20
Filtek ™ Supreme XTE Flowable Restorative TM Filtek technical product profile
Filtek™ Supreme XTEFlowable Restorative
TMFiltektechnical product profile
Table of ContentsIntroduction ............................................................................................................................ 1
Product Description ........................................................................................................... 2
Indications for Use ............................................................................................................ 2
Composition ....................................................................................................................... 2
Shades ................................................................................................................................ 3
Fluorescence...................................................................................................................... 3
Background ........................................................................................................................... 4
Fillers ................................................................................................................................... 4
Nanocomposites ............................................................................................................. 4
Filler Improvements in Filtek™ Supreme XTE Flowable Restorative .................................. 5
Resin System ...................................................................................................................6-7
Physical Properties ........................................................................................................... 8
Volumetric Shrinkage....................................................................................................... 8
Polish Retention ................................................................................................................ 9
Toothbrush Abrasion ....................................................................................................... 9
In-vitro, 3-Body Wear ..................................................................................................... 10
Fracture Toughness ........................................................................................................ 11
Compressive and Diametral Tensile Strength ........................................................... 12
Flexural Strength and Modulus ................................................................................... 13
Field Evaluation .................................................................................................................. 14
Current Flowable Usage ................................................................................................ 14
Evaluation of Filtek Supreme XTE Flowable Restorative ....................................... 15
Questions and Answers ................................................................................................. 16
References ........................................................................................................................... 16
Technical Data Summary ............................................................................................. 17
IntroductionBuilding upon over 40 years of innovation in the field of restorative dentistry, 3M ESPE created, at the turn
of this century, a new category of dental material—the nanocomposite. Through precise manipulation of
the filler architecture at the nanoscale, 3M ESPE developed a breakthrough composite filling material that
significantly advanced the clinical performance of universal composites.
In 2002, 3M ESPE launched Filtek™ Supreme Universal Restorative. This was the first product that utilized
nanotechnology to provide the esthetics of a microfill and the strength of a hybrid. All of the filler particles
in this novel composite are surface-modified, bonded nanofillers.
Incorporation of this filler technology into a flowable restorative was realized in 2005, with the introduction
of 3M™ ESPE™ Filtek™ Supreme XT Flowable Restorative. This product was formulated to blend the
strength and esthetics offered in 3M™ ESPE™ Filtek™ Supreme XT Universal Restorative, while still
maintaining the “flow-on-demand” handling of 3M™ ESPE™ Filtek™ Flow Flowable Restorative.
Through global customer research and discussions with general dentists and opinion leaders, usage and
areas of potential improvements for flowables were identified. Flowable usage has increased over the past
5 years because of new indications, better physical properties, better handling characteristics and, finally,
their ease of use. In order for this trend to continue, enhancements were needed. Based on customer feedback,
the following improvements are realized with the launch of Filtek™ Supreme XTE Flowable Restorative.
Improvements• Lowershrinkage
• Improvedesthetics
– Added fluorescence
– Improved polish retention
• Delivery
– Easier-to-read shade designation
– Capsule and syringe delivery
These improvements were made without compromising the strengths of Filtek Supreme XT
flowable restorative:
• “Flow-on-demand”handling
• Wear-resistance
• Physicalproperties
• ShadematchtothetoothandtoFiltek™ Supreme XTE Universal Restorative
1
Introduction
Product DescriptionFiltek™ Supreme XTE Flowable Restorative is a low-viscosity, visible light-cured, radiopaque flowable nanocomposite. Bonding to the tooth structure is accomplished through the use of dental adhesive systems, either total-etch or self-etch, that are designed to be compatible with methacrylate composites. Filtek Supreme XTE flowable restorative can be used alone, after placing a compatible adhesive, or in conjunction with a methacrylate-based restorative such as Z100™ Restorative, Filtek™ Z250 Restorative, Filtek™ P60 Restorative or Filtek™ Supreme XTE Universal Restorative.
The restorative is packaged in capsules and syringes. It is available in a variety of tooth-colored shades. The shades offered with Filtek Supreme XTE flowable restorative were designed to coordinate with shades offered with Filtek Supreme XTE universal restorative.
Indications for UseFiltek Supreme XTE flowable restorative is indicated for:
•Base/linerunderdirectrestorations
•Undercutblockout
•ClassIIIandVrestorations
•Restorationofminimallyinvasivecavitypreparations (including small, nonstress-bearing occlusal restorations)
•Repairofsmalldefectsinestheticindirectrestorations
•Pitandfissuresealant
•Repairofresinandacrylictemporarymaterials
CompositionFiltek Supreme XTE flowable restorative contains BisGMA, TEGDMA and Procrylat resins. The fillers are a combination of ytterbium trifluoride filler with a range of particle sizes from 0.1 to 5.0 microns, anon-agglomerated/non-aggregatedsurface-modified20nmsilicafiller,anon-agglomerated/ non-aggregatedsurfacemodified75nmsilicafiller,andasurface-modifiedaggregatedzirconia/silicacluster filler (comprised of 20 nm silica and 4 to 11 nm zirconia particles). The aggregate has an average cluster particle size of 0.6 to 10 microns. The inorganic filler loading is approximately 65% by weight (46% by volume).
Filtek Supreme XTE flowable restorative is a modification of Filtek™ Supreme XT Flowable Restorative based on customer needs. In a global market research study on flowable restoratives, overall esthetics and shrinkage were identified as key features that would impact product desirability. Also, many respondents believed that materials, made by the same manufacturer and utilizing similar components, work better together. The preference for flowables in capsules (unit dose delivery) was determined to be growing globally.
The formulation improvements of Filtek Supreme XTE flowable restorative take advantage of the advancements made in filler processing and resins since the introduction of Filtek Supreme XT flowable restorative. The formulation was modified to improve properties, such as shrinkage, fluorescence and polish retention.
