Go with the flow

One size fits all

Introduced in late 1996,[iii] flowable composites endeavoured to answer the question, what do dentists use when the viscosity of a direct restorative composite doesn’t allow for optimal adaptability to the cavity wall? By reducing the filler load, from between 50%-70% (volume) to 37%-53%, the material takes on an increasingly free-form structure.[iv] As a result, the tightest crevices can be filled. Solutions today display great range in this capacity, and preferences may differ from one clinician to the next. It may be helpful to request a demonstration of a new product you are considering to see if it will work for you.

With greater malleability comes an increased range of applications, allowing clinicians to diversify their options when approaching treatments. Suitable for Class I through to V restorations, and even when bonding orthodontic brackets or lingual orthodontic retainers,[v] the versatility of flowable composites is a key strength.

A wide range of uses would not mean much if flowable composites didn’t provide excellent results, too. They often have good aesthetics and provide better handling for the clinician,[vi] which could improve treatments and their eventual outcomes. A product’s adhesive capabilities must also be of a high quality. Class V cavities, for example, commonly present little to no enamel at the cervical margins, complicating attempts for adequate adhesion;[vii] to treat such a case with confidence, a clinician must employ a composite that they trust to bond well, as well as restore a natural appearance.

Bubble trouble

Despite all of the advantages of a flowable composite, one of the greatest frustrations is the creation of ‘voids’ or ‘bubbles’ within the restoration. These small pockets of air may inadvertently only be noticed on a radiograph following the completion of treatment. At this point it’s likely too late to make an adjustment; then follows an uncomfortable conversation about the need to consider redoing the treatment.

A tiny air bubble can present a large issue for a number of reasons. It could create a small visual defect,[viii]which can be detrimental if the treated case is in the aesthetic zone. It only takes a small blemish for a patient to be unhappy with the treatment, and perhaps seek future care at another practice.

Another unfavourable symptom will be more likely to affect patients who are frequent flyers. Barodontalgia is tooth pain that results from a change in pressure, as any present air bubbles expand or contract.[ix] Patients could experience sensations of sharp pain or squeezing, as the aeroplane cabin pressure changes during ascent and landing. The pain could even persist after pressure equalisation.[x]

A trusted tool

For the best-of-both-worlds, the strengths of flowable composites can be experienced without the frustration caused by bubbles when used correctly. Clinicians may need to incrementally place the flowable composite material in the cavity, light curing at each stage to avoid air bubbles.[xi] Whilst this may help curtail error-making in the placement process, a greater solution may come from the material and container itself.

To minimise voids or bubbles, clinicians rely on the mixing of the composite material when it is injected into the syringe.[xii] The design of the application tool could create trapped air within, leading to the creation of the minute spaces within the final restoration. Trying to ‘pop’ or remove these can often be a frustrating task in itself, so its important to optimise the application technique.

Effective results can be achieved brilliantly with the Filtek Supreme Flowable Restorative, an award winning* composite solution with high strength and wear resistance from 3M. Bubbles are virtually eliminated from your workflows with the introduction of an ergonomic syringe that provides excellent material control,** and creates effective results in a variety of applications. Clinicians can even request a free in-practice or virtual demo to understand how to maximise its potential.

Flowable composites are an essential part of so many workflows, and their excellent ability to adapt to small cavities make them a brilliant tool in the dental arsenal. With ways to minimise complications such as air bubbles, clinicians will long be providing aesthetic restorations with ease, and sending patients home filled with joy.

For more information, call 08705 360 036 or visit www.go.3M.com/ocsdpr

3M and Filtek are trademarks of the 3M Company.

* Dental Advisor award-winning product: https://www.dentaladvisor.com/evaluations/3m-filtek-supreme-flowable-restorative/

** 3M Internal data

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[i] Department of Health & Social Care, (2019). National plan to phase down use of Dental Amalgam in England. (Online) Available at: https://assets.publishing.service.gov.uk/media/5d12135be5274a0698d0b8a4/phasing-down-use-of-dental-amalgam-in-england.pdf

[ii] Abbasi, M. S., Lal, A., Das, G., Salman, F., Akram, A., Ahmed, A. R., … & Ahmed, N. (2022, October). Impact of Social Media on Aesthetic Dentistry: General Practitioners’ Perspectives. In Healthcare (Vol. 10, No. 10, p. 2055). MDPI.

[iii] Baroudi, K., & Rodrigues, J. C. (2015). Flowable resin composites: a systematic review and clinical considerations. Journal of clinical and diagnostic research: JCDR, 9(6), ZE18.

[iv] Baroudi, K., & Rodrigues, J. C. (2015). Flowable resin composites: a systematic review and clinical considerations. Journal of clinical and diagnostic research: JCDR, 9(6), ZE18.

[v] Khaja, M. A., Arani, N., & Vijayalakshmi, D. (2021). Are Flowable Restorative Composites Suitable for Orthodontic Bracket Bonding?. World, 12(4), 334.

[vi] Lassila, L., Säilynoja, E., Prinssi, R., Vallittu, P., & Garoushi, S. (2019). Characterization of a new fiber-reinforced flowable composite. Odontology, 107, 342-352.

[vii] Singh, S., Goel, D., Awasthi, N., Khandelwal, D., Sharma, A., & Patil, S. (2021). Comparative evaluation of marginal integrity of three esthetic restorative materials–An In-vitro study. Contemporary Clinical Dentistry, 12(3), 241.

[viii] Devoto, W., (2020). Bubble-free flowable restoration in estheetic anterior composites. Style Italiano. (Online) Available at: https://www.styleitaliano.org/bubble-free-flowable-restoration-in-esthetic-anterior-composites/ [Accessed December 2023]

[ix] Pain, C. D. (2007). Dental pain. US Pharm, 32(5), 18-23.

[x] Stoetzer, M., Kuehlhorn, C., Ruecker, M., Ziebolz, D., Gellrich, N. C., & von See, C. (2012). Pathophysiology of barodontalgia: a case report and review of the literature. Case reports in dentistry, 2012.

[xi] Dukić, W., Majić, M., Prica, N., & Oreški, I. (2021). Clinical evaluation of flowable composite materials in permanent molars small class I restorations: 3-year double blind clinical study. Materials, 14(15), 4283.

[xii] Devoto, W., (2020). Bubble-free flowable restoration in estheetic anterior composites. Style Italiano. (Online) Available at: https://www.styleitaliano.org/bubble-free-flowable-restoration-in-esthetic-anterior-composites/ [Accessed December 2023]