How to bulk a posterior cavity

9 Feb 2017 - 54873

Today more and more we need to be precise and fast in our operative procedures. With the introduction of the new bulk fill materials, both packables and flowables, we can get our aims of precision and correct shaping in posteriors, reducing the time spent chairside, with the right agreement and stress reduction of the patient. Here's described an easy way with which we treat this kind of restorative issues with predictable and long lasting results. We call this Bulk and Go Technique: easy, good and fast, the Style Italiano way.

Fig. 1

Img. 1 – Pre-operative view

Fig. 2

Img. 2 – Details of the old amalgam filling with secondary decay on 1.6 and of 1.5 which has a primary decay on the distal wall

Fig. 3

Img. 3 – Isolation with the rubber dam is mandatory. Tip: We start with the isolation before the preparation of the cavities and the cleaning of the caries not to have the contamination of the dentin. Tip: protect the dam from the accidental wear or perforation done with the burs, using a wooden wedge under the contact areas you have to open.

Fig. 4

Img. 4 – The removal of the old amalgam and the exposure of the primary decay on 1.5

Fig. 5

Img. 5 – The cleaning and the preparation of the cavities

Fig. 6

Img. 6 – Tip: refine the preps with fine grained diamond burs not to leave unsupported enamel prisms, use chisels or burs or sonic tips for the cervical step. Don't try to remove all the cracks because sometimes they end inside the root, so it's sufficient to clean the dentin with glycine powder, to disinfect it with clorexidine at 2% for 60 seconds, to refine the cervical step and to put the matrix in place (here is the new Polydentia Black Sectional Matrix System powered by Style Italiano) Tip: you can use the Garrison fishbone like wedges to increase the fitting of the matrix on the cervical step

Fig. 7

Img. 7 – We do not etch the dentin! In 2017 this is no more mandatory: you can do a selective etching procedure of the enamel for 20 seconds, and wash the etching gel away, dry the cavity completely and, hence, you won't need to do a wet bonding.

Fig. 8

Img. 8 – Tip: apply the Universal adhesive system on a dried cavity, in a self etch mode, with a brush for 20 seconds, remove the eccess with the aspirator and blow air for the evapotarion of the solvent. Then light-cure it for 40 seconds at least.

Fig. 9

Img. 9 – Tip: even with bulkfill materials, we suggest you start with the creation of the interproximal wall that can be done with only one layer, also due to the reduced shrinkage of this kind of material.

Fig. 10

Img. 10 – Tip: before the removal of the matrix, stabilize the interproximal wall twith a little amount of flow not to break the wall while removing the matrix

Fig. 11

Img. 11 – We cover all the exposed dentin with bulkfill flowable composite so to protect the pulp, to avoid the risk of postoperative sensitivity and to counteact the negative C factor of deep class I and II cavities. We chose the bulk flow also due to its capability of creating layers of 4-5 mm.

Fig. 12

Img. 12 – Tip: with new bulkfill materials you can fastly fill the whole cavity and chose the modeling technique you prefer, but to perform it perfectly and fastly the material allows to fill the cavity with only one layer ( 4-5 mm of depth ) and to model it with a subtractive technique. Here's used only an A2 bulk mass both for the interproximal wall and for the whole build up of the restoration.

Fig. 13

Img. 13 – This requires 2-3 minutes at all. Details of the 1st filling at the end of the modeling technique

Fig. 14

Img. 14 – Details of the second filling done on 1.5 with only one layer, before the modeling subtractive technique

Fig. 15

Img. 15 – Details before finishing and polishing procedures

Fig. 16

Img. 16 – Details after finishing and polishing under the dam

Fig. 17

Img. 17 – The occlusal check

Fig. 18

Img. 18 – Details of the two restorations twenty-four hours after the end of the procedures

Fig. 19

Img. 19 – Details of the morphologies

Fig. 20

Img. 20 – One week control

Fig. 21

Img. 21 – Details after one week. Morphological and chromatic integration integration is good.

Fig. 22

Img. 22 – Details of the morphologies

Fig. 23

Img. 23 – One month control

 

Conclusions

What’s really important in our daily practice is to be precise, neat and clean in our restorative procedures, and to get our goals without losing time. The new bulk fill composite materials can help us in doing this.
We all see some authors doing Class I of Black in 3-4-5 hours of work. We firmly believe that this is a nonsense, a waste of time and a situation pretty far from reality.
Instead, this is one of the ways in which everybody could reach a very good morphological and esthetic result with few predictable steps, spending the correct time chairside.

Bibliography

Caixeta RV, Guiraldo RD, Kaneshima EN, Barbosa AS, Picolotto CP, Lima AE, Gonini Júnior A, Berger SB. Push-Out Bond Strength of Restorations with Bulk-Fill, Flow, and Conventional Resin Composites. ScientificWorldJournal. 2015;2015:452976. doi: 10.1155/2015/452976
Monterubbianesi R, Orsini G, Tosi G, Conti C, Librando V, Procaccini M, Putignano A. Spectroscopic and Mechanical Properties of a New Generation of Bulk Fill Composites. Front Physiol. 2016 Dec 27;7:652. doi: 10.3389/fphys.2016.00652
Costa T, Rezende M, Sakamoto A, Bittencourt B, Dalzochio P, Loguercio AD, Reis A. Influence of Adhesive Type and Placement Technique on Postoperative Sensitivity in Posterior Composite Restorations. Oper Dent. 2016 Nov 28.
Abdelraouf RM, Habib NA. Color-Matching and Blending-Effect of Universal Shade Bulk-Fill-Resin-Composite in Resin-Composite-Models and Natural Teeth. Biomed Res Int. 2016;2016:4183432
Engelhardt F, Hahnel S, Preis V, Rosentritt M. Comparison of flowable bulk-fill and flowable resin-based composites: an in vitro analysis. Clin Oral Investig. 2016 Nov;20(8):2123-2130.
Zhang H, Zhang ML, Qiu LH, Yu JT, Zhan FL. Comparison of wear resistance and flexural strength of three kinds of bulk-fill composite resins. Shanghai Kou Qiang Yi Xue. 2016 Jun;25(3):292-5.
Van Dijken JW, Pallesen U. Posterior bulk-filled resin composite restorations: A 5-year randomized controlled clinical study. J Dent. 2016 Aug;51:29-35. doi: 10.1016/j.jdent.2016.05.008.