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SELF-STUDY COURSE CLINICAL UPDATE: FLOWABLE COMPOSITE RESINS

IntroductionSince the introduction of adhesive bonding, the types of den-tal resins have increased along with the number of uses. Theearliest composite resins were usually quartz-filled with rea-sonably large filler particles, making restorations difficult to

polish. Due to recent innova-tions, resins are now availablewith smaller filler particles forbetter polishability. A number ofnew product types have alsoemerged in response to needsexpressed by practitioners.

Composite resins are polymermatrix filled, tooth-coloredrestoratives that derive theirphysical properties and han-dling characteristics fromloading with reinforcing fillerparticles and the viscosity ofthe resin matrix. Compositeresins can be classified by fillersize and per cent filler loading,as well as by the viscosity ofthe composite. With theexpanded categories of com-posite resins, they can also beclassified by their uses.

The majority of direct restora-tive composite resins fall intoone of the following categories:hybrid, nano-filled or microma-trix hybrid, microfill, packablecomposites and flowable com-posites. What characterizes acomposite resin are its resinmatrix and filler particles. Oneof the primary reasons for theincreased loading of fillers incomposite resin is to improvephysical properties and resist-ance to functional wear. As fillerloading increased, so did com-posite resin viscosity. Most directrestorative composite resins havea putty-like consistency.

While the putty-like consis-tency of composite resins wasa desirable characteristic formost clinical uses, there was a

desire to have a less viscous composite resin but not onethat was as runny as dental sealants. For this reason, anew class of composite resins was introduced to thedental profession in late 1996. These flowable compos-ites had as their principal characteristic a viscosity thatallowed them to be injected into a cavity preparation.(1)

Most manufacturers packaged these flowable compos-ites in small syringes that allow for dispensing with verysmall gauge needles (usually 20 gauge). Two manufac-turers provide their flowables in unit dose packaging intubes with either a needle end (VersaFlo, Centrix,Shelton, CT) or a small canula end (Tetric Flow,Ivoclar/Vivadent, Amherst, NY). For practitioners withsmall hands, or skeleto-muscular difficulties, e.g.,arthritis, these small tubes can be inserted into a dis-pensing gun, making application of these resins easier.The application of flowable composites through smallneedles or canulas made them ideal for use in smallpreparations that would be difficult to fill with moreconventional composite resins.

Why use a flowable composite?The development of flowable composites was basedupon its flowable viscosity and not any clinical evidenceof success for specific applications. At first glance, flow-able composite resins are not highly filled and are moresusceptible to wear in stress-bearing areas. Dependingon the type of filler used, the majority of flowables arefilled between 41-53% by volume which translates into56-70% by weight.(2) Most manufacturers will citefiller content by weight because the number is alwayshigher. Some of the manufacturers are using fluoridecontaining glass fillers and can make the claim that theycontain fluoride. The availability of the fluoride is ques-tionable. Table 1 lists many of the more popular flow-able composite resins. While the earliest uses cited werefor small, conservative Class I preparations of pits andfissures (preventive resin restorations), today there havebeen case reports on expanded uses of flowable resincomposites.

These uses include:• preventive resin restorations (minimally invasive

occlusal Class I)• pit and fissure sealants• base or liner • small, angular Class V abfraction lesions• sealing ditched amalgam margins• repair of small porcelain fractures in non-stress-bear-

ing areas• surfacing ribbon-reinforced composite resin splints• repairing temporary restorations and adding to mar-

FIGURE 1: Fissurotomy burs (SS White Burs,Lakewood, NJ).

FIGURE 2: Thin and narrow diamonds for mini-mally invasive cavity preparations.

FIGURE 3: Pit and fissure caries on the occlusalsurfaces of the first and second maxillary premolars.

FIGURE 4: Preparation of the occlusal lesionswith air abrasion.

