Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-04-25, 08:59:39 | version 1.38.0
24 PAEDIATRIC Dental Tribune Middle East & Africa Edition | 2/2018 Advantages of using Dentsply Sirona’s SDR® Plus in Paediatric Dentistry By Dentsply Sirona Bulk-fill materials have been devel- oped to facilitate a filling to be placed quickly and reliably with a single layer of up to 4mm thickness1-3. The flowable bulk-fill material SDR® Plus, which excels by virtue of its extremely low shrinkage stress, has been available since 20104,5. Since 2014 it is also approved for Class I and II deciduous tooth fillings in the posterior region without an addi- tional capping layer. This extension of indications is a major benefit for the practitioner – especially in paedi- atric dentistry. Bulk-fill materials are ideal for de- ciduous teeth, where the focus is on rapid application and reliability of the materials used. The time saving in filling placement is a crucial ad- vantage, both in regular treatment of children, as well as in the treatment of children under general anesthe- sia. The reduced abrasion resistance of flowable bulk-fill materials is compatible with the natural decidu- ous tooth abrasion and so is not to be viewed as a disadvantage in the wear phase of primary dentition. The development of new shades (A1, A2, and A3) and the increased wear resistance in SDR® Plus, also provide dentists with additional aesthetic op- Fig. 1: tions whilst maintaining the durabil- ity required. Patient cases Three cases treating decidiuous teeth (Class I and II) in the posterior region using SDR® Plus are present- ed below. Treatment of a 9-year-old boy with hemophilia A A 9-year-old boy with severe he- mophilia A presented a carious le- sion on the upper left deciduous molar (Fig. 1). Following excavation and preparation of the cavity mar- gin, the AutoMatrix® system was applied (Fig. 2), which could be re- placed with Dentsply Sirona’s new Sectional Matrix System (Palodent® V3). An all-in-one universal adhesive (Prime&Bond universal™) was ap- plied and light-cured. SDR® Plus was applied directly with its Compula® Tip. Here it is important that the met- al cannula is placed on the proximal cavity floor and is extracted while continuously extruding the low- viscosity material. The entire cavity was filled in one single increment and then light-cured for 20 seconds. As it was possible to ensure reliable contamination control using den- tal rolls and four-handed working, a rubber dam was not used, which was an advantage taking into account the boy’s medical history as a hemophiliac. This excluded potential traumatisation of the gin- giva from the rubber dam clamp. Finally, the filling was finished with a fine diamond bur (Fig. 3) and the Enhance® finishing and polishing system. Treatment of a 5-year-old girl The 5-year-old girl was a former gen- eral anesthesia patient who has since allowed herself to be treated in the dental chair. However, the child was restless and not very compliant, so treatment had to be kept short. This is where an all-in-one adhesive and a bulk-fill material is very helpful in therapy, as the treatment steps of conditioning and spraying off the etching gel or multiple layer- ing of the filling are not necessary and the treatment can therefore be performed quickly. The patient pre- sented three carious deciduous mo- lars 85, 75 and 65 (Fig. 4). Following caries excavation on tooth 85 buccal, 75 occlusal and 65 occlusal (Fig. 5) us- ing a round bur and a polymer bur, the universal adhesive (Prime&Bond universal™) was applied and then light-cured. SDR® Plus was applied in a single layer and light-cured. The fillings were finished and polished as described above. In this case on tooth 85 buccal, the difference in shade to the primary tooth is hardly noticeable (Fig. 6). Similarly, with flat occlusal cavities, e.g. tooth 75 (Fig. 7) and 65 (Fig. 8), the higher translucency of the SDR® Plus universal shade does not affect the final outcome. Experience has shown that children and parents are satisfied with the shade as deciduous teeth are not subject to such high aesthetic requirements as perma- nent dentition. Nevertheless, SDR® Plus now offers 3 additional shades (A1, A2, and A3) to enable closer shade matching without any extra effort. Tooth 85 was photographed in the course of a follow-up examination and shows the buccal filling after two years and an occlusal compomer filling after five years (Fig. 9). The occlusal SDR® Plus filling on tooth 75 was also photographed after two years (Fig. 10). Fig. 11 shows the oc- clusal filling on tooth 65 in a follow- up examination after 1 ½ years. The fillings were in a good clinical state in the follow-up examinations. Treatment of a 4-year old boy under general anesthesia The top priority in dental treatment of children under general anesthe- sia is to keep the anesthesia time as short as possible. That is why the use of dependable and quick-to-apply materials is recommended. In total, the 4-year-old boy had 12 primary teeth to be treated, of which 9 were filled and 3 had to be extracted. The posterior fillings were carried out with SDR® Plus, whereas the front teeth were restored with the ceram. x® SphereTEC™. In the course of gen- eral anesthesia treatment, the cari- ous tooth 64 was excavated (Fig. 12). Excavation was performed as previ- ously described and conditioning also used an all-in-one adhesive. Fol- lowing finishing and polishing, the filling covered the occlusal surface, as well as the palatal surface of the tooth (Fig. 13). Conclusion Bulk-fill materials are ideal for decid- uous teeth, where rapid application is a crucial advantage, both in regular treatment of children, as well as in the treatment of children under gen- eral anesthesia. With SDR® Plus, den- tists can bulk-fill up to 4mm deep to perform faster, easier Class I and II procedures without affecting the durability and longevity of the resto- ration. The new shades and increased wear resistance also provide dentists with additional aesthetic options for creating Class V and Class II restora- tions when the restoration is visible. For more information or to request a demo, please contact your local Dent- sply Sirona representative. References 1. Fleming, G. J., Awan, M., Cooper, P. R., Sloan, A. J.: The potential of a res- in-composite to be cured to a 4 mm depth. Dent Mater 24, 522-529 (2008) 2. Burgess, J., Cakir, D.: Comparative properties of low-shrinkage com- posite resins. Compend Contin Educ Dent 31, 10-15 (2010) 3. Roggendorf, M. J., Krämer, N., Ap- pelt, A., Naumann, M., Frankenberg- er, R.: Marginal quality of flowable 4-mm base vs. conventionally lay- ered resin composite. J Dent 39, 643- 647 (2011) 4. Ilie, N., Hickel, R.: Investigations on a methacrylate-based flowable com- posite based on the SDR® technol- ogy. Dent Mater 27, 348-355 (2011) 5. Rullmann, I., Schattenberg, A., Marx, M., Willershausen, B., Ernst, C. P.: Photoelastic determination of po- lymerization shrinkage stress in low- shrinkage resin composites. Schweiz Monatsschr Zahnmed 122, 294-299 (2012) Polly Rutt Regional Marketing Leader Regional Commercial Organisation – EOC – MEA +971 56996 6052 (UAE) +44 7792 156740 (UK) polly.rutt@dentsplysirona.com www.dentsplysirona.com Fig. 2: Fig. 3: Fig. 4: Fig. 5: Fig. 6: Fig. 7: Fig. 8: Fig. 9: Fig. 10: Fig. 11: Fig. 12: Fig. 13: