Treatment of Pit and Fissure Caries With a New Flowable Composite

01 Oct 2019 Ross W. Nash, DDS
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INTRODUCTION
I started using flowable composites in the late 1980s, when they were first developed. Since then, many uses for them have been found in dental procedures, including as bases for composite restorations, filling undercuts before preparing teeth for indirect restorations, sealing margins of temporary restorations—and the list goes on. Previous generations of flowable composites were not meant for restoration surfaces because they couldn’t deliver the compressive and flexural strengths needed to withstand the daily wear and tear teeth are exposed to. Today, new materials with higher filler content are available, which are suitable to be used for these functional surfaces.
Tokuyama Dental has developed Estelite Universal Flow, which has excellent flexural and compressive strengths comparable to universal restorative composites. Estelite Universal Flow also has very low shrinkage upon polymerization, shows minimal shade shift after light curing, and has high resistance to staining due to its excellent gloss retention. I have found it useful in a variety of clinical situations due to the fact that it comes in 3 viscosities (Super Low Flow, Medium Flow, and High Flow).

CASE REPORT
A restoration for pit and fissure caries is an excellent indication for Estelite Universal Flow. While sealants can help prevent caries in these areas, they still occur with frequency in the human dentition. If left untreated, they can develop into deep cavitation or even pulp infection.
In this case, a patient (who happened to be a dentist) had received a sealant in tooth No. 21 when she was younger (Figure 1). Clinical examination showed that the distal pit had progressed through the enamel. The decision to proceed to a conservative composite restoration was agreed upon.

Figure 1. Preoperative view of a mandibular premolar. Figure 2. Preparation.
Figure 3. Etching gel in place. Figure 4. The bonding agent (Tokuyama Universal Bond [Tokuyama Dental America]) was applied.
Figure 5. Universal flowable composite (Estelite Universal Flow [Tokuyama Dental America]) was applied. Figure 6. The final result.

No anesthetic was used, and a rubber dam was placed for isolation. A small diamond bur was used to remove the previous sealant, a small amount of caries from the mesial pit, and more extensive caries from the distal pit. The prepared teeth can be seen in Figure 2.
The prepared surfaces were etched with 37% phosphoric acid gel for 10 seconds (Figure 3). The etching gel was then thoroughly rinsed, and the tooth was lightly air dried with an air/water syringe.
A universal, self-cured bonding agent (Tokuyama Universal Bond [Tokuyama Dental America]) was liberally applied (Figure 4) and thinned with air from the syringe. I chose the Medium viscosity of Estelite Universal Flow for this case to allow for good flow but controlled shape. In Figure 5, you can see its application to the distal pit after the mesial pit has already been filled. The composite was cured for 10 seconds with a light-curing unit. Very little shaping was needed with a carbide finishing bur, and the restorations were polished with composite polishing points. The final result is shown in Figure 6. Note the high gloss and almost imperceptible appearance of the conservative restorations.

CONCLUSION
By using a new flowable composite resin with high strength and easy application, I was able to restore these early carious pit lesions in an efficient and minimally invasive fashion while achieving esthetically desirable results.
For more information, call Tokuyama Dental America at (877) 378-3548 or visit tokuyama-us.com.
Dr. Nash maintains a private practice in Huntersville, NC, where he focuses on aesthetic and cosmetic dental treatment. He is co-founder of the Nash Institute for Dental Learning in Huntersville. He can be reached via the website thenashinstitute.com.

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