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gins of temporaries fabricated using bis-acryl composite resins

• inner layer for Class II posterior composite resinplacement in sealing the gingival margin to avoiddeficiencies

• enamel defect repair• repair of crown margins• repair of composite resin margins• luting porcelain and composite resin veneers• routine Class I restorations• small Class III restorations

Restoration of posterior teeth using flowable compositesMinimally invasive Class I - preventive resin restorations(PRR)In 1978, Simonsen described a minimally invasivepreparation using small burs and restored with a com-

bined adhesive-compositeresin-sealant technique thathe named preventive resinrestoration, or PRR.(3) Laterreports demonstrated theclinical success of these con-servative restorations.(4)

Today, with the introductionof less viscous, wear resistantcomposite resins (i.e. flowablecomposite resins), the PRRcan be accomplished in amore simplified restorativetechnique.(5, 6) Flowable com-posites offer the advantage ofneedle tip placement into thesmall, conservative prepara-tions of PRR's. Flowable

composite resins donot have the samedepth of cure as otherrestorative compositeresins. They requireincremental placementat a thickness of 2 mmand light curing of 10seconds with a quartzhalogen curing light orLED curing light witha light energy emissionof 600 mW/cm2.Plasma arc (PAC) cur-ing lights should have acuring time of 5 sec-onds.(6)

Since the main use offlowables is to restoreocclusal surfaces ofposterior teeth as a preventive resin restoration,one could be skeptical about the benefit ofchanging to a less wear-resistant, less filled com-posite resin. Actually, flowable composite resinsare an excellent choice as a preventive resinrestoration. By definition, preventive resinrestorations are very small preparations of isolat-ed areas of caries in pits and fissures restored withcomposite resin. After restoration of the isolatedpreparations, the entire occlusal surface is sealedwith a sealant. For billing purposes, these areone-surface posterior composite resins, butbecause these restorations require multiple mate-

CLINICAL UPDATE: FLOWABLE COMPOSITE RESINS SELF-STUDY COURSE

NAME MANUFACTURER

Filtek Supreme Plus Flow 3M-ESPE

FlowTEC Benco Dental

VersaFlo Centrix

Synergy Flow Coltène/Whaledent

Virtuoso Flowable Den-Mat

Dyract Flow Denstply

Esthet-X Flow Dentsply

Gradia Direct Flo GC America

Gradia Direct LoFlo GC America

Unifil Flow GC America

Venus Flow Heraeus-Kulzer

Four Seasons Flow Ivoclar

Tetric Flow Ivoclar

Heliomolar Flow Ivoclar

Point 4 Flowable Kerr-Sybron

Revolution Formula 2 Kerr-Sybron

Wave Southern Dental Industries

Wave HV Southern Dental Industries

Wave MV Southern Dental Industries

PermaFlo Ultradent

TABLE 1: Partial Listing of Flowable Composite Resins

FIGURE 5: Completed preparations.

FIGURE 6: Single component, 5th generationadhesive applied to preparations.

FIGURE 7: Completed restorations with flowablecomposite resin.

FIGURE 8: Pit and fissure caries in the maxillarysecond premolar, first and second molars.


rials—etch, prime, adhesive, hybrid composite resin,sealant—they can be time-consuming and relativelyexpensive to do. With a flowable composite resin, theadhesive technique is the same but only one restorativematerial, the flowable composite, is necessary, and it iseasier to place in these mini-preparations using needletip dispensing. In fact, with those flowables that areless runny, e.g. Gradia Direct LoFlo (GC America,Alsip, IL) and FlowTEC (Benco Dental, Wilkes-Barre,PA) you can build contours to the restoration by

adding small increments and light curing instead ofoverfilling and using a finishing bur to carve the con-tour and anatomy. This translates into less occlusaladjustment.

