Restoring Primary PosteriorTeeth With A Compomer Using L.D. Caulk’s “Dyract”

Dyract AP Dyract AP (Advanced Performance) is a compomer manufactured by Caulk. Compomers are polyacid-modified hydrophilic resin composites, containing glass particles, which are somewhat dissolved as oral fluids activate the acid in the biomaterial. As a result fluoride is released, creating cariostatic potential for the restoration.

Dyract AP Dyract is indicated for use in the conservative restoration of primary teeth. It is not recommended for use in permanent teeth as its long term service characterisitics (lower strength and higher wear rate) are less desirable than an amalgam or a resin-based composite such as Herculite.

resin-modified glass Ionomer polyacid-modified resin composite conventional glass-ionomer conventional resin-composite Ketac-Fil Fuji II LC Dyract Herculite

Technique A conservative, bio- mechanically sound cavity preparation is completed in the primary tooth. If a Class II, the preparation should be identical to a Class II amalgam preparation. If a Class I, the preparation should not be “extended for prevention,” rather any fissures remaining after extending sufficiently to eradicate the carious lesion should be conditioned and sealed with a fissure sealant.

Dyract Technique The cavity preparation is then etched with 37% orthophosphoric acid for 20 seconds, thoroughly washed for 20 seconds, and then air dried. The manufacturer indicates that enamel conditioning is not an absolute requirement when restoring primary teeth, and the Prime and Bond can be placed without conditioning. However, Caulk does acknowledge that etching does improve marginal integrity, and it is therefore recommended by Pediatric Dentistry.

Dyract Technique Caulk’s Prime and Bond is placed with a clean disposable brush, thoroughly wetting all surface of the preparation. The surfaces should remain wet for 20 seconds.

Dyract Technique Gently air dry for 5 seconds The surface should have a uniform glossy appearance; if not reapply Prime and Bond. Light cure for 10 seconds. When a matrix is being utilized, Prime and Bond should be applied and cured before the matrix band is placed.

Dyract Technique Dyract is supplied in compules with fourteen different shades. The shades employed with primary teeth are the two lightest: XL and B1.

Dyract Technique Dyract is dispensed in a compule and applied using a composite gun.

Dyract Technique Apply the Dyract biomaterial in increments no thicker than 3 mm; light curing each increment for 40 seconds. Restore the tooth to its normal contour and function.

Dyract Technique Finish with an appropriate composite finishing and polishing system. 12 fluted carbide burs can be used to finish and contour the restoration: –7406 (egg), for the occlusal –7902 (needle), for the proximal –7802 (bullet), for fine grooves on the occlusal Caulk’s Enhance polishing point can be used to polish the restoration. ESPE 3M’s Softflex and Caulk’s Prisma Gloss can be also used. Alternatively, the 3300 (green) and the 3301 (gray) diacomp points can be employed.

Herculite Herculite is a conventional resin-composite. As such, it has greater wear resistance and strength than a polyacid-modified resin composite such as Dyract. Therefore, it has considerable greater longevity. When completing Class I restorations (sometimes referred to as Preventive Resin Restorations-PRRs) on young permanent teeth, it is the material of choice—not Dyract; for the reasons identified above. Manufacturer’s instructions for using Herculite should be followed. However, they are essentially the same as those for Dyract. Please note that the Division of Pediatric Dentistry requires that conventional Class 1 preparations be employed in such instances, always completed in sound dentin, and extended such that the dentino-enamel junction of the preparation can be visualized throughout; ensuring no caries remains at the d.e.j. This is to be distinguished from what some advocate, that is, that only enamel need be removed, if thought that only enamel is involved; and that a conventional preparation with a flat pulpal floor completed in sound dentin is not required.