Kerr News Newsletter for Dental Professionals
New Kerr Product Demi™ Ultra LED Ultracapacitor Curing Light System Read more on page 7. Dr. Roxana Illici One Year Clinical Feedback on SonicFill™ Class II Restorations Read more on page 2. Kerr's Autumn of Tradeshows and Exhibitions Read more on page 20.
October | 2013
Kerr News | Issue October 2013
Content
Imprint
1
“Your practice is our inspiration” by Andrzej WiÊniewski Area Manager Kerr Poland
2
Clinical article: One Year Clinical Feedback on SonicFill™ Class II Restorations
Kerr News published by: Kerr Europe Via Strecce 4 6934 Bioggio Switzerland
6
Did you know...: Cleaning & Polishing Cups & Brushes
7
New product launch: Demi™ Ultra LED Ultracapacitor Curing Light System
11
Product feature: Demi Ultra and C.U.R.E Technology: what this brings versus competition?
13
New Microsite / Reporting back: New microsite focuses on prevention Amici di Brugg
14
Product feature: Simplify your indirect technique NX3 & XTR, the perfect match for all your indirect restorations, 1 Universal Cement and 1 Self-Etch Universal Adhesive
16
Clinical article: The self-adhesive composite Simplifying direct restorative procedures by incorporating a bonding agent into a flowable
20
Events: Tradeshows and Exhibitions
Editorial: Debra Engler Editorial Support and Coordination: Arianna Leo Graphic Design and Lithographics: Kerr Europe Contributing authors: Iratni Fayçal, Catherine Stahl, Olga Lamua-Olivar, Luisa Roncoroni, Anamaria Negulici
We welcome your feedback! Please contact us if you need more information, with suggestions or articles for Kerr News and anything you would like to share. We look forward to hearing from you:
[email protected] We cordially inform you that the materials selection and clinical approach described in articles by authors reflect their own personal experiences and practices.
Editorial | 1
I have been employed by Kerr/SpofaDental Poland since 2003. At that time, I began working as a sales representative for MIFAM TEETH, a company now owned by SpofaDental. By profession, I am a dental technician and a health service manager. I have found that my educational background and my wide professional experience gained before joining Kerr Polska are a worthy support in my current day-to day duties. Kerr is firmly positioned in Poland as one of the leading manufacturers of dental materials and equipment. Its development has progressed hand-inhand with the development of my professional career. In 2008, I was promoted to the position of regional manager. Today, I am responsible for the entire team of sales representatives in Poland. The people I manage definitely have a zeal for their job. Their optimism and devotion, combined with the involvement of other Kerr Poland employees, have created the spirit we channel to maintain our position as a leader in the dental market. This concept gives me great pleasure and everyday challenges ensure I am fully satisfied with my job, even though frequent business
trips mean being separated from my family. This year’s CEDE (Central European Dental Exhibition) in Poland saw the launch of a state-of-the-art Demi Ultra curing light – an exceptional device set apart from any other curing light currently available. Why? Because it works without a cord, without a battery, without comparison! Details can be found in this issue of Kerr News. Then there’s SonicFill, a product launched two years ago, which, to me, is as revolutionary as Demi Ultra. This innovative, sonic-activated, bulk-fill system for posterior restorations is definitely a hit with our dentists! SonicFill is the only material on the market that uses high density composite, offering properties such as mechanical resistance and low shrinkage rate. These properties offer a significant improvement over those of commonly used liquid composites. Another item worth mentioning at this point is our range of bonding systems. In search of adhesives, dentists often focus on strong bonds, reliability and durability. These attributes are linked to quality usually associated with traditional total-etch bonding systems, for example OptiBond FL.
However, OptiBond XTR, Kerr’s sixth generation self-etching adhesive, breaks this stereotype. A strong, reliable and universal system, OptiBond XTR, designed for use in direct procedures and seating of prostheses, works using all types of composite cements without silane. You can find out more about the clinical properties of OptiBond XTR in this installment of Kerr News. I strongly recommend reading this issue of Kerr News, in which you can find out about the innovative nature of Kerr and its readiness to meet your expectations. I believe that the new information presented in the journal will help to make your practices even better, offering solutions that you can use in your everyday professional life. To me, Kerr means people with passion, and knowing how to share this passion with others.
Andrzej WiÊniewski Area Manager Kerr Poland
2 | Clinical article
One Year Clinical Feedback on SonicFill™ Class II Restorations Dr. Roxana Ilici DDS, MSc, PhD Lecturer, Department of Prosthodontics Technologies and Dental Materials, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania Winner of the Poster Prize Competition “CLINICAL CASES” CONSEURO 2013 PARIS Abstract of the 6th biennial meeting of the European Federation of Conservative Dentistry (EFCD) held in assoaciation with the 33th national congress of the College National des Enseignants en Odontologie Conservatrice (CNEOC) Reference: Roxana Ilici, Ruxandra Sfeatcu, Andreea Didilescu, Eduard Gatin, Ion Patrascu. 1-Year Clinical Evaluation of a sonic-activated bulk-fill composite system. Clinical Oral Investigations 2013; 17 (3): 1054.