2
ShadesFiltek Supreme XTE flowable restorative is available in the same shades as Filtek Supreme XT flowable restorative. These shades are matched to the VITAPAN® Classical Shade Guide and correspond to shades of Filtek Supreme XTE universal restorative. The opacity of the shades corresponds to the Body shade opacity, except for the Opaque shade which has the opacity of the Dentin shades in Filtek Supreme XTE universal restorative.
Shades: A1, A2, A3, A3.5, A4, Opaque A3 B1, B2 C2 D2 W (White), XW (Extra White)
FluorescenceOne additional esthetic property of natural dentition is fluorescence. Fluorescence occurs when energy is absorbed and emitted at a longer wavelength. In teeth, this means the absorption of light in the UV region (350-365 nm) and emitting light in the visible region (400-600 nm with a peak maximum of 440 nm). It is thought that this property contributes to the vitality and lifelike appearance of dentition. In natural teeth, dentin (due to amino acids contained in the collagen)2 exhibits higher fluorescence than enamel. The fluorescence of Filtek Supreme XTE flowable restorative is similar to Filtek Supreme XTE universal restorative. Both fluoresce more than the disc of Filtek Supreme XT flowable restorative (Figure 1).
Figure 1: FluorescenceFiltek™ Supreme XTE Flowable Restorative
Filtek™ Supreme XTE Universal Restorative Filtek™ Supreme XT
Flowable Restorative
Product Description
3
BackgroundFillersNanocomposites
3M ESPE manufactures many of its fillers using a sol gel process. The sol gel process is a route wherein fillers are made from liquids precursors, or a “sol.” These liquids are chemically and mechanically processed to produce particles. One aspect of this process results in sintering which effectively coalesces primary particles together to form larger filler particles. Sintering can be viewed as a type of melting process whereby the particles are softened, creating a surface which can attach to neighboring particles resulting in a particle-to-particle bond. The sintering process can produce fillers that are highly densified or compacted, as found in 3M™ ESPE™ Z100™ Restorative and Filtek™ Z250 Universal Restorative (Figure 2).3
In 2002, 3M ESPE discovered a way to modify the sintering process to produce loosely agglomerated nanoparticles, i.e., nanoclusters. Although structurally different from densified particles, these nanoclusters behaved similarly to the densified particles found in other composites in terms of providing a range of particle sizes which allow for high filler loading. This resulted in a material with the strength and wear of hybrids with significantly improved polish retention and optical properties. This technology advance was first used in 3M™ ESPE™ Filtek™ Supreme Universal Restorative (Figures 3 and 4).
Filtek™ Supreme XT Flowable Restorative was formulated using the same surface-modified zirconia/silicananoclusterfillerfoundintheFiltekSupremeuniversalrestorativeDentin,Enameland Body shade composition. The nanocluster filler particles consist of loosely bound aggregates of engineered zirconiaandsilicananofillerparticles.Twonon-agglomerated/non-aggregatednanofillerswereadded to the formulation to reduce the interstitial spacing of the filler particles leading to higher filler loadings. Onewasthe75nmnon-agglomerated/non-aggregatedsilicapreviouslyfoundinFiltekSupremeUniversalRestorative Translucent shades. The other was a 5-10 nm zirconia particulate which was unique to the flowable composition, and enhanced the radiopacity provided by the nanoclusters. This optimized filler system contributed to the excellent physical, wear and polish properties of Filtek Supreme XT flowable restorative, while still allowing for the desired flowable handling.
Figure 2: Filtek™ Z250 Restorative Magnification 30,000X
Figure 3: Filtek™ Supreme XT Universal Restorative (DEB Shades) Magnification 30,000X
Figure 4: Filtek™ Supreme XT Universal Restorative (T Shades) Magnification 30,000X
4
Filler Improvements in Filtek™ Supreme XTE Flowable Restorative
This filler technology was improved again. The manufacturing process, where the clusters are formed, was modifiedtoproducelesssintering.Onceagain,thezirconia/silicananoclustersareproducedinabroadrangeof sizes enabling high filler loading and are surface-treated to chemically bond them to the resin. As the particles are not as strongly sintered, the cluster size range could be broadened (vs. Filtek Supreme XT flowable restorative) without adversely affecting properties such as polish retention. These nanoclusters still have the structural integrity to provide strength and fracture resistance. The bonded nanoclusters wear at a similar rate as the surrounding resin matrix. In the SEM (Figure 5), note the shape of the primary nanoparticles are still evident in the clusters. Two additional surface-treated engineered nanoparticles are added that, upon photoinitiation, will crosslink with the resin matrix. These fillers were previously used in Filtek™SupremeXTUniversalRestorative.The20nmnon-agglomerated/non-aggregatedsilicawasusedinDentin,EnamelandBodyshades.The75nmnon-agglomerated/non-aggregatedsilicawasusedintheTranslucent shades and Filtek Supreme XT flowable restorative formulations.
The fourth filler in this system, ytterbium trifluoride, is added to enhance radiopacity.
Figure 5: Filtek™ Supreme XTE Flowable Restorative Magnification 100,000X
Background
5
Resin systemThe key feature of flowable restoratives is their flow properties. The ability to wet the surface of the cavities quickly and with minimal instrumentation defines this filling material category. These materials are used as liners, as well as actual filling materials for small restorations. Besides flowable handling, these materials must possess adequate physical properties, such as strength and wear resistance, to ensure clinical success in a variety of indications.
The challenge to creating these materials is achieving a clinically acceptable balance of properties. Frequently modifications that produce a flowable restorative (lower viscosity) adversely affect strength, wear resistance and shrinkage.
