Glass hybrid restoratives offer a unique combination of advantages in dentistry. They are biocompatible and require neither the application of bonding agents for adhesion nor absolute isolation protocols. Their high viscosity and chemical setting make them suitable for bulk application, irrespective of cavity depth, avoiding interfaces, and make them easy to mould with the help of an instrument or—as will be shown in the case presented here—a stamp. Moreover, the cost-effectiveness of this class of materials, even for load-bearing posterior restorations, has recently gained attention in the scientific literature.1
EQUIA Forte HT (GC Europe) is the newest material in this category. Its composition includes highly reactive, surface-treated fluoroaluminosilicate glass particles and polyacrylic acid of high molecular weight. The particle size distribution has been meticulously optimised. Consequently, the handling has been improved and the compressive strength and wear resistance increased.2–5 The system includes a synergistic coat (EQUIA Forte Coat, GC Europe) that seals the restoration, renders a smoother surface and reduces wear, making the material adequate for long-term restorations. It also provides an aesthetic glazing effect while protecting the material from early loss of ions and water, both important for optimal mechanical properties.6 The material can be sculpted easily with a probe or a spatula and enables easy application of the stamp technique, using a copy of the tooth structure, based on the patient’s own tooth or even a conventional wax-up.
A case report: Class I restoration with EQUIA Forte HT and the stamp technique
A 16-year-old female patient in good general health had received restorations in the mandibular molars owing to carious lesions in the recent past, and in light of her background, the patient requested a dental check-up at least once a year and had tried to develop good hygiene habits. When she came for a dental check-up, she mentioned new black pigmentation in the mandibular molars and sensitivity in the last molar of the fourth quadrant (Fig. 1). During the clinical examination, retentive areas were found in teeth #46 and 47. The composite restorations in the molars of the third quadrant were apparently in good condition.
Observation of the lesions showed that the enamel of tooth #47 looked greyish, suggestive of an underlying dentine lesion in need of treatment. The occlusal surfaces were practically intact, without cavitation. Therefore, it was possible to make a copy of the anatomy using a ball instrument and a low-viscosity resin material. In this case, a blue-coloured utility resin (LC Block-Out Resin, Ultradent Products) with good visibility and flow was used, but any resinous material with sufficient flow and strength will do the trick.
First, a thin layer of the resin was applied to the pits and fissures and polymerised (Fig. 2a). A medium-sized ball instrument was then placed on the occlusal surface already covered with the resin and a second layer of resin was added, enclosing the ball. The addition of layers was continued until both the surface and the instrument were sufficiently covered (Figs. 2b & c). The stamp was then separated from the tooth (Fig. 3).
Fig. 1: Non-cavitated carious lesions in teeth #46 and 47. The greyish aspect of the enamel and the hypersensitivity of tooth #47 experienced by the patient suggested an underlying dentine lesion requiring restorative treatment.
Figs. 2a–c: The anatomy of the occlusal surface was copied with utility resin to create a stamp. The tip of a ball-shaped instrument was incorporated to give a handle to the stamp.
Fig. 3: The stamp shows a detailed imprint of the occlusal anatomy.
Once the copy of the occlusal face had been obtained, the lesion of tooth #47 was opened with a small round diamond bur at high speed and under abundant water irrigation. The resulting Class I cavity (Fig. 4) was restored with EQUIA Forte HT (Shade A2). Once the relative isolation with cotton rolls had been done, a very thin layer of GC Cocoa Butter (GC Europe) was applied to the adjacent teeth and areas where the glass hybrid was not to adhere. Owing to the good handling properties and the handy capsule format of EQUIA Forte HT, the material can be homogeneously mixed and injected into the cavity fast and easily. By applying the content of a single capsule, we managed to cover the cavity completely, and then we placed the stamp (Fig. 5), previously obtained with the low-viscosity resin, and pressed firmly on top of the tooth and restorative material. Excess was removed with the help of a spatula and probe during the rubbery phase of the glass hybrid. The stamp was removed, revealing the beautifully reproduced occlusal anatomy (Fig. 6). No separating agent, such as glycerine or PTFE tape, was required since the stamp does not stick to the glass hybrid material. When a resinous stamp is used, light-polymerising a resin composite restoration with the stamp in situ might cause issues—owing to light attenuation as well as co-polymerisation of the stamp with the restoration itself.
Fig. 4: The cavity after preparation.
Fig. 5: The stamp was firmly pressed on to the cavity filled with EQUIA Forte HT when the material had reached a rubbery state.
Fig. 6: After removal of the stamp, the nicely shaped occlusal anatomy could immediately be seen.
Fig. 7: EQUIA Forte Coat was applied and light-polymerised.
Fig. 8: Final result: easily obtained without the need for shaping or polishing.