It is important that flowables not be used to merely sealthe pits and fissures as a sealant replacement with a thinapplication. Thin applications of flowable resin com-posites will fracture in function and be less durable. If aflowable resin composite is desired, some preparation ofthe tooth is necessary to increase the bulk of the com-posite to improve durability and resistance to fracture.When using sealants for the preventive sealing ofocclusal pits and fissures where there will be no prepa-ration, their success is based upon their flexural modu-lus making them less susceptible to fracture. In fact,even with sealant placement you must apply at least athickness of 0.3-0.4 mm to achieve longer clinical suc-cess in sealing the occlusal surface from caries. Sincemost patients having sealant placement are childrenwith a transitional dentition, the addition of sealant tofunctional occlusal surfaces is not a problem. Thisthickness will allow the sealant to be maintained in a pitand fissure as the sealant wears in function.

Flowable composite resins have demonstrated a useful-ness for being matched with the use of air abrasion forcavity preparations .(7) Also, minimally invasive cavitypreparations can be accomplished with tooth prepara-tion using a YSGG (Yittrium Scandium Gallium

Garnet) like Waterlase or Biolase for preparation ofenamel, dentin and carious tooth structure(8) or aVersaWave (Hoya ConBio) for oral use, which is notonly for hard tissue applications but also for soft tissueand endodontic applications. In many cases there is noneed for local anesthetic when performing these prepa-rations. They are ideal for the pediatric patient. Theseminimally invasive cavity preparations created with anair abrasion unit or a laser can be controlled to be nar-row and deep into pits and fissures on the occlusal sur-

face and thus are more difficult to fill with the moreheavily filled, putty-like composite resins. However,precision needle placement with a flowable compositeassures a well adapted restoration. Bear in mind that theclinical success of preventive resin restorations is basedupon a minimal thickness of composite resin in order toresist both wear and fracture. Therefore, the use of airabrasion and the laser allow adequate room for suffi-cient thickness of the flowable composite resin restora-tive material.

If you do not want to use an air abrasion system, yetwant to prepare minimally invasive conservative cavitypreparations as preventive resin restorations (PRRs),then site specific burs can be used.(9) These smaller-tipped burs have been introduced to both diagnose andtreat enamel lesions and to evaluate the extension ofcaries. Originally, smaller burs such as the #330, #½round, #1 round, and #33½ inverted cone were recom-mended for preparing PRRs. Recently, a new class ofburs that are thin enough to allow easy penetration intopits and fissures was introduced (Fissurotomy burs, SSWhite, Lakewood, NJ).(10-12) In some cases, the surfaceof the pit or fissure appears to be intact and relativelyhealthy with only some slight discoloration or stainingof the pit and fissure. Use of these burs allows the clini-cian to prepare the pit or fissure, in many cases withoutanesthesia due to the small surface area of the tip. Oncethe preparation access has been opened and the cariesexplored, decisions for further extensions can be made.


FIGURE 9: Initial preparation with NTF MicroNarrow Tapered Fissurotomy bur (SS WhiteBurs, Lakewood, NJ).

FIGURE 10: Completed preparations. FIGURE 11: Restoring the minimally invasivepreparations with flowable composite.


Fissurotomy burs are available in three different config-urations: Fissurotomy original (1.1 mm wide/2.5 mmlong), Fissurotomy Micro NTF (0.7 mm wide/2.5 mmlong) and Fissurotomy Micro STF (0.6 mm wide/1.5mm long).(Figure 1) Other manufacturers have devel-oped thin diamonds to mimic the Fissurotomyshape.(Figure 2)

Case reports for use of flowable composite forClass I carious lesionsFlowable composite matched with air abrasion techniquesWith a diagnosis of caries, the treatment of the occlusalfissures on the maxillary premolars was initiated.(Figure 3) A dental dam was placed. When using an airabrasion device, the dental dam provides a better meansof controlling and evacuating the fine abrasive powderthat is used during cavity preparation. Since the lesionswere expected to be minimal with only slight extensioninto the dentin, local anesthetic was not administered.If the lesions became more extensive, the patient under-stood that local anesthetic would be used.