Both resin composition and filler loading contribute to shrinkage. Methacrylate composites inherently shrink during polymerization. The amount of shrinkage is impacted by the monomers used. Generally speaking,lowviscositymonomersarelowmolecularweight.Lowmolecularweightmonomerscancause the polymerized resin matrix of the composite system to be harder because the higher number of double bonds per unit of weight enables higher conversion and crosslinking. However, it can also lead to higher shrinkage.
Typically, in order to reduce shrinkage in a composite, manufacturers increase filler loading. The lower the viscosity of the resin system, the more filler can be added to the resin before the viscosity becomes stiff. In the case of flowable restoratives, increasing filler loading is not usually a viable option to reduce shrinkage because the flow properties diminish.
The challenge the Filtek™ Supreme XTE Flowable Restorative development team faced was how to reduce the shrinkage without adversely affecting the final composite hardness and the flow. The resin system of Filtek™ Supreme XT Flowable Restorative is a combination of two (2) high-molecular weight monomers BisGMA (2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy)phenyl]propane) and BisEMA(6) (2,2-Bis[4-methacryloxypolyethoxyphenyl]propane), and one low-molecular weight monomer TEGDMA (Tri[ethylene glycol]dimethacrylate).
TEGDMA is a low-viscosity monomer which can contribute to higher shrinkage but helps create a hard resin matrix. TEGDMA is present in a relatively high concentration to keep the viscosity of Filtek Supreme XT flowable restorative low enough to flow, while containing a high enough filler load to impart good strength and wear resistance. The shrinkage of Filtek Supreme XT flowable restorative, while higher than universal restoratives, was similar to other flowables.
BisEMA(6) Molecule
TEGDMA Molecule
O
OOO
OOO
OO
O
BisEMA (6)
O
O OO O
OTEG DMA
OO OO
OHOH
O O
BisGMA
OO OO
O O
Procrylat
O
OOO
OOO
OO
O
BisEMA (6)
O
O OO O
OTEG DMA
OO OO
OHOH
O O
BisGMA
OO OO
O O
Procrylat
6
BisGMA Molecule
To reduce the shrinkage, a substitute for TEGDMA needed to be found. The team identified a monomer, Procrylat (2,2-bis[4-(3-methacryloxypropoxy)phenyl]propane), which is high molecular weight but low viscosity. The high-molecular weight monomer is similar to BisGMA. The difference between BisGMA and Procrylat is the lack of pendant hydroxyl groups. The lack of hydroxyl groups reduces the viscosity of this monomer due to decreased hydrogen bonding potential.
In Filtek Supreme XTE flowable restorative, the new monomer replaces all of the BisEMA(6) and a portion of the TEGDMA and BisGMA monomers. This optimized combination of monomers results in a low-viscosity resin system which allows for a similar filler loading as Filtek Supreme XT flowable restorative. While the strength and wear resistance is similar for the two products, the shrinkage of Filtek Supreme XTE flowable restorative is significantly less than its predecessor.
In addition, a dimethacrylate polymer is added as rheology modifier to produce the “flow-on-demand” feature as in Filtek Supreme XT flowable restorative. This additive enables the viscosity of Filtek Supreme XTE flowable restorative to change when manipulated, offering greater control during placement. Many flowable composites will run when subjected to gravitational force. This property makes control of the restorative difficult in certain indications such as Class V restorations or liner indications. Filtek Supreme XTE flowable restorative holds its shape under these conditions. However, when a shear force is applied to Filtek Supreme XTE flowable restorative, such as during extrusion through the dispensing tip and manipulation on the preparation, the viscosity of the restorative decreases. This means Filtek Supreme XTE flowable restorative becomes more fluid, allowing for easy adaptation to the preparation. Once this shear force is removed, such as when manipulation stops, Filtek Supreme XTE flowable restorative returns to its original, non-slumping viscosity.
O
OOO
OOO
OO
O
BisEMA (6)
O
O OO O
OTEG DMA
OO OO
OHOH
O O
BisGMA
OO OO
O O
Procrylat
O
OOO
OOO
OO
O
BisEMA (6)
O
O OO O
OTEG DMA
OO OO
OHOH
O O
BisGMA
OO OO
O O
Procrylat
Background
7
Procrylat Molecule
Physical PropertiesVolumetric shrinkageA method for determining polymerization shrinkage was described by Watts and Cash (Meas. Sci. Technol. 2(1991), 788-794). In this method, a disc-shaped test specimen and uncured paste are sandwiched between two glass plates and light cured through the lower rigid plate. The flexible upper plate is deflected during the polymerization of the test specimen. The less the flexible plate bends, the lower the shrinkage. Deflection is measured and recorded as a function of time. Although this process actually measures linear shrinkage, volumetric shrinkage was closely approximated due to the fact that the dimensional changes were limited to the thickness dimension. The lower the value, the less the shrinkage.
In this test, samples were exposed for 60 seconds to a 3M™ ESPE™ Visilux™2VisibleLightCuringUnit.The final shrinkage was recorded 4 minutes after the end of light exposure.
The shrinkage of Filtek™ Supreme XTE Flowable Restorative is lower than Tetric EvoFlow, Premise Flowable, Heliomolar Flow, Filtek™ Supreme XT Flowable Restorative, TPH3 Flow, EsthetX Flow, Vertise Flow, VenusFlow,Flow-ItALCandRevolutionFormula2.TheshrinkageofFiltekSupremeXTEflowablerestorative is comparable to Grandio Flow.
