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38 ◊Page 37 RESTORATIVE Dental Tribune Middle East & Africa Edition | 3/2017 Fig. 2: Access to the cavity after removal of the temporary fi lling Fig. 3: Direct intraoral application of Adhese Univer- sal with the VivaPen Fig. 4: Agitation of Adhese Universal into the surface for 20 seconds Fig. 5: Quick and reliable light-curing of Adhese Universal with a high performance light (10 seconds, Bluephase Style) Fig. 6: Application of fl owable composite (Tetric EvoFlow®) to smooth out small irregularities in the pulp chamber Fig. 7: Contouring of a 4-mm increment of Tetric EvoCeram Bulk Fill Fig. 8: Adaptation of Tetric EvoCeram Bulk Fill to the cavity walls Fig. 9: Hybrid dentin composite core after placement of a retraction cord, ready for the next step Fig. 10: Due to the composite’s hardness level, the smooth surface (without irregularities and scratches) feels more similar to the natural dentin than the sur- face of a fl owable material with less stability. This is particularly evident when preparing the core with a bur. Fig. 11: Post-operative situation after the completion of the restoration (IPS Empress CAD crown) Fig. 12: Natural-looking appearance of the mono- lithic restoration after polishing Fig. 13: Final X-ray demonstrating the high radiopac- ity of Tetric EvoFlow and Tetric EvoCeram Bulk Fill Dental Institute Discover our range of high-quality, high-intensity postgraduate courses Study: MClinDent/MSc/Diploma • Full-time, part-time, on-campus and online • Online study includes residential blocks of training on-campus • Range of 19 courses including restorative specialty training Research: MPhil/MRes/PhD Four multidisciplinary science divisions • Craniofacial Development & Stem Cell Biology • Mucosal & Salivary Biology • Population & Patient Health • Tissue Engineering & Biophotonics RANKED NUMBER ONE IN EUROPE FOR DENTISTRY QS WORLD UNIVERSITY RANKINGS 2017 GLOBAL TOP 10 FOR CLINICAL, PRE-CLINICAL AND HEALTH (INCLUDING DENTISTRY) TIMES HIGHER EDUCATION WORLD UNIVERSITY RANKINGS 2015-16 RANKED NUMBER FOUR IN THE WORLD FOR DENTISTRY QS WORLD UNIVERSITY RANKINGS 2017 Find out more: visit www.kcl.ac.uk/dentistry email dental-postgraduate@kcl.ac.uk Tetric EvoCeram® Bulk Fill is a pos- terior composite designed for the fabrication of direct restorations and is part of this new category of mate- rials. The fi ller composition contains patented shrinkage stress relievers to reduce polymerization shrinkage and shrinkage stress. The composite is characterized by a fi ller content of 53 to 54 % (by volume) with par- ticle sizes ranging from 40nm to 3,000nm. To accelerate the polymer- ization process, Tetric EvoCeram Bulk Fill contains the new patented initia- tor Ivocerin® in addition to standard initiator systems (camphorquinone and Lucirin® TPO). As a result, 4-mm increments, high esthetics and short curing times are no longer mutu- ally exclusive. If a high-performance curing light (e.g. Bluephase® Style) is used, the bulk-fi ll composite can be cured in 10 seconds. Combined with a universal adhesive A new generation of universal adhe- sives have recently gained in popu- larity due to their fl exible applica- tion possibilities , effi ciency and ease of use. The new Adhese® Universal is a light-curing, universal single-com- ponent adhesive for direct and indi- rect restorations. Adhese Universal can be ideally combined with Tetric EvoCeram Bulk Fill. The universally applicable Adhese Universal estab- lishes a strong bond to various types of restorative materials. The mate- rial’s low fi lm thickness minimizes the risk of fi tting inaccuracies after cementation. No dual-cure activa- tor is required for the cementation of indirect restorations. Adhese Uni- versal combines hydrophilic and hy- drophobic properties. It is tolerant of moisture and penetrates open den- tin tubules effectively. Since Adhese Universal is moderately acidic, it is compatible with all etching meth- ods and ensures an optimum bond between the tooth structure and the restoration. The simple “Click“ activation of the VivaPen® delivery form allows the exact amount of material to be dis- pensed each time, eliminating the need for dispensing the material into a dish prior to applying it. As a result, considerably less material is wasted. The VivaPen contains 2ml of adhesive, which is suffi cient for ap- prox. 190 single-tooth applications. Compared to conventional bottle de- livery forms, this amounts to almost three times more applications per millilitre (Source: Berndt & Partner, VivaPen Benchmarking Study, Au- gust 2013). Clinical case The following clinical case describes the use of Tetric EvoCeram Bulk Fill as a core build-up material in com- bination with Adhese Universal. The report outlines an effi cient pro- cedure for building up a tooth after endodontic treatment and restoring it with a monolithic crown (IPS Em- press® CAD) (Figs 1 to 13) Conclusion By using a modern bulk-fi ll compos- ite in combination with a universal adhesive, endodontically treated teeth can be restored easily, effec- tively and reliably. Root canal posts are, in many cases, no longer re- quired, for instance when restoring a molar with two or more residual cavity walls. Dr. Eduardo Mahn, Chile, has graduated from the University of Chile in 2004. He received the German DDS, one year later. The New York Univer- sity College of Den- tistry certifi ed him as Implantologist in 2007. In 2008, he published his doctorate thesis in 2008 titled “Osseointegration of zirconia implants, an in vivo study” and got his doctorate degree in 2010 from the University of Düsseldorf, Germany.