Cusp Bulk Fill with plasma light setting- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

This is an 88 year old southern gentleman with #3 MP cusp fractured off + a huge old failing amalgam on #2. We're trying to incorporate bulk fill techniques with our Valo light on the "Xtra Power", or "plasma" setting (3200 mW/cm2). This is with Surpass, Titan Flowable and Exquisite. The buildup we did on #3 isn't really important, but look at the huge occlusal composite on #2. We're trying to identify fast procedures with excellent quality materials. We're interested in seeing complete curing and no "white lines". This specific procedure is working because Exquisite has very low shrinkage. From this morning, our patient is filling in for a 2 hour cancellation, so we have plenty of time to play around, but it's easy to see how these techniques can speed up procedures.

Thomas W. Mitchell, DDS, FAGD
#3 with fx'd off and missing MP cusp
Thomas W. Mitchell, DDS, FAGD
The other cusps are nice and strong, so I'm just going to build this one up. If it fx's off again we'll do a crown.
Thomas W. Mitchell, DDS, FAGD
The classic vertical/angular fracture just to the attachment.
Thomas W. Mitchell, DDS, FAGD
I placed a contoured Toffelmeyer matrix, then Clean and Boost, Surpass 1,2,3 and Titan A2 Flowable co-cured with the Valo light on XTRA POWER setting. (3 seconds).
Thomas W. Mitchell, DDS, FAGD
Matrix removed and a little disking done.
Thomas W. Mitchell, DDS, FAGD
The contour is really flat and I know that'll bother him so after I finished the composite on #2, I added more to that flat area on #3.
Thomas W. Mitchell, DDS, FAGD
#2 occlusal amalgam with chunks starting to come out.
Thomas W. Mitchell, DDS, FAGD
With the amalgam removed and the prep complete. John Kois recommends flattening out the whole occlusal, removing all those weak ridges and bonding on an Emax onlay. Certainly that's a valid procedure.
Thomas W. Mitchell, DDS, FAGD
This is after co-curing Surpass 1,2,3 and Titan A2 Flowable with the Valo light on XTRA POWER, or "plasma" setting.
Thomas W. Mitchell, DDS, FAGD
Bulk filled Exquisite, condensed with my gloved finger and lots of Seamfree, then shaped with a composite instrument and an Acorn carver.
Thomas W. Mitchell, DDS, FAGD
Final picture.

Conclusion: 

The buildup on 3 is something we all do one way or another. The important procedure here is the occlusal composite at 2. Note that even with the combination of bulk filling and pulse curing there are no white lines. This composite, Exquisite, is highly filled and we've seen it hold up under occlusal force for several years. The composites advertised for "bulk filling" all have a lower filler content, so necessarily will have a higher wear rate. We're able to bulk fill Exquisite primarily due to it's low shrinkage. I think now we finally have a bulk fill procedure with a high speed light that will show excellent results over time. Hope this helps

Case by: 

Thomas W. Mitchell, DDS, FAGD