Polymerization ShrinkagePolymerization Shrinkage
Source: 3M ESPE internal data
Filte
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Ultra
Flow
able
Res
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Filte
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Flow
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Res
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Revo
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2™
Verti
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Prem
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3 Fl
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Venu
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4.00
6.00
% S
hrin
kage
5.00
3.00
2.00
1.00
0.00
Polymerization Shrinkage
Sure
Fil®
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™ F
low
Flow
-It® A
LC™
Transducer
Cover Slide
Light
Deflection
Glass Slide
8
Filte
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Flow
able
Res
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Filte
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XTFl
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Revo
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Flow
-It A
LC
Verti
se F
low
Esth
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Gran
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Flow
Helio
mol
ar F
low
Prem
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Flow
able
SDR
Tetri
c Ev
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w
TPH3
Flo
w
Venu
s Fl
ow
4.00
6.00
% S
hrin
kage
5.00
3.00
2.00
1.00
0.00
Polymerization Shrinkage
Transducer
Cover Slide
Light
Deflection
Glass Slide
Polish retentionToothbrush abrasion
Composite materials were shaped into tiles and thoroughly cured. The surfaces were polished wet using a Beuhler variable-speed grinder-polisher to remove the air-inhibited layer and to ensure a uniform surface. They were stored in water at 37ºC for 24 hours. Gloss was measured. The samples were brushed with toothpaste and a toothbrush that was mounted on an Automatic Toothbrush Machine. Gloss measurements were taken after 500 cycles and then every 1000 cycles. The test was terminated after 6000 toothbrush strokes.
Polish Retention
Polish Retention versus other flowable restoratives
Source: 3M ESPE internal data
Physical Properties
9
After 6000 toothbrush abrasion cycles, Filtek Supreme XTE flowable restorative exhibits better polish retention than Filtek Supreme XT flowable restorative, Grandio Flow, Flow-It, SDR, Tetric EvoFlow, Venus Flow and Vertise Flow.
Filte
k™ S
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XTE
Flow
able
Res
tora
tive
Filte
k™ S
upre
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XTFl
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esto
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SDR0
10
100
20
30
40
50
60
70
80
90
Glos
s Un
its
Cycles of Toothbrush Abrasion60003000500Initial
Revo
lutio
n Fo
rmul
a 2
Flow
-It A
LC
Verti
se F
low
Esth
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Flow
Gran
dio
Flow
Helio
mol
ar F
low
Prem
ise
Flow
able
Tetri
c Ev
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w
TPH3
Flo
w
Venu
s Fl
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Polish Retention
10
In-vitro, 3-Body wearThe wear rate was determined by an in-vitro 3-body wear test. In this test, composite (1st body) is loaded onto a wheel, which contacts another wheel, which acts as an “antagonistic cusp” (2nd body). The two wheels counter-rotate against one another dragging abrasive slurry (3rd body) between them. Dimensional loss during 200,000 cycles is determined by profilometry at regular intervals (i.e., after every 40,000 cycles). As the wear in this method typically follows a linear pattern, the data is plotted using linear regression. The wear rates, i.e., the slope of the lines, are determined. The comparison of rates reduces some of the variability in the test due to sample preparation and can be predictive of anticipated wear beyond the length of the actual test.
The wear resistance of Filtek™ Supreme XTE Flowable Restorative is similar to the wear resistance of Filtek™ Supreme XT Flowable Restorative. The 3-body wear rate (in-vitro) of Filtek Supreme XTE flowablerestorativeislowerthanFlow-ItALC,VenusFlow,EsthetXFlow,TPH3Flow,VertiseFlow, Revolution Formula 2, Tetric EvoFlow, Heliomolar Flow and SDR. The 3-body wear rate (in-vitro) of Filtek Supreme XTE flowable restorative is comparable to Premise Flow.
Wear Rate (in-vitro)
Wear Rate
Source: 3M ESPE internal data
Revo
lutio
n Fo
rmul
a 2
Flow
-It A
LC
Verti
se F
low
Esth
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Flow
Gran
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Flow
Helio
mol
ar F
low
Prem
ise
Flow
able
Tetri
c Ev
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w
TPH3
Flo
w
Venu
s Fl
ow
20.00
30.00
um lo
ss/2
00,0
00 c
ycle
s
25.00
15.0010.005.000.00
Wear Rate (in-vitro)40.0035.00
Filte
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XTE
Flow
able
Res
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Filte
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XTFl
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esto
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SDR
Physical Properties
11
Fracture toughnessThe values reported for fracture toughness (K1c) are related to the energy required to propagate a crack. In this test, a short bar of material is cured. A notch is cut into it. The bar is placed on a fixture that supports either end, and an anvil is positioned above the notch. The anvil presses down until the bar breaks. This is similar to 3-point bend (similar to the fixture that provides flexural strength and modulus data).
Verti
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Flo
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Flo
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Flo
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Helio
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ar® F
low
Prem
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Flo
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Tetri
c Ev
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TPH®
3 Fl
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2.00
K1c
2.50
1.50
1.00
0.50
0.00
Fracture Toughness
Fixture
Sample Notch
Anvil
Instron Fixture
Filte
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Ultra
Flow
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Res
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Filte
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Plus
Flow
able
Res
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Venu
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Sure
Fil®
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™ F
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Flow
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Revo
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Fracture Toughness
The fracture toughness of Filtek Supreme XTE flowable restorative is higher than Grandio Flow. The fracture toughness of Filtek Supreme XTE flowable restorative is comparable to Filtek Supreme XT flowable restorative, EsthetX Flow, Flow-It, Heliomolar Flow, Premise Flow, Revolution Formula 2, Tetric EvoFlow, TPH3 Flow and Vertise Flow.
Fracture Toughness
Source: 3M ESPE internal data
Revo
lutio
n Fo
rmul
a 2
Flow
-It A
LC
Verti
se F
low
Esth
etX
Flow
Gran
dio
Flow
Helio
mol
ar F
low
Prem
ise
Flow
able
Tetri
c Ev
oFlo
w
TPH3
Flo
w2.00
K1c
2.50
1.50
1.00
0.50
0.00
Fracture Toughness
Fixture
Sample Notch
Anvil
Instron Fixture
Filte
k™ S
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XTE
Flow
able
Res
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Filte
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XTFl
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SDR
Venu
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Compressive and diametral tensile strengthCompressive strength is particularly important because of chewing forces. Rods are made of the material and simultaneous forces are applied to the opposite ends of the sample length. The sample failure is a result of shear and tensile forces.
