Sealant Replacment with Bulk Fill- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

This is my current bulk fill protocol. This is 31 Occlusal with Clean and Boost, Superb and Titan Flowable A2 co-cured with my Valo light set to XTRA POWER (3200mW/cm2), then Exquisite.

Thomas W. Mitchell, DDS, FAGD
3rd year college student with a sealant I did when he was 12 years old.
Thomas W. Mitchell, DDS, FAGD
Opened with a 330. The head is 2mm long, and we know we have to go 2mm into the grooves, so this step goes really fast.
Thomas W. Mitchell, DDS, FAGD
Finished prepping using a straight-sided round ended diamond.
Thomas W. Mitchell, DDS, FAGD
First Clean and Boost left on for 15-20 seconds, then washed and gently dried. Then 1 coat of Superb agitated for 20 seconds, then add 2 more coats and air thin it. Immediately add a thin layer of Titan A2 Flowable and co-cure with the Valo light on XTRA POWER for 3 seconds.
Thomas W. Mitchell, DDS, FAGD
Then I "finger plow" Exquisite into the prep (is that the same as "snow plow"?), clear the excess off the margins, lay in simple grooves with an Acorn carver and a composite instrument and cure for 3 seconds.
Thomas W. Mitchell, DDS, FAGD
It was high right where you'd expect in the central fossa (that's why I prefer layering the buccal and lingual separately) so I adjusted the occlusion, cleaned it off with pumice and glazed it with Superb. Then one more blast with the Valo light for 3 seconds.

Conclusion: 

So far this technique is only for Exquisite. Don't know what'll happen with other materials, but I suspect the dreaded white lines and/or sensitivity. Maybe some of the new bulk fills will work, but none of them will hold up to occlusal forces for long as we've already seen.

Case by: 

Thomas W. Mitchell, DDS, FAGD