Bulk Fill Slot Prep- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

This is a simple procedure that I know many of us are doing so it's a nice review. Here I'm using Apex Dental Materials products including Clean and Boost, Bondsaver D, Superb, Titan Flowable, Seamfree and Exquisite. I'm using the Valo light set on it's highest setting ("Xtra Power") of 3200 mW/cm2. Slot preps are very simple to do, but to be successful they require the same attention to detail as more advanced preps. Exquisite is not a "bulk fill" material. Unlike the "bulk fills" it's a highly filled material. The "bulk fills" are lightly filled to allow the light to penetrate deeper. We've been able to cure Exquisite to a 4 mm depth, so in these smaller preps we can place just one increment. In deeper preps I'm usually placing 3 triangular shaped increments. Because Exquisite is a very low shrinkage/low stress composite (due to the molecular configuration) we can cure it really fast without tearing apart the enamel margins ("white lines"). With traditional composites you need to be pulse curing 2 mm thick increments to avoid "white lines" with your light set on 1000 mW/cm2.

Thomas W. Mitchell, DDS, FAGD
We're replacing the failed slot filling at #3 mesial and we're concerned there may be decay at #4 distal.
Thomas W. Mitchell, DDS, FAGD
My initial prep before refining the margins. I had to bevel the gingival to get good separation/room for the matrix.
Thomas W. Mitchell, DDS, FAGD
Here's the final prep
Thomas W. Mitchell, DDS, FAGD
This is a standard Triodent matrix with a white Wave Wedge and a Garrison Ring. Here the Garrison Ring is bending the Wave Wedge to hold it tightly against the gingival margin.
Thomas W. Mitchell, DDS, FAGD
This is after Clean and Boost, wash and dry, Bondsaver D and left damp, 3 coats of Superb ("slobbered on" per Dr. John Kanca), air thinned completely and co-cured with a thin layer of Titan flowable composite for 3 seconds with the Valo light on Xtra Power.
Thomas W. Mitchell, DDS, FAGD
Then bulk filled Exquisite, using Seamfree to help condense it and shape it. Then cured for 3 seconds with the Valo light on Xtra Power.
Thomas W. Mitchell, DDS, FAGD
Simple polishing with red Softflex Discs
Thomas W. Mitchell, DDS, FAGD
And after occlusal adjustment glazed with a coat of Superb. Then added 3 more seconds of light from each direction. with the Valo light on Xtra Power. Note that there are no "white lines".
Thomas W. Mitchell, DDS, FAGD
I rarely take final films, but I wanted you to see how nice these can turn out with a well sealed gingival margin, a good strong contact area, and a good occlusal embrasure for easy flossing.

Conclusion: 

I did three things to speed up this procedure. I used Superb, a one bottle bonding system. I used Exquisite so I could cure 4 mm increments and in this case place just one increment, and, because I'm using Exquisite I turned my Valo up to "Xtra Power" so I only needed to cure each add for 3 seconds, and then a final cure of 9 seconds. We know "bulk filling" is popular and speed is important, but we know the "bulk fill" materials will not wear very well over time because they aren't highly filled. Here's a fast procedure for you with excellent materials that will hold up over time. Hope this helps - Tom

Case by: 

Thomas W. Mitchell, DDS, FAGD