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January 2010 | Dental Products Report A new category of Vertise Flow, a new self adhering flowable composite, combines the adhesive and flowable steps into one to simplify direct restoration placement.  Vertise Flow self adhering flowable composite eliminates the need for conventional bonding steps that include etching, rinsing and adhesive placement before application. Photo: Vertise Flow The set-up “Imagine placing a direct composite restoration without the added steps of etching and bonding. Sound impossible? A new self adhering flowable resin has been developed that combines etching, bonding and lining the cavity into one step. Learn how to incorporate this exciting development in composite resin science with the use of nanohybrid composite restorative materials and sectional matrices to simplify the direct restorative process.”—Dr. Robert Lowe, Team Lead There is no material in the history of dentistry that has undergone as much evolution as composite resin. The face of restorative dentistry changed forever when successful bonding to dentin was achieved. Since then, the goal of clinical and material science has been to find simple, predictable approaches to the composite restorative process. Unlike dental amalgam, the patrician of direct restoratives, placing composite requires many more steps and exacting technique to achieve the best results. The process of adhesion, conditioning the tooth surface, applying primers and adhesives, followed by layering the composite resins to complete the restorative process involves many independent steps that must be properly executed to ensure good results. Successive generations of dentin adhesives have sought to decrease the number of steps for placement without sacrificing clinical results. The seventh-generation self-etching dentin bonding systems have helped decrease technique and post-operative sensitivity issues while still yielding clinically acceptable restorations. Many clinicians even have used flowable resins as the first layer of composite resin after placing adhesive to ensure precise wetting of the adhesive surface, while creating a layer with less polymerization stress because of a lower modulus of elasticity (< 0.5 mm thickness). A new composite material, Kerr Corp.’s Vertise Flow (kerrdental.com), combines the adhesive and flowable steps into one, resulting in one of the first self adhering composite materials on the market. Mechanism of adhesion There are two distinct mechanisms of adhesion for self adhering materials—chemical and micro-mechanical. The primary bonding mechanism for Vertise Flow is chemical bonding between the calcium ions in the hydroxyapatite crystals and the phosphate groups in the glycerol diphosphate dimethacrylate (GPDM), which is the adhesive monomer common to all adhesives in Kerr’s OptiBond family of dentin adhesives. Vertise Flow also bonds to tooth structure via micro-mechanical retention, which is the result of the interpenetrating network formed between the polymerized monomers in the material and the collagen fibers and hydroxyapatite crystals within the smear layer. Brushing this first layer of material vigorously into the tooth surface enhances this penetration into the smear layer and creates a bond comparable to what most available seventh-generation dentin bonding agents can achieve. A simplified approach Two clinical cases will be presented to illustrate a “simplified approach” to matrix and placement of direct posterior composites. This technique provides an accurate reproduction of the proximal surface and contact, also decreasing the number of steps involved in the adhesive restoration process. Decreasing the amount of rotary finishing and contouring required to complete the restorative process also saves chair time. Preparation and matrix The patient presented with a Class II cavity present on the mesial surface of a maxillary left second molar (Fig. 1). After preparation of the proximal box portion of the preparation, the interproximal gingival papillae was “nicked” with the bur, causing hemorrhage that could interfere with the bonding process. A new hemostatic product, Kerr’s Hemostasyl, is syringed into the proximal area. It remains in place for about one minute (Fig. 2) and is then rinsed away with an air-water spray. Hemostasyl’s consistency keeps it in place until it is removed, unlike liquid-type hemostatic agents. Fig. 3 shows two approximating preparations in the maxillary left first and second premolars. CONTINUED ON NEXT PAGE
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