Fig. 1. Female patient 52 years old. Preoperative view of teeth 1.4, 1.5, 1.6 (shade A2). 1.6 old amalgam to be replaced, 1.5 primary mesial decay and distal old amalgam filling, 1.4 old amalgam to be replaced
Fig. 2. First appointment. Initially the patient requested only the treatment of 1.5 with the primary decay and replacement of the old amalgam filling, thus resulting an MOD cavity.
Fig. 3. Cavity cleaning with polyacrilic acid for 10 sec using Kavitan Conditioner (SpofaDental)
Fig. 4. A resin modified glass-ionomer base (Kavitan LC/SpofaDental) was applied to reduce the volume of the cavity and to protect the pulp
Fig. 5. SuperMat Circular Metal Matrix System applied and stabilized with Sycamore wooden wedges; adaptation at the level of the cervical floor can be seen
Fig. 6. The MOD axial cavities measure approx.5 mm depth from the cervical wall
Clinical article | 3
Fig. 7. Connecting the SonicFill Multiflex Coupling to the turbine hose.
Fig. 8. Attaching the SonicFill hand piece onto the SonicFill Multiflex coupling, selection of the shade (A2) and speed of extrusion of SonicFill composite (speed 3)
Fig. 9. SonicFill System prepared for restoration session: SonicFill composite A2 unidose fully seated and a medium dispensing rate established.
Fig. 10. Selective phosphoric acid preetching of the enamel was accomplished before the application of a two-steps selfetch adhesive system (OptiBond XTR) in order to withstand the polymerization shrinkage stress of the MOD bulk-fill applied SonicFill composite.
Fig. 11 Occlusal shiny aspect of the SonicFill composite before light-curing
Fig. 12. Finishing and polishing using different OptiDisc grit sizes (old colour codes)
Fig. 13. Finishing and polishing using OptiStrip
Fig. 14. Aspect of tooth 1.5. after restoration and its neighbouring to the adjacent teeth and soft tissues.
Fig. 15. Occlusal view of 1.5. MOD bulk-fill restoration at the end of the session with SonicFill System
4 | Clinical article
Fig. 16. Check-up 1.5 SonicFill restoration after 3 months.
Fig 17. During the second appointment the patient requested the replacement of the deteriorated amalgam fillings and esthetic restoration of 1.4 and 1.6. Second appointment. Esthetic restoration of 1.4 and 1.6. Operative area isolated with the OptiDam Posterior rubber dam stabilised with a universal SoftClamp distally and with FixaFloss mesially
Fig. 18. Clinical situation after removal of the amalgam restorations and secondary caries on 1.4 and 1.6
Fig. 19. Application of a thin layer of a resin modified glass-ionomer (Kavitan LC/SpofaDental) on the pulpal floor of the deep cavities.
Fig. 20. Operative area prepared for adhesive filling. Adaptation of Metafix All-In-One circular matrices and Sycamore wooden wedges.
Fig. 21. Application of the Self-Etch OptiBond XTR – Primer Adhesive System
Fig. 22. Application of the Self-Etch OptiBond XTR – Bonding Adhesive System followed by 10 second light-curing with Demi.
Fig. 23. SonicFill Bulk-Filling of the OM cavity of the 1.6 and OD cavity of the 1.4. After light-curing the adhesive the SonicFill tip is placed adjacent to matrix band at the bottom of the cavity before activation. The sonic vibration causes liquefaction and extrusion in a steady, continuous stream.
Fig. 24. Consistency of the SonicFill composite immediately after placement with the SonicFill hand-piece.
Clinical article | 5
Fig. 25. The nonsticky, nonslumping sonically-activated composite is easily shaped both wih conventional hand instruments and with the vibrating tip of Compothixo.
Fig. 26. Light-curing of the composite from the occlusal surface for 20 sec using Demi curing light; cure buccal and lingual aspects of tooth for an additional 10 seconds each after matrix removal.
Fig. 27. Pre-lustered aspect of the lightcured SonicFill composite.
Fig. 28. Removal of the Metafix circular matrix using a metal probe. The tear strip opening system allows easy opening and removal of the matrix, without damaging the filling.
Fig. 29. Opened Metafix matrix on both teeth, ready to be removed laterally.
Fig. 30. Aspect of the teeth after contouring the restorations with carbide burs, OptiDisc and OptiStrip.
