CATEGORY AUSTRALASIAN DENTIST49 CLINICAL irrigation. e adhesive was agitated and dispensed immediately prior to application (CLEARFIL™ Universal Bond Quick 2, Kuraray Noritake Dental Inc.). After air drying and light activation with a polywave LED curing light (Valo X, Ultradent Products), the proximogingival box was microlayered using 0.25 mm to 0.5 mm increments with a highly- lled owable composite (CLEARFIL MAJESTY™ Flow, Kuraray Noritake Dental Inc.). Care was taken not to link dentin with enamel in signi cant thicknesses within a 5 minute decoupling period (3). e marginal ridge was constructed using the chameleon U shade of the CLEARFIL MAJESTY™ ES-2 Universal system, e ectively converting a Class II restoration into a Class I. e occlusal aspects of the three consecutive lesions were restored using a single shade of a chameleon composite (CLEARFIL MAJESTY™ ES-2 Universal (U Shade, Kuraray Noritake Dental Inc.) to precise anatomical form. Fissure systems were tinted using a highly owable composite system (Final Touch, Voco) prior to nishing and polishing (A.S.A.P. Diamond, Clinicians Choice). e rubber dam was removed and the restorations adjusted to be conformative with occlusion. of 115 MPa due to the presence of a novel amide monomer, which in its uncured form is more hydrophilic than HEMA, allowing for deeper component penetration. Finally, the presence of both the original 10-MDP monomer and a urethane methacrylate work harmoniously to ensure integrity and exibility of the hybrid link between composite and tooth. e ideal restorative material to bolster the residual strength of a tooth should have physical properties that are congruent with that of the missing structure. Enamel features a modulus of elasticity which ranges from 80-90 GPa, which does not correlate well with that o ered by resin composite. Indeed, due to its inherent exural strength weakness, composite re ects more accurately the e-modulus range of dentin (10-20 GPa) relative to enamel and behaves as such, with an Achilles heel of tensile weakness. It is paramount that when adjusting occlusion that the contact points are designed to impact either on the restoration itself, or on native enamel, never on the restorative-tooth margin or interface. It is equally imperative that these composite restorative-tooth complexes are not loaded in lateral excursive function, as this imparts tensile stress to the residual cusps, increasing their risk of fracture. Modern supercomposites are propelling direct restorations into a realm of clinical indications never thought possible. With an unbeatable combination of both beauty and brawn, e ciency and precision of application in the form of super owables now rede ne and challenge the new bar of everyday direct functional and esthetic excellence. u References 1. Magne P, Oganesyan T. Premolar cuspal exure as a function of restorative material and occlusal contact location. Quintessence Int. 2009 May;40(5):363-70. PMID: 19582240. 2. Moussa C, Savard G, Rochefort G, Renaud M, Denis F, Daou MH. Fracture Resistance of Direct versus Indirect Restorations on Posterior Teeth: A Systematic Review and Meta-Analysis. Bioengineering (Basel). 2024 May 24;11(6):536. doi: 10.3390/bioengineering11060536. PMID: 38927772; PMCID: PMC11201167. 3. Wilson NH, Cowan AJ, Unterbrink G, Wilson MA, Crisp RJ. A clinical evaluation of Class II composites placed using a decoupling technique. J Adhes Dent. 2000 Winter;2(4):319-29. PMID: 11317379. Figure 7. Alternate view of 3.7 buccal lesion being restored using increments of CLEARFIL MAJESTY™ ES Flow (Kuraray Noritake Dental Inc.). Figure 10. Post-operative radiographic control film. Figure 8. Completed restorations Figure 6. Axial restorations completed leaving the occlusal left to restore. Note that microlayers of CLEARFIL MAJESTY™ Flow (Kuraray Noritake Dental Inc,) have been completed on the occlusal aspect at this stage leaving room for the capping composite (CLEARFIL MAJESTY™ ES-2 Universal (U Shade), Kuraray Noritake Dental Inc.). Figure 9. Restorations checked to be conformative to occlusion e next step involved microlayering the dentin bases of the 3.6 occlusal (with buccal ssurotomy) as well as the larger 3.7 occlusobuccal lesion, the buccal aspect of the latter which was restored in its entirety with CLEARFIL MAJESTY™ ES Flow in appropriate increments. A post-operative bitewing radiograph was taken as a new baseline. Discussion is case demonstrates the use of a composite system that aims to maximize prognostic value through the use of a highly lled owable composite, which is not only easily dispensed, but feature innate physicality that rivals that of native dentin from a exural strength perspective. CLEARFIL MAJESTY™ ES Flow exhibits a compressive strength of 373 MPa and a exural strength of 151 MPa; metrics that easily exceed that of many ubiquitous packable composites (dentin = 165.6 MPa). CLEARFIL MAJESTY™ ES-2 Universal (U shade) was also used, which demonstrates a chameleon e ect due to its innovative synergy of chroma, light di usion and translucency. CLEARFIL™ Universal Bond Quick 2 is a novel multimodal 8th generation adhesive system which features an ultralow lm thickness of 3-5 micrometers and yet features an intrinsic exural strength
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