A rewarding way to work with restorative materials

Aug 07, 2019

Shiraz Khan discusses what to look for when investing in your material of choice and presents a case to demonstrate their full potential

It’s a great time for dentistry today, particularly in the discipline of restorative dentistry. In the past five years, there have been huge advances in material science and technology that even in my relatively short career, have made a massive difference to my clinical practice. There is an abundant choice of restorative materials on the market and, though the advantages of this are obvious, it can also make it difficult for clinicians to choose between them.

I have used a variety of composites in my clinical practice but the products I consistently go back to are supported by extensive data and research. This includes promising results from in vitro trials and are evidence-based to ensure a strong, aesthetic restorative material – which is after all everything we need in a material.

The key qualities I look for in my composite of choice include:

• Ease of use – can it be easily manipulated, yet retain its shape?

• Handling properties – consider its thixotropy and viscosity to ensure it doesn’t slump or stick to instruments

• Shade variety – opt for a shade guide system that offers a good range of shades for your dentine and enamel needs

• Durable aesthetics – the longevity of aesthetic restorations is essential to the satisfaction of both the dentist and patient alike. Consider its hardness, compression strength and shrinkage volume.

An often port-of-call for posterior composite restorations is the first purely ceramic-based restorative material, Admira Fusion, with its pure silicate technology, which contains no monomers. Its low polymerisation shrinkage (1.25% by volume) and low shrinkage stress is favourable and it delivers excellent longevity with its ormocer (organically modified ceramics) properties.

Final Touch is an excellent light-curing characterisation material, which delivers life-like characteristics and is the perfect extension to Admira Fusion to create the final aesthetic result. It’s easy to handle with an even consistency for accurate application and a non-dripping syringe, and minimal application often offers the optimal result.

I regularly use Futurabond U too, which I find achieves a good bond strength and is convenient to use with its one-dose disposable application blisters, which avoids the problem of solvent evaporation. It is universal and can be applied in a single layer, which makes my workflow really simple. It results in virtually no postoperative sensitivity and is reinforced with nanoparticles for long-lasting bond strengths. 

Professional partnerships

I have worked particularly closely with this manufacturer for many years now. I find my relationship with Voco brings great value to my clinical work. It sees itself as the dentist’s partner, not only through the quality of its products, but also through constant communication and conversation with dental professionals. Because it’s committed to fostering close links with clinicians for an exchange of ideas, it has taken the time to invest in me and my practice. I have had the pleasure of attending Voco’s European sales meetings and various fellowship events, where I have presented some of my work to like-minded professionals. 

Armed with considerable experience and knowledge, Voco recognises the power that we as dental professionals have in providing information, guidance and inspiration regarding its products. The company sends me articles and materials to review, so in effect I am testing in the field to see what works and what doesn’t. 

This has fostered a collaborative relationship in which Voco is investing in me and vice versa – to both our benefits. As a result, I feel I am able to develop a prototype of what the best restoration process should be, which then gives me more confidence in my ability to carry out this type of work.

With Voco’s support, clinicians can learn to reinforce their knowledge in the science behind its products, so they can rise to the demands of modern minimally invasive restorative dentistry with an emphasis on achieving lasting results, functionality and aesthetics with products and materials that guarantee stability and durability. 

With so much choice on the market, it’s sometimes hard to pick the products that will work best in practice. This is when an open and collaborative dialogue with a trusted manufacturer can really add value and ensure that I have the materials and knowledge necessary to practise the high-quality dentistry I aspire to. Below is a case study using Admira Fusion. 

Case study

A patient came into my clinic with multiple carious lesions. The patient was a 28-year-old male who had not been to the dentist for six years prior to coming to see me. 

After taking a detailed history it was clear that the patient had previously had a bad experience; however, he was extremely motivated to improve oral hygiene and over time improve the appearance of his teeth.

After an initial examination and radiographs, the patient went for an intensive course of hygiene therapy, the aim of which was to improve the patient’s cleaning, particularly interproximally. After two visits, the patient was already starting to notice a difference, which was a positive reinforcement.

The patient presented with nine carious lesions, with a grossly carious LL7 that was un-restorable and subsequently was extracted.

The choice of material for this patient was simple. He needed something easy to maintain that would deliver optimum aesthetics and exhibit good long-term wear. My experience of Admira Fusion, the first restorative to incorporate ormocer within a nanohybrid material, prompted me to make this my choice.

During the restorative appointment the handling characteristics were great. The composite does not slump, it holds its shape well whilst being carved into the correct anatomy. Also the shade-system is simple, following the classic Vita shade-guide system making this a simple system to use for routine, high-quality restorative dentistry.           

I used Futurabond U to ensure good bond strength was achieved under rubber dam isolation.

Furthermore, the finishing touches of the primary and secondary fissure anatomy were added using Final Touch, shades brown, orange, and white. This provided a nice depth to the restoration and the appearance of perfect integration.

Overall the patient was delighted with his restoration, and was sincerely complimentary. As an added benefit, I showed him photographs of the restoration, which meant he was able to understand what can be achieved with today’s range of great materials. 

The patient will continue on his restorative journey with renewed confidence
and dedication.

To find out about Voco’s range of restorative materials, call the expert team today on Voco’s international freephone number 00800 44 444 555, email info@voco.social or visit www.voco.social

Pic captions

Figure 1: Preoperative situation

Figure 2: Rubber dam isolation of full quadrant

 

Figure 3: Minimal caries removal and sectional matrix placement

 

Figure 4: Air abrasion followed by etching enamel for 30 seconds and dentine for 15 seconds

 

Figure 5: Post-bond application (Futurabond U) and creation of the mesial marginal ridge

Figure 6: Restoration complete with Admira Fusion A2 and Final Touch fissure staining

Figure 7: Immediate postoperative with occlusal marking to show confirmation of restoration