Fig. 31. Different accessories from Kerr used for finishing and polishing of the restorations: Beavers Crabide burs (12 and 30 blades), OptiDisc (new colour codes), OptiStrip, OptiShine and Opti1Step Polisher.
Fig. 32. Occlusal check-up after removal of the rubber dam.
Fig. 33. Aspect of the fillings at the end of the restorative session of 1.4 and 1.6. Completed restorations after occlusion check-up and finishing and polishing with Hawe accessories.
Fig. 34. 6 months recall aspect for 1.5 ; 3 months recall for 1.4 and 1.6 (distance view)
Fig. 35. 6 months recall aspect for 1.5; 3 months recall for 1.4 and 1.6 (closer view).
Fig. 36. 12 months recall for 1.4 bulk-fill class II 0D and 1.6 bulk-fill class II OM restorations. 15 months recall aspect for 1.5 bulk-fill MOD restoration.
LED Ultracapacitor Curing Light System
DON’T CHANGE BATTERIES, CHANGE CURING LIGHTS! The Kerr Demi™ Ultra LED Ultracapacitor Curing Light System represents the latest technological advancement in dental curing from the Kerr Demi brand. It is the first curing light to free dentists from both batteries and cords, while offering the unmatched performance and reliability of a Demetron curing light. The Demi Ultra is powered by the revolutionary U-40™ Ultracapacitor – exclusive technology that re-energizes to full power in just 40 seconds, for incomparable convenience. Proprietary C.U.R.E. Technology™ allows the Demi Ultra to rapidly deliver a uniform depth of cure with industry leading low temperatures, and the Easy Suite feature set combines simple and intuitive operation with worry-free cleaning. A new after sales service gives you the peace of mind to know your investment and budget are protected from the hassles of unexpected repair expenses. Demi Ultra is a quantum leap in curing light technology!
NO BATTERY, NO CORD, NO EQUAL
√
REVOLUTIONARY U-40™ ULTRACAPACITOR
√
PROPRIETARY C.U.R.E.™ TECHNOLOGY
√
EASY SUITE FEATURE SET
√
AFTER SALES SERVICE
Order information: Demi™ Ultra LED Ultracapacitor Curing Light System Item nr 35664 Contains: 1 x handpiece, 1 x 8 mm light attachment, 1 x charging dock with radiometer, 1 x power supply, 1 x protective light shield, 1 x hardness disk kit, 1 x 5-pack disposable barrier bag, 1 x IFU Accessories Item nr 35665 Item nr 35666 Item nr 35667 Item nr 35668 Item nr 35815 Item nr 35837 Item nr 21042 Item nr PEDEMIULTRA-100
Demi Ultra LED Light Attachment 8mm Demi Ultra Charging dock with built-in radiometer Demi Ultra Handpiece Demi Ultra Light Shield Demi Ultra Power Supply Disposable Hardness Disk Kit (pack of 1) Optics Maintenance Kit Demi Ultra Barrier Bag (pack of 100)
ULTRACAPACITOR: CHANGING THE GAME! Batteries have always been a problem in curing lights. A battery takes 90 to 180 minutes to recharge and requires a chemical reaction to generate power. Each time it is used some of the chemicals are used up until eventually the batteries performance is reduced and requires an expensive replacement. With the introduction of the Ultracapacitor, Demi Ultra definetly solves all these issues! Ultracapacitors are a proven, trusted power source that have been used successfully for decades across many key industries such as aviation, automotive, renewable energies. Instead of create energy through a chemical reaction, they exploit the movement of charged ions, storing energy in an electric field. The Kerr Demi Ultra is the first and only curing light powered by state-of-the art ultracapacitor technology. Although ultracapacitors are similar in size and shape to traditional batteries, they work much differently – re-energizing in a matter of seconds and maintaining their energy capacity year after year. This means Ultracapacitor frees users from the need to buy expensive replacement batteries, while also freeing them from cords in the operative area. In practical terms, the U-40 Ultracapacitor-powered Demi Ultra is never more than 40 seconds away from being able to deliver 25 x 10 second-cures. In your practice, the Demi Ultra is always ready and delivers convenience, efficiency and reliability – like nothing you’ve experienced before.
Ultracapacitor: how it works 40 seconds re-energizing with U-40 Ultracapacitor Re-energized When an electrical current is applied to the plates (this occurs when the handpiece is in the dock), the ions accumulate on each plate, creating an electric field to power the curing light
Low energy Inside the U-40 Ultracapacitor, ions float between two carbon-coated electrodes.
