When faced with large posterior cavities, as many dentists are on a regular basis, I prefer to use a reliable bulk filling material for speed and accuracy. There have been a number of advances in this area over recent years and some of the materials now available are very good, with features that address a number of clinical issues simultaneously. Manufacturers’ efforts to develop materials that have low shrinkage and thus reduce polymerisation stress, effectively
avoiding de-bonding, reduce postoperative sensitivity and minimise marginal discrepancies, are to be applauded. When such a material is also versatile enough to use across a range of indications, in my view it becomes an extremely beneficial part of the dentists’ toolkit.
SDR (Smart Dentine Replacement) from Dentsply is one such material that I personally wouldn’t be without. Its flowability makes it an excellent option for bulk filling, where, in contrast to traditional materials, it adapts to the cavity extremely easily, giving an excellent and reliable fit. In addition, it is indicated for a number of applications and I routinely use it not only to fill large posterior cavities, but also as a reliable core build-up material after endodontic treatment.
The benefits of using a bulk filling material over a conventional composite is that the latter needs to be packed and can often be quite ‘tacky’, sticking to instruments and making the procedure frustrating and time consuming. I prefer a material with flowable properties that enable it to be layered in large incremental layers (ideally up to 4mm), as this vastly reduces the amount of time spent performing the procedure. Of course this feature must also be combined with minimal polymerisation stress so that the efficacy of the restoration is not compromised and, in research, SDR has proven to be liable to up to 60 per cent less shrinkage stress than comparable composites. The procedure is also quickened if the material has a high translucency and able to be rapidly light cured. In the case of SDR, the light is able to penetrate up to 4mm below the surface of the material, giving a very controlled and predictable cure, which in turn provides a stable and reliable result.
Flexibility is very important for materials being used for bulk filling, as it is this feature that gives adequate support to the cusps. In addition I have also found, although this is anecdotal, that my patients often experience less sensitivity when a tooth is filled using SDR in comparison to other materials.
I find that whilst the translucency of a material provides some advantages it also creates some challenges with regard to colour matching. Where necessary these can be overcome by combining the filling material with an opaquing composite, and I often use Ceram.X mono for this purpose as it is available in a wide range of shades.
I find the system approach to be most beneficial and take confidence from the fact that when I need to combine
several different materials, I do so in the knowledge that by using materials from a single manufacturer I am less
likely to encounter any issues in terms of compatibility.
By combining SDR with Ceram.X I get all the physical properties that enable a large cavity to be effectively treated, combined with a good aesthetic finish that means I can achieve a very pleasing result.
I use conventional composites to restore in both the anterior and posterior region and for these I require a material with good shade matching to achieve the desired result. For this reason I often favour Ceram.X duo for anterior teeth as its colour matching is more detailed. Posteriorly, I use Ceram.X mono composite to fill small cavities where bulk fill properties are not needed, but where I still require good handling characteristics. A material that is not too tacky, adapts to the cavity well, is easy to build up and aesthetically has the benefit of a good colour match is the ideal. Using a material that enables me to perform procedures with ease and is fast, efficient and gives the patient a good, reliable, aesthetic result is the perfect solution.
To complete my armoury for achieving a successful restorative result, I like to use a sectional matrix system that enables me to successfully encase the tooth around the contact points. This can be a slight challenge if a patient presents with a cavity that has open contacts both mesially and distally because it necessitates the placement of two separate sections or requires each side to be built up independently. Palodent Plus is a sectional matrix system in which the metal sections are very flexible and adaptable, and therefore more readily take the shape of the tooth. This enables me to achieve very good contouring and gives the tooth a convincing natural appearance.
The plastic wedges that are part of the system can be joined together in a jigsaw fashion making the construction of the contact space as anatomically shaped as possible.
Before I start to prepare the cavity, I insert the guard, which comes as part of the kit and prevents any contact with the adjacent tooth that would cause iatrogenic damage. The guard and plastic wedge are inserted simultaneously and once the cavity has been cut the guard is removed leaving the wedge in place. This process gives the wedge sufficient time to adapt the space through a degree of movement of the tooth. As a clinician I appreciate all these small features, which combine to create huge benefits in terms of clinical efficiency and enable a very pleasing result to be achieved.
There are numerous examples in which I have used this family of products together in a single case and with complete confidence. I think it makes a huge difference when companies engage with clinicians to develop products, as it is noticeable that the resultant materials are well thought through in terms of their practical application. Like most dentists I use filling materials and composites on a daily basis and I appreciate the fact that these particular materials take into account all the minor details that are so important to the smooth running and clinical efficiency of my practice.