Recently I have been using a revolutionary new posterior tooth filling material, BulkEZ from Danville Materials in the US, and it fills all the requirements in one material that I had only been able to accomplish using a number of materials and a much more complex and time-consuming method.
For a number of years I have been using a technique recommended to me by Ray Bertolotti who many of you may know is one of the foremost experts in the world on bonding and composites. This is what I have been doing to fill posterior teeth and why;
- Using a bonding agent. In my case I have a preference for a self-etching product as in my hands it created zero sensitivity. Retention is not an issue in these cavities and there is some belief that these do break down due to water absorption over time. The product I used was a 2 bottle system – Prelude primer and adhesive.
- Immediately over this on the base of the cavity I placed a thin layer of a highly radiopaque flowable composite (Accolade SRO) which I light cured for 30 seconds. I always over-cure for extra safety. This layer adapted to the cavity surface well and showed clearly on X-rays to help identify future possible caries.
- Over this I placed 2mm increments of another flowable composite (Startflow) with a high compressive strength, each layer being cured for 30 seconds. Depending on the overall depth of the cavity this would occupy about ½ to ⅔ of the overall depth and was designed to reduce stress on the walls of the cavity.
- Finally I placed a conventional composite effectively as an enamel replacement for strength and smoothness, again in 2mm increments, light cured each layer for 30 seconds and then made any adjustments required.
This was a time consuming and demanding technique with much of the time spent light curing. In order to ensure that the light reached all areas of the restorative material, the curing light was moved and angles changed during the setting.
You may question why I did not use an existing bulk fill material in place of the flowable composite. I did not for a number of reasons:
- They have a depth limit and I defy anyone to ensure that this depth is not exceeded in any part of the cavity leading to possible incomplete curing.
- All light cured composites shrink towards the light which could cause the material to pull away from the bonding agent with resultant microleakage and sensitivity.
Any replacement material had to be able to do many things:
- Be radiopaque
- Be flowable enough to readily adapt to the cavity
- Be able to reduce stress on the cavity walls
- Have unlimited depth of cure without microleakage
- Be strong enough and wear resistant
- Have a very smooth surface
So it was with some amazement when I was told by Danville Materials that they had developed a material that would do all these things and set in 90 seconds in the mouth. They claimed that it utilised a new catalyst and something that they called Intellitek® technology.
I have now been using BulkEZ for around 6 months and this is what I have experienced:
I have changed my bonding to a single component bond – Prelude ONE. If I was making my life easier with BulkEZ, I might as well simplify my bonding.
It is important to use a good matrix system. As the material is not packable a sectional matrix system that creates some separation and has contoured matrices is a necessity. Danville produce such a system – Mega V.
Initial bleeding of the automix cartridge before first use is essential – after that the nozzles should be left on the cartridge until next use and then after placing the new nozzle, a small amount should be bled from the application nozzle before placing the material.
BulkEZ is syringed into the cavity from the base up keeping the nozzle tip covered with material as the cavity fills. This should be continued until the cavity is full or just short if you wish to cap with a conventional composite. For me the aesthetics are that good that I have not been capping. The material cures at the tooth surface first so any shrinkage is towards the tooth, eliminating microleakage. BulkEZ must NOT be light cured during setting which takes around 90 seconds.
As the material is setting the occlusal surface can be contoured either with the tip of the syringe itself or an instrument, ensuring that any movement of the instrument is towards the cavity wall.
Self-cure composites have a thin unset air inhibited layer on the surface. If no occlusal adjustment needs to be carried out which would remove this layer, I light cure for 10 seconds AFTER the material is completely set to fully set the surface.
I have used this material not only for fillings, but also for cores and to cement posts as well. No patient has suffered any sensitivity, I am saving lots of time and no fillings have failed. My dental nurse loves the material because we are not both sitting there holding the light cure gun, impatiently waiting for the 30 seconds to be up, often multiple times during each filling. When I fill a number of teeth at the same time it saves even more time as I just syringe into the cavities one after the other and 90 seconds later they are all set. This can often save over 10 minutes, appreciated by both the dental team and the patient.
While I have a personal interest in Evident, the distributor of this product in the UK, we only sell products that I totally believe in and in my opinion will benefit both the dentist and the patient. There is so much more information about BulkEZ that Evident have produced a dedicated website (bulkez.co.uk) with information and instructional videos, research articles and technical information. Find out the full story behind BulkEZ by visiting the site.
Stephen Selwyn is Managing Director of Evident and in private practice in central London. Evident has successfully brought many innovative products to the profession.
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