-
+
:00
+ + + + + + +
:40
The advantages versus traditional batteries are immediately clear:
ULTRA reliable performance
√ √
Improved longevity
√
No replacement costs
√
ULTRA fast re-energizing
Fully ‘re-energizes’ in under 40 seconds Compared to 1.5-3 hours for batteries Energy capacity does not diminish over time Compared to traditional batteries that decline by 30% after 12 months 8 x longer life expectancy Compared to traditional lithium-based batteries Ultracapacitors do not require replacement Compared to recurring costs of expensive replacement batteries
C.U.R.E.™ TECHNOLOGY: KEEPING IT COOL! The Demi Ultra takes a responsible approach to curing and energy management by using proprietary C.U.R.E. Technology (Curing Uniformity and Reduced Energy) that rapidly delivers uniform depth of cure every time with Cool Curing™ efficiency. C.U.R.E. technology is possible by four Demi Ultra design features that work in unison to provide uniform curing and improved energy efficiency:
1
2
3
High-efficiency LEDs at the Tip
Dual Purpose extra-large heat sink: pulls heat away from the tip, towards the handpiece. Transfer power from the U-40 to the LEDs and pulls heat away from the LEDs
Total Internal Reflector (TIR) lens: Blends and collimates light right at the tip, providing a uniform beam that delivers consistent, cool energy across the treatment area.
4
Faster cures without excess heat Pulsing power of PLS
OUTPUT mW/cm2
1400 1300 1200 1100
0
1
2
3
4
5
Time in seconds
Periodic Level Shifting (PLS): Automatically pulses energy levels to ensure optimal power output and eliminate thermal shutdown During each second of a curing cycle, Periodic Level Shifting, or PLS, shifts the energy output of the LEDs from a base value of 1,100 mW/cm2 to a peak value of 1,330 mW/cm2 for one quarter of a second. The modulated energy delivered by PLS provides rapid curing reducing heat
The benefits that these four features provide are substantial: By locating high-efficiency LEDs at the tip and incorporating an extra-large heat sink, the tip temperature is kept low compared to other LED curing lights on the market. Less heat and the large dual-purpose heat sink allow the Demi Ultra LEDs to run continuously without the need for a fan or interruptions from thermal shutdown. Collimated beam of light
Uniform beam cross section
√ √
More curing power at distance Less sensitive to positioning of tip Consistent depth of cure
Lower temperature at the tip
√
Improved safety/comfort for the patient
Reduced pulpal temperature rise
√
Reduced incidence of pulpitis that can cause extended post op sensitivity that is blamed on other aspects of the restoration
Less energy, less heat, but NO compromise on curing performance
LED Ultracapacitor Curing Light System
EASY SUITE USER INTERFACE: MEETING YOUR EVERY NEED The Demi Ultra Easy Suite feature set provides simple and intuitive operation and maintenance Durable, lightweight construction Hybrid construction unites metal and patented Valox-molded plastic in an ultra-light, durable, and chemicalresistant design Comfortable ergonomic design The handpiece’s lightweight, ergonomic design and 360° rotating tip invites a wide range of comfortable hand positions
Two-button operation Easy access to all system functions, new silent mode activation.
Easy to clean and keep clean Sealed, ventless handpiece and docking station engineered to simplify cleaning Fully-integrated radiometer Fully integrated, easy-to-use radiometer with LED indicators
NEW DEMI ULTRA AFTER SALES SERVICE When choosing a top curing light, you must expect a top after sales service! At the time you purchase your Demi Ultra you may elect to take advantage of an extended warranty and an accidental damage from handling coverage. For a nominal charge you can extend the standard 3-years warranty on your device to a full 5-years warranty and protect your curing light from unexpected (accidental damage coverage). This gives you the peace of mind to know your investment and budget are protected from the hassles of unexpected expenses! Don’t forget to register on our website www.demiultra.eu on the service support page to make valid your warranty option.
Order information: Item nr 35664 EXT Item nr 35664 ACD
Demi Ultra Warranty Extension «Extension +2» Demi Ultra Warranty Extension and Accidental Damage Coverage «Extension +2 & Safe»
IMPORTANT SPECIFICATIONS Output – 1’100 to 1’330 mW/cm2
«Re-energize» time – 40 seconds after full discharge
Wavelenght – 450 to 470nm
Run time on a full charge – 25 10-second cures
Curing modes – 5, 10 and 20 seconds
Total weight – 184 grams
LED Light Attachment – 8mm with 60° angle, non-autoclavable
Warranty 3 years standard + 2 years and accidental damage coverage optionals Discover more on www.demiultra.eu
Product feature | 11
Clinical Tips: Demi™ Ultra and C.U.R.E™ Technology: (Curing Uniformity & Reduced Energy)
what this brings versus competition? C.U.R.E.™ Technology
Collimation Comparison1
CURING UNIFORMITY:
1
2
DEPTH OF CURE: according to the JADA, 37% of all composite restorations are insufficiently cured (Fan et al, 2002). Demi Ultra, compared to other lights, guarantees, in addition to an optimal curing uniformity, the best depth of cure.
