Universal Composite Mimics the Physical and Chemical Properties of Natural Teeth
By Robert A. Lowe, DDS
Recurrent caries is the primary reason for restorative failure. A new generation of biomaterials currently has been introduced that not only helps to restore lost tooth structure, but also supports the natural remineralization process through the availability of fluoride, calcium, and phosphate ions.
ACTIVA Presto from Pulpdent is the first light-cure, mineral-enriched composite that mimics the physical and chemical properties of teeth, according to the manufacturer. It is a universal composite material that holds its shape and does not slump during placement, yet adapts intimately to tooth structure. This strong, durable ionic resin material is indicated for all restorative applications.
ACTIVA Presto has two unique properties that mimic natural teeth and set the product apart from all other composite materials:
1) A mineral-rich, moisture-friendly ionic resin contains calcium, phosphate, and fluoride, and makes these ions available to the tooth
2) A shock-absorbing, rubberized resin component that is not only wear resistant, but also mimics the ability of dentin and the periodontal ligament to absorb stress and occlusal forces protecting adhesive/tooth interfaces.
ACTIVA Presto has a stackable consistency that stays where it is placed yet can be spread and sculpted with an instrument, making it easy to place in all classes of cavity preparations.
The following case demonstrates how to place a Class III restoration with ACTIVA Presto:
Class III Restoration with ACTIVA Presto
Figures 1 and 2 show existing carious lesions on the distal proximal surface of tooth No. 26 and the mesial proximal surface of tooth No. 27.
Figure 1. Shows existing caries lesions on the distal proximal surface of tooth #26
Figure 2. Shows caries lesions on the mesial proximal surface of tooth #27
Cavity preparation for an ACTIVA Presto restoration is the same as for conventional composite resin materials (Figure 3).
Figure 3. Shows cavity preparation
After establishing the outline form of the cavity preparation, infected dentin can be removed using a polymer bur that is the exact Knoop hardness of heathy dentin (Smart Bur II, SS White). A super pulsed diode laser (Gemini, Ultradent) is used to remove interproximal gingival tissues, creating a supragingival margin that will facilitate matrix placement and application of the restorative material. A unique mylar matrix (Bioclear) is used to better recreate the anatomic convex profile of the interproximal surface.
ACTIVA Presto is injected to fill the preparation to the cavosurface margins (Figure 4). Once the matrix is adapted closely to the tooth and secured, the material is light cured per the manufacturer’s instructions. Finishing is done using a fine carbide composite finishing bur (FG-7901, SS White). Final polish is accomplished using rubber composite polishing abrasives (A.S.A.P. All Access All Surface Polishers, Clinician’s Choice). Figure 5 shows the final restoration immediately after placement. Two years later, the restorations appear to have "matured" and bled well with the surrounding tooth structure (Figure 6).
Figure 4. ACTIVA Presto is injected into the preparation
Figure 5. Shows a post-insertion view of the ACTIVA Presto restorations placed in teeth #26 and 27.
Figure 6. Image of 2-year post-operative photo. The restorations bled well with the color of the surrounding tooth structure.
The case demonstrates the composite material's ability to stack and hold its shape, and to integrate with the tooth structure to provide long-term esthetics and strength.
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About Dr. Robert A. Lowe: A consummate dentist and educator based in Charlotte, Dr. Lowe maintains a private practice in Charlotte, NC, while lecturing internationally and frequently authoring articles on dental care and dental health topics. Dr. Lowe is a member of the Catapult Elite Speakers Bureau and has Fellowships in the AGD, ICD, ADI, ACD, IADFE, and ASDA. He has received the Gordon Christensen Outstanding Lecturers Award and Diplomat status on the American Board of Esthetic Dentistry.