To finish the restoration, any excess material that remained was removed with a probe and a small flame-shaped diamond bur was only briefly used on the mesiolingual cusp to make a small occlusal adjustment. EQUIA Forte Coat facilitates the final steps of the restoration, as no polishing procedures are required. The field was again isolated with cotton rolls, and a thin layer of EQUIA Forte Coat (Fig. 7) was applied and light-polymerised for 20 seconds, leaving a smooth, shiny surface (Fig. 8). The coat is on average 35–40 µm thick and did not interfere with the occlusion.
Conclusion
Keeping in mind the patient’s history and the cavity’s properties, a glass hybrid restorative material was very well indicated in this case. The bulk fill material with fluoride content enables durable restoration of large and deep cavities in the posterior area—even those that are loaded during mastication—in a fast and cost-effective manner.
Editorial note:
A complete list of references can be obtained from the publisher.
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:sharpen(level=0):output(format=webp)/up/dt/2022/02/Marcano_The-stamp-technique_1.jpg "Fig. 1: Non-cavitated carious lesions in teeth #46 and 47. The greyish aspect of the enamel and the hypersensitivity of tooth #47 experienced by the patient suggested an underlying dentine lesion requiring restorative treatment.")
:sharpen(level=0):output(format=webp)/up/dt/2022/02/Marcano_The-stamp-technique_2a.jpg "Figs. 2a–c: The anatomy of the occlusal surface was copied with utility resin to create a stamp. The tip of a ball-shaped instrument was incorporated to give a handle to the stamp.")
:sharpen(level=0):output(format=webp)/up/dt/2022/02/Marcano_The-stamp-technique_-2b.jpg "Fig. 2b")
:sharpen(level=0):output(format=webp)/up/dt/2022/02/Marcano_The-stamp-technique_2c.jpg "Fig. 2c")
:sharpen(level=0):output(format=webp)/up/dt/2022/02/Marcano_The-stamp-technique_3.jpg "Fig. 3: The stamp shows a detailed imprint of the occlusal anatomy.")
:sharpen(level=0):output(format=jpeg)/up/dt/2022/02/Marcano_The-stamp-technique_1.jpg "Fig. 1: Non-cavitated carious lesions in teeth #46 and 47. The greyish aspect of the enamel and the hypersensitivity of tooth #47 experienced by the patient suggested an underlying dentine lesion requiring restorative treatment.")
:sharpen(level=0):output(format=jpeg)/up/dt/2022/02/Marcano_The-stamp-technique_2a.jpg "Figs. 2a–c: The anatomy of the occlusal surface was copied with utility resin to create a stamp. The tip of a ball-shaped instrument was incorporated to give a handle to the stamp.")
:sharpen(level=0):output(format=jpeg)/up/dt/2022/02/Marcano_The-stamp-technique_-2b.jpg "Fig. 2b")
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:sharpen(level=0):output(format=jpeg)/up/dt/2022/02/Marcano_The-stamp-technique_3.jpg "Fig. 3: The stamp shows a detailed imprint of the occlusal anatomy.")
:sharpen(level=0):output(format=webp)/up/dt/2022/02/Marcano_The-stamp-technique_4.jpg "Fig. 4: The cavity after preparation.")
:sharpen(level=0):output(format=webp)/up/dt/2022/02/Marcano_The-stamp-technique_5.jpg "Fig. 5: The stamp was firmly pressed on to the cavity filled with EQUIA Forte HT when the material had reached a rubbery state.")
:sharpen(level=0):output(format=webp)/up/dt/2022/02/Marcano_The-stamp-technique_6.jpg "Fig. 6: After removal of the stamp, the nicely shaped occlusal anatomy could immediately be seen.")
:sharpen(level=0):output(format=webp)/up/dt/2022/02/Marcano_The-stamp-technique_7.jpg "Fig. 7: EQUIA Forte Coat was applied and light-polymerised.")
:sharpen(level=0):output(format=webp)/up/dt/2022/02/Marcano_The-stamp-technique_8.jpg "Fig. 8: Final result: easily obtained without the need for shaping or polishing.")
:sharpen(level=0):output(format=jpeg)/up/dt/2022/02/Marcano_The-stamp-technique_4.jpg "Fig. 4: The cavity after preparation.")
:sharpen(level=0):output(format=jpeg)/up/dt/2022/02/Marcano_The-stamp-technique_5.jpg "Fig. 5: The stamp was firmly pressed on to the cavity filled with EQUIA Forte HT when the material had reached a rubbery state.")
:sharpen(level=0):output(format=jpeg)/up/dt/2022/02/Marcano_The-stamp-technique_6.jpg "Fig. 6: After removal of the stamp, the nicely shaped occlusal anatomy could immediately be seen.")
:sharpen(level=0):output(format=jpeg)/up/dt/2022/02/Marcano_The-stamp-technique_7.jpg "Fig. 7: EQUIA Forte Coat was applied and light-polymerised.")
:sharpen(level=0):output(format=jpeg)/up/dt/2022/02/Marcano_The-stamp-technique_8.jpg "Fig. 8: Final result: easily obtained without the need for shaping or polishing.")
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