Australasian Dentist Magazine May June 2021

Category 66 Australasian Dentist were covered with flowable bulk fill material. This material can be applied in increments of up to 4mm (Fig. 13). The Tetric PowerFlow is identical to the previous Tetric Evoflow Bulk Fill but is now approved for light-curing in 3 seconds in combination with the Bluephase PowerCure curing light. As before, the flowable bulk fill material can also be polymerised with less powerful curing lights. In this case, the recommended curing time is still 10s, as in the previous version. Once the flowable was cured, the occlusal surface was built up increment by increment, using the above presented TetricPrime (Figs14-17).TetricPrime isnot a bulk fill material and should therefore be applied in thinner increments. However, it offers a complete range of shades and an ideal degree of translucency to blend into the posterior region harmoniously. In the present case, it is debatable whether the shade match of a molar is really that important or whether the occlusal surface should rather have been recreated with a sculptable bulk fill. In Class I and II restorations, I always use a bulk fill material as a standard procedure. However, if the cusps, and especially the buccal cusps, need replacing, I take the esthetic needs of my patients into account in my decision. Case 3: Adjacent teeth restored with Tetric PowerFill The preoperative examination revealed D3 caries lesions on the distal side of tooth 34 and the mesial side of tooth 34 (Fig. 18). When restoring adjacent cavities, both matrix bands are inserted and wedged in place in the interdental space at the same time after preparation (Fig. 19). Restoring one tooth after the other (i.e. placing only one matrix band, restoring the tooth in question and then repeating the same procedure on the other tooth) usually leads to the sectional matrix bulging into the cavity of the adjacent tooth once the separation ring is placed and results in the restoration being overcontoured. This then needs to be addressed before the adjacent tooth can be restored. If both matrices are applied simultaneously, the proximal contact will be placed correctly at the centre of the interproximal space and overcontouring is avoided. However, this doubles the amount by which the teeth would have to be separated, since each matrix has a thickness of approx. 30µm. To make sure that this does not result in an inadequate proximal contact, I modified the procedure as shown in the images (Figs 20-23). First, the steps of the adhesive technique were performed (Fig. 21). When using a modern universal adhesive, the enamel should be selectively etched with phosphoric acid (selective etch technique) whenever possible before the adhesive is applied (da Rosa et al. 2015, Tsujimoto et al. 2016). After the etching procedure, the universal adhesive was applied to the enamel and dentin. The adhesive should always be applied actively, i.e. it should be agitated on the surface for at least 20 seconds with a microbrush. This was followed by careful drying with blown air to evaporate the solvent (universal adhesives usually contain an alcohol/ water mixture). The Adhese Universal adhesive used in this case can be light cured in 3 seconds using the 3-s program (3050 mW/ cm2) of the Bluephase PowerCure light unit. If a conventional curing light in the performance range of 500-1400mW/cm2 is used, the curing time remains 10s, as before. Upon completion of the adhesive procedure, the restorations were restored with Tetric PowerFill. The material can be applied and cured in 4mm increments, like a bulk fill composite. So, if the cavities are not deeper than 4mm, they can be restored using a 1-layer technique. If there are doubts about the depth of the cavity, the depth can be easily checked with a periodontal probe. Fig. 21 shows the clinical situation after the cavity on tooth 34 was filled with a layer of Tetric PowerFill and light cured for 3 s. This short exposure time is only permitted in conjunction with the Bluephase PowerCure light in the 3-s mode. If a different curing light is used, the clinical Fig. 14 Applying Tetric Prime step by step. Fig. 16 Completely layered occlusal surface. Fig. 15 Ideally, the occlusal surface is contoured to the correct shape right from the start. Fig. 18 Preoperative situation. Proximal caries in teeth 34 and 35. Fig. 17 Completed restoration immediately after the treatment. Fig. 19 When restoring adjacent cavities, both matrix bands are inserted and wedged in place at the same time to achieve an adequate proximal contour and correct position of the proximal contact. Fig. 20 Selective enamel etching of both cavities with phosphoric acid for 15 seconds. Followed by the application of universal adhesive (Adhese Universal).