20
Filtek ™ Ultimate Flowable Restorative TM Filtek technical product profile
Filtek™ UltimateFlowable Restorative
TMFiltektechnical product profi le
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™ Ultimate 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 Ultimate Flowable Restorative ................................................ 15
Questions and Answers ................................................................................................. 16
References ........................................................................................................................... 16
Technical Data Summary ............................................................................................. 17
IntroductionBuilding upon over 40 years of innovation in the fi eld 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 fi ller architecture at the nanoscale, 3M ESPE developed a breakthrough composite fi lling material that
signifi cantly advanced the clinical performance of universal composites.
In 2002, 3M ESPE launched Filtek™ Supreme Universal Restorative. This was the fi rst product that utilized
nanotechnology to provide the esthetics of a microfi ll and the strength of a hybrid. All of the fi ller particles
in this novel composite are surface-modifi ed, bonded nanofi llers.
Incorporation of this fi ller technology into a fl owable 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 “fl ow-on-demand” handling of 3M™ ESPE™ Filtek™ Flowable Restorative.
Through global customer research and discussions with general dentists and opinion leaders, usage and
areas of potential improvements for fl owables were identifi ed. Flowable usage has increased over the past
5 years because of new indications, better physical properties, better handling characteristics and, fi nally,
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™ Ultimate Flowable Restorative.
Improvements• Lower shrinkage
• Improved esthetics
– Added fl uorescence
– Improved polish retention
• Delivery
– Easier-to-read shade designation
– Syringe delivery
These improvements were made without compromising the strengths of Filtek Supreme XT
fl owable restorative:
• “Flow-on-demand” handling
• Wear-resistance
• Physical properties
• Shade match to the tooth and to Filtek™ Ultimate Universal Restorative
1
Introduction
Product DescriptionFiltek™ Ultimate Flowable Restorative is a low-viscosity, visible light-cured, radiopaque fl owable 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 Ultimate fl owable restorative can be used alone, after placing a compatible adhesive, or in con-junction with a methacrylate-based restorative such as Valux™ Plus Restorative, Filtek™ Z250 Restorative, Filtek™ P60 Restorative or Filtek™ Ultimate Universal Restorative.
The restorative is packaged in syringes. It is available in a variety of tooth-colored shades. The shades offered with Filtek Ultimate fl owable restorative were designed to coordinate with shades offered with Filtek Ultimate universal restorative.
Indications for UseFiltek Ultimate fl owable restorative is indicated for:
• Base/liner under direct restorations
• Undercut blockout
• Class III and V restorations
• Restoration of minimally invasive cavity preparations (including small, nonstress-bearing occlusal restorations)
• Repair of small defects in esthetic indirect restorations
• Pit and fi ssure sealant
• Repair of resin and acrylic temporary materials
CompositionFiltek Ultimate fl owable restorative contains BisGMA, TEGDMA and Procrylat resins. The fi llers are a combination of ytterbium trifl uoride fi ller with a range of particle sizes from 0.1 to 5.0 microns, a non-agglomerated/non-aggregated surface-modifi ed 20 nm silica fi ller, a non-agglomerated/non-aggregated surface modifi ed 75 nm silica fi ller, and a surface-modifi ed aggregated zirconia/silica cluster fi ller (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 fi ller loading is approximately 65% by weight (46% by volume).
Filtek Ultimate fl owable restorative is a modifi cation of Filtek™ Supreme XT Flowable Restorative based on customer needs. In a global market research study on fl owable restoratives, overall esthetics and shrinkage were identifi ed as key features that would impact product desirability. Also, manyrespondents believed that materials, made by the same manufacturer and utilizing similar components,work better together. The preference for fl owables was determined to be growing globally.
The formulation improvements of Filtek Ultimate fl owable restorative take advantage of the advancements made in fi ller processing and resins since the introduction of Filtek Supreme XT fl owable restorative. The formulation was modifi ed to improve properties, such as shrinkage, fl uorescence and polish retention.
2
ShadesFiltek Ultimate fl owable restorative is available in the same shades as Filtek Supreme XT fl owable restorative. These shades are matched to the VITAPAN® Classical Shade Guide and correspond to shades of Filtek Ultimate 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 Ultimate 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 fl uorescence. 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 fl uorescence than enamel. The fl uorescence of Filtek Ultimate fl owable restorative is similar to Filtek Ultimate universal restorative. Both fl uoresce more than the disc of Filtek Supreme XT fl owable restorative (Figure 1).