Using a setting of 70 psi, with a powder flow of 2grams/minute set on pulsed mode with a 0.014" noz-zle, the aluminum oxide air abrasion device preparedthe occlusal surfaces.(Figure 4) Santos-Pinto andcoworkers found that different tip designs and diam-eters of the air abrasion nozzle produced differentcutting patterns.(13) Smaller diameter tips producednarrower, more controlled cuts. Narrow cutting fol-lows the conceptual preparation parameters ofocclusal surfaces of preventive resin preparations. Thepreparations were evaluated for complete cariesremoval. (Figure 5) The cavity preparations wereetched for 15 seconds with a phosphoric acid etchant,then rinsed for 10 seconds with an air-water spray anddried. A single component, 5th generation adhesivewas applied to the preparations with a microapplica-tor. (Figure 6) An air stream was used to evaporatethe solvent from the adhesive and air-thin the adhe-

sive before light curing. The adhesive was light curedfor 10 seconds. A flowable composite resin was placedinto the preparations and light cured for 20 secondswith a quartz halogen curing light. The restorationswere finished and polished using conventional tech-niques. The completed restorations were wellsealed.(Figure 7) The dam was removed and theocclusion was checked and adjusted.

Use of site-specific burs and flowable compositeA patient presented for treatment with a past histo-ry of not having dental treatment for five years. Themaxillary first and second molars and second premo-lar were diagnosed with caries. (Figure 8) Bitewingradiographs did not show the extent of the caries.After anesthesia was administered, a dental dam wasplaced. In order to gain access to the distal portionof the maxillary second molar, a W8AD wingless dis-tal extension rubber dam retainer (Hu-Friedy,Chicago, IL) was used. While the occlusal surfacefelt hard to an explorer, when the teeth were transil-

luminated the caries appeared to be more extensive.The first and second molars were entered with aFissurotomy bur (SS White, Lakewood, NJ) and afterthe caries was better visualized, the teeth were pre-pared using a #245 bur. The mesio-occlusal pit of thefirst molar and occlusal pit of the second premolar hadminimal caries. The decision was made to do a preven-tive resin preparation using a NTF Micro NarrowTapered Fissurotomy bur. (Figure 9) The NTFFissurotomy bur allows the fissure to be explored withminimal tooth removal to evaluate the extent of thecaries and to complete the preparation. The outline ofthe preparations was dictated by the extension of thecaries. (Figure 10)

The cavity preparations were etched for 15 seconds witha phosphoric acid etchant, then rinsed for 10 secondswith an air-water spray and dried. A single component,


FIGURE 12: Completed restorations. FIGURE 13: Radiographic evidence of mesialcaries in mandibular second premolar.

FIGURE 14: Completed cavity preparation.


5th generation adhesive wasapplied to the preparations witha microapplicator. An air streamwas used to evaporate the sol-vent from the adhesive and airthin the adhesive before lightcuring. The adhesive was lightcured for 10 seconds. The largerpreparations were restored byplacing increments of packablecomposite resin into the prepa-rations with preloaded tips. Theminimally invasive preventiveresin preparations in the firstmolar and second premolar wererestored with flowable compos-ite resin. (Figure 11) As statedbefore, flowable compositeresins are perfectly matched tofissurotomy preparationsbecause they can be placed witha needle tip and the materialadapts to the small conservativesized preparations. The restora-tions were finished and polishedusing conventional compositeresin techniques. The rubberdam was removed and occlusionverified. (Figure 12)

Flowable composites forClass II preparationsFor conservative preparation ofClass II interproximal carieswith only initial caries on theproximal surface and no carieson the occlusal surface, a facialapproach for the cavity prepara-tion will leave the marginal ridgeintact.(14) Flowable compositeresins are also ideally suited forthe restoration of a facialapproach Class II cavity prepara-tion. Another use for flowablecomposite resins is in conjunc-tion with placement of viscouspackable composite resins.

For this case, the diagnosis ofproximal caries can be seen inthe bitewing radiograph(Figure 13). The cavity prepa-

ration was completed (Figure 14). After the adhesiveprocedure, an initial increment of a flowable compositewas syringed into the proximal box (Figure 15) toassure complete adaptation of the composite resin at allaspects of the gingival margin. The flowable compositeresin was not light cured until placement of the firstincrement of the packable composite. Once placed, theflowable and packable composite resins become sand-wiched together and are then light cured. Tung andcoworkers evaluated packable composite resin place-ment with and without a flowable composite resin.They found that there was significantly less microleak-age in teeth restored with the flowable composite resinas the first increment in the proximal box.(15) Leevailojand others also showed less microleakage at the gingivalmargin of Class II preparations.(16) These findings havebeen confirmed by other research at New YorkUniversity School of Dentistry.(17) Figure 16 shows thecompleted Class II restoration.

Flowable resins used as a base or linerBases and liners have been traditionally used as pulpal protec-tion when the dentin is thin over the pulp, to build-up cavitypreparations and to block out undercuts. It has been reportedthat flowable composite resins have been used as a base andliner in clinical applications. In recent years, there has beeninterest in using flowable composite as a liner that parallels theincrease in postoperative sensitivity reported by clinicianswhen placing posterior composite resins.(18-20)

The use of a flowable composite resin as a liner has beencontroversial.(21) While many clinicians have beenachieving success at reducing postoperative sensitivitywith the use of flowable composite resin as a liner,(18)

clinical research shows no difference in postoperativesensitivity between using an adhesive alone compared tousing a flowable composite as liner.(21) Also, anecdotal-ly, the use of self-etch systems have been reported todecrease postoperative sensitivity with posterior com-posite resins that are not supported by clinical trialscomparing total etch and self etch adhesive use withposterior composites.(22) The final conclusion of thisresearch study was that postoperative sensitivity is clini-cian specific.

Due to the techniques they are using, some practition-ers tend to see increased postoperative sensitivity.(22)

When using flowable composite resins as liners, increasethe curing time for conventional quartz halogen andLED lights to 20 seconds. The depth of cure of flowablecomposite resins when compared to hybrid compositeresins is less due to increased light scatter created by the


FIGURE 15: Placement of flowable compositeresin as first increment in proximal box.

FIGURE 16: Completed restorations.

FIGURE 17: Periodontally compromisedmandibular anterior teeth with incisal wear ofthese anterior teeth.

FIGURE 18: Preparation into the dentin to adepth of 1.0 mm of the incisal edges of themandibular incisors.

FIGURE 19: Completed restorations and fiberreinforced periodontal splint.



filler particles and opacity of flowable compositeresins.(23) Also note that in future radiographs, flowablecomposites may appear less radiopaque than the pack-able composite resin placed with them. There are vari-ances in the radiopacity of different flowable compos-ites.(24, 25) If used as the first increment for a Class IIrestoration or as a liner to prevent sensitivity, they mayappear as a gap or less radiolucent under a moreradiopaque hybrid composite resin that you typicallyuse to restore teeth. The clinical appearance of the radi-ograph may mimic recurrent caries. It is important thatyou verify intact margins with your explorer. If using aflowable composite as a liner to prevent postoperativesensitivity, a good recommendation is to make a radi-ograph of your chosen flowable placed in an extractedtooth to mimic the placement of a liner in a routinecavity preparation and then restore that tooth with yourchosen restorative composite resin. This will provideyou with a baseline. The restored tooth can now be usedas a reference to the radiographic appearance of theflowable within the cavity preparation.

