When I first heard about SonicFill composite – a bulk fill that cures successfully up to 5 mm with excellent compressive strength, flexural strength, and low volumetric shrinkage – it sounded too good to be true. My scale tips heavily toward skepticism over early adaptation with new technologies.
After hearing Dr. Ron Jackson, one of the creators, speak on it at a lecture a few years ago, I opened my eyes and gave it a try. Since then, posterior composites have not only been easier and more predictable for me, they’ve become fun.
A few weeks ago I was doing volunteer dentistry where traditional composites were available for posterior restorations, and I realized that my placement ability and technique have changed quite significantly over the last two years using SonicFill. If you haven’t tried it, you should.
Facts and tips on SonicFill
1. What is it?
SonicFill is a composite that has rheological modifiers that reduce its viscosity up to 84 percent through sonic energy from a handpiece. Basically, the handpiece applies shear stress to the composite to make it less viscous. The reduction in viscosity is almost three times greater than traditional composites. It becomes quite flowable on placement, allowing for easy condensability and easy adaptation. As time goes on, the sonic energy dissipates and it handles more like a traditional composite; it is non-slumping and handles extremely well for sculpapility. It has the benefits of flowable composite for placement, and the benefits of traditional incrementally placed composites for sculpting anatomy and durability.
2. What about marginal adaptation and microleakage?
When SonicFill was tested for microleakage at the occlusal and cervical margins of class II restorations, it had the best overall score over SureFil SDR, Xeno IV, ceram.x, Filtek Supreme Ultra and Adper, although its improvement over these traditional composites was not statistically significant. Even if the result is not statistically significant, it shows equivalent ability to these well-documented, successful composites.
SonicFill placed in one bulk increment up to 5 mm has the equivalent marginal adaptation of Filtek Supreme Ultra and SureFil SDR in 2 mm increments. In addition, SonicFill is free of voids as a result of the sonic activation on placement. This means there is less likelihood of bulk fracture even when placed up to 5 mm.
3. How do we know we can cure up to 5 mm at once?
SonicFill composite at a depth of 5 mm with a single cure yields a ratio of 98 percent bottom/top hardness. The standard acceptable ratio is 80 percent. This shows an excellent depth of cure.
4. What about flexural strength, volumetric shrinkage and compressive strength?
Flexural strength informs you on the ability of a composite to deform and degrade over time. A high flexural strength has less likelihood of deforming and degrading in a high-stress environment (like a class II restoration). SonicFill has a higher flexural strength than Filtek Supreme Plus, Tetric EvoCeram, Surefil SDR and Venus, to name a few.
Volumetric shrinkage indicates the likelihood of the composite to pull away from the tooth structure during curing. A low volumetric shrinkage indicates lower likelihood of pulling away. SonicFill had significantly less than most traditional composite materials against which it was tested. Filtek Supreme Plus showed a slightly lower percentage (1.4 percent compared with SonicFill at 1.6 percent). This level indicates a reduced potential for microleakage and marginal staining.
Compressive strength indicates the ability of a composite to withstand occlusal forces and therefore the longevity of the restorative material. SonicFill has a higher compressive strength than most of the restorative materials against which it was evaluated. Although it was lower than Filtek Supreme Ultra, it was higher than Tetric EvoCeram, Surefil SDR, Esthet-X, QuiXX, Venus and others.
SonicFill lessons learned
1. It has incredible ease of use.
After you’ve placed a few, you get used to the handling and it becomes really fun. I take a post-op intraoral photo of all of my restorations. With traditional composites, I use to cross my fingers for a nice contact and send up a Hail Mary that there wouldn’t be a void on my next radiograph of the tooth. Now the contacts (with Ultradent's ring system) are predictable, and it’s reliably condensable without voids. Once the difficulty in placement is eliminated, you can concentrate on the artistry. Stress has decreased, satisfaction has increased.
2. It’s efficient and has different settings.
I rarely place more than one layer of SonicFill, with the exception of placing a build-up in an endo access. It comes out of the handpiece quickly and in a constant stream. You hold the tip at the bottom of the preparation and allow it to fill around the tip, slowly pulling the tip out as it’s expressed.