Kerr Demi Ultra 18°
Ivoclar Bluephase Style 31°
3M ESPE Elipar™ S10 36°
1 Collimation as measured by the angle of beam divergence.
Depth of Cure (mm) for 80% Barcol Hardness 2 mm Tip-to-Target Distance with SonicFill A2 Depth of cure (mm) for 80% Barcol Hardness
COLLIMATION: collimated light is light with rays are parallel, and therefore wil spread slowly as it propagates. The word is related to «collinear» and implies light that does not disperse with distance. A better collimation translates in more curing power and a less sensitivity to tip positioning.
Demi Ultra (1x10)
VALO (3x4; HIGH)
Bluephase 20i (2x5; TURBO)
VALO (2x3; XTRA)
Bluephase Style (1x10)
SmartLite Max (1x10)
Bluephase 20i (1x10; HIGH)
ELIPAR S10 (1X10)
Source: Dental Advisor, R. Yapp, May 2013!
Curing Light Tip Temp after 20 Second Exposure
R.E.™ Technology
C.U.
Kerr Demi Ultra (1x20) Ivoclar Bluephase Style (1x20)
REDUCED ENERGY:
1
TIP TEMPERATURE: an increase of 5.5°C can cause irreversible damages to pulp. Thanks to its proprietary C.U.R.E technology, Demi Ultra is able to maintain low temperatures avoiding any tissue damage.
Ivoclar Bluephase 20i (High; 1x20) 3M Elipar S10 (1X10) Ultradent VALO® (Std; 1x20) Ultradent VALO® (XTRA; 3x3 only)*
Tip Temperature (°C) *Used 3 second safety delay between multiple cures
12 | Product feature
Universal curing? Seems to be a compromise. Light and quality of cure.
Demi Ultra
Competitors claiming curing all composites
Change in total beam irradiance with increasing tip distance
Irradiance (mW/cm2)
The photopolymerization process of dimethacrylate-based dental resins is a reaction triggered by free radicals, which are generated by irradiation of a light-sensitive initiator and open the double bond of methacrylate groups (C=C), generating a chain reaction. The depth of cure can settle by playing on light intensity (or irradiance), wavelength and concentration and/or type of light initiators. Curing Lights with violet LED to cure alternative photoinitiators provide non-uniform beam irradiance that leads to non-uniform cure. The power is distributed inefficiently and additional energy is needed to cure in depth. This unnecessary energy increases the heat and the risk of pulpal damages. A non–uniform beam also penalized the irradiance when increasing the tip distance as can be seen in the graph. In dental composites, the most commonly used photoinitiator system is a combination of camphorquinone and tertiary amines (CQ/Amine). Other materials are blends of CQ and other photoinitiators. Moreover recent works reports that single diode blue LED light achieve similar degrees of polymerization than broadband (multiple diode) LED and halogen lights, just increasing the curing time when curing clear and white composite shades.
Beam profiles at 0 mm distance
Tip distance (mm)
Light guide tip positioning! Effect of Light Emission Angle to Resin Being Cured The adequate positioning of the light guide tip/attachment can significantly affect the energy received by the RBC, and thereby the quality of its polymerization. The light should be stabilized during the irradiation procedure. As the irradiance decreases with the increase of the distance between tip and restoration, the position of the light guide should be perpendicular to the tooth and positioned on the proximity of the tooth surface being restored. Intensity and depth of cure decreases as the position of the light moves from the perpendicular. It will be necessary to increase the cure time and/or cure from multiple directions if optimum positioning cannot be obtained.
Depth of cure decreases with less perpendicular angle
Light intensity decreases with less perpendicular angle
Light Emission Angle As the angle decreased from perpendicular, there’s a significant drop in intensity! which results in a slight decrease in depth of cure. Demi Ultra, thanks to its 60°C angle makes easy the access to the posterior area and the curing phase more confortable for the patient.