Restoration of Class V preparations with flowablecompositesSmall, angular Class V non-carious lesions have beenassociated with abfraction.(26) These lesions, which arecaused by flexure of the tooth once it has beenrestored with stiff hybrid composite resins, have beenassociated with a clinical success rate of only 70%.(27)

It was assumed that the stiffness of the compositeresin contributed to this high failure rate. By using aflowable composite resin with a lower biaxial flexuralstrength than traditional hybrid composite resins, itwas assumed that clinical success of adhesive restora-tions for these Class V lesions would improve. Afterone year, a Class V clinical study using a flowablecomposite resin demonstrated that all restorationswere intact.(28) This study also reported no sensitivi-ty after one year. This correlates to in-vitro microleak-age studies of flowable composites that have demon-strated good marginal sealing at enamel and dentinmargins with an adhesive technique using a flowablecomposite resin.(29,30) Use of a flowable compositeresin with an adhesive technique for non-cariousClass V lesions has merit.

Other applications for flowable compositesBesides the primary uses for flowable composite resins thathave been stated, other uses for flowable composite resinshave been described. In clinical situations where there aresmall areas of incisal wear into the dentin, a small prepara-tion with a 329 bur to a depth of 1.0 mm and an adhesive

restoration with a flowablecomposite resin is indicated.(1,

31) For this case, the teeth wereperiodontally compromisedwith mobility.(Figure 17) Thepatient's chief complaint wasdiscomfort when biting intofood due to the occlusal trau-ma on the anterior teeth andshe was unhappy with theappearance of the worn incisaledges.

A minimally invasive prepara-tion with a depth of 1 mm wasmade using a 329 bur. (Figure18) The mandibular anteriorteeth were splinted with anadhesive fiber reinforced com-posite resin and the incisaledges restored with a flowablecomposite resin. (Figure 19)The lingual surface of thefiber splint was covered withflowable. When using fiberreinforcement ribbon for peri-odontal splinting, the use of aflowable composite resin tosmooth the lingual surface ofthe splint has been demon-strated to be useful.(32, 33) Also,there has been an increasingnumber of young patientswith the "cupping out" of thecusp tips on the maxillary andmandibular first molars.(31)

(Figure 20) These are pre-pared with either a 329 or 330bur to a depth of 1 mm.(Figure 21) The depth of 1mm improves the durablilityof these restorations.(31) Usingeither a total etch or self-etchadhesive, these are thenrestored with a flowable com-posite resin. (Figure 22)

Other uses for flowable com-posite include the repair ofamalgam margin defects toextend the life of an amalgamrestoration.(34) With the

FIGURE 20: "Cupping" of cusp tips of mandibularfirst molar due to wear.

FIGURE 21: Preparation of cusp tips to depth of 1.0 mm.

FIGURE 22A: Cusp tip preparations restored withflowable composite.

FIGURE 22B: 7-year recall of restorations (note thewear of the flowable as a sealant over the pastseven years.

FIGURE 23A: . Preoperative view of overlappingmaxillary central incisors.

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1. Moon PC, Tabassian MS, CulbreathTE. Flow characteristics and film thick-ness of flowable resin composites.Oper Dent 2002; 27:248-253.

2. Bayne SC. et al. A characterization offirst-generation flowable composites. JAm Dent Assoc 1998; 129:567-77.

3. Simonsen RJ. Preventive resin restora-tions. Quintessence Int 1978; 9:69-76.

4. Simonsen RJ, Landy NA. Preventiveresin restorations: fracture resistanceand 7 year clinical results. J Dent Res(Special Issue) 1984; 63:175, abstractno. 39.

5. Moon PC, Tabassian, Culbreath TE.Flow characteristics and film thicknessof flowable resin composites. OperDent 2002; 27:248-253.

6. Strassler HE, Goodman HS. A durableflowable composite resin for preventiveresin restorations. Dentistry Today2002; 21:116-121.

7. Hamilton JC, Dennison JB, StoffersKW, Welch KB. A clinical evaluation ofair-abrasion treatment of questionablecarious lesions. A 12-month report. JAm Dent Assoc 2001; 132:762-9.

