The Best Bulk Fill Technique- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

Bulk fill procedures to date have been using materials that do not have good wear characteristics, so we know they won't hold up for many years. Our search has brought us to this procedure. We know we can cure Exquisite (as completely as possible) up to 4 mm's thickness, and we only need 3 seconds with our light on "plasma mode". For depths greater than 4 mm's, a second layer will be needed to insure complete cure. I've shown that already using Injectafil as a base and layering Exquisite for the occlusal surface. In this technique today I'm filling the bonded preparation with one layer of Exquisite and curing it for 3 seconds. Here's the procedure:

Thomas W. Mitchell, DDS, FAGD
#18 has an old broken O + B pit amalgam with old mesial decay. The space at 19 is waiting for it's implant.
Thomas W. Mitchell, DDS, FAGD
MOB prep design. The "small" amalgam B pit communicated with the occlusal amalgam. The rubber dam provided such good isolation (thanks to my world class assistant Deanna) that I didn't need a matrix. The first step is to clean the surfaces with Clean and Boost for 5-10 secs, then wash and dry and apply Surpass 1,2,3 and co-cure a thin layer of Titan Flowable with the Valo light set on "XTRA POWER" or "plasma mode" at 3200 mW/cm2 for 3 seconds.
Thomas W. Mitchell, DDS, FAGD
Then I filled the whole prep with Exquisite, and using a flat bladed instrument, an Acorn carver and Seamfree shaped the occlusal surface. I follow the angles of the remaining triangular ridges so there's minimal occlusal adjusting needed. That's cured for 3 seconds with the Valo light on XTRA POWER.
Thomas W. Mitchell, DDS, FAGD
The dam is removed and the occlusion checked. The only contact on the composite was on the buccal extension. That was adjusted as were the contacts on the lingual cusp tips.
Thomas W. Mitchell, DDS, FAGD
Then I sealed the restoration with Surpass 1,2,3 (actually we just touch it with the brushes, we don't dispense any more material) and added 3 more seconds of light.

Conclusion: 

So once the prep is complete this is a 4 step procedure. First to bond with Surpass 1,2,3 and Titan Flowable. Add 3 seconds of light. Second fill the prep with Exquisite and shape it with Seamfree. Add 3 more seconds of light. Third adjust the occlusion. Forth seal the prep and add the last 3 seconds of light. Total time spend curing is 9 seconds (that's for all you guys counting to 20). Total procedure time less than 10 minutes. Final result is an excellent restoration that will stand up to wear for many many years. Hope this helps.

Case by: 

Thomas W. Mitchell, DDS, FAGD

Email: 

[email protected]