Figure 1: FluorescenceFiltek™ Ultimate Flowable Restorative
Filtek™ Ultimate Universal Restorative Filtek™ Supreme XT
Flowable Restorative
Product Description
3
BackgroundFillersNanocomposites
3M ESPE manufactures many of its fi llers using a sol gel process. The sol gel process is a route wherein fi llers 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 fi ller 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 fi llers that are highly densifi ed or compacted, as found in 3M™ ESPE™ Valux™ Plus 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 densifi ed particles, these nanoclusters behaved similarly to the densifi ed particles found in other composites in terms of providing a range of particle sizes which allow for high fi ller loading. This resulted in a material with the strength and wear of hybrids with signifi cantly improved polish retention and optical properties. This technology advance was fi rst used in 3M™ ESPE™ Filtek™ Supreme Universal Restorative (Figures 3 and 4).
Filtek™ Supreme XT Flowable Restorative was formulated using the same surface-modifi ed zirconia/silica nanocluster fi ller found in the Filtek Supreme universal restorative Dentin, Enamel and Body shade composition. The nanocluster fi ller particles consist of loosely bound aggregates of engineered zirconia and silica nanofi ller particles. Two non-agglomerated/non-aggregated nanofi llers were added to the formulation to reduce the interstitial spacing of the fi ller particles leading to higher fi ller loadings. One was the 75 nm non-agglomerated/non-aggregated silica previously found in Filtek Supreme Universal Restorative Translucent shades. The other was a 5-10 nm zirconia particulate which was unique to the fl owable composition, and enhanced the radiopacity provided by the nanoclusters. This optimized fi ller system contributed to the excellent physical, wear and polish properties of Filtek Supreme XT fl owable restorative, while still allowing for the desired fl owable handling.
Figure 2: Filtek™ Z250 RestorativeMagnification 30,000X
Figure 3: Filtek™ Supreme XT Universal Restorative(DEB Shades)Magnification 30,000X
Figure 4: Filtek™ Supreme XTUniversal Restorative(T Shades)Magnification 30,000X
4
Filler Improvements in Filtek™ Ultimate Flowable Restorative
This fi ller technology was improved again. The manufacturing process, where the clusters are formed, was modifi ed to produce less sintering. Once again, the zirconia/silica nanoclusters are produced in a broad range of sizes enabling high fi ller 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 fl owable 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 fi llers were previously used in Filtek™ Supreme XT Universal Restorative. The 20 nm non-agglomerated/non-aggregated silica was used in Dentin, Enamel and Body shades. The 75 nm non-agglomerated/non-aggregated silica was used in the Translucent shades and Filtek Supreme XT fl owable restorative formulations.
The fourth fi ller in this system, ytterbium trifl uoride, is added to enhance radiopacity.
Figure 5: Filtek™ Ultimate Flowable RestorativeMagnification 100,000X
Background
5
Resin systemThe key feature of fl owable restoratives is their fl ow properties. The ability to wet the surface of the cavities quickly and with minimal instrumentation defi nes this fi lling material category. These materials are used as liners, as well as actual fi lling materials for small restorations. Besides fl owable 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 modifi cations that produce a fl owable restorative (lower viscosity) adversely affect strength, wear resistance and shrinkage.
Both resin composition and fi ller loading contribute to shrinkage. Methacrylate composites inherently shrink during polymerization. The amount of shrinkage is impacted by the monomers used. Generally speaking, low viscosity monomers are low molecular weight. Low molecular weight monomers can cause 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 fi ller loading. The lower the viscosity of the resin system, the more fi ller can be added to the resin before the viscosity becomes stiff. In the case of fl owable restoratives, increasing fi ller loading is not usually a viable option to reduce shrinkage because the fl ow properties diminish.
The challenge the Filtek™ Ultimate Flowable Restorative development team faced was how to reduce the shrinkage without adversely affecting the fi nal composite hardness and the fl ow. 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 fl owable restorative low enough to fl ow, while containing a high enough fi ller load to impart good strength and wear resistance. The shrinkage of Filtek Supreme XT fl owable restorative, while higher than universal restoratives, was similar to other fl owables.
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 identifi ed 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 Ultimate fl owable 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 fi ller loading as Filtek Supreme XT fl owable restorative. While the strength and wear resistance is similar for the two products, the shrinkage of Filtek Ultimate fl owable restorative is signifi cantly less than its predecessor.