The compressive strength of Filtek™ Supreme XTE Flowable Restorative is higher than SDR. The compressive strength of Filtek Supreme XTE flowable restorative is comparable to Filtek™ Supreme XT Flowable Restorative, EsthetX Flow, Flow-It, Grandio Flow, Heliomolar Flow, Premise Flow, Revolution Formula 2, Tetric EvoFlow, TPH3 Flow, Venus Flow and Vertise Flow.
Flow
-It® A
LC™
Verti
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Flo
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Flo
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Helio
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Prem
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Flo
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Tetri
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3 Fl
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Venu
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low
200
300
MPa 250
150100500
Compressive Strength
350
450400
Revo
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n® F
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2™
Filte
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Res
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Res
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Compressive Strength
Diametral tensile strength is measured using a similar apparatus. Compressive forces are applied to the sides of the sample, not the ends, until fracture occurs.
The diametral tensile strength of Filtek Supreme XTE flowable restorative is higher than Revolution Formula 2, Premise Flow, Heliomolar Flow, SDR and Tetric EvoFlow.
The diametral tensile strength of Filtek Supreme XTE flowable restorative is comparable to Filtek Supreme XT flowable restorative, EsthetX Flow, Flow-It, Grandio Flow, Vertise Flow, Venus Flow and TPH3 Flow.
Flow
-It® A
LC™
Verti
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Flo
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Esth
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Flo
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Helio
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low
Prem
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Flo
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Tetri
c Ev
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TPH®
3 Fl
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Venu
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low
40
60
MPa
50
3020100
Diametral Tensile Strength8070
Filte
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Ultra
Flow
able
Res
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Filte
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Res
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Fil®
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Revo
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Diametral Tensile Strength
Compressive Strength
Source: 3M ESPE internal data
Diametral Tensile Strength
Source: 3M ESPE internal data
12
Revo
lutio
n Fo
rmul
a 2
Flow
-It A
LC
Verti
se F
low
Esth
etX
Flow
Gran
dio
Flow
Helio
mol
ar F
low
Prem
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Flow
able
Tetri
c Ev
oFlo
w
TPH3
Flo
w
Venu
s Fl
ow
200
300
MPa 250
150100500
Compressive Strength
350
450400
Filte
k™ S
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Flow
able
Res
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Filte
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SDR
Revo
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Flow
-It A
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Verti
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low
Esth
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Flow
Gran
dio
Flow
Helio
mol
ar F
low
Prem
ise
Flow
able
Tetri
c Ev
oFlo
w
TPH3
Flo
w
Venu
s Fl
ow
40
60
MPa
50
3020100
Diametral Tensile Strength8070
Filte
k™ S
upre
me
XTE
Flow
able
Res
tora
tive
Filte
k™ S
upre
me
XTFl
owab
le R
esto
rativ
e
SDR
Physical Properties
Flexural strength and modulusFlexural strength is determined in the same test as flexural modulus. Flexural strength is the value obtained when the sample breaks. This test combines the forces found in compression and tension. The flexural strength of Filtek Supreme XTE flowable restorative is comparable to Filtek Supreme XT flowable restorative, EsthetX Flow, Vertise Flow, Grandio Flow, Venus Flow, TPH3 Flow, Tetric EvoFlow, Flow-ItALC,SDR,HeliomolarFlow,RevolutionFormula2andPremiseFlow.
Verti
se™
Flo
w
Esth
etX®
Flo
w
Gran
dio®
Flo
w
Helio
mol
ar® F
low
Prem
ise™
Flo
wab
le
Tetri
c Ev
oFlo
w®
TPH®
3 Fl
ow
Venu
s® F
low
80
120
MPa
100
6040200
Flexural Strength
140160
Filte
k™ S
upre
me
Ultra
Flow
able
Res
tora
tive
Filte
k™ S
upre
me
Plus
Flow
able
Res
tora
tive
Revo
lutio
n® F
orm
ula
2™
Flow
-It® A
LC™
Sure
Fil®
SDR
™ F
low
Flexural modulus is a method of defining a material’s stiffness. A low modulus indicates a flexible material. The flexural modulus is measured by applying a load to a material specimen that is supported at each end.
The flexural modulus of Filtek Supreme XTE flowable restorative is comparable to Filtek Supreme XT flowable restorative, Premise Flow and Grandio Flow.
