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© Borgis - Nowa Stomatologia 3/2018, s. 110-115 | DOI: 10.25121/NS.2018.23.3.110
*Anna Ogonowska1, Sylwia Falkowska1, Anna Oreszczuk1, Katarzyna Sokołowska2, Elżbieta Łuczaj-Cepowicz2, Grażyna Marczuk-Kolada2
Clinical evaluation of carious cavity restorations using Vertise Flow – 2-year observations
Kliniczna ocena wypełnień ubytków próchnicowych wykonanych z zastosowaniem materiału Vertise Flow – obserwacje dwuletnie
1Specialist Dental Surgery of Medical University of Białystok Sp. z o.o.
Head of Surgery: Anna Klimiuk, MD, PhD
2Department of Paediatric Dentistry, Medical University of Białystok
Head of Department: Grażyna Marczuk-Kolada, MD, PhD
Wstęp. Wprowadzenie materiałów samoadhezyjnych w stomatologii znacznie skróciło czas wypełniania ubytków próchnicowych. Do tej grupy należy m.in. światłoutwardzalny, półpłynny materiał kompozytowy firmy Kerr – Vertise Flow.
Cel pracy. Celem pracy była ocena kliniczna wypełnień wykonanych z użyciem materiału Vertise Flow w ubytkach klasy I zębów stałych.
Materiał i metody. U dzieci w wieku 8-17 lat wypełniono 154 ubytki próchnicowe przy użyciu materiału Vertise Flow. Po 2 latach przeprowadzono ocenę kliniczną 49 wypełnień, stosując kryteria zmodyfikowanej skali Ryge’a. Oceniono: kształt anatomiczny, barwę, gładkość, szczelność brzeżną wypełnień oraz obecność próchnicy wtórnej.
Na przeprowadzone procedury medyczne otrzymano zgodę rodzica bądź opiekuna prawnego dziecka.
Wyniki. Stwierdzono utrzymanie wszystkich kontrolowanych wypełnień oraz akceptowalny kształt anatomiczny i gładkość. Jedno wypełnienie nieznacznie zmieniło barwę, a nieakceptowalną szczelność brzeżną wykazano w dwóch przypadkach. Próchnica wtórna dotyczyła dwóch zębów.
Wnioski. W dwuletniej ocenie Vertise Flow spełnia wymogi stawiane materiałom do wypełniania oszczędnie opracowanych ubytków próchnicowych klasy I w zębach stałych u młodych pacjentów.
Introduction. The introduction of self-adhesive materials in dentistry has significantly reduced the duration of filling carious cavities. This group includes a light-curing, semi-liquid composite material from Kerr, called Vertise Flow.
Aim. The aim of the study was clinical evaluation of restorations made using Vertise Flow in class I cavities in permanent teeth.
Material and methods. In children aged 8-17 years, 154 cavities were filled with Vertise Flow. After 2 years, 49 fillings were clinically evaluated according to the modified Ryge’s criteria. The anatomical shape, colour, smoothness, marginal integrity of restorations and the evidence of secondary caries were assessed.
Parents or legal guardians of the children consented to the medical procedures.
Results. All the evaluated restorations were found retained, with acceptable anatomical shape and smoothness. One restoration slightly changed the colour, and unacceptable marginal integrity was seen in 2 cases. Secondary caries involved 2 teeth.
Conclusions. In this 2-year observation, Vertise Flow meets the requirements for materials used for filling minimally prepared class I carious cavities in permanent teeth of young patients.

