Nano-Hybrid Composite Visalys Fill and Visalys Flow: A Case Report on a Novel Composite Material for Esthetic Use

Introduction

Of chief concern to dental practitioners and patients alike are conservative techniques to save tooth structure, restoration ease of placement, and ideal esthetic results, including proper shade, natural translucency, and minimal transition visibility between tooth and restoration. Kettenbach Dental has touted Visalays Fill and Visalys Flow radiopaque nano-hybrid-fill composite to achieve such results predictably without compromising restoration stability. This report seeks to evaluate treatment success with their composite pertaining to ease of placement, restoration stability, and esthetics.

Case 1

A 69-year-old female presented with #7 incisal fracture, which was esthetically displeasing to the patient, with a defective lingual composite restoration. Due to the size and location of the fracture and lesion, and in accordance with patient request, a resin restoration was indicated .

Anterior Incisal Fracture Restoration

Clinical examination of the lateral incisor #7 revealed non-endodontic involvement of the fractured margin (Fig. 1). Endodontic testing, including cold/hot, percussion, and palpation testing revealed tooth vitality. Enamel craze lines and minor incisal chipping of adjacent teeth #6, #8, and #9 suggested habitual bruxing and clenching. Occlusal stability and contacts were assessed prior to restoration commencement

and rubber dam placement. Occlusal markings revealed contacts on #7 and adjacent teeth which were recorded to ensure recreation.

Shade selection occurred prior to rubber dam placement with the wettened tooth. Per the recommended Flex Shade system accompanying Visalys Fill and Visalys Flow, shade A2 was selected. A rubber dam was placed to achieve adequate isolation and airway protection.

The defective lingual composite was removed using carbide burs with a high-speed handpiece. Fracture margins and preparation internal features were refined using fine-diamond burs. After ensuring rounded preparation features, a minor circumferential bevel (<1.0mm) was placed to aid in adequate composite bonding and an esthetic tooth-restoration transition. The caries-free preparation measured <1.5mm in depth (Fig. 2).

The preparation enamel and dentin were first etched for total 30 sec. and 15 sec., respectively (Scotchbond Total Etch with 37% phosphoric acid), rinsed, and dried but not desiccated. Bonding agent iBond Universal by Kulzer was placed on the entire preparation, rubbed with a Microbrush for 20 sec., air thinned for 5 sec. to produce a glossy appearance of the preparation, and light cured for 10 sec. (LED polymerization light intensity: 1200 mW/cm2 ).

A thin (<0.5mm) layer of Visalys Flow shade A2 was applied to the dentin surfaces of the preparation and light cured for 20 sec. Visalys Fill shade A2 was then applied with composite resin placement instruments and cured for 20 sec. in incremental layers (<2mm). Finishing diamond burs were utilized prior to rubber dam removal for margin adjustments. Super Snap polishing discs and Enhance Finishing and Polishing resin finishers with Prisma Gloss Extra Fine Paste were used for final polishing adjustments. The rubber dam was removed, proper interproximal and occlusal contacts were verified, and patient satisfaction with feel and esthetic appearance was confirmed (Fig.3).