Consultants’ Comments

• “The esthetics was exceptional in non-discolored teeth.”
• “I used an opaque composite or flowable to tone down any discoloration with good results.”
• “I love the ease of placement of their composite – it is not sticky and contours well.”
• “The surface polish at 2 years was excellent – looked like a mirror.”
• “In many cases I could not even see the filling – it blended so well with the tooth.”

Description

Tetric EvoCeram Bulk Fill is a nano-hybrid composite indicated for direct restorations in posterior teeth. This radiopaque composite contains patented pre-polymers that reduce shrinkage stress; Ivocerin, a photointiator that results in a deeper depth of cure; and light sensitivity filters for extended working time. The composite is filled 53-54% by volume with particles in the 40-3000 nm range. Tetric EvoCeram Bulk Fill cures in 10 seconds and can be placed in layers up to 4 mm.

Clinical Evaluation Protocol

Over a two-year period, more than 130 Tetric EvoCeram Bulk Fill restorations were placed and monitored. At two years 100 restorations were recalled, including one- to four-surface posterior restorations (Figure 2).

The recalled restorations were evaluated in the following areas: esthetics, resistance to fracture/chipping, resistance to marginal discoloration, wear resistance, and lack of postoperative sensitivity. Restorations were evaluated on a scale of 1-5 with 1 = poor, 2 = fair, 3 = good, 4 = very good, and 5 = excellent.

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Clinical Observations

• Esthetics
  • 98% of recalled Tetric EvoCeram Bulk Fill restorations exhibited excellent esthetics (Figure 1). Although the composite material is slightly translucent, this was not an issue when the tooth was not originally discolored. Place an opaque flowable composite if the tooth is discolored.
• Resistance to Fracture/Chipping
  • Resistance to fracture/chipping was rated excellent (Figure 1). Five restorations were replaced over the two-year period. In one case the root fractured, necessitating the extraction of the tooth. The fracture was unrelated to the composite material. The four remaining teeth had very large restorations, two of which were cores. All four were crowned with ceramic restorations. No chipping was noted on any of the remaining restorations.
• Resistance to Marginal Discoloration
  • Resistance to marginal discoloration was rated excellent (Figure 1). Four restorations that exhibited superficial staining at the cavosurface margin were re-polished with excellent results.
• Wear Resistance
  • Wear resistance was rated excellent (Figure 1). None of the recalled restorations exhibited any wear of the composite or the opposing dentition.
• Lack of Postoperative Sensitivity
  • All restorations were bonded with self-etching bonding agents. None of the patients reported any postoperative sensitivity (Figure 1). The products patented technology that reduces polymerization shrinkage may have contributed to the lack of postoperative sensitivity.

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Conclusions

Tetric EvoCeram Bulk Fill performed extremely well at two years. The clinical outcomes of this two-year evaluation of 100 restorations were exceptional. Tetric EvoCeram Bulk Fill received a 99% clinical performance rating.