New Microsite / Reporting back| 13
New microsite focuses on prevention Kerr is a leader in Europe when it comes to Prevention and Prophylaxis products, offering well-known brands such as Cleanic®, the unique, topquality prophy paste, and Pro-Cup®. These are only two of the successful products developed by our own Research & Development team, made to the very highest standards at Kerr’s European headquarters in Lugano, Switzerland. No other company can match the Kerr range; our products include pastes for cleaning and polishing, complementary accessories, and instruments for preventive care. Surf our new website for more information; a complete range of products for a total workflow solution is just waiting to be discovered by you. Everything you need to treat your patients is described in detail, including features, pictures and technical information, and is enriched with
studies and clinical cases from colleagues across Europe. For ease of use, the website will be soon available in five different languages: English, German, French, Italian and Spanish. A link – located at the top right corner of the home page – allows you to sign up to stay in contact with Kerr, plus receive a free sample of new Cleanic® Light, our prophy paste free of both flavourings and artificial colours. We cordially invite you to have a look and enjoy. http://prevention.kerrdental.eu
Reporting back from Amici di Brugg Kerr participated, as it does every year, in the Amici di Brugg Dental Show which was held at Rimini from 23 to 25 May 2013. This trade show, the most important for the dental industry in Italy. It is eagerly awaited for many months in advance by both medical-odontological and prosthodontic professionals as it is an opportunity to preview the latest innovations which are presented by the various producers. At the Kerr booth, one of our highlights was introducing the pre-launch campaign for the new LED Demi Ultra lamp, which will be commercially available from September 2013. Personal invitations were handed out to participate on one of the 6 presentations which were held on Thursday, 24. May. Kerr’s dealers and a number of dentists were able to attend a preview presented by the Product Manager for the Kerr Demi Brand.
Our sales team were often kept busy during the Amici di Brugg Dental Show demonstrating our key products, explaining the sales promotions and taking many orders.
The Kerr stand at Brugg 2013 is of a new design and construction to promote a good interaction with the clinicians through and attractive open and light approach. For visitors to the tradeshow a corner was specifically set aside for building client relations and in-depth consultations.
The position of the Kerr stand in the middle of pavilion C7 at the Dental Show was certainly advantageous. It made it very easy for the many dentists and hygienists who were interested in Kerr’s latest products to consult with our sales team.
14 | Product feature
Product feature | 15
16 | Clinical article
The self-adhesive composite Simplifying direct restorative procedures by incorporating a bonding agent into a flowable Over many years, numerous practitioners have expressed their desire for a self-adhesive composite. Vertise Flow, Kerr’s self-adhesive composite, now boasts more than four years of clinical use, having been launched in 2009 during IDS, the exhibition for the dental sector held in Cologne, Germany. Vertise Flow’s adhesion to the dental tissues occurs as a result of two mechanisms: 1. First through a micromechanical retention resulting from a network of interpenetration between the polymerised monomers of Vertise Flow and the collagen in the dentine. As a result, an interdiffusion zone is created, similar to the mechanism described in the adhesion of a glass ionomer cement 2. A chemical reaction between the phosphate functional groups and the calcium in the dental tissues. Highly magnified images also show close contact between Vertise Flow and the enamel surface. The interface and the close contact, both with the enamel and the dentine, demonstrate the self-adhesive capability of Vertise Flow composite.
Phosphate functional group for etching and adhesion
Two methacrylate functional groups for copolymerisation / reticulation with the other methacrylate comonomers Tight interface on the enamel
Dentine interdiffusion zone
Clinical article | 17
Ceramic repair In laboratory tests, Vertise Flow has demonstrated its ability to adhere naturally to different substrates, in particular to the metallic components of these surfaces, without treatment or initial primer. Applying a silane (ceramic adhesion promoter) is not necessary. This ability allows Vertise Flow to be used for ceramic repairs on a metal- or zirconia-based prosthetic restoration. The clinical procedure for repairing ceramic with Vertise Flow is simple,
and its adhesive properties are excellent. Moreover, the Universal Opaque shade of Vertise Flow, with its 80% opacity, provides a substantial advantage when the procedure involves masking visible metal during the repair phase. Vertise Flow adheres to the ceramic thanks to the ionic bonds between the phosphate ions of the GPDM (glycerophosphate dimethacrylate) groups and the metallic elements of the ceramic such as aluminium and lithium. Hydrogen bonds are also
formed between the acids or the hydroxyl groups of the adhesive monomers and the silanol groups at the surface of the ceramic. Mechanical retention is obtained by etching the surface of the ceramic using hydrofluoric acid. Etching the ceramic, followed by the application of Vertise Flow, produces the best adhesive outcome. Illustrated below is a procedure involving a ceramic restoration performed in the dental laboratory.
Ceramic crown on tooth 11, with a fracture leaving metal exposed.
Shaping the area using a diamond-coated bur.
Using Vertise Flow as a first layer.
Applying a thin layer of Vertise Flow with a brushing motion.
Polymerisation for 20 seconds.
Using Premise, a nano-filled composite, to reconstruct the free margin.
Creating an incisal layer on the palatal surface.
Applying an A3 opaque dentine mass.
