Posterior Composite Injection Over-Molding Following Root Canal Treatment
September 16, 2024 | Dr. David Clark
About the Case
30-year-old male presented with irreversible pulpitis on tooth #18 and significant recurrent decay underneath a poorly placed Class V composite. The challenge was to create a long-term endo-restorative outcome using direct restorative methods – both because of external time pressures and to preserve more tooth integrity – while minimizing bubbles in flowable composite.| Learn more about the product used in this clinical case |
Endodontic therapy is complete and caries removal is confirmed with advanced magnification and hardness testing using a sharp explorer.
Lateral cuspal overlay preparation will protect the undermined buccal cusps, and the Bioclear Class I or “Calla Lily” preparation will splint the lingual cusps. Radius bevels are key.
After application and 10 second light curing of 3M™ Scotchbond™ Universal Adhesive, a first layer of 3M™ Filtek™ Bulk Flowable Restorative (Universal Shade) was placed over the gutta percha stumps (counter-sunk 1 mm below the surface) and light cured for 10 seconds using a 3M™ Elipar™ DeepCure-S LED Curing Light.*
Before final injection molding, a flowable composite “curb” is placed and light cured to improve management of the injection phase. The new 3M™ Filtek™ Bulk Fill Flowable Restorative delivery system allows virtually bubble free injection directly on to the prepared tooth and up to a 4 mm depth of cure.
Final phase of injection molding includes:
- Re-applying 3M™ Scotchbond™ Universal Adhesive and air thinning without light curing.
- Injection of warm 3M™ Filtek™ Bulk Fill Flowable Restorative without light curing.
- Injection of warm 3M™ Filtek™ One Bulk Fill Restorative.
The composite is “troweled” with a sculpting paddle (Bioclear®) and excess composite is maintained at the curb.
After light curing the composite, a 3M™ Sof-Lex™ Extra-Thin Contouring and Polishing Disc (Course Grit) is critical for sculpting of cuspal areas, margination of the infinity edge, and pre-polishing.
Simple occlusal anatomy is carved with the Q-Finisher® (Komet®).
A TruContact Saw (Bioclear®) is used to clean and groom the unrestored mesial contact. It is common that adhesive and small bits of flowable can block the occlusal embrasure. Beautiful contacts are an important part of the patient experience.
Magic Mix (Bioclear®) is worked over the entire tooth-restoration complex to achieve infinity edge margins that are stain resistant. The composite will now have a matte finish with omni-directional scratches. This is the first step of the Bioclear® Rockstar Polish.
The RS Polisher (Bioclear®) is diamond impregnated and autoclavable. It is utilized with light pressure in the dry phase, and then heavy pressure and constant air-water spray in the final polishing phase.
3M™ Filtek™ One Bulk Fill Restorative (B1) provides the best of both worlds: beauty and bulk filling. It has a 4 mm depth of cure (5 mm in Class II restorations with 3-point curing), stress mitigation to offset polymerization shrinkage, and beautiful esthetics and shine retention rivaling anterior composites.
Pre-operative (left) and post-operative (right) radiographs of the completed endo-restorative. The treatment was completed in one appointment. The cuspal splinting and monolithic restoration should serve the patient for years, even decades, without having to remove the strong “shell” of enamel to make way for a crown. The radiographic appearance of the 3M™ Filtek™ One Bulk Fill Restorative “paste” is slightly more radiopaque than 3M™ Filtek™ Bulk Fill Flowable Restorative. The author feels that the radiopacity of these materials is ideal for monitoring recurrent decay.
Refer to Instructions for Use (IFU) for complete product information. Results may vary.
* Light cured according to the manufacturer’s guidelines