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CDE0211

I 35 industry report _ compobonds I cosmeticdentistry 2_2011 content).35 In addition to filler content, other con- stituents such as the type and quantity of resin, photoinitiators and accelerators also influence the final MOE of the material. As a generalisation, flow- ables with a lower MOE may act as shock absorbers when placed as pre-cured liners below subsequent incrementsofnon-flowables.Butcurrentstudiesare inconclusive regarding this beneficial property,36, 37 and further research is necessary to clarify the issue. In the following case, large Class I cavities in two mandibular molars were restored using Vertise Flow as an initial layer to act as a shock absorber before completing the restoration with subsequent layers of a non-flowable composite. This case shows the second and third mandibular molars with defective amalgam restorations requiring replacement. In ad- dition, these teeth also exhibit bruxism activity with tooth wear, resulting in occlusal enamel loss. Initial occlusal contacts were verified (Fig. 34) before plac- ingarubberdamandremovingtheamalgamrestora- tions. Notice the extensive decay in the third molar (Fig. 35). Since molars are prone to high occlusal forces, placing bevels on enamel margins is unsuit- able because the thin layer of composite resin pe- riphery is likely to fracture during mastication. How- ever, to achieve an efficacious bond to aprismatic enamel, it is prudent to etch the periphery while maintaining a 90° cavo-surface angle (Fig. 36). After thoroughly rinsing and drying, the etched enamel periphery of both cavities was clearly visible (Figs. 37 & 38). Vertise Flow was dispensed into the cavity, brushed to ensure that the material was evenly spread along the cavity walls and floor, mak- ing sure that its thickness did not exceed 0.5 mm (Figs. 39–40b). This initial layer of Vertise Flow was light cured for 20 seconds and acted as the stress- relieving lining (Fig. 41). Subsequent layers of the filling were built-up using increments of a regular composite,HerculiteXRVUltra(Kerr),toreplaceden- tine, and then successively building-up the buccal and lingual cusps38 separately without contacting the opposing sides (Fig. 42). Staining fissures is a contentious issue; some patients are indifferent to this practice, while others adamantly refuse to have their teeth stained. For thosepatientswhoareunconcerned,fissurestaining and patterns impart a realistic appearance to a com- posite filling. The technique involves using different stains, for example Kolor + Plus (Kerr), that are draggedthroughtheunsetcompositeresinusingan endodonticreamerorfile(Figs.43&44).Oncethede- siredfissurepatternhadbeencreated,thecomposite was light cured (Figs. 45 & 46). After removing the rubberdam,articulationpaperwasusedtocheckoc- clusal contacts (Fig. 47), and necessary adjustments were made to ensure occlusal harmony. The final stagewasachievingahighsurfacelustreandtexture using Opti1Step Polisher. The post-operative view shows composite fillings emulating natural cusps and fissure patterns, with imperceptible transition between the composite filing and surrounding enamel (Fig. 48). Blockingundercuts Another useful application of flowables is block- ingundesirableundercutspriortoprovidingindirect restorations.Undercutsoftencomplicatemanyclin- ical and laboratory procedures, for example impres- Fig. 45_Once the fissure pattern has been established, the composite is light cured in the second molar. Fig. 46_Once the fissure pattern has been established, the composite is light cured in the third molar. Fig. 47_After removing the rubber dam, occlusal contacts are checked using articulation paper. Fig. 48_The filling is polished to a high lustre with Opti1Step Polisher, ensuring an indiscernible transition between the composite filling and surrounding natural tooth. Fig. 49_Underlying decay is evident after removing an old amalgam filling from the maxillary molar. Fig. 50_Undercuts are evident following excavation of soft, carious dentine. Fig. 46 Fig. 47Fig. 45 Fig. 49 Fig. 50Fig. 48