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Figure 32: Next, we syringe an initial layer of
Vertise Flow into the preparation. As shown
here, this composite contains a self-etching
bonding agent that is activated by using a
disposable brush to burnish the material into
the dentin for 20 seconds. In reality, you end up
removing most of the first layer from the prep
while doing this, but the point is to get a very
thin layer in close contact with the dentin.
Figure 33: Here we are light-curing the initial
layer of Vertise Flow for 20 seconds. The light
curing actually stops the self-etching of the
dentin that was taking place. Now that we have
that layer bonded to the dentin, we can add 2
mm layers of Vertise Flow, curing for 20 seconds
between each increment. As we are just bonding
composite to composite at this point, there is
no need to use the brush or agitate the material
any more. The process simply is to add some
material, light cure and repeat. Most flowables
won’t support their own weight, so you are
better off placing them in smaller increments.
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Figure 34: I always slightly overbuild these
types of small build-ups, or fillers. I want to be
able to prep it back flush against the natural
tooth, so that I don’t leave an undercut in the
tooth. We receive far too many maxillary anterior
impressions at the lab with multiple undercuts
in the teeth where direct composites used to
be. Not only does this cause the impression to
distort, but it also creates weakened dies. It is
my hope that a simplified build-up technique
like this one with Vertise Flow will help more
dentists invest the time needed to place and
charge for these build-ups.
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