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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
From bulk fill and curing to manufacturing control, composite technology is changing the way doctors operate.
Composite technologies continue to evolve, making workflows better and easier with each generation. Current composite advances are improving doctors’ workflows further, giving patients better outcomes.
We spoke with representatives from Ultradent, 3M and Kerr to find out how they think composite advances are changing and improving doctors’ workflows.
Control and handling
Doctors must be able to easily control their composites. If they are too sticky or unwieldy, clinicians get less than optimal results. Manufacturers are improving overall handling characteristics to ensure that doctors have an easier time.
“Before launching Mosaic Universal Composite, we facilitated a number of pre-launch activities to gauge the overall clinical impression of the product,” Andrea Bailey, Ultradent’s global brand manager for composites and crown and bridge materials, says. “Our evaluators’ initial comments had a lot to do with the level of control related to the handling. The most resounding comment was, ‘It doesn’t stick to the instrument!’ They also noticed that it manipulates well – that they didn't have to fight against it as they were shaping, sculpting and adapting the composite.”
Ultimately, easier to handle composites streamline the doctor’s workflow and deliver more expected, reliable outcomes.
“The doctor's workflow and efficiency becomes more streamlined with Mosaic because they're not wasting time dealing with a material pulling, sticking, tugging or slumping as they use it,” Bailey says.
Esthetics may be the most important quality to patients – they want their restorations to be as natural and lifelike as possible.
At Kerr, Charles Christianson, global product manager, says their Harmonize Universal Composite was formulated in a way that is ideal for anterior restorations.
“We did a massive outreach to doctors to figure out what they want out of a product,” Christianson says. “What we see is universal composites, while they need to play everywhere in the mouth, are generally getting pushed toward the front in anterior restorations. This is because of bulk fill adoption. Not everyone is there yet, but there is a movement.”
Finding the correct shade seems like a straightforward affair, but in reality it can be difficult. Bailey says that Mosaic was designed to easily achieve the best balance and combination of shades for both easy and complex cases.
“We felt that a two-layer approach (dentin + enamel) provides the most natural result,” she says. “We've seen simple cases where a single enamel shade was all that was needed. On the other hand, we've seen a number of impressive cosmetic cases that utilized multiple shades. As a universal, nanohybrid composite that is esthetic with high polishability – while also strong enough for posterior use – Mosaic can span a very broad range of restorative capabilities.”
Up next: Making bulk fill material easier to handle ...
Bulk fill and curing
Traditionally, to fill a large space, clinicians would have to place a small layer of composite, light cure it and repeat until the void was filled. However, bulk fill products are designed to do it in one step.
Daniel Krueger, lead technical service specialist at 3M, says new innovations make their bulk fill material easier to handle and cure. 3M’s new product is called Filtek One Bulk Fill Restorative.
“The challenge that we’ve had with that material, as well as with the majority of the competitors, is that if we’re doing a bulk fill placement, where you’re actually taking the material up 4 to 5 millimeters in depth, the trade-off on those materials has always been that you’ve had to make them fairly translucent to allow the curing light to penetrate all the way through,” Krueger says. “We figured out some new 3M technologies, and now we can manage the nanofillers better. We now have a material that has a good translucency and allows us to get the 4 and 5 millimeter depth that we want, and we’re still managing the stress component of it. But upon final curing, it has a higher final opacity. By doing that, the material is more esthetic.”
Filtek One is totally light-cured, giving doctors more time to work with the product.
“The benefit there is the doctor has infinite work time, and it allows for faster placement,” Krueger says. “We can place a 4 millimeter depth and then cure that from the occlusal surface in one 20-second cure. It allows for a very efficient and fast procedure.”
In developing new products, manufacturers often seek input from client doctors. The result of that input led Kerr to understand that strength was the most important characteristic of their composites. If the strength was there, doctors tended to be fickle because of other traits.
“Far and away what we saw was handling and blending,” Christianson says. “It told us that, understanding that there is a trade-off, people are not willing to compromise on strength. It’s table stakes at a poker game. It’s a seatbelt in your car. Given the choice, any restoration they put in a patient’s mouth they want to last for a long time, and you’re going to correlate strength with safety of the product and also reward. That made it that much more important to develop a product that hit those three areas – strength, handling and esthetics.
“Harmonize is the strongest universal composite that we’ve every produced,” he continues. “We’ve had incremental gains in strength, and that’s because of the arrangement of the particles in our filler network and the cross-linking that’s able to happen through our curing process.”
Achieving new levels of composite characteristics requires manufacturers to improve their engineering capabilities. For Kerr, that meant looking at formulation in a whole new way.
Harmonize is a nanohybrid composite with zirconia and silica fused together on a nano scale.
“The size of those fused particles is about 30 nanometers,” Christianson says. “They’re then arranged in agglomerated clusters that are about the size of 2 to 3 microns. We are able to, in a sense, grow these structures, and that’s a lot different than a prepolymerized filler (PPF), which might fully cure the product and then smash it and grind it back up before introducing it to the surrounding resin. We don’t have PPF in our filler. We’re going from the ground up as opposed to smashing something, grinding it up and calling that a nanocomposite. So that consistency is a variant of our discrete particles and our filler network is much tighter.”
Technology is allowing manufacturers to do exciting thing with composites, promising stronger, easier to handle and better looking restorations.