CASE PRESENTATION
Using Chemically Compatible Materials for Restorative Success
Our current restorative world is crowded with more materials to choose from than ever before, so finding a product that stands out in the crowd can be challenging. For me, it helps to keep in mind the 2 most important features in a dental material: an alkaline pH and calcium availability.
Case in Point
The patient presented as a healthy young male without distress. He was concerned about a dark area on his molar and had some history of sensitivity. Radiographic examination revealed a deep carious occlusal lesion of the maxillary first molar, so the patient was scheduled for a restorative procedure.
At the appointment, the molar was anesthetized and a rubber dam placed for isolation. The occlusal preparation uncovered deep dentin carious involvement, which explained the patient’s history of preoperative sensitivity. Full caries excavation to remove all infected dentin was achieved with a round bur and a sharp spoon excavator, and undermined enamel also was removed by beveling with the round bur.
A high-viscosity acid etchant (Select HV Etch, BISCO) was placed on both the enamel margins and dentin, each for 15 seconds, to remove the smear layer but leave the dentinal plugs intact— reducing the likelihood of postoperative sensitivity.
The etchant was removed with a copious water spray and the dentin was left moist so that a resinmodified calcium silicate base material (TheraCal PT, BISCO) could be placed and then light-cured for 10 seconds. Thanks to TheraCal PT’s proprietary dualcure technology, it will continue to cure while releasing calcium ions and maintaining an alkaline pH.
Two coats of a universal adhesive (ALL-BOND UNIVERSAL, BISCO) were applied and then light-cured for 10 seconds, after which a bulk-fill resin-based composite (REVEAL HD Bulk, BISCO) was injected into the cavity preparation and properly packed with a condenser to remove any air voids and achieve optimal marginal integrity.
Preliminary anatomy was created with the acorn lateral condenser and the composite was light cured with a high-output LED curing light (Demi Ultra, KaVo Kerr). Final occlusal anatomy was accomplished with a diamond bur and the surface polished with mini single- patient-use composite polishers (Rally, Garrison).
Supporting the Final Restoration
This case is a prime example of how using products that are chemically compatible with each other is key to achieving successful results. I take great comfort in knowing that BISCO bonding agents, composites, and liners are extensively researched and developed by the same team of scientists and clinicians, which ensures me that they possess the mechanical properties necessary to support the final restoration.
Go-To Products Used in this Case
A versatile universal adhesive that can be used with direct and indirect restorations and formulated to be compatible with light-, dual-, and self-cured materials.
Featuring a category-leading depth of cure, REVEAL HD Bulk is a light-cured bulk-fill restorative composite with optimized handling and polishability, superior compressive strength, and high radiopacity.
A biocompatible, dual-cured, resin-modified calcium silicate material designed for pulpotomy treatment, TheraCal PT maintains tooth vitality by performing as a barrier and protectant of the dental pulpal complex.
Mark L. Cannon, DDS, MS
Dr. Cannon is a professor of Otolaryngology, Division of Dentistry at Northwestern University, Feinberg School of Medicine, and an attending physician and research coordinator in the Pediatric Dental Residency Program at Ann and Robert Lurie Children’s Hospital in Chicago, IL. He is the founder of Associated Dental Specialists of Long Grove and a member of the International Association of Pediatric Dentistry. Dr. Cannon has 40 years of experience in pediatric dentistry and has presented lectures both nationally and internationally on various oral health topics, including evolutionary oral medicine, the gateway microbiomes, biologic and bioactive dental materials, probiotics, and all aspects of pediatric oral health.