In addition, a dimethacrylate polymer is added as rheology modifi er to produce the “fl ow-on-demand” feature as in Filtek Supreme XT fl owable restorative. This additive enables the viscosity of Filtek Ultimatefl owable restorative to change when manipulated, offering greater control during placement. Many fl owable composites will run when subjected to gravitational force. This property makes control of the restorative diffi cult in certain indications such as Class V restorations or liner indications. Filtek Ultimate fl owable restorative holds its shape under these conditions. However, when a shear force is applied to Filtek Ultimate fl owable restorative, such as during extrusion through the dispensing tip and manipulation on the preparation, the viscosity of the restorative decreases. This means Filtek Ultimate fl owable restorative becomes more fl uid, allowing for easy adaptation to the preparation. Once this shear force is removed, such as when manipulation stops, Filtek Ultimate fl owable 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 fl exible upper plate is defl ected during the polymerization of the test specimen. The less the fl exible plate bends, the lower the shrinkage. Defl ection 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™ 2 Visible Light Curing Unit. The fi nal shrinkage was recorded 4 minutes after the end of light exposure.
The shrinkage of Filtek™ Ultimate Flowable Restorative is lower than Tetric EvoFlow, Premise Flowable, Heliomolar Flow, Filtek™ Supreme XT Flowable Restorative, TPH3 Flow, EsthetX Flow, Vertise Flow, Venus Flow, Flow-It ALC and Revolution Formula 2. The shrinkage of Filtek Ultimate fl owable restorative is comparable to Grandio Flow.
Filte
k™ U
ltim
ate
Flow
able
Res
tora
tive
Filte
k™ S
upre
me
XTFl
owab
le R
esto
rativ
e
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
SDR
Tetri
c Ev
oFlo
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
Polymerization ShrinkagePolymerization Shrinkage
Source: 3M ESPE internal data
Filte
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Flow
able
Res
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Filte
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upre
me
XTFl
owab
le R
esto
rativ
e
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
SDR
Tetri
c Ev
oFlo
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
8
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.
Filte
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ate
Flow
able
Res
tora
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Filte
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upre
me
XTFl
owab
le R
esto
rativ
e
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
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
Polish RetentionPolish Retention
Polish Retention versus other flowable restoratives
Source: 3M ESPE internal data
Physical Properties
9
After 6000 toothbrush abrasion cycles, Filtek Ultimate fl owable restorative exhibits better polish retention than Filtek Supreme XT fl owable restorative, Grandio Flow, Flow-It, SDR, Tetric EvoFlow, Venus Flow and Vertise Flow.
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 profi lometry 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.
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
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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Flow
able
Res
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Filte
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XTFl
owab
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SDR
The wear resistance of Filtek™ Ultimate Flowable Restorative is similar to the wear resistance of Filtek™ Supreme XT Flowable Restorative. The 3-body wear rate (in-vitro) of Filtek Ultimate fl owable restorative is lower than Flow-It ALC, Venus Flow, EsthetX Flow, TPH3 Flow, Vertise Flow, Revolution Formula 2, Tetric EvoFlow, Heliomolar Flow and SDR. The 3-body wear rate (in-vitro) of Filtek Ultimate fl owable restorative is comparable to Premise Flow.
Wear Rate (in-vitro)
Wear Rate
Source: 3M ESPE internal data
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 fi xture 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 fi xture that provides fl exural strength and modulus 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
w
2.00
K1c
2.50
1.50
1.00
0.50
0.00
Fracture Toughness
Fixture
Sample Notch
Anvil
Instron Fixture
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Flow
able
Res
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Filte
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upre
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XTFl
owab
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esto
rativ
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SDR
Venu
s Fl
ow
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
2.00
K1c
2.50
1.50
1.00
0.50
0.00
Fracture Toughness
Fixture
Sample Notch
Anvil
Instron Fixture
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Flow
able
Res
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Filte
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owab
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SDR
Venu
s Fl
ow
Fracture Toughness
The fracture toughness of Filtek Ultimate fl owable restorative is higher than Grandio Flow. The fracture toughness of Filtek Ultimate fl owable restorative is comparable to Filtek Supreme XT fl owable 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
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™ Ultimate Flowable Restorative is higher than SDR. The compressive strength of Filtek Ultimate fl owable 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.
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
200
300
MPa 250
150100500
Compressive Strength
350
450400
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Flow
able
Res
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owab
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SDR
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
200
300
MPa 250
150100500
Compressive Strength
350
450400
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Flow
able
Res
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Filte
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SDR
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 Ultimate fl owable restorative is higher than Revolution Formula 2, Premise Flow, Heliomolar Flow, SDR and Tetric EvoFlow.
The diametral tensile strength of Filtek Ultimate fl owable restorative is comparable to Filtek Supreme XT fl owable restorative, EsthetX Flow, Flow-It, Grandio Flow, Vertise Flow, Venus Flow and TPH3 Flow.