Verti
se™
Flo
w
Esth
etX®
Flo
w
Gran
dio®
Flo
w
Helio
mol
ar® F
low
Prem
ise®
Flo
wab
le
Tetri
c Ev
oFlo
w®
TPH®
3 Fl
ow
Venu
s® F
low
4000
6000
MPa 5000
300020001000
0
Flexural Modulus
700080009000
Filte
k™ S
upre
me
Ultra
Flow
able
Res
tora
tive
Filte
k™ S
upre
me
Plus
Flow
able
Res
tora
tive
Sure
Fil®
SDR
™ F
low
Flow
-It® A
LC™
Revo
lutio
n® F
orm
ula
2™
Flexural Modulus
Flexural Strength
Source: 3M ESPE internal data
Flexural Modulus
Source: 3M ESPE internal data
13
Revo
lutio
n Fo
rmul
a 2
Flow
-It A
LC
Verti
se F
low
Esth
etX
Flow
Gran
dio
Flow
Helio
mol
ar F
low
Prem
ise
Flow
able
Tetri
c Ev
oFlo
w
TPH3
Flo
w
Venu
s Fl
ow
80
120
MPa
100
6040200
Flexural Strength
140160
Filte
k™ S
upre
me
XTE
Flow
able
Res
tora
tive
Filte
k™ S
upre
me
XTFl
owab
le R
esto
rativ
e
SDR
Flexural StrengthRe
volu
tion
Form
ula
2
Flow
-It A
LC
Verti
se F
low
Esth
etX
Flow
Gran
dio
Flow
Helio
mol
ar F
low
Prem
ise
Flow
able
Tetri
c Ev
oFlo
w
TPH3
Flo
w
Venu
s Fl
ow
4000
6000
MPa 5000
300020001000
0
Flexural Modulus
700080009000
Filte
k™ S
upre
me
XTE
Flow
able
Res
tora
tive
Filte
k™ S
upre
me
XTFl
owab
le R
esto
rativ
e
SDR
14
Field evaluationA field evaluation was conducted in two countries, Germany and Sweden, to confirm the clinical performance and acceptability of Filtek™ Supreme XTE Flowable Restorative. Data detailed in this section includes the 133 respondents.
Recruitment criteria were designed to obtain 80% competitive flowable users and 20% Filtek™ Supreme XT Flowable Restorative users. Approximately 43% of the former were Tetric EvoFlow users. Evaluators received a selection of 6 shades in either capsules or syringes depending on their delivery preference.
Current flowable usageSixty-three percent of the respondents use more than one flowable in their practice. Dentists are using flowable for a variety of indications, both as an interior surface material and as a final filling material. The frequency that these types of restorations are done in a week and the frequency a flowable is used in these indications varies significantly. Therefore, the number of times a flowable is used in each indicationvariesfromahighof12liner/baseapplicationsperweek(mean),toalowof2porcelainorcomposite repair restorations per week.
Line
r/Ba
se
Clas
s II
Enam
el D
efec
t Rep
air
Clas
s III
Seal
ant
Porc
elai
n or
Com
posi
te R
epai
r
Clas
s I
Bloc
k-ou
t of
Smal
l Und
ercu
ts
Clas
s V
40
% o
f Res
pond
ents
60
20
0
% of dentists using flowable in each indication100
80
75.2
71.4
94.7
80.5
71.4
94
77.4
78.2
63.975.2 71.4
94.7
80.571.4
94
77.4 78.2
63.9
Liner/base
Block-out of small
undercuts
Class I Class IIClass III
Class V Sealant
Enamel defect repairPorcelain or composite
repair
Percent of Dentists Using Flowable in Each IndicationPercent of dentists using flowable
Source: 3M ESPE internal data
The primary reasons cited for using a flowable composite as a liner/base include:
•Stressrelief
•Cavityandmarginaladaptation(includingtheabilityofthematerialtowetthesurface,flow,the ability to seal dentin, and to produce a gap-free restoration)
•Handling
•Easeofuse
•Shades(eitheralayerthatcanbediscriminatedfromdentin,ortohaveamaterialthatmatches surrounding tooth or universal composite)
The primary reasons cited for using flowables as filling materials include:
•Theyprovideasmoothtransitionfromrestorationtotooth
•Handlingintermsofflow,abilitytoadapttothecavityandmargins,andthewettingcharacteristics
•Theprocedureisfaster—finishingandpolishingtimeisreduced
•Theprocedureissimple—frequentlydentistsdon’tneedtotouchthematerialtoadapt,andthey are easy to apply
Class III8%
SmallClass I16%
Sealant 7%
Liner/base21%
Total Placements—5,063
SmallClass II
11%
Class V19%
Enamel DefectRepair 5%
Porcelainor CompositeRepair 2%
Other2%Block-out of Small
Undercut 9%
15
Field Evaluation
Evaluation of Filtek Supreme XTE Flowable RestorativeThere were 5,063 placements made with Filtek Supreme XTE flowable restorative during the field evaluation.
Thirty percent of the placements were internal surface applications. The remaining 70% of the placements were as a filling material. This distribution did not change for capsule users vs. syringe users. Capsule evaluators accounted for 1,426 placements.
Capsule users found the Filtek Supreme XTE flowable restorative capsule design acceptable. In all design attributes (i.e., tip access into the prep, ease of dispensing, control of dispensing, visibility into the prep, and overall delivery satisfaction), the new Filtek Supreme XTE flowable restorative capsule was rated comparable to their current capsule.
Dentists, including Tetric EvoFlow users, rated their satisfaction with the following features significantly higher for Filtek Supreme XTE flowable restorative than their current, most frequently used flowable.
Esthetic features:
•Easeofpolish
•Shadeblendwithsurroundingtoothstructure
•Shadematchwiththeuniversal (no matter which universal composite was used)
•Finalpolish
•Chameleoneffect
•Overallestheticresults
Handling features:
•Abilitytoholdshape (stays where I put it, doesn’t slump)
•Cavityadaptation
•Stickiness
Overall satisfaction with the product:
More than 50% of the dentists rated the “Flow” and the “Overall esthetic results” as better with Filtek Supreme XTE flowable restorative than their current, most frequently used flowable. In all features compared, more than 80% of the dentists rated Filtek Supreme XTE flowable restorative the same or better than their most frequently used flowable.
Total Placements—5,063
Filtek Supreme XTE Flowable Restorative Compared to
Current Flowable
100 30
OverallHandling
Ease ofPolish
Flow
Match to VITAPAN® Shade Guide
Overall EstheticResults
% Respondents20 40 50 60 701020
Tetric EvoFlow®
Other flowable
Tetric EvoFlow®
Other flowable
Tetric EvoFlow®
Other flowable
Tetric EvoFlow®
Other flowable
Tetric EvoFlow®
Other flowable
1 2 3 = Filtek™ Supreme Ultra Flowable Restorative is Much Worse to Worse
4 = Filtek™ Supreme Ultra Flowable Restorative is the Same – (not shown)
5 6 7 = Filtek™ Supreme Ultra Flowable Restorative is Better to Much Better
Worse Better
Supreme Users
16
Questions and AnswersQ. What is the difference between Filtek™ Supreme XT Flowable Restorative and Filtek™ Supreme XTE Flowable Restorative?
