Tetric EvoCeram – nano-hybrid composite

Tetric Evoceram

Tetric EvoCeram is a state-of-the-art, light-curing, radiopaque, nano-hybrid composite for the direct restorative therapy. Tetric EvoCeram cures with light in the wavelength range of 400–500 nm (blue light).

Shades
Tetric EvoCeram is available in the following 22 shades:
– Enamel shades: A1, A2, A3, A3.5, A4, B1, B2, B3, C1, C2, C3, D2, D3, T
– Dentin shades: A2 Dentin, A3.5 Dentin, A4 Dentin, B2 Dentin
– Bleach shades: Bleach XL, Bleach L, Bleach I, Bleach M

Composition
The monomer matrix is composed of dimethacrylates (17–18% weight). The fillers contain barium glass, ytterbium trifluoride, mixed oxide and prepolymer (82–83% weight).Additional contents: additives, catalysts, stabilizers and pigments (<1.0% weight). The total content of inorganic fillers for the Bleach shades is 79–80% weight or 60–61% volume, for all the other shades 75–76% weight or 53–55% volume. The particle size of the inorganic fillers is between 40 nm and 3,000 nm with a mean particle size of 550 nm.

Indication

  • Restorations of deciduous teeth
  • Restorations in the posterior region (Classes I and II)
  • Anterior restorations (Classes III, IV)
  • Class V restorations (cervical caries, root erosion, wedge-shaped defects)
  • Veneering of discoloured anterior teeth
  • Splinting of mobile teeth
  • Extended fissure sealing in molars and premolars
  • Repair of composite and ceramic veneers
  • Build-ups for transparent, removable Invisalign orthodontic retainers

Contraindication
Placement of Tetric EvoCeram restorations is contra-indicated:
– if a dry working field cannot be established, or if the stipulated technique cannot be applied.
– if a patient is known to be allergic to any of the ingredients in Tetric EvoCeram

Side effects
In individual cases, components of Tetric EvoCeram may lead to sensitization. Tetric EvoCeram should not be used in such cases. To avoid possible irritation of the pulp, areas close to the pulp should be protected with a suitable pulp/dentin protector (apply a calcium hydroxide-based preparation in areas close to the pulp).

Interactions
Substances containing eugenol/oil of cloves may inhibit the polymerization of composite materials. Consequently, application of such materials together with Tetric EvoCeram must be avoided. Discolouration may occur in combination with cationic mouthwashes, plaque disclosing agents, and chlorhexidine.

Application Tetric EvoCeram

1. Shade determination
Clean the teeth prior to shade determination. The shade is selected with the tooth still moist.

2. Isolation
Appropriate isolation, best with a rubber dam (e.g. OptraDam Plus), is required.

3. Cavity preparation
Cavity preparation is carried out according to the requirements of the adhesive technique, i.e. protecting the tooth structure. Do not prepare sharp, internal edges or additional undercuts in caries-free areas. The dimensions of the cavity are generally determined by the extent of the caries or the size of the old restoration. Bevel enamel edges in the anterior region. For the posterior region, only the sharp enamel edges should be rounded (finishing diamonds, 25–40 µm). Caries-free cervical defects are not prepared, only cleaned with pumice or other suitable cleaning pastes with the help of rubber cups or rotary brushes. Subsequently, remove all residue in the cavity with water spray and dry with water- and oil-free air.

4. Pulp protection / Base
Do not apply a base material when using an enamel/dentin bonding agent. Only cover very deep areas close to the pulp with a calcium hydroxide material (e.g. ApexCal) and subsequently use a pressure-resistant cement (e.g. a glass ionomer cement, such as Vivaglass Liner). Do not cover other cavity walls, since they can be used to support the bond with an enamel/dentin adhesive.

5. Matrix / Interdental wedge
Use a wrap around matrix for cavities affecting the proximal area (e.g. the selectively thinned OptraMatrix) or a sectional matrix and wedge it.

6. Conditioning / Application of the bonding agent
Condition and apply the bonding agent according to the Instructions for Use of the product in use.We recommend using Syntac (with phosphoric acid etching) or ExciTE F (with phosphoric acid etching) or the self-etching adhesive AdheSE One F.

7. Application of Tetric EvoCeram

  • For an optimum result, apply Tetric EvoCeram in layers of max. 2 mm or 1.5 mm (Dentin shades, Bleach XL) and adapt with a suitable instrument(e.g. OptraSculpt). Use a special contact point instrument (e.g. the bifurcated OptraContact) for large cavities where the contacts are difficult to create
  • Sufficient exposure to the curing light prevents incomplete polimerization. For the recommendations regarding exposure time and light intensity see Table 1.
  • When using a metal matrix, additionally polymerize from the buccal or lingual/palatal after removing the matrix.
  • In many cases, a flowable composite is used today as an initial layer to create an even cavity floor and to facilitate the adaptation of the subsequently used restorative material. A flowable composite (e.g. Tetric EvoFlow) can be used in a thin initial layer. This optional layer has to be cured separately (please refer to the respective Instructions for Use).

8. Finishing / Checking the occlusion / Polishing
Remove excess material with suitable finishers (e.g. Astropol F) or fine diamonds after polymerization. Remove proximal excess with diamond or tungsten carbide finishers, finishing strips, or flexible finishing discs. Check the occlusion and articulation and apply appropriate grinding corrections to prevent premature contacts or undesired articulation paths on the surface of the restorations. Use silicone polishers (e.g.Astropol P,Astropol HP or Astrobrush) as well as polishing discs and polishing strips to polish the restorations to a durable high gloss.

Additional information
1. In the case of repair, additional Tetric EvoCeram can be directly applied to polymerized material. If the Tetric EvoCeram restoration has already been polished, it must first be roughened and wetted with Heliobond before fresh Tetric EvoCeram is applied.
2. Tetric EvoCeram should have at least room temperature when applied. Cool temperatures render the material difficult to extrude.
3. If Tetric EvoCeram is applied from the Cavifil directly in the mouth of the patient, the Cavifil must not be used for more than one patient due to hygienic reasons (prevention of cross-contamination between patients).
4. Syringes or Cavifils should not be disinfected with oxidizing disinfection agents.

Warning
Unpolymerized Tetric EvoCeram should not come in contact with skin, mucous membrane, or eyes. Unpolymerized Tetric EvoCeram may have a slight irritating effect and may lead to a sensitization against methacrylates. Commercial medical gloves do not provide protection against the sensitizing effect of methacrylates.

Storage
– Do not use Tetric EvoCeram after the indicated date of expiration.
– Storage temperature 2–28 °C / 36–82 °F.
– Close syringes / Cavifils immediately after usage. Exposure to light causes premature polymerization.
– Shelf life: see information on Cavifils, syringes and packages.

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