Creating an incisal margin. Courtesy of M. Richard Abulius
The majority of practitioners who have incorporated Vertise Flow into their practice have indicated that they predominantly use it for prosthetic restorations. However, Vertise Flow is indicated: • For small dimension class I cavities not supporting the occlusion • As a liner in class II and class III cavities
• For all restorations in micro-dentistry and minimally-invasive dentistry • For orthodontic and periodontal splints • For pits and fissures sealing • For all paedodontic restorations. Proven effectiveness In a clinical study by the Dental Advisor, published in March 2013,
Vertise Flow was used as an adhesive and compared with Optibond XTR, a self-etching universal adhesive. The filling was performed using Herculite XRV Ultra composite. The patient recall after 1 year allowed the following parameters to be monitored: marginal discoloration; the lack of post-op sensitivity; and the retention rate.
18 | Clinical article
The restorations were graded on a scale of 1 to 5: 1 = poor; 2 = average; 3 = good; 4 = very good; 5 = excellent. Vertise Flow and Herculite Ultra
15 minutes
24 hours
15 minutes
25
25
20
20
15
15
10
10
5
5
24 hours
5 4
4.9
5.0
Ratings
0
0
Vertise Flow
3
Vertise Flow
Adhesion to enamel Study by Dr Carlos Munoz, SUNY (Buffalo)
2 1
Adhesion to dentine Study by Dr Carlos Munoz, SUNY (Buffalo)
0
Resistance to Marginal Staining
Lack of sensitivity
Enamel
Dentin
25
Vertise Flow and Herculite Ultra 5
Ratings
4
20 15
5.0
5.0
10 3 2
5
1
0 0
Resistance to Marginal Staining
Lack of sensitivity
Vertise™ Flow
Adper™ Easy Bond/Filtek™ Supreme Plus Flow
G-Bond/Gradia® Direct Flo
Xeno® IV/ ® Esthet-X Flow
AdheSE ® One/ ® Tetric EvoFlow
iBond ® Self Etch/ ® Venus Flow
Adhesion to enamel and dentine Study by Dr Ed Swift, University of North Carolina
The patient follow-up indicated that no restorations were lost following the 81 procedures performed. No post-op sensitivities in any of the restorations were mentioned by the patients, and only a minor marginal discoloration was indicated on one restoration using Vertise Flow. The study concluded that Vertise Flow produces an excellent adhesion for restorations created using Herculite XRV Ultra, achieving a clinical score of 99%. The results of this study were correlated with that of a report from Prof. Ferrari at the University of Siena (Italy). The results for Vertise Flow, when used as a filling for class I cavities (at 18 months) and used as a liner under class II restorations (at 12 months), are equivalent to those for restorations performed using self-etching adhesive systems and conventional flowable restorative composites. Other studies comparing Vertise Flow with combinations of self-etching
adhesives and flowable restorative composites showed Vertise Flow’s superior characteristics and confirmed the effectiveness of this composite. Preventive dentistry Vertise Flow has a role to play in modern preventive dentistry, when providing protection by hermetically sealing pits and fissures. This sealing technique involves applying hydrophobic resins following preparation of the enamel surface via sandblasting using aluminium oxide or roughening using pumice stone. The pumice stone can be passed over the surface with a chlorhexidine solution instead of the water, to decontaminate the surface. The surface is then etched for 20 to 30 seconds using a 37% phosphoric acid gel. Historically, the hydrophobic resins used have offered no adhesive capacity and fulfil their function by taking hold via mechanical retention alone.
This simple, minimally-invasive technique remains identical when Vertise Flow is used. Even though Vertise Flow is self-adhesive, it is recommended that the clinician treat the enamel using the same principles to remove the superficial aprismatic enamel layer, to etch and then to apply Vertise Flow. The advantage of using Vertise Flow for this procedure lies in its hydrophilic property and its ability to correct a lack of etching as a result of its selfadhesive qualities. In the CRA report on pits and fissures sealing in June 2011 (volume 4, issue 6), different products manufactured for this indication were compared. The teeth were thermocycled (2500x), then sliced. In this evaluation, Vertise Flow was graded as excellent and showed 0% leakage.
Clinical article | 19
Below is a clinical case demonstrating the use of Vertise Flow for pits and fissures sealing.
The pre-operative view shows a defective sealant.
The view of the occlusal surface following removal of the old sealant.
Cleaning with pumice stone. The water can be replaced with chlorhexidine for an antibacterial effect
Etching the enamel for 20 to 30 seconds.
The chalky white appearance of the enamel, signifying an effective etching treatment.
Application of Vertise Flow on the occlusal surface.
Application of Vertise Flow using Vertise brushes.
Checking the occlusion.
