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CATEGORY LINICAL

Bulk-fill and universal composites

By Dr med. Dent. Markus Lenhard

Dr med. Dent. Markus Lenhard

R ecently, there has been a major renewal of the Tetric family. e tried-and tested bulk- ll materials Tetric EvoCeram Bulk ll and Tetric EvoFlow BulkFill have been successors. In addition, the light polymerisation has been optimised and o ers features that are unique on the market so far. With Tetric Prime, a new universal composite for the anterior and posterior region has also been launched on the market, which is characterised above all by its optimised, very pleasant handling. e following article sheds light on the potential of the current Tetric family based on clinical cases. Universal composites have the widest range of indications in restorative therapy. ey work without restriction in the posterior region and also cover almost everything in the anterior region. e use of a special anterior composite is only necessary in a very limited number of cases and also requires a lot of experience and skill (and honestly, luck) to achieve a clinically relevant improvement over a universal composite. It is therefore quite realistic to use only one universal composite for everyday practice. While a universal composite covers the largest range of indications, it is desirable to simplify the layering technique in the posterior region. Universal composites are tailored to the tooth in their translucency and o er a wide colour spectrum, i.e. also dark shades. As a result, they are limited to a layer thickness of 2mm per layer. In contrast, bulk- ll composites allow the curing of 4mm thick layers. In some cases, the limited colour palette and slightly higher translucency prevent an adequate colour match with the tooth structure. In the posterior region, I consider this to be completely irrelevant in the indication area of class I and II. Only in aesthetically more sensitive cases, e.g. replacement of the buccal wall or occlusal surface reconstruction, the use of a universal composite may again be advantageous. e data situation for the bulk- ll composites is very good. ere is currently nothing to suggest that bulk- ll composites are clinically worse than conventional

5-7). ese monochromatic restorations were fabricated using only one shade (A3.5 in this case). e adjustment of the Tetric Prime colours with a translucency of 11.5% represents a good compromise between the transparency of dentin and enamel to realise most restorations without layering with di erent colours. If an opaque (i.e. less translucent) layering in the front or covering discolouration of the dentin is indeed required, the colours A2 and A3.5 are also o ered as dentin masses with a signi cantly lower translucency of 7.5%. In addition, the workmanship of the new Tetric Prime is very pleasant from my point of view, as it is soft and very easy to model. In principle, a universal composite, such as the Tetric Prime presented here, is su cient to cover everyday restorative practice. However, since the introduction of bulk- ll composites, it has been possible to simplify work without sacri cing quality. One variant is the combination of a universal composite with a owable bulk- ll composite shown here in the 2nd case, which is intended as a volume replacement and thus reduces the number of layers required.

composites. Clinical studies comparing bulk lls and conventional composites nd no di erences 3–6 . e bulk- ll composites shorten the process of layering. is is only part of the treatment protocol, in which all other steps (anesthesia, preparation, etc.) remain unchanged. e possibilities of saving time are therefore limited, but it is precisely the section in which the restoration is vulnerable to contamination that is simpli ed. erefore, the simpli cation made possible by the bulk- ll technique is very welcome. e patient presented herself in the practice with the desire to straighten the incisal edges at 11 and 21 and to replace the old, discoloured lling, mesial and distal on the same teeth (Fig. 1). Anamnestic studies showed that the fractures of the incisal edges were not functional, but primarily due to a habit. Fig. 2 shows the teeth after removal of the existing llings. Following selective enamel etching with phosphoric acid (Fig. 3) and application of a universal adhesive (Adhese Universal, Fig. 4), the anterior teeth were restored using Tetric Prime (Figs Patient case 1: Class III and IV with Tetric Prime

Fig. 1: Old fillings and fractures caused by habits on the incisors of the middle incisors.

Fig. 2: Condition after removal of the old fillings.

Fig. 3: Selective fusion etching with phosphoric acid for 15 seconds.

Fig. 4: Active application of a universal adhesive (Adhesis Universal) for 20 seconds.

All photos © Dr. M. Lenhard

82 AUSTRALASIAN DENTIST