Flowable composite materials were introduced in dentistry in the 1990s (1). They have rheological and self-adapting properties, and are characterised by lower viscosity compared to conventional composites as they contain 20-25% less filler. They exhibit good marginal integrity and a low elasticity module. Moreover, most of these materials are contrasted on X-ray and have aesthetic effects (2).
Vertise Flow is a self-adhesive, light-curing and semi-liquid composite from Kerr, with its formulation based on the OptiBond technology. It is available in 9 shades (3). The composite contains phosphoric acid methacrylate ester and a monomer, glicerodimethacrylate phosphate (GPDM) (4). According to the manufacturer, this material bonds with mineralised dental tissue via two mechanisms. The first involves chemical interaction between calcium ions of these tissues and functional phosphate groups in GPDM contained in the composite. The other is based on tissue micromechanic etching, facilitated by low pH of the filling material (pH = 1.9) (5). However, the use of this type of composite is restricted to special clinical situations. According to the manufacturer, Vertise Flow is indicated for small Black’s class I and V caries lesions, as a liner under class I and II restorations, as a sealant for pits and fissures, and for repair of enamel defects, porcelain restorations and incisal abrasions. The introduction of self-adhesives has significantly shortened the duration of application, which seems to be significant as for procedures conducted in paediatric patients (2, 3, 5).
The aim of the study was to conduct a two-year clinical observation of Black’s class I restorations in permanent teeth, performed with the use of Vertise Flow.
Material and methods
Between 20 January 2015 and 28 December 2015, Vertise Flow (VF) was used in 154 restorations in patients reporting for dental treatment to the Department of Paediatric Dentistry of the Medical University of Białystok, Poland. Parents or legal guardians of the children consented to the medical procedures. Patients older than 16 years of age also expressed consent themselves. Cavities were prepped in accordance with the current principles, with minimal removal of carious tissue (minimally invasive technique). They were opened with diamond burrs on fast-speed handpieces, and carious tissue was removed using carbide burrs on slow-speed handpieces. After cavity preparation, the material, adjusted to tooth shade, was applied directly from a syringe with an application tip. The material was subsequently spread with a brush for 15-20 seconds, and then cured for 20 seconds using a halogen polymerisation lamp. The duration of light-curing was longer (40 seconds) only for shades A3.5 and Universal Opaquer. Excess material was removed with a diamond-coated burr on a slow-speed handpiece, and subsequently the restoration was polished.
Two years later, the Vertise Flow restorations were inspected visually and tactually. Again, consent of the parents/legal guardians and patients over 16 years of age was obtained. No other medical procedures were conducted during the assessment. When the filling needed replacement, the patients were informed accordingly.
Clinical follow-up involved 45 children, both girls and boys, aged 8 to 17 years (age on the day of examination). Evaluations were made for Black’s class I restorations in permanent teeth, with superficial and moderate caries diagnosed prior to Vertise Flow application. Restorations of other classes in permanent dentition and restorations in primary dentition were not subject to assessment due to their low number in patients who reported for follow-up. In 40 children and adolescents who met the criteria, 49 restorations were evaluated (tab. 1). The examination was conducted by two examiners using a mirror and an explorer in artificial lighting, with the assessment based on the modified Ryge’s criteria (tab. 2) (6-8). Prior to the assessment, the results of one examiner and between two examiners were calibrated based on 20 restorations.
Tab. 1. The study material with a division into tooth groups
Number of examined teethUpperLowerTotal
Tab. 2. Modified Ryge’s criteria
ParameterModified evaluation criteria
Anatomic form0 – the restoration is a continuation of the anatomic form of a tooth 1 – minor overhangs or fillings that do not reach the ridge; height of occlusion is locally decreased
2 – a discontinuous filling exposes the dentine or base; incomplete occlusal contact
3 – partial or complete absence of filling; lost occlusal contact; this is a reason of pain in the tooth or periodontium
Colour0 – no discoloration
1 – small localised discoloration, easy to remove
2 – discoloration requiring a more major intervention
3 – significant discoloration that cannot be repaired
Roughness0 – the surface is smooth
1 – the surface is slightly rough; smoothness can be restored by polishing
2 – the surface is rough; smoothness cannot be restored by polishing
3 – the surface is coarse, rough
Marginal integrity0 – the explorer tip does not catch on the filling edges
1 – a crevice along the filling exposes the enamel
2 – a crevice along the filling exposes the dentine or base
3 – the filling is movable, fractured or missing entirely
Secondary caries0 – no evidence of secondary caries along the margin of the restoration
1 – evidence of secondary caries along the margin of the restoration
Restorations with scores 0 and 1 were considered clinically acceptable, whilst those with scores 2 and 3 were not deemed acceptable and needed to be replaced: replacement could be postponed in score 2 restorations and had to be done immediately in score 3 restorations. All restorations with secondary caries were selected for replacement.

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otrzymano: 2018-07-16
zaakceptowano do druku: 2018-07-27

Adres do korespondencji:
*Anna Ogonowska
Zakład Stomatologii Dziecięcej Uniwersytet Medyczny w Białymstoku
ul. Waszyngtona 15a, 15-274 Białystok
tel.: +48 (85) 745-09-56

Nowa Stomatologia 3/2018
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