"I like the simplicity, handling and esthetics for my everyday posterior restorations."
Dr. Amanda Seay of Charleston, South Carolina was presented with a patient who was looking for a more esthetic result with her posterior restoration. She used a combination of Tetric EvoFlow Bulk Fill and Tetric EvoCeram to mask the amalgam staining and achieve high level results. Read the case below!
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Dr. Seay's Case Report
Direct posterior fillings are the most commonly performed dental procedure, but when the restorations are placed with direct composites, the protocol can be time consuming. Also, meticulous attention to placing and curing layers of composite is necessary to ensure complete polymerization and prevent microleakage and postoperative sensitivity.
Tetric EvoCeram Bulk Fill is a nanohybrid composite containing Ivocerin, a patented-germanium-based-light-initiator that raises the composite’s reactivity to curing lights, providing an efficient and greater depth of cure. An additive ingredient in Ivocerin acts as a light sensitivity filter, thereby delaying the effects of ambient light and providing dentists with extended working time.
With Tetric EvoCeram Bulk Fill, dentists can predictably place and completely cure the material in a single increment of 4 mm, eliminating the need for a flowable composite and decreasing chair time. The composite adapts well to cavity walls and surfaces, and can be easily placed using conventional dental instruments. The smooth consistency and adaptability make contouring easy.
 Isolate the teeth using a non-latex rubber dam. Use liquid dam in areas where the rubber dam may not be completely sealed |
 Remove the existing amalgam restorations and any decay. Complete the cavity preparation and ensure that any sharp line angles are eliminated. Assess the depth of the preparation using a perio-probe or length of bur during tooth preparation. |
 Perform a selective etch technique using a 35% phosphoric acid etch on the enamel first, agitating for 15 seconds, then on the dentin, ensuring the proper contact time. Thoroughly rinse away the etchant, then lightly dry. |
 Scrub a fifth generation bonding adhesive (e.g., ExciTE F, Ivoclar Vivadent) onto the enamel and dentin, air thin, then cure for 10 seconds using an LED curing light |
 Place a 4-mm increment of Tetric EvoCeram Bulk Fill composite into the preparation, then shape and contour the composite to the preparation walls, as well as ensure proper anatomical form |
 Finish and polish the restoration using small football burs and polishing points to achieve a resilient high gloss. |
The ability to place a 4-mm increment of composite greatly saved time during this posterior restorative procedure, in addition to contributing to an efficient protocol. The viscosity and handling of the Tetric EvoCeram Bulk Fill composite were ideal, contributing to high sculptability. The composite’s chameleon effect blended well with the adjacent tooth structure, and its excellent adaptability and low shrinkage eliminate concern about leakage or shrinkage stress.
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