For Better Dentistry

Case Report: Advantages of using SDR in Paediatric Dentistry Dr Vicky Ehlers

Advantages of using SDR® in Paediatric Dentistry

Dr Vicky Ehlers, Mainz, Germany

Bulk fill materials have been developed to facilitate the fast and reliable placement of a dental restoration with a single layer of up to 4mm in thickness1,2,3. The flowable bulk fill material SDR (DENTSPLY), has been available since 2010 and has since been used across the globe in over 30 million indicated procedures4,5, including post endodontic restorations, core build up, pit and fissure sealing and as a base in class I and II restorations. In 2014, DENTSPLY extended the indications of SDR to class I and II restorations in posterior deciduous teeth without the need for an additional capping layer. This extension of indications is a major benefit for the practitioner - especially in paediatric dentistry.

Bulk fill materials are ideal for deciduous teeth, where the focus is on rapid application and reliability of the materials used. The time saving offered by the bulk filling placement is a crucial advantage, both in the regular treatment of children, as well as in the treatment of children under general anaesthesia. The reduced abrasion resistance of flowable bulk fill materials is comparible with the natural deciduous tooth abrasion and so is not to be viewed as a disadvantage in the wear phase of primary dentition. Due to the higher translucence of the SDR material, there is a slight difference in shade to the deciduous tooth, although this tends to be a lesser concern in deciduous tooth restorations.

Patient Cases
Three cases treating deciduous teeth (class I and II) in the posterior region using the material SDR are presented below.

Treatment of a 9 year-old boy with haemophilia A
A 9 year-old patient with severe haemophilia A presented a carious lesion on the upper left deciduous molar (Fig. 1). Firstly the caries were excavated with a conventional round bur and polymer bur (PolyBur, P1, Komet Dental*).
 
image 1.jpg
 

















Fig. 1: Caries occlusalmesial
on tooth 65.

**Not a registered trademark of DENTSPLY International, Inc.

Following preparation of the cavity margin, the AutoMatrix® system (DENTSPLY) was applied (Fig. 2). The use of a matrix is always recommended, as otherwise, due to its low viscosity, the bulk fill material flows into places that do not belong to the contour of the filling. A universal adhesive (prime&bond® one SELECT, DENTSPLY) was used, which was air-dried and light-cured. The bulk fill material SDR was applied directly with its Compula® Tip. Here it is important to note that the metal cannula should be on the approximal cavity floor and is slowly removed while continuously extruding the low-viscosity material. The entire cavity was filled in one single increment (not exceeding 4mm in depth) and then light-cured for 20 seconds. As it wasn’t possible to ensure reliable contamination control using dental rolls and four-handed working, a rubber dam was used, which was advantageous in view of the patient's medical history as a haemophiliac. Finally, the filling was finished with a fine diamond bur (Fig. 3) and the finishing and polishing system Enhance® (DENTSPLY). At the time of the follow-up examination, the deciduous tooth was no longer in situ as a result of natural exfoliation, so a follow-up radiograph is not available.

image 2 sdr.jpgimage 3 sdr.png
Fig. 2: Tooth 65 after                     Fig. 3: Class II twosurface filling on tooth 65.
caries excavation with
matrix and wedge.

Treatment of a 5 year old girl
The 5 year old girl was a former general anesthesia patient who has since allowed treatment to take place in the dental chair. However, the child was restless and non-compliant, so treatment had to be completed quickly. This is the type of restorative case where an all-in-one adhesive and a bulk fill material is very helpful, as the treatment steps of conditioning and spraying off the etching gel or multiple layering of the filling are not necessary and the treatment can therefore be performed quickly. The patient presented three carious deciduous molars 85, 75 and 65 (Fig. 4).

Following caries excavation on tooth 85 buccal, 75 occlusal and 65 occlusal (Fig. 5) using a round bur and a polymer bur, the universal adhesive prime&bond one SELECT (DENTSPLY) was applied and then light-cured. As only buccal and occlusal fillings were involved, a matrix system was not used. The bulk fill material SDR was applied in a single layer (not exceeding a depth of 4mm) and lightcured. The fillings were finished and polished with a fine diamond bur and the finishing and polishing system Enhance (DENTSPLY) (Fig. 6).
 
image 4 sdr.png     image 5 sdr.png    image 6 sdr.png
Fig. 4: Carious lesion                          Fig. 5: Situation after caries               Fig. 6: Final filling on tooth 65.
on tooth 65 (occlusal).                       excavation on tooth 65.                                                           


Treatment of a 4 year old boy under general anaesthesia
The top priority in dental treatment of children under anaesthesia is to keep the anaesthesia time as short as possible. That is why the use of dependable and quick-to-apply materials comes highly recommended. In total, the 4 year old patient had 12 deciduous teeth that required treatment; 9 of which were to be filled and 3 were to be extracted. The deciduous tooth fillings in the posterior region were carried out with SDR, whereas the front teeth were restored with the compomer Dyract® XP, dental shade A2 (DENTSPLY). The use of compomers is considered to be the worldwide standard for the restoration of deciduous dental defects2. During the treatment, the carious tooth 64 was excavated and is presented in Fig. 7. Excavation was completed with a round and polymer bur, the universal adhesive prime&bond one SELECT (DENTSPLY) was then applied and then light-cured. Following finishing and polishing, the final filling covered the mesial-occlusal surface, as well as the palatal surface of the tooth (Fig. 8). The appointment for the follow-up examination was not kept.

image 7 sdr.jpg             image 9 sdr.jpg
Fig. 7: Tooth 64 after caries excavation.     Fig. 8: Palatal-occlusal filling on tooth 64.                                                                      


For more information on SDR please contact your local DENTSPLY representative or click the image below. 



yuyuyyui.jpg







References
1 Fleming, G. J., Awan, M., Cooper, P. R., Sloan, A. J.: The potential of a resin-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 composite resins.
Compend Contin Educ Dent 31, 10-15 (2010)
3 Roggendorf, M. J., Krämer, N., Appelt, A., Naumann, M., Frankenberger, R.: Marginal
quality of flowable 4-mm base vs. conventionally layered resin composite. J Dent 39,
643 -647 (2011)
4 Data on file
5 Rullmann, I., Schattenberg, A., Marx, M., Willershausen, B., Ernst, C. P.: Photoelastic
determination of polymerization shrinkage stress in low-shrinkage resin composites.
Schweiz Monatsschr Zahnmed 122, 294 - 299 (2012)
website 0.1.png