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has been continuously improved. The new generations of bonding agents, with less polymerisation shrinkage and greater abrasion resistance, together with modern layer techniques, are now the standard in dental practice. Nonetheless, composite restorations
in the posterior region still remain quite time-consuming. To meet the needs of many dental practitioners and for the purposes of simplification, particularly with regards to the time-consuming layer technique in the less aesthetics-oriented posterior region, the dental industry has for some time now started developing a variety of bulk-fill composites. To date there have been two groups, the bulk-fill composites with low viscosity and the bulk-fill materials with high viscosity. Fill-Up!, which is presented here, can be classified as a new third group of bulk-fill materials, with medium viscosity with good abrasion stability. The expression “bulk fill” actually
implies “filling in a single step”. This means quick and simple application and finishing, less polymerisation stress and good durability at lower technique sensi- tivity with the known bonding agents, as well as adequate bonding to enamel and dentine. The maximum curing depth of 4-5 mm remains a limiting factor with many bulk-fill materials, both for low and high viscosity composites. However, the Fill-Up! material used
here is a dual-curing bulk composite. This allows the application of layer thick- nesses of more than 5 mm in a single step, without any impairment in curing of the entire increment. This is an advantage in the case of approximal surfaces in the posterior region, for example, if deep root caries is also present in a Class II. Reliable chemical curing is assured after 3 minutes (including processing time), it is not essential to measure whether a layer thickness of between 4-5 mm can be attained. By using additional short-
With the Fill-up! Universal material used here, the final shade is achieved after 24 hours and is comparable to the shade VITA A2/A3
Application of Fill-Up! (COLTENE) Fig. 7
light-curing, the polymerisation process of the upper layers can be accelerated and the filling processed directly. Slight post-darkening is generally observed in chemically curing materials. With the Fill-Up! Universal material used here, the final shade is achieved after 24 hours and is comparable to the shade VITA A2/A3. Only a few patients demand highly aesthetic restorations in the poorly visible posterior region, so the disadvan- tage of different shaded fillings can be ignored after the first molar in both the maxilla and the mandible. For example, this includes patients presenting in the dental practice for the replacement of old amalgam fillings or also patients who want shorter treatment sessions. This also applies to the treatment of children, which will not be addressed in this case study. Using the dual-curing Fill-Up! Bulk
Fig. 8
Light polymerisation of Fill-Up! With S.P.E.C 3 lamp (COLTENE) for five seconds
composite it is possible to facilitate Class I and Class II fillings quickly and easily. The material used demonstrates excellent flow behaviour here, which is extremely helpful, especially for deep Class II fillings. An approximate 2 mm thick covering
Fig. 9
Cavity filled with Fill-Up!, whereby approximately 2 mm of room was left occlusally for a covering layer of SYN- ERGY D6 (COLTENE)
layer of hybrid composite, here SYNERGY D6, is not essential, but was chosen in this case for occlusal design purposes and improved aesthetics, as well as approx- imal contact-point design. This also reinforces the mechanical stability of the entire filling. Highly viscous bulk-fill materials with
a limited range of shades can be used for modelling, but the poorer adaptation behaviour at this viscosity can lead to the known problems of primary marginal gaps or air bubbles. Therefore, this material group is not the optimal solution per se. When performing a cover-layer filling,
Final outcome, filling after four weeks Fig. 10
Fig. 11
Final outcome, fillings mandibular pre- molar, opposite molar after four weeks
it is possible to fill the cavity in two steps when using the Fill-Up! Material applied here. This also represents clear savings in time compared with the usual four to five increments for conventional meth- acrylate-based hybrid composites and the corresponding longer and additive exposure times. The S.P.E.C 3 polymer- isation lamp by COLTENE usedhere, takes five seconds at a performance setting of ı600 mW/cm2. Add to this the manufacturer’s reference that the recommended exposure time should not be exceeded to keep the shrinking stress as low as possible. In addition, it is also recommended to adhere to the curing time of two minutes in case of very deep cavities (over 4-5 mm) to avoid adhesion of the material to the matrix.
Continued » Ireland’s Dental magazine 33
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