In 2009, SDR was the first technology that allowed 4mm bulk placement in flowable consistency. More than 50 million applications and several long-term clinical studies later, it is the bulk fill technology of choice for faster and easier creation of reliable direct restorations. SDR technology answers the two challenges of direct restorations: adaptation and efficiency.
Adaption is the key to long term success
Voids and gaps between restoration and cavity walls directly influence secondary caries formation1
Improper adaptation of composite during placement leads to the formation of voids2
High shrinkage stress may lead to marginal gap formation2
1 Kuper NK, Opdam NJ, Ruben JL, de Soet JJ, Cenci MS,Bronkhorst EM, et al. Gap size and wall lesion development next to composite. J Dent Res 2014;93, 108S–13S 2 Nedeljkovic et al. Is secondary caries with composites a material-based problem? Dent Mater 31 (2 0 1 5), e247–e277 3 Data on file
Low shrinkage stress
During light-cured polymerization, resin monomers are in chaotic movement as they begin to form the polymer matrix. SDR technology enables the formation of a more relaxed network, minimizing the build-up of stress. This reduces the risk of gap formation during polymerization.
Shrinkage stress: Shown as a ratio of SDR Plus material vs. competitors
Flowability
SDR’s unique chemistry helps ensure the longevity and overall quality of a bulk fill restoration. SDR flowable bulk fill technology fills and easily adapts to the cavity, flowing into nooks and crannies to provide excellent cavity adaptation during placement.
Efficiency is the key to productivity
Direct restorations represent approximately a third of the annual revenue of a general practice. Increasing the efficiency of the Class II treatment directly impacts day-to-day dental office revenue.5,6 SDR bulk fill technology allows the material to be applied in 4mm increments without an additional liner. This automatically decreases procedural time and inventory.
Self-levels for up to 40% time savings over classic layering technique
Use without an additional liner
Self-levels and does not require additional manipulation to adapt
5 2010 Survey of Dental Practice – Income from the Private Practice of Dentistry. http://www. ada.org/1444.aspx
6 American Dental Association Procedure Recap Report (2006)
SDR Plus procedure
Orange Line = Bonding
SDR Plus material
Capping Layer: Universal composite
Conventional procedure
Orange Line = Bonding
Flowable Liner
Increment 1: Universal Composite
Increment 2: Universal Composite
Increment 3: Universal Composite
More Versatility
The upgraded formulation of SDR Plus material adds even more versatility, by introducing new shades and expanding the range of indications.
More Shades
In addition to one universal shade, three new A-shades of SDR Plus - A1, A2, and A3 - increase versatility even further in a wide range of cases including visible Class II restorations, primary posterior dentition, Class III and Class V restorations.
More Indications
Additional oportunities to use SDR Plus material.
+ Class III and V Restorations
Due to its unique chemistry and improved wear resistance, SDR Plus material is now approved to be used in Class III and Class V restorations where a capping agent wouldn’t be used. This expands its capabilities to be used in more restoration classes than many other flowable material.
+ Primary Posterior Dentition
SDR Plus material can be used without an additional universal composite and in increments up to the occlusal surface. Fast and easy application technique make it ideal for the treatment of children.
Primary molar with SDR Plus restoration after 2 years in-situ. Dr. V. Ehlers
+Pit & Fissure Sealing
The thin compule allows the material to flow easily into all fissures for highly precise application.
Image: Dentsply Sirona internal picture
+Core Build-Up
The 4mm depth of cure of SDR Plus material make it a fast and easy alternative for core build-up. It handles instrumentation and shaping with ease.
Image: Dr. van der Vyver
Reliable adhesion and tight seal in high C-factor endo cavities
+ Reliable adhesion
Endodontic cavities are particularly challenging for bulk fill composites, as most are very deep Class I cavities. This maximizes shrinkage stress potential, indicated by a high C-factor. Studies indicate that when high C-factor cavities are filled in bulk, the choice of the composite is an important element to avoiding adhesive debonding.8 SDR Plus material with SDR technology can deal with high C-factor cavities, leading to a tight coronal seal even for post-endodontic cavities.
Image: Pre-test failures [%] during micro tensile bond strength testing to cavity 8,9
8 Van Ende A et al., 2016: Effect of Bulk-filling on the bonding efficacy in Occlusal Class I Cavities. J Adhes Dent.; 18(2):119-24
9 Internal Report Ebert J, Study No 14 1408 (2011). Available upon request, see contact details
+ Tight Seal
“SDR Plus ensures a tight seal of the endodontic access cavity – an important factor for long-term endodontic treatment success.”
Prof. Dr. Schirrmeister, University of Freiburg, Germany
Image: Relative number [%] of specimen showing leakage into root canal9
9 Internal Report Ebert J, Study No 14 1408 (2011). Available upon request, see contact details
Years of clinical success
While making Class I and Class II restorations faster and easier, the SDR technology in SDR Plus material also shows excellent long-term reliability in several clinical studies. In fact, the long-term survival rates of bulk fill restorations with SDR technology provided to be equivalent to those of restorations done in the conventional layering technique.
6 YEAR FOLLOW-UP (GROUP 1: XENO V/SDR/Ceram·X)
JWV van Dijken and U. Pallesen11
“During the six year follow up, the bulk fill technique was proven to be a clinically safe technique; highly acceptable; clinically durable.”
A total of 183 Class I and Class II restorations were evaluated at recall. 92 using SDR and Ceram·X in the bulk-fill technique against 91 using just Ceram·X composite in the layering technique. The observers conclude:
Clinically safe
Highly acceptable clinical durability
Clinical performance and failure rate was equivalent to conventional layering (3 failures in both test and control group)
11 Internal report # 14.1488 (2016-11-07); Data on file
5 YEAR FOLLOW-UP (GROUP 2: XENO V+/SDR Ceram·X)
JWV van Dijken and U. Pallesen11
“The use of a 4mm incremental technique with the flowable bulk-fill resin composite showed during the 5-year follow up slightly better, but not statistical significant, durability compared to the conventional 2mm layering technique in posterior resin composite restorations.”12
A total of 183 Class I and Class II restorations were evaluated at recall. 92 using SDR and Ceram·X in the bulk-fill technique against 91 using just Ceram·X composite in the layering technique. The observers conclude:
Both restorative techniques showed good surface, marginal stability and color stability
No statistically different annual failure rates between bulk-fill and layering technique were observed
No post-op sensitivities have been observed at all
11 Internal report # 14.1488 (2016-11-07); Data on file
12 van Dijken JWV, Pallesen U, 2016: Posterior bulk-filled resin composite restorations: A 5-year
36 MONTH CLINICAL TRIAL RESULTS
J. Burgess and C. Munoz13
“There were no observations of recurrent caries associated with the low stress resin and no reports of adverse events throughout the duration of the trial.”12
No failures attributable to SDR
No post-operative sensitivities
No adverse effects on gingiva in contact with SDR
12 van Dijken JWV, Pallesen U, 2016: Posterior bulk-filled resin composite restorations: A 5-year randomized controlled clinical study; J Dent 2016 Aug;51:29-35
13 Internal report #765-540 (2012-02-17); Data on file
The filling concept designed for efficient and reliable results.
From matrix system to bulk fill flowable to universal composite, Dentsply Sirona Restorative provides the only complete solution with unmatched adaptation at each critical step of a Class II restoration.
