Courtesy of Dr. Johan Figueira, DDS and Dr. John Monges, DDS
Early advances in resin-based materials broadened their use to direct posterior restorations. Conventional composite resin restorations (designed to be placed in 2mm increments) are subject to problems associated with polymerization contraction, which may generate microfiltration, air trapped between layers, and cuspal deflection. In order to address these problems, as well as optimize clinical efficiency, BISCO has created REVEAL HD Bulk, a high viscosity material that is placed in increments up to 6mm*.
Evolution of Bulk Fill Composites
Bulk fill composite materials are characterized as having a lower shrinkage stress and a higher depth of cure than conventional composites. Shrinkage stress is defined as the amount of force per area exerted on the walls of a cavity preparation by a composite as it polymerizes. Also, depth of cure is commonly measured by examining the hardness or the degree of double-bond conversion at the surface of a composite exposed to a curing light and comparing it with the degree of conversion at various depths of the restoration.
When a composite is light-cured from the occlusal direction, light energy from the curing light must be transmitted through the bulk of the composite without being absorbed or deflected before reaching the bottom of the restoration. By adjusting the translucency of the composite or matching the refractive index of the filler and the resin, light can travel through an increase
Technique
A 33-year-old Caucasian female presented with a history of old composite restorations and generalized decay in the posterior teeth. Upon examination, caries lesion (#18) and old composite restoration Class 1 (#19) was found (Figure 1). Removal of the temporary restoration and excavation of the remaining carious dentin and previous restorative material was quick (Figure 2). The preparations were etched with UNI-ETCH® w/BAC (Figure 3). Two layers of ALL-BOND UNIVERSAL® were applied and cured with a polywave (VALO® by Ultradent) (Figure 4). REVEAL HD Bulk was placed in one 5mm increment and light-cured (Figure 5). REVEAL HD Bulk is easy to condense and “shape” (Figure 5). Finishing and polishing are steps of paramount importance in any restorative procedure in order to ensure the longevity of the restorations. (Figure 6)
[Figure 1] Pre-Operative
[Figure 2] Excavation of carious lesions (#18) and existing composite w/recurrent decay (#19)
[Figure 3] Phosphoric acid etchant w/BAC (total etch technique #18, selective etch technique #19)
[Figure 4] Application of ALL-BOND UNIVERSAL
[Figure 5] Placement of REVEAL HD Bulk in 5mm increments
[Figure 6] Immediate post-operative photo
Summary
In this particular case, placing REVEAL HD Bulk in a 5mm increment reduced clinical time significantly, and achieved the ideal adaptation to the cavity walls due to the fluidity of the material. REVEAL HD Bulk allows you to shape the occlusal anatomy and offers the desired esthetics for the final restoration.