CATEGORY 76 AUSTRALASIAN DENTIST light to penetrate deeply and supports effective polymerisation at the base of deep cavities. During curing, the monomer matrix changes and its refractive index diverges from that of the fillers, increasing light scattering and reducing translucency to around 13–14%; this continues to decrease slightly over the next 24 hours as polymerisation completes. The cured material therefore becomes sufficiently opaque to provide masking, shade stability, and natural integration in the finished restoration. A characterisation stain was then applied to the defined fissure pattern to reproduce the subtle pigmentation that is naturally present in their occlusal anatomy before the final curing step. In this case, the Bluephase PowerCure was used to cure each composite increment for 3 seconds. This is the shortest curing protocol validated for use only in posterior Tetric plus restorations in permanent teeth from the occlusal surface, operating at a light intensity of approximately 3000 MW/ cm². This rapid curing protocol is made possible by the energy reciprocity of Tetric plus. It has been shown for Tetric plus that the total curing energy (intensity x time) delivered in 3 seconds at high intensity is sufficient to achieve the same degree of conversion and marginal integrity as longer conventional protocols at a lower intensity.3 The proximal marginal ridge has been restored with Tetric plus Fill Bleach plus in a single increment. Tetric plus Fill A2 plus forms the occlusal body, and brown characterisation stain has been applied to the fissure pattern. The restoration exhibits anatomically defined cusp ridges and fissure morphology (Fig. 6). It is equally important to note how the material behaves during polymerisation. The controlled shrinkage stress of Tetric plus reduces the forces transmitted to cavity walls as the composite sets, helping to maintain marginal integrity and supporting the long-term stability of the restoration. I have found that, together, these mechanical properties and the efficiency of the 4mm curing concept make Tetric plus a practical and dependable choice for the posterior restorations that form the backbone of everyday restorative dentistry. Finishing and polishing Following removal of the rubber dam and initial occlusal adjustment, polishing was performed with the OptraGloss system (Ivoclar) (Fig. 7). The conical OptraGloss tip was used across the occlusal surface and at the buccal aspect of the restoration. The compressive, abrasive mechanism of the OptraGloss polisher produces a high surface gloss efficiently, without the multistep abrasive sequences required by many conventional polishing systems. The predictable surface response of Tetric plus Fill to polishing reflects its nanohybrid filler design, in which nanoparticles fill the gaps between larger microparticles to produce a dense, smooth surface that reaches a clinically acceptable gloss level quickly, without having to overwork the material. Outcome At the recall appointment, tooth 16 presented with a well-integrated restoration. The occlusal anatomy, including cusp morphology and fissure characterisation, was well-preserved, and the composite shade matched the surrounding natural tooth structure under clinical lighting conditions. Gingival health was good, too. No marginal discrepancies or signs of degradation were clinically detectable at this stage. This case demonstrates the efficiency that the 4mm depth of cure makes possible in posterior restorations. The cavity was restored using only three material applications (liner, proximal wall, occlusal body), with each increment cured in 3 seconds. The result was clinically indistinguishable from the surrounding tooth structure in terms of shade, surface texture, and occlusal form (Fig. 8). Case 2: Anterior Restoration Traumatic Fractures of Teeth 11 and 21 Patient information A 43-year-old female patient presented as an emergency following a traumatic fall while running. She sustained incisal fractures to both maxillary central incisors: a major fracture of tooth 21 (upper left central incisor), involving the mesio-incisal angle and extending into the mid-third of the crown, and a smaller chip fracture of the mesial incisal edge of tooth 11 (upper right central incisor). Associated soft tissue trauma was noted on the upper lip. The patient was medically fit and well. Clinical examination Clinical examination confirmed the fractures of teeth 11 and 21 from both buccal and palatal perspectives. An apical radiograph and vitality testing were performed to assess the endodontic status of the affected teeth. Vitality was confirmed in both teeth, and no periapical pathology was identified radiographically. The natural tooth colour was warm and relatively homogeneous across both central incisors, providing a clear shade reference and supporting the selection of a simplified monochromatic layering approach. The aesthetic challenge in this case was defined by two main factors: the extent of the fracture on tooth 21, which required full reconstruction of the incisal edge, proximal wall, and labial surface; and the need to achieve shade harmony between the restoration and the patient's natural, moderately warm central incisor shade, without recourse to a multi-material, highly specialised aesthetic workflow (Fig. 9-10). CLINICAL Fig. a: Disc specimens of Tetric plus Fill and Tetric plus Flow (both shade A3 plus) illustrating the translucency shift at three stages: unpolymerised (left), immediately after curing (centre), and following 24-hour water storage at 37°C (right). [Scientific Report, Price 2024a/b; Bielec 2024a] Fig. 7: The OptraGloss polishing system in use. The blue conical tip is positioned at the buccal aspect of the completed restoration following occlusal adjustment. The developing gloss on the restoration surface is visible, with the adjacent teeth providing a natural shade and reflectance reference. Fig. 6: Proximal ridge restored with Tetric plus Fill Bleach and Tetric plus Fill A2 plus, with brown fissure characterization. Fig. 8: Final clinical outcome at recall. The completed restoration on tooth 16 shows wellintegrated anatomy, convincing shade match with the surrounding natural dentition, and no clinically detectable marginal discrepancies. Gingival tissue is healthy and well-contoured.
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