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
40
60
MPa
50
3020100
Diametral Tensile Strength8070
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Res
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SDR
Revo
lutio
n Fo
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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
40
60
MPa
50
3020100
Diametral Tensile Strength8070
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Res
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e
SDR
Diametral Tensile Strength
Compressive Strength
Source: 3M ESPE internal data
Diametral Tensile Strength
Source: 3M ESPE internal data
12
Physical Properties
Flexural strength and modulusFlexural strength is determined in the same test as fl exural modulus. Flexural strength is the value obtained when the sample breaks. This test combines the forces found in compression and tension. The fl exural strength of Filtek Ultimate fl owable restorative is comparable to Filtek Supreme XT fl owable restorative, EsthetX Flow, Vertise Flow, Grandio Flow, Venus Flow, TPH3 Flow, Tetric EvoFlow, Flow-It ALC, SDR, Heliomolar Flow, Revolution Formula 2 and Premise Flow.
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™ U
ltim
ate
Flow
able
Res
tora
tive
Filte
k™ S
upre
me
XTFl
owab
le R
esto
rativ
e
SDR
Flexural modulus is a method of defi ning a material’s stiffness. A low modulus indicates a fl exible material. The fl exural modulus is measured by applying a load to a material specimen that is supported at each end.
The fl exural modulus of Filtek Ultimate fl owable restorative is comparable to Filtek Supreme XT fl owable restorative, Premise Flow and Grandio Flow.
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
4000
6000
MPa 5000
300020001000
0
Flexural Modulus
700080009000
Filte
k™ U
ltim
ate
Flow
able
Res
tora
tive
Filte
k™ S
upre
me
XTFl
owab
le R
esto
rativ
e
SDR
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
ow80
120
MPa
100
6040200
Flexural Strength
140160
Filte
k™ U
ltim
ate
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™ U
ltim
ate
Flow
able
Res
tora
tive
Filte
k™ S
upre
me
XTFl
owab
le R
esto
rativ
e
SDR
Flexural Modulus
Flexural Strength
Source: 3M ESPE internal data
Flexural Modulus
Source: 3M ESPE internal data
13
14
Field evaluationA fi eld evaluation was conducted in two countries, Germany and Sweden, to confi rm the clinical performance and acceptability of Filtek™ Ultimate Flowable Restorative. Data detailed in this section includes the 133 respondents.
Recruitment criteria were designed to obtain 80% competitive fl owable users and 20% Filtek™ Supreme XTFlowable Restorative users. Approximately 43% of the former were Tetric EvoFlow users. Evaluators received a selection of 6 shades.
Current fl owable usageSixty-three percent of the respondents use more than one fl owable in their practice. Dentists are using fl owable for a variety of indications, both as an interior surface material and as a fi nal fi lling material. The frequency that these types of restorations are done in a week and the frequency a fl owable is used in these indications varies signifi cantly. Therefore, the number of times a fl owable is used in each indication varies from a high of 12 liner/base applications per week (mean), to a low of 2 porcelain or composite 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
63.9
Percent of Dentists Using Flowable in Each Indication
Percent of dentists using flowable
Source: 3M ESPE internal data
The primary reasons cited for using a fl owable composite as a liner/base include:
• Stress relief
• Cavity and marginal adaptation (including the ability of the material to wet the surface, fl ow, the ability to seal dentin, and to produce a gap-free restoration)
• Handling
• Ease of use
• Shades (either a layer that can be discriminated from dentin, or to have a material that matches surrounding tooth or universal composite)
The primary reasons cited for using fl owables as fi lling materials include:
• They provide a smooth transition from restoration to tooth
• Handling in terms of fl ow, ability to adapt to the cavity and margins, and the wetting characteristics
• The procedure is faster—fi nishing and polishing time is reduced
• The procedure is simple—frequently dentists don’t need to touch the material to adapt, and they are easy to apply
15
Field Evaluation
Evaluation of Filtek Ultimate Flowable RestorativeThere were 5,063 placements made with Filtek Ultimate fl owable restorative during the fi eld evaluation.
Thirty percent of the placements were internal surface applications. The remaining 70% of the placements were as a fi lling material.
Dentists, including Tetric EvoFlow users, rated their satisfaction with the following features signifi cantly higher for Filtek Ultimate fl owable restorative than their current, most frequently used fl owable.
