CATEGORY 86 AUSTRALASIAN DENTIST CLINICAL single-dose delivery, minimising waste and facilitating consistent adhesive film thickness across the prepared substrate. Polymerisation of both the adhesive and subsequent composite layers was performed using the Bluephase PowerCure light-curing unit, delivering a high irradiance of 3,000 mW/cm² (Fig. 9). At this intensity, both adhesive and composite layers can be reliably cured in as little as 3 seconds. High-irradiance curing has been shown to enhance polymer crosslink density, contributing to improved mechanical properties, wear resistance, and degree of conversion while pulpal temperature increase rates as well as maximum pulpal temperatures remained low (Maucoski 2025). Restorative Phase On tooth #36, an initial layer of Tetric plus Flow was placed as a base layer (Figs. 10 and 11). Its lower viscosity and thixotropic properties facilitate superior adaptation to cavity walls, reducing the likelihood of void formation at the pulpal floor and axial walls, and providing an ideal foundation for the subsequent sculptable layer of Tetric plus Fill. The flowable layer of Tetric plus Flow was then light-cured for 3 seconds using the Bluephase PowerCure. Before polymerisation, the high translucency of Tetric plus Flow allows effective light transmission, facilitating reliable depth of cure. Upon polymerisation, the progressive refractive index mismatch between the filler and monomer matrix increases opacity, resulting in a tooth-coloured appearance that integrates naturally with the surrounding tooth structure and effectively masks the underlying discoloured dentin (Fig. 11). To restore the remaining cavity volume, a single mass of Tetric plus Fill, shade A2 plus, was placed directly over the cured flowable base layer in each tooth. The OptraSculpt Pad (Ivoclar, Schaan, Liechtenstein) was then used to adapt and condense the composite against the cavity walls and to begin modelling the occlusal morphology (tooth #36 in Fig. 12 and tooth #37 in Fig. 14). The ball-ended instrument facilitated precise material distribution and initial anatomical contouring, taking advantage of the sculptable viscosity of Tetric plus Fill to reproduce the natural occlusal anatomies in a single, streamlined placement step. This single-mass placement approach, made possible by the bulk-fill capability of Tetric plus, drastically streamlines the restorative workflow without compromising anatomical detail of the restorations. On tooth #37, following the same bonding protocol, Tetric plus Fill was applied directly without a flowable base layer (Figs. 14 and 15), demonstrating the versatility of the material across varying cavity configurations. The sculptable viscosity of Tetric plus Fill maintained its dimensional stability during placement, allowing accurate anatomical contouring to be achieved without the material deforming before being cured (Fig. 14). The cavity geometry of tooth #37 was deep and narrow and therefore presented a configuration where conventional incremental layering would have been technically demanding and risked inadequate light access to the cavity floor. The bulk-fill capability of Tetric plus Fill, however, enabled reliable single-increment placement of a 4mm layer, and thereby proved to be a significant clinical advantage of the material in geometrically challenging cavity preparations. After the final polymerisation with the Bluephase PowerCure in 3-second mode, a small amount of brown characterisation stain was added by applying the IPS Empress Direct Color composites (Ivoclar, Schaan, Liechtenstein) to the occlusal fissures of both restorations (Fig. 16). Selective fissure staining is a method used for enhancing the optical naturalness of posterior composite restorations, as naturally occurring occlusal grooves typically have some degree of subtle pigmentation that uniform composite shades alone cannot fully replicate. This step helped the restorations achieve a depth and visual complexity comparable to that of the surrounding natural dentition. Fig. 14: Single-increment bulk placement of Tetric plus Fill on tooth #37, with excess material being removed and occlusal morphology modelled using the OptraSculpt Pad. Fig. 11: Occlusal view of teeth #36 and #37 following light curing of the initial Tetric plus Flow base layer, demonstrating the clinically observable translucency shift facilitated by Aessencio technology. Fig. 15: Occlusal view of tooth #37 following composite placement and anatomical contouring, prior to final light curing. Fig. 12: Application and anatomical contouring of Tetric plus Fill, shade A2 plus, as a single occlusal mass on tooth #36, using the OptraSculpt Pad (Ivoclar, Schaan, Liechtenstein). Fig. 16: Occlusal view of teeth #36 and #37 after final light curing and fissure characterisation using IPS Empress Direct Color (Ivoclar, Schaan, Liechtenstein). A small amount of brown stain was applied to the primary and secondary grooves to replicate the natural pigmentation of occlusal fissures, enhancing the optical naturalness of the restorations. Fig. 13: Occlusal view of tooth #36 after completion of anatomical refinement of the composite restoration using micro brushes to define the primary grooves and occlusal details, before final light curing.
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