Bulk Fill Exquisite with Valo Light on high (plasma) setting- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

As part of my quest for faster, simpler, better composites this is #29 DO - low C factor - done with Clean and Boost, Superb, Titan A2 Flowable, and bulk filled Exquisite, all cured with my Valo light set on high - 3200mW/cm2 - or "Plasma" setting. This is an ideal scenario for this procedure, and if I were more efficient it could have been done faster. Exquisite's great for this because it has very low shrinkage. My main concern was would I see the dreaded "white lines". I did not.

Thomas W. Mitchell, DDS, FAGD
#29 with fractured and decayed distal marginal ridge.
Thomas W. Mitchell, DDS, FAGD
A basic slot prep extended buccally and lingually out of the decalcified enamel.
Thomas W. Mitchell, DDS, FAGD
Triodent matrix with the medium size wave wedge. Then we let Clean and Boost sit on the prep for 15-20 secs, washed and lightly dried, applied one coat of Superb, let it sit for 20 secs, then 2 more coats, lightly air thinned those and added a thin layer of Titan Flowable A2. Then with the Valo light on high "Plasma Mode" I co-cured that for 3 secs.
Thomas W. Mitchell, DDS, FAGD
Then filled the whole prep with Exquisite, condensed and shaped it with Seamfree and composite instruments, and cured for 3 secs with the Valo light on high.
Thomas W. Mitchell, DDS, FAGD
I removed the matrix and verified a good strong contact area.
Thomas W. Mitchell, DDS, FAGD
And finished with red Softflex discs
Thomas W. Mitchell, DDS, FAGD
With the dam off occlusion was high on the distal marginal ridge. Adjusted that with a high speed diamond.
Thomas W. Mitchell, DDS, FAGD
Then I glazed it with a thin layer of Superb and completed the curing with the Valo light on high for (2) 3 second cures. I rechecked the contact and it was closed and tight. Note that there are no "white lines".
Thomas W. Mitchell, DDS, FAGD
Final x-ray shows good density of the Exquisite. The distal contact looks like it might be open but I checked that closely and it wasn't. I don't have a good explanation for that.

Conclusion: 

I'll keep trying these as I think it's a simple and quick procedure in these low C factor areas. I don't think we need to limit this technique to small preps, but I wouldn't recommend it if there's a cusp that's not well supported by dentin. I'm still looking for an explanation for the x-ray appearance of an open contact when it was tight, closed, with floss snapping thru.

Case by: 

Thomas W. Mitchell, DDS, FAGD