The completed clinical case. Courtesy of Dr Irfan Ahmed
Conclusion The self-adhesive composite, Vertise Flow, simplifies treatment procedures considerably. Various laboratory and clinical evaluations show that it performs just as well and, in certain cases, better than specified combinations of self-etching adhesive systems and conventional flowable composites. Following four years of use in-practice, Vertise Flow appears to offer a step in the right direction in terms of simplifying procedures, as well as in achieving good results within the limits of its clinical indications and recommendations.
20 | Events
Tradeshows and Exhibitions United Kingdom BDTA Dental Showcase 17. - 19. October 2013 Birmingham NEC Stand N14
Norway Nordental: (Norwegian Dental Exhibition) 31. October – 2. November 2013 Lillestrøm, Norway http://www.ntfslandsmote.no
www.dentalshowcase.com/bdta -dental-showcase-2013
Sweden Swedental: (Swedish Dental Exhibition) 14. - 16. November 2013 Stockholms (Stockholmässans), Sweden www.swedental.org/
Finnland Finnish Dental Congress & Exhibition 7. - 9. November 2013 Helsinki, Finland
France ADF 2013 26. - 30. November 2013 Palais des Congrès de Paris, Porte Maillot Stand 1N04
www.finnexpo.fi/sites1/Hammaslaaka ripaivat/en/Pages/default.aspx
Latvia Baltmedica 18. - 20. September 2013 Riga, Latvia
www.adf.asso.fr/fr/le-congres
Lithuania Medbaltica 26. - 27. September 2013 Vilnius, Lithuania
Iberia XXII Congresso Anual da Ordem dos Médicos Dentistas (OMD 2013) 21. - 23. November 2013 Exhibition Centre of Lisbon www.omd.pt/congresso
Switzerland 38. Jahreskongress “Swiss Dental Hygienists” 15. – 16. November 2013 Lausanne http://www.dentalhygienists.ch/
SVDA Kongress 2013 22. – 23. November 2013 Hotel Arte, Olten www.svda.ch
Belgium - GOLD SPONSOR CIDAE 2013 3rd International Conference Adhesive & Aesthetic Dentistry 13. - 14. December 2013 Brussels, @ Brussels Square, Belgium
Maxcem Elite™ Self-etch, self-adhesive resin cement
2008
For indirect restorations is simplicity refined – with higher bond strengths and superior ease of use – offering proven technology without sacrificing performance: easy to clean up with no hand mixing, and no refrigeration required. For more convenience, intra-oral and root canal tips allow for dispensing of material in areas hard-to-reach. • Bond strengths between 22-36 MPa. High bond strengths without an adhesive. • Ease of use. No need to refrigerate, easy clean up and no hand mixing required. • Compatibility with common substrates. Anterior or posterior ceramics, PFMs and metal restorations and CAD/CAM materials. • Efficient self-cure mechanism. Cures completely in the absence of light. For clinicians who want great bond strength and material stability in a single-step resin cement for indirect restorations, Maxcem Elite resin cement offers superior color stability and can be used for esthetic restorations anywhere in the mouth, dispensing directly into the restoration or prep.
KerrHawe SA P.O. Box 272 6934 Bioggio Switzerland Freephone: 00800 41 05 05 05 Fax: ++41 91 610 05 14 www.kerrdental.eu
Kerr Brands – Your practice is our inspiration™ Kerr is committed to dental professionals in all that they do. The Kerr premier range of dental consumables offers you solutions that can guarantee reliability and economic advantage in your daily dental practice. Focusing on restorative processes, dental hygiene and prophylaxis, Kerr portfolio reflects an ongoing exchange with you, the clinician. The value Kerr bring to you daily is based on technologies that meet the expectations of your patients, while minimizing the time and discomfort of the treatment, and relies on more than 100 years of cooperation with dentists like you. Premium innovative products, highest performance.
Spofa offers dental products that combine proven first-class quality with new technologies for the right price. As the Kerr value brand, you benefit from our company’s experience in R&D and international presence, which in turn, allows us to select for you a comprehensive portfolio of products, designed to meet the challenges of today’s discerning professionals in new markets. Excellent products, highest price quality ratio.
Pentron Clinical sets a standard for quality and value in the dental consumables marketplace. Pentron is constantly focused on new product development and the latest in materials science to ensure being able to provide you with new dental materials that are beneficial, convenient and effective. Pentron’s goal today is the same as it was over 40 years ago – to develop quality products that are technologically advanced and which enhance the practice of dentistry. Pentron maintains this commitment by continuing to provide the innovative quality products and knowledgeable service on which you rely to help build your practice. Great products, dependable quality, reasonable prices.
Kerr Europe Via Strecce 4, PO Box 272, 6934 Bioggio, Switzerland office: +41 9 16 10 05 05, fax: +41 9 16 10 05 14
www.kerrdental.eu
