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Direct Restorations
Dentsply SDR - Smart Dentin Replacement
Occlusal Restoration

image
Before & After: Click to magnify

SDR is a flowable bulk filler for posterior teeth from Dentsply. It allows light penetration for curing up to 4mm at a time. Polymerisation shrinkage is 3.5%, comparable to other flowables, but less than many hybrid composites. Dentsply claim that the marginal stress caused by polymerisation shrinkage is around 1.5 MPa - substantially less than other composites, so the chance of marginal leakage is greatly reduced.

After bulk filling with SDR, a 2mm "capping layer" of aesthetic composite is placed on top of the SDR.

This allows the bulk of a cavity to be filled in one step, with less chance of problems due to voids / poor adaptation. This page has a promotional video by Denstply showing how it works, and a step-by-step case example undertaken by the dentaljuce team for an undermined occlusal restoration.



 

No flash? MP4 version here.

Occlusal Restoration: Case Example
Click images to magnify
image Occlusal molar caries

What two clues suggest this is an extensive lesion?
 
image Access to lesion

What bur is most suitable for access when planning composite restoration, and why?
 
image Peripheral Caries Removal

What bur is most suitable for removing peripheral caries?
 
  image Removal of peripheral carious dentine leaves unsupported enamel.

This would require removal for an amalgam restoration 
But it may be retained if composite is used as enamel will be bonded to and supported by composite.

A large proportion of the cavity's buccal wall is now pure enamel.
  image Caries detector dye

Caries detector dye has been applied to reveal caries in undercuts peripherally (Operator preference, not a standard party of the procedure.)
  image Caries detector dye - peripheral caries

Wash after 10 seconds.

Still a bit of enamel-dentine junction caries left. This is removed with a rosehead bur (slow handpiece).
  image Caries detector dye - not reliable for pulpal caries removal

Pulpal caries removal is judged by hardness NOT dye penetration 

Why do currently available caries detectors promote over-preparation?
 
  image Pulpal caries removal completes preparation

What is most suitable for removing pulpal floor caries?
 
  image Lining (operator preference)

A thin layer (<1mm) of Resin-modified Glass ionomer has been placed over the pulpal dentine. (Operator preference)
  image Total etch (15 seconds) 

Extended 1mm beyond margins and into fissures due to be sealed
  image Check etch pattern.

Check etch by washing and drying tooth. Ensure frosty appearance, and all fissures etched.
  image Apply Adhesive (Dentine Bonding System)

Follow manufacturer's instructions regarding evaporation, timing and curing.
  image Apply SDR Flowable Composite (max 4mm thickness in one go)

One increment was used, leaving 2mm for "capping" aesthetic composite.

Keep the tip in the material during injection.

Allow a few seconds for the SDR to self-level / adapt to undercuts
  image Light-cure the SDR - 20 Seconds
  image Place 2mm ‘Capping composite’ increment

Use your favourite aesthetic posterior composite. Finish shape as much as possible by hand before curing.

The SDR increment will bond in the normal way to it.
  image Apply Fissure Sealant to fissures and pits
  image  Minor finishing with burs and discs

 
Did you notice the "white line" on the buccal margin of the restoration? What is it?
 
  image Solvent-free surface sealant applied & light cured. Restoration Complete.

We like Biscover at dentaljuce



Dentsply SDR Cases on dentaljuce


Occlusal Restoration

Failed Fissure Sealant



Proximal Restoration



Multiple Restorations


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