The need for efficient, easy-to-use materials and techniques continues to grow in dentistry. Yet, this demand should not be fulfilled at the expense of quality. The particular case uses the new adhesive bonding system from Ivoclar Vivadent, Adhese Universal, meets all the requirements. Adhese Universal is a light-curing single-component system for direct and indirect restorative techniques, and stands out due to its compatibility with different etching protocols- total etch, self-etch and selective enamel-etch.
A 30-year old patient came to our practice with the request that we replace her old fillings. We discovered carious lesions under the restorations during the examination (Figs. 1a & 1b). Furthermore, we noted that the old fillings did not have any cusps or fissures and decided to incorporate these features when we restored the quadrant. Composite resins are well suited for posterior fillings, because they allow the teeth to be reconstructed without having to sacrifice significant amounts of tooth structure. Additional benefits of modern composites include efficient handling and improved patient friendliness.
In preparation for the procedure, the fillings and the carious tissue were removed and a rubber dam was placed (Fig.2). At this stage, I was free to choose with approach to take in order to establish the bond between the composite resin and the tooth with Adhese Universal. In the case at hand, I will demonstrate the options that were available to me.
The Three Bonding Options:
The self-etch protocol was chosen for tooth 14. After the matrix (from Garrison) had been placed, the adhesive was agitated on the enamel and dentin for 20 seconds and then dispersed with a weak stream of air (Fig 3). Next, the bonding agent was light-cured for 10 seconds (Fig 4). The bulk fill composite Tetric EvoCeram Bulk Fill IVA was used to restore the tooth. Since this material can be placed in increments of up to 4mm in thickness, only two increments were necessary to fill the cavity (Figs. 5 and 6). The individual layers were cured for 10 seconds each. I like to use this technique for treating children and difficult-to-reach teeth. Fillings can be placed quickly and effectively with this treatment protocol.
The second method, selective enamel etching, was used to restore tooth 16. Before etching the tooth for 30 seconds (Fig. 7), a Garrison matrix was placed. The phosphoric acid was rinsed off with water spray after the procedure. The adhesive was agitated on the dentin and enamel for 20 seconds (Fig. 8) and then dispersed with a gentle stream of air. The next part of the procedure followed the same steps as the self-etch technique: The bonding agent was light-cured for 10 seconds and the filling was placed with two increments of Bulk Fill IVA (Figs. 9 and 10)
The third bonding protocol that was used with Adhese Universal in this case was the total-etch technique. This method generates a strong bond between the enamel and dentin. The phosphoric acid was applied to the enamel tissue for 30 seconds and additionally on the dentin for 15 seconds (Figs. 11 and 12). Subsequently, the phosphoric acid was rinsed off with water and the tooth was dried with a weak stream of air. One of the useful features is its VivaPen delivery form, which greatly facilitates the product's application. Difficult-to-reach areas, like in the case of tooth 17, can be optimally coated with the adhesive. Three clicks are all that is needed to we the syringe tip and dispense the required material in the cavity (Fig. 13). Next, the bonding material was dispersed with blown air and polymerized. Each of the two composite layers were light-cured for 10 seconds. The fourth tool was also treated using the total-etch technique.
The restorations were finished with rotary diamond burs and polishing discs. The occlusal adjustments were ground in and the restorations were polished with OptraPol Next Generation. The restorations were polished to a high gloss finish with Astrobrush (Fig. 14).
Highly aesthetic restorations are quickly placed and contoured with 4mm increments. As a result, the treatment time is reduced. Initially, I was rather skeptical about the VivaPen delivery form in terms of its handling and materials consumption. But I was surprised to find how easy it is to dispense just the right amount of bonding agent from the pen.