Q: What do you think of the new bulk fill composites?
A: Bulk filling of cavity preparations is part of the holy grail of restoring teeth. Who would not want to have a flowable that could be used to completely fill a cavity preparation? Unfortunately, current bulk fill composites cannot completely fill a large cavity preparation and support occlusion.
The newest bulk fill flowable composites are Heraeus Kulzer Venus Bulk Fill and Dentsply International's Surefil SDR. Both of these can be used as a flowable composite in increments up to 4 mm.
Standard flowable composites are usually 0.5 to 1 mm in the initial placement and up to 2 mm in subsequent increments. Bulk fill composites have low shrinkage rates of less than 1.5%. So in a reasonably sized cavity preparation you would apply your standard bonding regime and proceed to dispense 4 mm of bulk composite and light cure. In the event you need more base, you can add more bulk fill composite and cure. Then proceed to your favorite composite, light cure, and finish.
What is the downside to bulk fill composites? Cost is one issue, as they are more expensive than traditional flowable composites.
In addition, the bulk fill composite comes in a single universal shade and are very translucent. (This translucency is what allows the composite to be cured in 4-mm increments.) So in many cases, the restoration may show gray or darker than a standard composite and may be a cosmetic issue. The translucency may even bleed through the tooth if there is limited dentin. This may not make a difference in a deep class I restoration on a molar, but the translucency should be taken into account if you are doing a mesial occlusal restoration on a maxillary first premolar. Dentsply recently came out with bulk fill shades for Surefil SDR, but I have not tried them yet.
I have tried both the Heraeus Bulk Fill and Dentsply SDR in my practice. I have had no issues of sensitivity or shrinkage issues associated with these bulk-filled restorations. They are a nice option to consider when the situation can handle this type of composite.
Martin Jablow, D.M.D., is a practicing dentist and a self-professed technophile who lectures and blogs on a variety of technologies used in dentistry (dentechblog.blogspot.com). If you have a technology question for Dr. Jablow, e-mail it to us at [email protected].
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
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