The bottom of the handpiece has five settings, 1-5. I typically keep mine on a 3-4 for routine placement, and will crank it up to a 5 if I’m sealing an endo access.
I’ll be honest that I tend to use what works in my hands and what has scientific backing long before I check the cost of an item. My mentality is that less headache and fewer redoes are worth more for my mental health as well as well as my pocket in the long run. That being said, it’s comparable to the penny with Filtek Supreme Ultra from my supplier.
You have to purchase the handpiece, which also requires a coupler, but you can get the handpiece for free if you purchase enough composite, which makes most of the additional start-up costs a wash.
4. Some tips and tricks with color matching!
The biggest complaint I have with the material is that it is slightly too translucent with amalgam-stained preps. We all like our composites to be as imperceivable as possible when finished, and although it excels the majority of the time, when you have a dark prep, it’s just not that pretty. I’ve found using white opaquer from Cosmedent over the stain on the pulpal floor helps significantly if the preparation is deep enough.
I almost always use A3 composite on all class IIs. I use to be very selective with posterior composite shade selection when I was using Venus Diamond (I had every shade in A, B and C). I’ve found that A3 blends beautiful (and holds the shade over time) in the majority of teeth. It comes in very few shades currently, but aside from a more opaque option, I’ve found the selection is sufficient.
5. It’s beautiful on radiographs
You don’t have to close one eye and blur the other one when you look at radiographs; it always looks fantastic. I’ve been using it for two years and I haven’t run into a problem with voids or needing to replace one.
A little extra tidbit: You need isolation! I recommend a dam or Isolite system for all composite placement, but this system gives you time to carve beautiful anatomy and really eliminate occlusal adjustments other than polishing. Don’t chase the clock because of pooling saliva!
If you haven’t tried SonicFill yet, I really do recommend you give it a try. It sounded too good to be true, but I’ve found it to be all that Kerr purports it to be.
Clinical Evaluation of Restorations using a New Composite Material and Oscillating Handpiece and Comparing it with Traditional Composite Material and Placement Technique – 6 months recall Authors: Dr. Parag Kachalia, Dr. Marc Geissberger, Dr.Shika Gupta, University of Pacific, San Francisco, CA
Marginal Quality and Associated Cusp Displacement of SonicFill™ Restorations Authors: Prof. Dr. Roland Frankenberger, Philipps University Marburg, Germany
Monomer Conversion of various thicknesses of SonicFill and competitive products Authors: Dr. Fred Rueggeberg, Georgia Health Sciences University, Augusta, GA
Viscosity change of SonicFill™ when subjected to sonic vibration Authors: Cao Luu, Ulf Drechsler, Kerr Dental Materials Center, Orange, CA 92867
Microleakage in Class II preparations restored with the SonicFill system Authors: Carlos A. Munoz-Viveros, DDS, MSD; Marc Campillo-Funollet, PhD, Dental Biomaterials Research Laboratory, State University of New York at Buffalo SonicFill™ Microleakage Authors: Dr. Ruben Begino, DDS, Santa Ana, CA; Christine Tran, Ulf Drechsler, Kerr Dental Materials Center, Orange, CA
SonicFill™ Depth of Cure Authors: Dr. Jeffrey Y. Thompson, NOVA Southeastern University, Ft. Lauderdale, FL
Depth of Cure of Several Composite Restorative Materials Authors: Yapp R, Powers JM.
Depth of Cure of Several Composite Restorative Materials. Dental Advisor Res Rpt 33:1. February 2011.
Evaluation of the effectiveness of different adhesive systems in combination with SonicFill (Kerr) in Class I cavities Authors: Dr. U. Blunck, Dept. Operative Dentistry, Charite-Universitatsmedizin Berlin, Germany
SonicFill™ Flexural Strength Authors: Dr. Jeffrey Y. Thompson, NOVA Southeastern University, Ft. Lauderdale, FL
SonicFill™ Volumetric Shrinkage Authors: Dr. Jeffrey Y. Thompson, NOVA Southeastern University, Ft. Lauderdale, FL
SonicFill™ Compressive Strength Authors: Dr. Jeffrey Y. Thompson, NOVA Southeastern University, Ft. Lauderdale, FL Submitted to AADR 2010