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Dr. Marty Jablow is America’s Dental Technology Coach. Due to his expertise in dental technologies, he is in high demand both as a lecturer worldwide and as a consultant to the manufacturer community. He is a member of the prestigious Cellerant Best of Class selection committee, charged with the annual selection of industry awards, and is the Chief Development Officer of Cellerant Consulting Group dentistry’s leading incubator and accelerator. Dr. Jablow has written articles for every major dental journal including his own column and video series. He is president of Dental Tech Advisors, a dental consulting company.
Learn how to use this new material in a patient with mandibular right first premolar with an open contact and a defective composite restoration.
An ORMOCER® is an ORganically MOdified CERamic. It is a combination of inorganic (ceramic) and organic materials.
ORMOCER®s are are pre-polymerized molecular groupings that create unique properties within the resin matrix that translate to enhanced properties offered by the restorative material. They are very biocompatible because they have no residual monomers.
Admira Fusion is a nano-ORMOCER® direct restorative material. Using silicon oxide for the nano filler along with the glass ceramics, VOCO has achieved the world’s first all ceramic-based restorative material. Due to the high degree of cross-linking between the large pre-polymerized ORMOCER® groupings within the ORMOCER®resin matrix and the various silicon oxide-based glass filler particles, Admira Fusion’s nano-ORMOCER® technology offers enhanced physical properties that go well beyond what conventional modern composites have offered.
This all ceramic-based restorative has no classic monomers, BisGMA or other substances released during polymerization, making Admira Fusion very biocompatible. Using pre-polymerized materials within the composite resin reduces volume shrinkage to an extremely low 1.25 percent and reduces the shrinkage stress to 3.71 MPa. With this low volume of stress, there is enhanced marginal integrity, and you will see longer-lasting restorations. Admira Fusion is 84 percent (w/w) filler, imparting an increased surface hardness and making the shades very stable and better able to withstand occlusal forces.
What are the indications for Admira Fusion? It can be used just about anywhere you would use a composite: simple Class I or II preparations, Class Vs, repairing porcelain veneer, or correcting defects in temporary crown and bridge material. It is easy to use and has a non-sticky consistency and great adaptation to the cavity walls when placed in standard 2 mm increments. Not only can it be used in the same way as a universal composite, but Admira Fusion comes in 10 VITA®¹ shades along with opaque dentin shades and four special shades for those unique situations. It takes a quick 20-second cure with a standard 500 mW/cm² curing light and 40 seconds for opaque shades. For those areas where sculpting is important, take your time as you have more than three minutes before natural light will cure the material. Admira Fusion polishes quickly and simply to a high luster.
But, what about bulk filling? VOCO has you covered there, too, using the same nano-ORMOCER® technology and incorporating it into an all ceramic-based bulk fill restorative material called Admira Fusion x-tra. The restorative is easily placed as a base in deeper preparations to save time with the same low 1.25 percent volumetric shrinkage. This bulk-fill material allows the clinician reliable placement in 4 mm increments. It comes in a single universal dentin shade with a desirable chameleon effect, which you then have the option to cap off with the Admira Fusion creating a direct, bulk-filled, all-ceramic-based restoration.
In one case, the patient presents with mandibular right first premolar with an open contact and a defective composite restoration. The tooth was anesthetized using a Milestone STA machine using buffered 4 percent Septocaine with a PDL injection. The tooth was isolated with a DMG Mini Dam and the composite and decay were removed. A Triodent sectional tab matrix band was placed along with a white V-wedge. The V-Ring was placed to establish proper contact.
VOCO’s Futurabond U, a dual-cure universal adhesive in a single-dose delivery system was chosen as the universal adhesive for this case. The bonding agent is activated by pressing on the tab, forcing the liquids to combine within the package. The brush is used to perforate the foil and then mix the bonding agent. The bonding agent is then applied homogeneously to all cavity surfaces and rubbed in for 20 seconds. The adhesive layer was dried with oil-free air for at least five seconds to remove any solvents. The adhesive layer was cured for 10 seconds using a curing light with a minimum output of > 500 mW/ cm². The cured adhesive layer should have a sheen to it after curing.
The first layer was GrandioSO Flow, a nano-hybrid flowable restorative. A layer of less than 2 mm was syringed into the bottom of the Class II box along with the axial wall and pulpal floor. The material was then light-cured for 20 seconds.
The next layer was Admira Fusion x-tra, a light-curing, radiopaque, nano-ORMOCER® direct restorative material. It is characterized by an increased depth of cure while at the same time showing reduced shrinkage stress, which means it can be cured in layers of 4 mm thickness. This bulk-fill layer was placed and light-cured for 20 seconds. The final layer was Admira Fusion a light-curing, radiopaque nano-ORMOCER® direct restorative material. The material was then light-cured for 20 seconds.
The matrix was removed and the occlusion was checked with articulating paper and adjusted. The final step was polishing the restoration. The restoration was then light-cured for an additional 20 seconds from the buccal and lingual to ensure curing of the interproximal box completing the restoration.
Admira Fusion and Admira Fusion x-tra are available in both syringes and caps for your favorite composite gun. They are compatible with all conventional bonding agents and provide for a simplified approach to direct ceramic-based restorations.
Admira Fusion sets new standards in restorative dentistry with respect to materials science plus there is no new technique to learn. Now you have the option of placing all ceramic-based restorations chairside and in just the same straightforward way as you are accustomed to working with a good restorative composite.
¹VITA is not a trademark of VOCO GmbH
Watch a video of the technique below: