The configuration of post-endodontic treatment cavities is typically deep. If the surrounding tooth structure is still intact, there will be a high C-factor (cavity configuration factor) due to the large surface area for the filling material to bond to.
Polymerisation shrinkage stress builds up inside a cavity according to the size of the bonded surface area that is holding a composite in place. The larger the bonded surface area the higher the level of polymerisation stress, resulting in an increased risk of composite detachment from the cavity walls or marginal leakage. Not only does this result in a failed restoration, it also poses risk to the integrity of the endodontic procedure underneath¹.
SDR® Plus from Dentsply Sirona is the ideal material for coronal sealing of endodontic cavities, especially with high C-factors. SDR® Plus can be bulk-filled in increments of 4mm due to its patented formulation which provides the necessary viscoelastic properties for low-stress, controlled polymerisation2. As a result, SDR® Plus has up to 60% lower shrinkage stress3 than competing conventional and bulk-fill composites. In addition, SDR® Plus has unique self-levelling properties which allow it to automatically adapt to the geometry of a cavity. This, in combination with the fact that SDR® Plus has sufficient mechanical strength for use in the posterior region, high micro-tensile bond strength and has shown excellent adhesion to the cavity-floor, makes SDR® Plus the ideal material for post endo, high C-factor access cavities.
Case Study
The present case shows the use of SDR® Plus for coronal sealing and bulk-filling of endodontic cavities in one single step.
Fig: 1. Direct restorations Class I and II after endodontic treatment. The access cavities show the root canals.
Fig: 2. The root canals were obturated with Gutta-Percha and AH® Plus sealer.
Fig: 3. Etching procedure with phosphoric acid gel (DeTrey® Conditioner 36).
Fig: 4. After rinsing and drying of the cavity the universal adhesive Prime&Bond universal™ was applied. The adhesive was gently air-blowed and light-cured.
Fig: 5. Bulk-filling (one increment, up to 4mm) of the Class I cavity with SDR® Plus and subsequent light-curing for 20 secs.
Fig: 6. Occlusal surface was restored with the universal composite ceram.x® SphereTEC™ one.
Fig: 7. In this case study a circumferential matrix band was placed around the second tooth followed by the application of Prime&Bond universal™ adhesive. It would be recommended to use a sectional matrix system such as Palodent® V3 for more accurate and contoured contacts.
Fig: 8. After bulk-filling the Class II cavity with SDR® Plus the occlusal surface was reconstructed with a 2mm layer of ceram.x® SphereTEC™ one.
Conclusion
Given the depth of many access cavities, the possibility of bulk-filling cavities is also important in post-endodontic treatment. In the present case, SDR® Plus was used to fill Class I and II cavities in bulk up to 4mm immediately after the root canal treatment. The self-leveling consistency as well as the reduced polymerisation shrinkage stress of SDR® Plus in cavities (Van Ende et al. 2016), allows both optimal adaptation and adhesion to the cavity and thus coronal sealing of the root canal filling. Another advantage of this bulk-filling composite is its transparency allowing an easy retrieval of the root canal filling, e.g. in case of a subsequent post placement.
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:sharpen(level=0):output(format=webp)/up/dt/2018/08/IMG_8405-ok-9-3.jpg "SDR® Plus – The Ideal Bulk-Fill Material in High-C Factor Cavities")
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:sharpen(level=0):output(format=webp)/up/dt/2018/08/IMG_8382-ok_2-2.jpg "Before")
:sharpen(level=0):output(format=webp)/up/dt/2018/08/IMG_8405-ok-9-2.jpg "After")
:sharpen(level=0):output(format=webp)/up/dt/2018/08/IMG_8261-ok_-1-1.jpg "Fig: 1. Direct restorations Class I and II after endodontic treatment. The access cavities show the root canals.")
:sharpen(level=0):output(format=webp)/up/dt/2018/08/IMG_8382-ok_2-3.jpg "Fig: 2. The root canals were obturated with Gutta-Percha and AH® Plus sealer.")
:sharpen(level=0):output(format=webp)/up/dt/2018/08/IMG_8386-ok-3-1.jpg "Fig: 3. Etching procedure with phosphoric acid gel (DeTrey® Conditioner 36).")
:sharpen(level=0):output(format=webp)/up/dt/2018/08/IMG_8388-ok-4-1.jpg "Fig: 4. After rinsing and drying of the cavity the universal adhesive Prime&Bond universal™ was applied. The adhesive was gently air-blowed and light-cured.")
:sharpen(level=0):output(format=webp)/up/dt/2018/08/IMG_8392-ok-5-1.jpg "Fig: 5. Bulk-filling (one increment, up to 4mm) of the Class I cavity with SDR® Plus and subsequent light-curing for 20 secs.")
:sharpen(level=0):output(format=webp)/up/dt/2018/08/IMG_8393-ok-6-1.jpg "Fig: 6. Occlusal surface was restored with the universal composite ceram.x® SphereTEC™ one.")
:sharpen(level=0):output(format=webp)/up/dt/2018/08/IMG_8394-ok-7-1.jpg "Fig: 7. In this case study a circumferential matrix band was placed around the second tooth followed by the application of Prime&Bond universal™ adhesive. It would be recommended to use a sectional matrix system such as Palodent® V3 for more accurate and contoured contacts.")
:sharpen(level=0):output(format=webp)/up/dt/2018/08/IMG_8405-ok-9-3.jpg "Fig: 8. After bulk-filling the Class II cavity with SDR® Plus the occlusal surface was reconstructed with a 2mm layer of ceram.x® SphereTEC™ one.")
:sharpen(level=0):output(format=jpeg)/up/dt/2018/08/IMG_8382-ok_2-2.jpg "Before")
:sharpen(level=0):output(format=jpeg)/up/dt/2018/08/IMG_8405-ok-9-2.jpg "After")
:sharpen(level=0):output(format=jpeg)/up/dt/2018/08/IMG_8261-ok_-1-1.jpg "Fig: 1. Direct restorations Class I and II after endodontic treatment. The access cavities show the root canals.")
:sharpen(level=0):output(format=jpeg)/up/dt/2018/08/IMG_8382-ok_2-3.jpg "Fig: 2. The root canals were obturated with Gutta-Percha and AH® Plus sealer.")
:sharpen(level=0):output(format=jpeg)/up/dt/2018/08/IMG_8386-ok-3-1.jpg "Fig: 3. Etching procedure with phosphoric acid gel (DeTrey® Conditioner 36).")
:sharpen(level=0):output(format=jpeg)/up/dt/2018/08/IMG_8388-ok-4-1.jpg "Fig: 4. After rinsing and drying of the cavity the universal adhesive Prime&Bond universal™ was applied. The adhesive was gently air-blowed and light-cured.")
:sharpen(level=0):output(format=jpeg)/up/dt/2018/08/IMG_8392-ok-5-1.jpg "Fig: 5. Bulk-filling (one increment, up to 4mm) of the Class I cavity with SDR® Plus and subsequent light-curing for 20 secs.")
:sharpen(level=0):output(format=jpeg)/up/dt/2018/08/IMG_8393-ok-6-1.jpg "Fig: 6. Occlusal surface was restored with the universal composite ceram.x® SphereTEC™ one.")
:sharpen(level=0):output(format=jpeg)/up/dt/2018/08/IMG_8394-ok-7-1.jpg "Fig: 7. In this case study a circumferential matrix band was placed around the second tooth followed by the application of Prime&Bond universal™ adhesive. It would be recommended to use a sectional matrix system such as Palodent® V3 for more accurate and contoured contacts.")
:sharpen(level=0):output(format=jpeg)/up/dt/2018/08/IMG_8405-ok-9-3.jpg "Fig: 8. After bulk-filling the Class II cavity with SDR® Plus the occlusal surface was reconstructed with a 2mm layer of ceram.x® SphereTEC™ one.")
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