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Live Q&A
Should the adhesive bond be polymerized prior to cementation of indirect restorations? And why?
Light-curing adhesives such as Adhese Universal must be light-cured prior to cementation. This is because Adhese Universal is only polymerized by light and the light transmission through the ceramic could be hindered by its opacity and thickness. By light-curing the adhesive, you achieve the important hybrid layer which will not be washed away by the more viscous luting material.
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Are there enough long term studies about bulk-fill composites?
Yes, there are plenty of long-term studies that support bulk-fill composites as a good alternative to the conventional layering technique. Here is a great systematic review and meta-analysis regarding this topic: "Clinical performance and chemical-physical properties of bulk-fill composites resin - a systematic review and meta-analysis." by Boaro et al 2019
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Very short curing times (3s) were shown in the early 2000s to result in incomplete, less cross-linked polymers which led to leaching of unpolymerized monomers. These studies have shown the need for an adequate polymerization time that is longer than 3-5s. How has that changed now?
Tetric PowerFill and Tetric PowerFlow incorporate several technologies which ensure an appropriate polymerization. The light initiator Ivocerin enables a safe and fast curing depth of up to 4mm. The degree of conversion (monomers to cross-linked polymers) were investigated by N. Ilie (University of Munich) and W. Pallin (University of Birmingham). There was no significant difference between the depth of cure in the 4mm sample when cured in the 3s cure mode compared to conventional curing. Both curing modes resulted in similar curing results in terms of degree of monomer conversion. For more information, please refer to our scientific documentation of the 3s PowerCure system at https://www.ivoclarvivadent.com/en/download-center/scientific-documentations/.
Assist. Prof. Dr. Ronaldo HirataDoes the MDP component serve as desensitizer?
No, this is not the primary function of 10-MDP.
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Regarding the Tetric line composites, where can we purchase them?
Please contact the local Ivoclar Vivadent representative. Availability of products and distribution vary by country. More information: www.ivoclarvivadent.com
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For twenty years I have been doing removable prostheses. Now I would like to learn CAD/CAM. We have the new Sirona mc xl machine in our lab. Please advise how I should start.
For fixed prosthetics CAD/CAM courses, please contact your local Ivoclar Vivadent sales rep or alternatively check our website at www.ivoclarvivadent.com
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Is there any reason to use a multi-step adhesive protocol these days?
The newest universal adhesive systems offer a lot of advantages. We have a significantly higher bonding strength especially on dentin, a lower risk of post-op sensitivity. There is no reason to use the multistep protocol today. The best solution now is the selective etching of the enamel and the use of a universal self etch adhesive system.
Dr. Petr HajnýBefore bonding, do you need to rehydrate the dentine after etching and drying the cavity?
When using a universal adhesive such as Adhese Universal, its formulation helps to rewet the collagen fibrils and infiltrate the collagen network. Regardless of the etching technique employed, Adhese Universal can be used in both wet and dry conditions without any compromise in terms of performance.
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Could someone comment on the use of direct composites versus ceramics for a class 2 cavity?
For a class 2 cavity, depending on its size, a direct composite restoration is often a good choice. Studies have shown that this treatment option is a good alternative to ceramic. For the benefit of your patients, it is a quicker, cheaper and more conservative option. However, in some cases, indirect ceramic inlays/onlays may be the better choice, e. g. if there is a thin wall/possibility of cuspal fracture. You may also think about an indirect option if interproximal contact points are not achievable with a direct composite restoration.
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Should we use glass ionomer or composite for restoring a class V cavity?
It depends on the situation of the class V cavity. If enamel is present, there is the possibility to bond to the enamel and the dentin for a composite resin. With Adhese Universal and the selective etch/total etch technique, one can achieve great long lasting results with composite resin alone. However, in the case of a class V cavity that extends subgingivally where isolation is not possible, glass ionomer could be a good option in an open-sandwich technique.
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Are there any concerns with the shrinkage stress for the 3s PowerCure?
There are no concerns since both composites (Tetric PowerFill & Tetric PowerFlow) were carefully verified and validated during the development phase. The shrinkage stress reliever in both materials and the additional chain transfer agent in Tetric PowerFill are the techniques used in the composites to control the shrinkage stress. If you are interested in the scientific background, please refer to the scientific documentation on the 3s PowerCure system at https://www.ivoclarvivadent.com/en/download-center/scientific-documentations/.
Assist. Prof. Dr. Ronaldo HirataHow can we manage marginal leakage or staining in anterior composite restorations?
Use a fine grit diamond to finish the enamel margins (about 40 microns or less). Always etch the enamel with phosphoric acid.
Dr. Markus LenhardWhich generation of adhesive bond do you recommend to use for resin restorations?
The latest generation, a universal adhesive (e.g. Adhese Universal) is a reasonable choice. Use it in the selective enamel etch mode.
Dr. Markus LenhardWhat is the best way to replace old composites?
First check whether there is really a reason. Bigger fillings can be replaced with indirect composite inlays or ceramic inlays.
Dr. Petr HajnýOcclusal rehabilitation cases? Ceramic or composite, what do you use?
When we do full-mouth cases, patients usually wish to also change the colour, so I prefer IPS e.max CAD ceramic restorations. In cases where we just need to increase the bite, especially in one jaw only, then we do Tetric CAD ultra-thin restorations on molars with mostly no preparation of the teeth and direct composite fillings on premolars and front teeth. It depends on the level of attrition.
Dr. Petr HajnýHow do you polish your restorations?
For composite fillings I use the OptraPol polishing system, and for the ceramics, the most effective polishing system is the OptraFine system.
Dr. Petr Hajný
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ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Tribune Group designates this activity for 1 continuing education credits.
This continuing education activity has been planned and implemented in accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between Tribune Group GmbH and Dental Tribune International GmbH.
Deep dive into the subject matter:
On Demand
Changing for the better – in your daily practice
Dr Petr Hajný
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Direct Esthetics in a digital world
Assist. Prof. Dr Ronaldo Hirata
14 Comments
Your opinion about bulk composite ? Suitable in all situations ?
To gain time, you propose to use an universal adhesive. Do you think that universal adhesive are as efficient as etch and prime 3 steps or self etching in 2 steps ?
According to your concept efficiency is shorter treatment time ? speed and quality is possible ?
Are bulk composite essential in today dentistry ? Not too translucent ?
You propose an universel composite in anterior teeth and a bulkfill and Universal Composite for posterior teeth. Should we throw away our body, enamel and dentin composite ?
According to you, in dentistry to day there is too much esthetic. Because esthetic should be visible on speaking distance ? Do we do too much ?
What is the curing time you advise for bulk composite ? Does it increase stresses induces by an increased polymérisation shrinkage ?
What is your preference for the adhesive ?
You show very nice result for a case after 24 years. What is your secret ? It was done with very old composite resin and maybe not still available. Has there been no progress in dental materials for 24 years ?
According to you, in dentistry today there is too much ceramic and too much digital dentistry – too many congresses on these two topics?
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Thank you for joining the last day of Ivoclar Vivadent’s International Expert Symposium. We are going to start on time at 7:00PM CEST (Berlin) / 1:00PM EST (New York).