A. There have been changes made in the filler, pigments and resin system. These changes have provided for lower shrinkage, better polish retention and fluorescence.
Q. Do the shades of Filtek Supreme XTE Flowable Restorative match Filtek™ Supreme XTE Universal Restorative?
A. Yes. In addition, the shades of Filtek Supreme XTE flowable restorative are the same as its predecessor, Filtek Supreme XT flowable restorative.
Q. What is the source of the almost 20% shrinkage reduction in Filtek Supreme XTE Flowable Restorative compared to its predecessor?
A. The changes in the resin system components have provided a low viscosity and lower shrinking framework.
1. Mitra SB, Wu D, Holmes BN. JADA (2003) 134, 1382-1390.
2. Takahashi MK, Vieira S, Rached RN, Almeida JB, Aguiar M, Souza EM. Operative Dentistry (2008), 33(2), 189-195.
3. SEMs courtesy of Dr. Jorge Perdigao, University of Minnesota, Division of Operative Dentistry, Department of Restorative Sciences.
References
17
Q&A, References, Technical Data Summary
Le
vel
Filte
k™ S
upre
me
XTE
(D
EB s
hade
s)Fi
ltek™
Sup
rem
e X
TE
(T s
hade
s)Fi
ltek™
Sup
rem
e X
TC
eram
X™
M
ono
Dur
afill
® V
SE
stel
ite®
Sig
ma
Qui
ckEs
thet
X® H
DG
radi
a®
Dire
ct
Gra
ndio
®H
ercu
lite®
XR
V U
ltra™
Pre
mis
e™
Com
pre
ssiv
e s
tre
ng
thM
Pa
37
0.5
63
94
.01
36
1.3
734
6.8
03
49.8
63
64
.19
37
6.8
332
3.4
03
41
.84
34
9.1
03
70
.81
StD
ev
15
.13
25
.05
23
.78
22
.96
10.4
014
.03
35
.41
7.9
21
6.0
42
3.5
11
8.8
3
Dia
me
tra
l Te
ns
ile S
tren
gthMP
a8
6.1
29
0.6
48
5.5
36
3.3
15
5.8
977
.56
73
.64
52
.82
81
.28
80
.65
65
.89
StD
ev
3.9
11
.40
5.4
76
.49
2.8
72
.98
2.3
85
.89
5.6
35
.76
8.1
8
Fle
xu
ral S
tre
ngth
MP
a1
65
.14
15
7.9
81
65
.90
11
3.6
86
4.5
01
11
.08
13
2.9
010
6.0
71
44
.03
10
6.4
81
08
.64
StD
ev
13
.59
8.1
65
.40
11
.52
3.6
23
.94
8.6
56
.77
17
.54
14
.34
9.6
4
Fle
xu
ral M
odu
lus
MP
a1
13
48
.00
91
80
.00
114
36
.00
883
0.0
02
61
3.0
07
552
.00
10
12
8.0
06
29
9.0
01
94
37
.00
76
79
.00
78
39
.00
StD
ev
27
1.0
04
31
.00
44
2.0
037
9.0
06
6.0
02
02
.00
14
6.0
018
5.0
02
99
.00
54
1.0
01
83
.00
Fra
ctu
re T
ou
gh
ne
ss
K1
c1
.84
1.5
11
.92
1.6
91.0
11
.70
1.0
51
.68
1.8
1S
tDe
v0
.19
0.0
30
.21
0.0
50.0
90
.12
0.0
60
.07
0.0
3
Shri
nk
ag
e%
1.9
72
.48
2.0
61
.97
2.0
01
.80
2.5
81
.92
1.6
92
.70
1.6
6
StD
ev
0.0
30
.06
0.0
60
.05
0.0
80
.05
0.0
50
.04
0.0
40
.07
0.0
6
Polish R
ete
ntion
Me
an
94
.83
93
.83
92
.81
72
.90
86.3
393
.93
92
.45
76
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67
.27
89
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91
.60
StD
ev
1.0
31
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2.3
5*
0.1
50
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2.3
30
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1.7
12
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6
Me
an
86
.82
88
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83
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36
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74.8
267
.62
54
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37
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43
.47
69
.63
70
.36
StD
ev
5.7
76
.01
6.0
87
.27
4.8
57
.45
3.8
61
0.2
74
.82
9.2
15
.97
Me
an
83
.32
85
.72
78
.73
25
.50
68.0
864
.14
27
.65
21
.58
35
.31
60
.83
63
.11
StD
ev
5.9
65
.60
7.6
96
.39
5.6
73
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1.0
31
2.8
66
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7.2
95
.81
Me
an
76
.55
82
.83
69
.74
23
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59.0
363
.55
25
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13
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20
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54
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49
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StD
ev
6.4
35
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8.5
72
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6.1
53
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2.6
45
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3.2
96
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8.4
8
Me
an
73
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82
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62
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10
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58.7
064
.29
29
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13
.00
17
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52
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44
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StD
ev
5.9
95
.96
8.6
91
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3.3
89
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2.5
90
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2.8
11
1.3
44
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Me
an
70
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81
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56
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9.8
05
5.6
762
.35
26
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10
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13
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53
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39
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StD
ev
5.5
24
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81
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6.5
73
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1.3
35
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6.9
7
Me
an
69
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79
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53
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52
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39
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StD
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5.3
66
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8.1
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3.5
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0.6
51
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0.9
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1.5
83
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Me
an
68
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79
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54
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7.9
85
3.2
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10
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11
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54
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37
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StD
ev
4.7
74
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7.7
50
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6.3
23
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1.0
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0.9
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5.0
0
3-b
od
y W
ea
r ra
teu
m lo
st
/20
0,0
00 c
ycle
s5
.61
6.5
45
.07
32
.04
15.2
27
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81
5.1
78
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St
de
v0
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0.5
00
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80.5
50
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0.5
5
400
0 c
ycle
s
500
0 c
ycle
s
60
00
Cyc
les
500
cycle
s
100
0 c
ycle
s
200
0 c
ycle
s
300
0 c
ycle
s
Init
ial
Filte
k™ S
upre
me
XTE
Flow
able
Res
tora
tive
Filte
k™ S
upre
me
XTFl
owab
le R
esto
rativ
eHe
liom
olar
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Prem
ise
Flow
able
Revo
lutio
nFo
rmul
a 2
SDR
TPH3
Flow
Venu
sFl
owVe
rtis
eFl
owTe
tric
EvoF
low
Shrin
kage
% StDe
v
K1c
StDe
v
MPa
StDe
v
MPa
StDe
v
MPa
StDe
v
MPa
StDe
v
Loss
per
200
,000
/cyc
les
StDe
v/20
0,00
0/cy
cles
3.28
0.03
1.67
0.07
317.
