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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.
One dentist on the benefits of using this bulk fill composite.
Dr. David Clark, DDS, president of Bioclear Matrix in Tacoma, Washington, has had a rewarding experience using 3M’s Filtek One Bulk Fill Restorative.
Bioclear Matrix and Learning Center affords cutting-edge education, tools and equipment to provide patients with long-lasting, strong and esthetic composite restorations.
Dr. Clark notes that the transition from amalgam fillings to composites has been difficult.
“The whole implementation in dentistry has been sort of a disjointed journey,” Dr. Clark says. “The problem with composite is that we never fully shifted gears. We only added it in a bit at a time. When composites first came out and we used them on posterior teeth, about 35 years ago, we were using them like ‘white amalgam.’ We’ve been cutting posterior cavity preparations the same way for 120 years. The standard cavity prep that everyone did since dental school decades ago is still the standard in most schools today. When we first got composites, we didn’t change any of that. We just started jamming the white stuff in a hole that was prepped for the silver stuff. So there was never a formal shift toward a modern composite procedure. It’s basically a bastardized amalgam procedure. And somehow it just hasn’t ever changed.
“But oh, happy day,” he continues. “With modern cavity preps, Filtek One plus Filtek bulk fill flowable and the Biofit Matrix System, we can truly injection mold with the material. We have finally been able to modernize the entire procedure. The composite goes from being a bad ‘filling’ material, an inferior material to amalgam, to something that’s just incredible-if we change the entire procedure.”
Because Filtek One is a bulk fill material, the application process is faster and easier.
“Filtek One allows us to do pure injection molding with minimal layering” Dr. Clark says. “Because it is a true bulk fill material, we can get up to 5 mm in a single injection, which means that it is going to be one monolithic mass, instead of a bunch of layers.”
Bulk fills are nothing new, but what sets Filtek One apart from others is its esthetics.
“We’ve had bulk fills around for about seven or eight years,” Dr. Clark says. “In the beginning, they were very ugly, they were weak and they were grainy. They’ve slowly gotten better, and Filtek was one of the first with a small particle size, so it’s not grainy and it’s very strong.”
Earlier formulations of Filtek, like other bulk fills, were less esthetically pleasing because of their translucency, which was a necessary evil.
“They had to make Filtek Bulk Fill translucent,” Dr. Clark explains, “because the only way you’re going to get through a bulk fill with a curing light is that it has to be translucent.”
Filtek One’s esthetics advantage over prior formulations is that it turns opaque as it cures. It’s an interesting process, technically defined as, “A controlled mismatch of the refractive indices of the resin and filler,” which occurs as it polymerizes.
“They realized that doctors wanted to have a more esthetic outcome, but still wanted a bulk fill that was translucent to allow 5 mm depth of cure, so they came up with some chemistry that, as you cure the bulk fill, it’s translucent, but then it becomes more opaque, more esthetic,” he describes. “Until now all of the bulk fills were overly translucent for what we view as an esthetic composite. They’re just too translucent, and translucency equates to darkness, so they’re just not as pretty.
“So we get our cake and eat it too,” he continues. “We get a material that’s translucent, and we get that deep depth of cure, but as it cures it becomes opaque. It’s still not as esthetic as their regular Filtek, but it’s almost there. It’s not dark and grey like the other bulk fills. From my perspective, it’s more than adequate for esthetics. I don’t think a reasonable person will ever complain about the color.”
Filtek One’s particle size means that patients won’t be disturbed by how the composite looks or feels.
“It’s more than just esthetics,” Dr. Clark says. “Patients are just as in tune with the smoothness of a restoration as they are the esthetics. Manufacturers are all fired up about what’s the prettiest? What’s the most esthetic? But in reality, one of the number one complaints that patients have about composites is that they don’t feel smooth to their tongue. People rub their tongue on their teeth to find out, ‘Do I have food in my teeth?’, ‘Do I need to brush them?’ We feel our teeth more than we look at them. The thing about Filtek is it’s incredibly smooth. That has esthetic benefits, because then you’re going to get less staining if it’s smooth. So immediately it’s more esthetic, but it’s also more esthetic long-term because of the smoothness of the particle size. It stays polished better for longer, and a more polished restoration will be able to resist staining, wear, micro-fracturing and macro-fracturing.”
Handling is another trait of Filtek One that Dr. Clark says will appeal to clinicians.
“People in the United States always liked the creaminess of Filtek,” he explains. “In other countries, in Europe, they like stiff composites because of this odd obsession with layering and hand manipulation of the material. Filtek has always had great handling in our hands, because to optimize strength we started injecting our composites and we are minimizing hand manipulation. Hand manipulation ruins the integrity of the material. One thing they did with Filtek Posterior, and then Filtek One, is that they are extra creamy. As an injectable, it flows better than most paste composites. That said, at our learning center we recommend heating the composite. Between heating and Filtek One’s natural creaminess, it works incredibly well. We use Filtek One (bulk fill posterior) and Filtek Supreme Ultra (anterior) combined with a ‘wash’ of heated flowable composite together for true injection molded monolithic composites. They look and perform like porcelain, which has created a whole new movement in dentistry: Less cutting, better outcomes, happy patients.”