) was applied vigorously for 20 seconds and air thinned thoroughly for 10 to 20 seconds to evaporate the solvent, and then was lightcured. (Figure 3). A2 shade of Bulk EZ was placed into the preparation by first filling the bottom of the box while keeping the tip embedded in the material filling up the box, and then across the occlusal preparation (Figure 4). The preparation was filled with Bulk EZ without a need to place another layer of composite over it.

I like to use an explorer to pull the Bulk EZ onto the enamel margin, and while the material sets, I carve in the occlusal anatomy (Figure 5). Having the time to carve in the anatomy of the restoration makes the final adjustments and polishing very quick and easy. After the 90-second set, I light-cured the occlusal for 10 seconds, which is not required, but ensures the optimal chemical conversion. The bite was adjusted and the restoration was easily polished (Figure 6).
Figure 4—Filling Bulk EZ from the bottom of the preparation and then coming up and across the preparation makes for quick placement
Figure 5—Carving the anatomy into the Bulk EZ as it sets
Figure 6—Immediate postoperative appearance
Saving Chair Time
Bulk EZ is really a time-saving material. The fact that it does not need to be topped with any other material saves me chair time and keeps my armamentarium streamlined. My assistant appreciates that our instrument transfers during composite placement have been reduced from 17 to 3. Over the years that I have used Bulk EZ, I have found the wear and esthetics to be very good, so I feel we are providing a clinically superior restoration. Making the switch to Bulk EZ is a change I do not regret.
Bulk EZ is an easy-to-place, dual-cure composite that combines flowable cavity adaptation with high strength and wear resistance—all in one, simple step. Its self-cure, patentpending IntelliTek Technology is designed to specifically control and direct shrinkage while eliminating leakage in all posterior restorations. Bulk EZ has reinvented bulk-fill composites by addressing the limitations in bulk fills that plague current products, such as gap formation and stress from rapid curing. It has universal compatibility with modern, more acidic bonding agents, and offers long-term color stability.
Dr. Miyasaki practices general dentistry in Sacramento, CA, and has been involved in dental education for over 30 years. Today, he presents and writes about restorative techniques, occlusion, technology, and aesthetics. He conducts live-patient treatment courses and instructs for the Pacific Aesthetic Continuum. His goal is to make it easier for his colleagues to provide quality dental care and be successful in practice with happy patients.
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