8217
.20
67.2
58.
51
120.
9618
.64
6815
.80
924.
00
19.3
30.
97
4.04
0.16
1.71
0.10
313.
2227
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68.9
13.
21
117.
1915
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6410
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210.
00
16.2
71.
07
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0.10
1.42
0.05
306.
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72.3
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58
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0
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09
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964.
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64
Leve
l
Com
pres
sive
Str
engt
h
Frac
ture
Tou
ghne
ss
Diam
etra
l Ten
sile
Str
engt
h
Flex
ural
Str
engt
h
Flex
ural
Mod
ulus
95.1
51.
98
89.5
23.
43
82.8
13.
31
77.8
53.
13
74.6
63.
43
74.4
73.
00
70.5
33.
49
71.2
32.
43
68.8
72.
63
1.70
0.05
95.0
01.
93
86.3
32.
35
79.7
81.
97
68.4
53.
66
62.3
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84
59.6
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24
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81.
65
45.6
02.
93
50.5
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94
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0.04
89.5
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78.9
33.
04
69.9
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20
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85
56.4
58.
60
33.8
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67
29.0
33.
16
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95
20.4
20.
82
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89.9
81.
11
83.4
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20
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63.
31
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83.
10
75.9
32.
74
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61.
68
70.8
62.
10
72.5
72.
08
69.6
52.
69
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0.03
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81.
51
85.4
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82
81.9
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11
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34
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55
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53.
75
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13
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29
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45
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91.5
21.
18
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69
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45
79.7
63.
19
77.8
03.
62
70.7
95.
08
69.4
76.
48
66.1
28.
00
62.7
98.
68
0.77
0.05
80.6
00.
42
28.5
33.
88
13.6
52.
10
13.3
82.
00
12.8
81.
60
12.2
41.
48
11.7
00.
97
11.4
01.
68
11.9
90.
74
2.18
0.02
92.0
82.
20
78.7
74.
42
74.1
54.
18
67.4
02.
40
64.1
52.
17
62.5
32.
28
56.5
51.
25
57.4
21.
26
51.6
72.
11
2.35
0.04
92.1
81.
75
87.0
31.
68
85.0
21.
62
81.7
71.
34
79.6
30.
97
74.5
81.
74
71.8
81.
70
67.2
52.
40
63.3
54.
20
1.51
0.12
95.0
30.
16
87.6
84.
55
70.3
78.
95
64.3
77.
88
58.1
78.
37
51.5
86.
04
46.3
26.
27
37.5
33.
72
37.9
73.
70
1.23
0.05
83.9
71.
83
74.6
34.
54
65.3
36.
22
56.8
22.
67
45.6
03.
96
34.5
24.
81
23.1
72.
18
17.1
32.
54
16.9
82.
28
2.44
0.10
Mea
nSt
Dev
Mea
nSt
Dev
Mea
nSt
Dev
Mea
nSt
Dev
Mea
nSt
Dev
Mea
nSt
Dev
Mea
nSt
Dev
Mea
nSt
Dev
Mea
nSt
Dev
mm
AI
StDe
v
Polis
h Re
tent
ion
Initi
al
1,00
0 cy
cles
500
cycl
es
1,50
0 cy
cles
2,00
0 cy
cles
3,00
0 cy
cles
4,00
0 cy
cles
5,00
0 cy
cles
Gran
dio
Flow
4.89
0.08
1.54
0.04
297.
8018
.94
64.7
34.
67
114.
8816
.89
5969
.10
600.
90
20.6
31.
05
91.0
31.
02
78.0
52.
68
63.9
56.
65
54.2
38.
70
45.2
310
.61
40.0
09.
66
35.7
57.
43
36.4
84.
05
36.4
43.
30
1.56
0.01
Flow
-It
ALC
4.14
0.03
1.76
0.18
304.
1911
.27
65.7
97.
02
127.
865.
21
5970
.70
226.
20
23.0
21.
21
92.2
32.
82
83.2
55.
75
79.1
87.
20
74.7
36.
02
73.1
27.
17
70.1
16.
63
66.7
86.
60
64.3
24.
47
64.4
04.
71
1.49
0.11
Esth
etX
Flow
3-Bo
dy W
ear R
ate
6,00
0 cy
cles
Radi
opac
ity
StDe
v =
sta
ndar
d de
viat
ion
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