Esthetic features:
• Ease of polish
• Shade blend with surrounding tooth structure
• Shade match with the universal (no matter which universal composite was used)
• Final polish
• Chameleon effect
• Overall esthetic results
Handling features:
• Ability to hold shape (stays where I put it, doesn’t slump)
• Cavity adaptation
• Stickiness
Overall satisfaction with the product:
More than 50% of the dentists rated the “Flow” and the “Overall esthetic results” as better with Filtek Ultimate fl owable restorative than their current, most frequently used fl owable. In all features compared, more than 80% of the dentists rated Filtek Ultimate fl owable restorative the same or better than their most frequently used fl owable.
Total Placements—5,063
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™ Ultimate Flowable Restorative is Much Worse to Worse
4 = Filtek™ Ultimate Flowable Restorative is the Same – (not shown)
5 6 7 = Filtek™ Ultimate Flowable Restorative is Better to Much Better
Worse Better
Supreme UsersFiltek Ultimate Flowable Restorative Compared to
Current Flowable
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%
16
Questions and AnswersQ. What is the difference between Filtek™ Supreme XT Flowable Restorative and Filtek™ Ultimate Flowable Restorative?
A. There have been changes made in the fi ller, pigments and resin system. These changes have provided for lower shrinkage, better polish retention and fl uorescence.
Q. Do the shades of Filtek Ultimate Flowable Restorative match Filtek™ Ultimate Universal Restorative?
A. Yes. In addition, the shades of Filtek Ultimate fl owable restorative are the same as its predecessor, Filtek Supreme XT fl owable restorative.
Q. What is the source of the almost 20% shrinkage reduction in Filtek Ultimate 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
15.1
32
5.0
52
3.7
82
2.9
61
0.4
014
.03
35
.41
7.9
21
6.0
42
3.5
118
.83
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
65.1
41
57
.98
16
5.9
011
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
13.5
98
.16
5.4
01
1.5
23.6
23
.94
8.6
56
.77
17
.54
14
.34
9.6
4
Fle
xu
ral M
odu
lus
MP
a1
13
48.0
091
80
.00
114
36
.00
883
0.0
02
61
3.0
07
552
.00
10
12
8.0
06
29
9.0
019
43
7.0
076
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
c1.8
41
.51
1.9
21
.69
1.0
11
.70
1.0
51
.68
1.8
1S
tDe
v0.1
90
.03
0.2
10
.05
0.0
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
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0.0
40
.07
0.0
6
Polish R
ete
ntion
Me
an
94.8
39
3.8
39
2.8
17
2.9
08
6.3
393
.93
92
.45
76
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67
.27
89
.67
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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0.9
6
Me
an
86.8
28
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48
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93
6.0
37
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267
.62
54
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37
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43
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69
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70
.36
StD
ev
5.7
76
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6.0
87
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4.8
57
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3.8
61
0.2
74
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9.2
15
.97
Me
an
83.3
28
5.7
27
8.7
32
5.5
06
8.0
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
76.5
58
2.8
36
9.7
42
3.1
85
9.0
363
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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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ev
6.4
35
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8.5
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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
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Me
an
73.1
98
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16
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55
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an
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5.5
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69.6
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an
68.6
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53.2
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ev
4.7
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3-b
od
y W
ea
r ra
teu
m lo
st
/20
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ycle
s5.6
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St
de
v0.6
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400
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s
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les
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cycle
s
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s
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s
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s
Initia
l
Filte
k™ U
ltim
ate
Flow
able
Res
tora
tive
Filte
k™ S
upre
me
XTFl
owab
le R
esto
rativ
eHe
liom
olar
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ise
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able
Revo
lutio
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rmul
a 2
SDR
TPH3
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Venu
sFl
owVe
rtis
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tric
EvoF
low
Shrin
kage
% StDe
v
K1c
StDe
v
MPa
StDe
v
MPa
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v
MPa
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v
MPa
StDe
v
Loss
per
200
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/cyc
les
StDe
v/20
0,00
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cles
3.28
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317.
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00
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97
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00
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Leve
l
Com
pres
sive
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h
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ture
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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
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93
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35
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97
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95
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31
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08
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55
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75
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69
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45
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62
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08
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48
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00
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68
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88
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10
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97
11.4
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68
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42
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18
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28
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26
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11
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92.1
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75
87.0
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62
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34
79.6
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97
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74
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70
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40
63.3
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20
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95.0
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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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3M, ESPE, Filtek, Visilux and Valux are trademarks of 3M or 3M ESPE AG. EsthetX, Flow-It ALC, Grandio Flow, Heliomolar, Premise Flowable, Revolution Formula 2, SDR, Tetric EvoFlow, TPH3, Venus Flow, Vertise Flow and VITAPAN are not trademarks of 3M.