8. Freedman G. On the cutting edge oflasers. Dentistry Today 2004;23(11):148-156.

9. Strassler HE. Easy-to-place packableposterior composite resin.Contemporary Esthet Rest Pract 2000;3(10):44-48.

10. Goff, S. Less is more. Dental ProductsReport May 2004:18-26.

11. Hudson P. Conservative treatment ofthe Class I lesion. A new paradigm fordentistry. J Am Dent Assoc2004;135:760-4.

12. Strassler HE, Park S. Easy-to-placepackable composite resin, ContemEsthet and Rest Pract 2000; 4(10):44-48.

13. Leibenberg WH. A useful evacuationaid for intraoral air-abrasive devices.Quintessence Int 1997; 28:105-108.

14. Strassler HE. Predicatable and suc-cessful posterior packable Class IIcomposite resins. Am Dent Instit for CE2001; 75:15-23.

15. Chuang SF, et al. Effects of flowablecomposite lining and operator experi-ence on microleakage and internalvoids in class II composite restorations.J Prosthet Dent 2001; 85:177-83.

16. Leevailoj C, et al. Microleakage of pos-terior packable resin composites withand without flowable liners. Oper Dent2001; 26:302-7.

17. Tung FF, Hsieh WW, Estafan D. In vitromicroleakage study of a condensableand flowable composite resin. GenDent 2000; 48:711-5.

18. Christensen G. Preventing postopera-tive sensitivity in Class I, II, and Vrestoratations. J Am Dent Assoc 2002;133:229-231.

19. Eick JD, Welch FH. Polymerizationshrinkage of posterior composite resinsand its possible influence on postoper-ative sensitivity. Quintessence Int1986; 17:103-111.

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microleakage. Am J Dent 1998;11:229-234.

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References

increased usage of auto mix BIS-acrylcomposite resins as provisional restora-tions, the need to repair margins hasbeen a problem. Methylmethacrylaterepairs have been unsuccessful.However, the use of a flowable compos-ite resin has been shown to be a reliablemethod of repair for BIS-acryl compos-ite resin provisional restorations.(35) Theflowability of these composites havemade it useful for placement of porce-lain veneers(2) (Figure 23), reattachmentof a tooth segment(20) and for repair-ing composite resin and crown margin-al defects (2, 37).

ConclusionWhen flowable composite resins werefirst introduced, they appeared to beone- dimensional restorative materialswith very limited uses. Over the last fewyears, the usefulness of flowable com-posite resins has been demonstrated.When choosing a flowable compositeresin, pick one that works well in yourhands. Most flowables have a variety ofshades to manage most esthetic clinicalsituations. There is variability in theviscosity of these restorative materials;choose the viscosity that will best suityour needs.

FIGURE 23B: Minimally invasive preparation of themaxillary incisors

FIGURE 23C: Completed LUMINEERS porcelainveneers bonded using a flowable composite resin.

07 • incisal edge 1 69


Self-Test1. All the following are types of composite

resins EXCEPT:a. hybrid composite resinb. flowable composite resinc. xenophobic composite resin d. packable composite resin

2. According to this article, flowable com-posite resins were introduced in:a. 1985b. 1996 c. 2001d. 2005

3. Flowable composite resins can be char-acterized as:a. having a high viscosity and are

filled 75-80% by weightb. having a low viscosity and are filled

75%-80% by weightc. having a high viscosity and being

filled 56-70% by weightd. having a low viscosity and being

filled 56-70% by weight

4. Flowable composite resins can be usedfor the following applications EXCEPT:a. preventive resin restorations

(minimally invasive occlusal Class I)b. sealing margins of amalgam

restorationsc. cementing porcelain veneersd. as an endodontic filling material

5. TRUE or FALSE: A deficient margin of aprovisional restoration fabricated froma BIS-Acryl composite resin can berepaired with a flowable compositeresin.a. True b. False

6. Preventive resin restorations (PRR) areclassified as:a. Class III restorationsb. Class I restorationsc. Class V restorationsd. Class IV restorations

