Case study: Herculite® XRV Ultra™ and OptiBond™ XTR

Clinical Case
Case study: Herculite® XRV Ultra™
and OptiBond™ XTR
Marco Bambace
Case study: Herculite® XRV Ultra™
and OptiBond™ XTR
Supporting the future generations in dentistry
Marco Bambace,
Is currently a student at the University of Padova (Department of Dentistry) in his fifth year of
studies. He will achieve the degree of Doctor in Dentistry in 2016. With his talent for direct
restorations, Marco Bambace performed this in vivo case using Kerr restorative products
and filling accessories.
A 52-year-old patient presented with a request to replace defective,
old restorations and improve the aesthetics of the smile.
A decision was made to remove the old restorations from teeth 11,
12, 21 and 22, as well performing coronoplasty to improve the final
aesthetic results. For reasons related to the patient’s health, the
treatment was performed over two sessions.
For the bonding procedure, the 2-step self-etching bonding system
OptiBond XTR was chosen. The clinical procedure consisted of the
application of a self-etching primer that changes the morphology of
the enamel surface depending on its pH, followed by the application
of the adhesive.
The pH of Optibond XTR Primer is 2.3 and decreases to 1.7 during
application. Then it switches to a value of 7, due to a chemical
reaction with the calcium ions of the dental tissues. Optibond XTR
performs very well on the dentine surface as well, dissolving the
smear layer effectively.
The self-etching primer was applied using a microbrush with gentle
and active brushing for at least 20 seconds in order to promote
the remineralisation and the infiltration of the substrate (“continuous
brushing technique”). The solvent was evaporated using an indirect
and gentle air stream.
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The adhesive was applied using a microbrush with active
“scrubbing”, waiting for 15-30 seconds in order to obtain the
diffusion of the resin by capillarity into the substrate and the excess
was removed through a capillary action into air stream and light
substrate, and for 10 seconds, using the LED curing light Kerr
Demi Ultra
The main benefits of using the Optibond XTR Bonding System are:
1. Fast application and predictable results
2. No need to rinse and therefore no risk of issues related to
moisture control of the dentine surface
3. Good bond strength to both enamel and dentine.
Knowing the functional and aesthetic features of Herculite XRV Ultra
composite, the cavity was prepared by completely removing the
previous restorations and any carious dentine, without removing
the discoloured/secondary dentine, which will be perfectly masked
by the opacity of the dentine shade of Herculite XRV Ultra.
The opacity of Herculite XRV Ultra Dentine shade is able to cover
the dentine discolouration without the need for further opaque
shades. The application and sculpting of the composite was
performed using the Kerr Comporoller, a useful modelling tool that
consists of a handle and interchangeable tips with different shapes
to use depending on the type of restoration. Moreover, thanks to
the unique material of which they are made, the composite doesn’t
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stick to the tips and therefore its placement is fast and easy.
Polishing and high-gloss polishing of the restoration was performed
in few fast and simple steps. Unlike other materials, Herculite XRV
Ultra makes it possible to obtain high aesthetic results with a natural
appearance in few minutes.
The results achieved show that use of Kerr Herculite XRV Ultra
composite materials in the anterior can achieve a significant
aesthetic improvement of the smile using conservative techniques
and without recourse to prosthetic solutions.
In addition, the use of Herculite XRV Ultra as an anterior restorative
can achieve a significantly improved aesthetic simile without using
indirect restorations.
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Dr. Emiliano Rossi
The following case was conducted under the supervision of Dr.
Emiliano Rossi (Chief of Department of Dentistry in the same
University, Padova).
1, 2, 3 – Pre-operative views. Note the presence of large and faulty fillings and
the lack of harmony between the substrate and the restorations.
4, 5 – Placement of Kerr OptiDam rubber dam; anterior and occlusal views.
6 – Removal of old restorations and secondary caries on teeth 12 and 22.
7 – Application of OptiBond XTR Premier and Bonding on the surface in two
different steps. Then stratification of the Kerr Herculite XRV Ultra dentine on
tooth 22. (Dentine A3 in the cervical portion, Dentine A2 in the middle third and
incisal / neutral in the incisal third).
8 – Stratification of Kerr Herculite XRV Ultra enamel (Enamel A2) on tooth 22.
9 – Polymerization of the composite using an LED Kerr Demi Ultra curing light.
10 – Polymerization of the composite using an LED Kerr Demi Ultra curing light
with applications of glycerin-based gel, in order to avoid the oxygen inhibited
layer.
11, 12 – Removal of the old restorations for teeth 11 and 21, as well as a
vestibular layer of tooth structure to allow proper stratification of the composite.
13 – After bonding with the Kerr OptiBond XTR system, stratification of the Kerr
Herculite XRV Ultra dentine mass (Dentine A2) at 11 and 21 was performed.
14, 15 – Stratification of the Kerr Herculite XRV Ultra using enamel A2. Note
that the handling features of Herculite Ultra composite allows the layering of a
large mass of composite to restore the shape of tooth in a single step, without
the need of using a mock-up technique.
16 – Surface finishing and shaping, using diamond burs (40,15 micron) and
macro texture performed with carbide burs. Finishing with Kerr Opti1Step
polisher (Dia1Step in Italy, distributed by Ravelli S.p.a.).
17 – Finishing with Kerr OptiDisc Extra-Fine 10-µm.
18 – Polishing using a Kerr Occlubrush.
19, 20 – Final aesthetic result. The patient shows a completely renewed,
natural and harmonious smile. The procedure was performed in 2 hours in a
single appointment, with reduced biological trauma and economic expense.
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