Bulk Fill #3 MO- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

This is getting interesting as Exquisite Restoration composite can now be bulk filled up to 4mm in depth, you guys with the right lights (XTRA Power) should try this. It is specific to very low shrinkage composites. If you don't have Exquisite, don't try this.

I used Clean and Boost, Superb, Titan Flowable shade A2, and Exquisite shade A2 with Seamfree.

Thomas W. Mitchell, DDS, FAGD
Old fills at 3MO that my hygienist hates
Thomas W. Mitchell, DDS, FAGD
Actually the composite's worn out and the amalgam looks iffy.
Thomas W. Mitchell, DDS, FAGD
Really standard prepping. Nothing unusual here. Can you see the crack on the internal wall of the distal marginal ridge? Dr. John Kanca keeps telling me that amalgams don't crack teeth. Who's to argue with him...
Thomas W. Mitchell, DDS, FAGD
Here I'm looking at the distal surface of #4 with the stain/decalcified area. It was smooth so I polished it further with a couple of garnet discs and painted on Vanish, which is a fluoride infused resin that you can bond onto these surfaces.
Thomas W. Mitchell, DDS, FAGD
Triodent matrix with a white Wave Wedge and I used a Garrison ring that bends the wedge back against the margin to seal it. Then Clean and Boost for 20 secs to add enamel etching since I'm using Superb (Self-Etch).
Thomas W. Mitchell, DDS, FAGD
This is co-cured Superb and Titan A2 Flowable cured for 3 secs with the Valo light on "plasma" setting, 3200 mw/cm2.
Thomas W. Mitchell, DDS, FAGD
Then I bulk filled the rest with Exquisite shade A2, shaped it as best I could and cured for 3 secs with the Valo Light on "plasma".
Thomas W. Mitchell, DDS, FAGD
I took off the matrix and smoothed everything with red Softflex discs.
Thomas W. Mitchell, DDS, FAGD
Occlusion was just a little off, but easily adjusted. There was a slight bulge at the gingival margin which I smoothed off with a finishing strip.
Thomas W. Mitchell, DDS, FAGD
Finally I pumice the surface, wash and dry and add a thin layer of Superb to glaze the surface. Then the final cure with the Valo on "plasma". Note that with all this high speed curing there are no white lines. Don't try this with a traditional composite that is not very low shrinkage. Only Exquisite Restoration.
Thomas W. Mitchell, DDS, FAGD
Hopefully this looks good to you. The key is the Exquisite Restoration Composite.

Conclusion: 

This is about as fast of a procedure as I can do. Composites require a bunch of small steps, and each one ads time. With insurance limitations we have to be quick, and the combination of fast curing with bulk filling sure speeds this up. Exquisite, actually not a "bulk fill" composite, can be bulk filled in smaller preps up to 4mm if you use the high intensity lights.

Case by: 

Thomas W. Mitchell, DDS, FAGD