7. Sealants should have a thickness of___________ to assure a higher level ofclinical success when placed on occlusalsurfaces of posterior teeth.a. 0.1 mmb. 0.3-0.4 mmc. 0.5-1.0 mmd. 1.5-2.0 mm

8. Preventive resin restorations (PRR) canbe prepared using:a. small burs such as #1 round burs or

#330 pear shaped bursb. air abrasion systemsc. pointed fluted Fissurotomy bursd. all of the above

9. According to this article, the techniquesequence for a PRR after tooth prepara-tion is:a. laser etch, air abrade, adhesive,

flowable composite resinb. etch, adhesive, flowable composite

resin c. glass ionomer liner, etch,

adhesive, flowable composite resind. flowable composite resin only

10. According to this article, which uniquefeature of flowable composite resinsmakes them easier to place in small,minimally prepared preventive resinpreparations?a. wide selection of shadesb. needle-tip placementc. easier to shape with

plastic filling instrumentsd. putty-like consistency allows

them to be placed without distorting

11. Flowable composite resins are useful forClass II, proximal surface restorations ofposterior teeth when using a packablecomposite resin as:a. a surface sealer after placement of

the packableb. as the first increment in the proximal

box before placement of the packable composite resin

c. as an intermediary second increment to assure occlusal sealing of the margins

d. total filling of the proximal box of a Class II restorations with only the occlusal surface filled with packable composites

12. TRUE or FALSE: It has been reported that aflowable composite resin can be used as aliner when placing posterior compositeresin restorations as a way to reduce postoperative sensitivity.a. True b. False

13. One way of minimizing post operativesensitivity when placing posterior com-posite resins is to:a. extend the etching time before

adhesive placementb. use only self-cure composite resinsc. use a flowable composite resin as

a linerd. make sure the tooth is very dry

before placing bonding agent

14. When a flowable composite resin is usedas a liner in cavity preparations, the curingtime for LED and quartz halogen lights asrecommended by this article is:a. 5 secondsb. 10 secondsc. 20 secondsd. 60 seconds

15. When viewing a radiograph, flowablecomposite resins appear:a. to be more radiolucent than amalgamb. to be more radiopaque than amalgamc. vary from product to productd. a and c

16. TRUE or FALSE: Adhesive flowable com-posite resin is used for the restoration ofangular, Class V non-carious lesionsbecause these resins have a lower biaxialflexural strength than traditional hybridcomposite resins, and as a result, havebeen demonstrated to have good clinicalsuccess.a. Trueb. False

17. Flowable composite resins are a goodchoice as a restorative when restoring theworn incisal edge of anterior teeth that:a. are small in size and are prepared

with very small diameter bursb. are large in size, even if you are

building additional incisal heightc. Flowable composite resins should

never be used for worn incisal edgesd. Flowable composite resins should

only be used for maxillary incisors because there are not enough shades to match the color of teeth

18. TRUE or FALSE: Fiber reinforcementmaterials embedded in composite resinare successful when splinting periodon-tally compromised teeth. When usingfiber reinforcement ribbon for periodontalsplinting, the use of a flowable compos-ite resin can be used to smooth the lin-gual surface of the splint after embed-ding the fiber ribbon into the more highlyfilled composite resin. a. Trueb. False

19. When using an automix BIS-acryl com-posite resin for provisional (temporary)crowns and bridges, when a margin isdeficient, the material of choice to repairthat margin would be:a. microfill composite resinb. methyl methacrylate unfilled resinc. flowable composite resind. do not repair, remake the restoration

20. Although there are specific light-curedcomposite resin cements for use inplacing porcelain veneers, what otherrestorative material can be used forporcelain veneer bonding?a. zinc phosphate cementb. resin-modified glass ionomer

cementc. flowable composite resind. packable composite resin



CLINICAL UPDATE:Flowable Composite Resins

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