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Ekspert testuje

19 kwietnia 2018

NR 36 (Styczeń 2017)

Tested by an expert Fill-Up!
New Aspect of bulk-fill

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The desire to obtain composite materials that are both easy and complication-free in clinical work and ensure lasting reconstruction of lost hard tissues of teeth becomes the inspiration for manufacturers and causes that new materials continue to emerge on the market.

The variety makes the choice more difficult and in practice learning about the full range familiar is impossible. Bulk-Fill technique, a solution for concurrent applications of large portions of the composite which was introduced a few years ago, carries a lot of risks arising from attempts to overcome the primary disadvantages of materials undergoing light-induced polymerization in a direct application. Obtaining the maximum relaxation of shrinkage stresses accompanying the conversion of a mixture of monomers into polymerized material of satisfactory crosslinking space is just one of the problems. Another problem is to obtain such composition which contains a perfectly balanced proportion of photoinitiator, accelerators in conjunction with colour and a degree of material transparency. On one hand, the material must maintain stability and not be subject to premature polymerization and, on the other hand, it is necessary to ensure the proper reaction in hard-to-reach places for reaction-initiating light. The consequence for many materials of this group is excessive transparency which ensures the penetration of lamp light but at the same time it does not provide for a natural tooth tissue degree of opacity. Excessively „transparent” fills give the impression of grey and thus negates the effort of aesthetic reconstruction.

The problem of controlling the polymerization initiation onset and ensuring its proper course is solved in the case of structural materials (core build up) and cement through the use of dual methods of initiation, the so-called light-chemo (Dual cure).
On the one hand, the effect ensures proper chemically-initiated polymerization to the bottom of deep cavities, and on the other hand, the reaction acceleration by photo-initiator excitation. Unfortunately, the course of a chemical reaction is determined and the delay it is not possible, but usually working time for these materials is entirely satisfactory.

New aspect – what it is

It is time to go into the details.

Fill-Up! (Fig. 1), new material offered by COLTENE, which uses a two-pronged method of initiating polymerization reaction is the new aspect of Bulk-Fill technique. This material is intended for filling with the use of method of class I and II simultaneous application method, extensive restorations and reconstructions. In addition, it proves useful as material with a possibility for cementing standard inlays at the same time. It is supplied by the manufacturer in two types of kits enclosed with different bonding systems. It is either ParaBond, a two-bottle system, or ONE COAT 7 UNIVERSAL with One Coat 7.0 Activator (Fig. 2 and 3). The possibility of using a system that combines chemically polymerizing frees us from the limitations in the availability of light and thus ensures proper adhesion even in a very deep cavity with missing enamel and dentine substance.

The sets supplied by the manufacturer contain all required components including applicators, automix tips in two diameters (Fig. 4) and bases with light-protecting casing required for the preparation of the blending system. 

In practice one can begin work after opening the set. There are two alternative blending systems available and the simple „pictographic” manual significantly minimizes the risk of error in their application. Just one glimpse replaces the cumbersome reading, and in times when we use a lot of preparations, such facilitation improves work comfort. 

As they say „a small thing can bring a lot of joy” (Fig. 5 and 6). After using the blending system one proceeds to the application of material using the preferred version of mixing tips.

Application simplicity

The application is surprisingly easy as a result of rather flowable materials. Low surface tension combined with the properties of bonding systems facilitate „flowing” of material in the nooks and hard-to-reach places. But on the other hand, the result of these properties is the lack of thixotropic effect, which in practice means no possibility for modelling the surface morphology. COLTENE suggests two ways to compensate for this: one, to apply a top layer with conventional composite or two, to shape the morphology with rotary instruments after curing. In the author’s opinion and in the light of the proven performance of Fill-Up! it is possible to use this material „alone” with the fact that it will be necessary to model with the use of „lost material method”. This technique is well known and well mastered by many clinicians, and it is still „foundation” of preclinical education. At this point it should be emphasized one more feature of this material namely low transparency and the availa...

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