How to bulk a posterior cavity

9 Feb 2017 - 55477

Using bulk materials in posterior cavities is today a predictable way to speed up restorative procedures as we need to be more and more fast and accurate in our operative procedures. With the introduction of the new bulk fill materials, both masses and flowables, we can get our aims of precision and correct shaping in posteriors, reducing the time spent chair-side, 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

Pre-operative view

Fig. 2

Details of the old amalgam filling with secondary decay on 16 and of 15 which has a primary decay on the distal wall

Fig. 3

Isolation with the rubber dam is mandatory.

TIP 1: 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 2: 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

The removal of the old amalgam and the exposure of the primary decay on 15

Fig. 5

The cleaning and the preparation of the cavities

Fig. 6

TIP 3: refine the preparations with fine grain 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 enough to clean the dentin with glycine powder, to disinfect it with 2% chlorhexidine 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 4: you can use the Garrison fishbone like wedges to increase the fitting of the matrix on the cervical step

Fig. 7

We do not etch the dentin! In 2017 this isn’t mandatory anymore; you can carry out 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

TIP 5: apply the Universal adhesive system on a dried cavity, in a self etching mode, with a brush for 20 seconds, remove excess material and blow air to make the solvent evaporate. Then light-cure it for 40 seconds at least.

Fig. 9

TIP 6: even with bulk-fill materials, we suggest you start by creating the interproximal wall that can be built with one single layer, also tanks to the reduced shrinkage of this kind of material.

Fig. 10

TIP 7: before the removal of the matrix, stabilize the interproximal wall with a little amount of flowable composite not to break the wall while removing the matrix

Fig. 11

We cover all the exposed dentin with bulk-fill flowable composite so to protect the pulp, avoid the risk of postoperative sensitivity and to counteract the negative C factor of deep class I and II cavities. We chose the bulk flow also as it allows creating 4-5 mm layers.

Fig. 12

TIP 8: With new bulk-fill materials you can quickly fill the whole cavity and chose the modeling technique you prefer, as the material allows to fill the cavity with only one layer (4-5 mm depth) and to model it with a subtractive technique. In this case only an A2 bulk mass is used both for the interproximal wall and for the whole build up of the restoration.

Fig. 13

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

Fig. 14

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

Fig. 15

Details before finishing and polishing procedures

Fig. 16

Details after finishing and polishing under the dam

Fig. 17

The occlusal check

Fig. 18

Details of the two restorations twenty-four hours after the end of the procedures

Fig. 19

Details of the morphology

Fig. 20

One week control

Fig. 21

Details after one week. Morphological and chromatic integration is good.

Fig. 22

Details of the morphology

Fig. 23

One month control

 

Conclusions

What’s really important in our daily practice is to be 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 so.
This is one of the ways in which everybody could reach a very good morphological and esthetic result with few predictable steps, spending a proper amount of chair-side time for the procedure.

Bibliography

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