Flowable composite resins have been around since the mid-1990s and are found today in most restorative dental practices. With advances in materials science, such as a variety of viscosities, higher filler content, and less shrinkage stress, these newer “universal” flowable composites have become much more versatile and now have a wider range of clinical applications. When combined with early caries detection and micro-cavity preparation using fissurotomy burs (SS White Burs), universal flowable composites become the material of choice, as traditional “paste”-type composites have limitations when it comes to precise placement in cavity preparations with limited access.
The following case demonstrates the use of Estelite Universal Flow (Tokuyama Dental America) to restore Class I pit and fissure micro-cavity preparations. The patient shown in Figure 1 presented with a suspicious stain in the central groove of tooth No. 29. Although the explorer does not stick, it is not advisable to “watch” this lesion get larger and encroach upon and undermine the porcelain veneer that has been in service for more than 15 years. Using the caries detection mode on the intraoral camera (SOPROCARE [Acteon]), the fissure is shown to fluoresce, indicating active caries is present (Figure 2).
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| Figure 1. This occlusal groove in tooth No. 4 has suspected caries present, although the explorer does not “stick.” | Figure 2. The presence of caries is shown through fluorescence using intraoral imaging (SOPROCARE [Acteon]). |
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| Figure 3. A fissurotomy bur (SS White Burs) is used to create a minimally invasive cavity preparation that maximizes the preservation of healthy tooth structure. | Figure 4. A universal adhesive (Tokuyama Universal Bond [Tokuyama Dental America]) is applied to the cavity preparation. |
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| Figure 5. A universal flowable composite (Estelite Universal Flow [Tokuyama America]) is syringed into the cavity preparation to complete the restoration of this carious groove. | Figure 6. An occlusal view of the completed restoration of the carious groove in tooth No. 4 done by flowable composite. |
A fissurotomy bur (SS White Burs) is used to conservatively remove the caries in the fissure while maximizing the conservation of the remaining enamel and dentin surrounding the lesion (Figure 3). After a 15-second etch with 37% phosphoric acid, followed by a 15- to 30-second copious rinse with water, the excess moisture is removed from the cavity preparation using a high-volume suction. A universal bonding agent (Tokuyama Universal Bond [Tokuyama Dental America]) is then applied to the cavity preparation on a microbrush.
Tokuyama Universal Bond is a unique, 2-bottle system that requires no agitation with the microbrush during cavity preparation or light curing prior to composite placement (Figure 4). Estelite Universal Flow comes in 3 viscosities to cover a variety of clinical applications. For this particular case, high flow (shade A2) was chosen because of the small dimensions of the cavity preparation to eliminate the chance of voids between the adhesive and the composite layers (Figure 5). Once the restorative material is placed, it is light cured, per manufacturer’s instructions, for 10 seconds. Articulating paper is then used to check occlusion on the restoration, and adjustments are made as required. Next, a rubber composite polishing wheel (A.S.A.P. All Surface All Access Polishers [CLINICIAN’S CHOICE Dental Products]) is used. Figure 6 shows an occlusal view of the completed restoration. The progression of caries was eliminated, preserving the integrity of the porcelain veneer for years to come.
For more information, call Tokuyama Dental America at (877) 378-3548 or visit tokuyama-us.com.
Dr. Lowe received his DDS degree from the Loyola University School of Dentistry in 1982. He previously taught at the Loyola University School of Dentistry while building a private practice in Chicago. Dr. Lowe currently maintains a full-time practice in Charlotte, NC. He can be reached at boblowedds@aol.com.
