There are a variety of core buildup materials for dentists to choose from today. This product category has a long history, and the options have continued to improve over time.
The Catapult Group was recently asked to review one of the newest options: Visalys® Core, the first core buildup material from Kettenbach. The evaluators were not disappointed, with the material receiving a very high 95% overall approval rating.
A Closer Look at the Material
Unlike other core buildup materials, clinicians can use Visalys® Core with any of the most popular bonding agents on the market. How is that possible? The material features Active-Connect- Technology (ACT), which allows it to fully polymerize and actively bond to all popular adhesives—without the need for an additional activator. This means dentists can use their favorite bonding agent without worrying about delayed de-bonding.
To fully understand how this works, this chemistry allows the self-cure reaction of the core material regardless of the bonding agent, so, unlike other core buildup materials, Visalys® Core is not adversely affected by different acidities from various bonding agents. Hence there is no need for additional activators, different protocols and ultimately added costs.
The Catapult Group dentists used 11 different bonding agents which is consistent with the wide variety of bonding agents used in dentistry today. The bottom line for Visalys® Core is that regardless of whatever light curing bonding agent you are using (dual activators not necessary), this material can self- cure if light curing cannot penetrate the full extent of the buildup. Ultimately this allows a safety factor in the deepest parts of your core buildups.
Now to the “but”! As seen in the case in this article, I still prefer the usage of a thin/universal bonding agent that will light cure/dual/self-cure when doing posts such that within the canal, even with light curing, I have the additional safety factor of complete hybridization.
While ACT is a great feature, in order to switch materials, I need a core buildup material that offers excellent handling, which happens to be an area Visalys excels in as well.
This is what Catapult’s evaluators said about the material’s characteristics as they relate to handling:
Evaluators also found the material was easy to inject post preparation without voids and that it’s possible to place the material around the post as the core without slumping.
Improvements evaluators would like to see
Though overall the group was very happy with the material, there’s always room for improvement. Per the DFU, it takes 5 minutes for the material to self-cure. The Catapult Group would like self-curing to happen a little faster.
The clinical case
I want to share a case that I completed in my practice using Visalys® Core. In this case, the patient presented with a failing root canal that either needed retreatment or the tooth removed so an implant could be placed. The patient opted to have the root canal retreated. Afterward, post or posts needed to be placed for retention of the core buildup.
Here's the overview of the case:
Fig. 1 The patient presented with a PFM restoration that she wanted redone along with a failing root canal, treated more than 25 years earlier.
Fig. 2 After re-treatment, the crown was removed and little anatomical tooth structure remained. Add, a difficult occlusion and the ultimate long-term prognosis was guarded and explained to the patient. She preferred this approach as she wanted to avoid any surgical procedure if possible and did not want any orthodontic procedures. Additional bonding was treatment planned for teeth #7 and #9 after the completion of the temporary for tooth #8.
Fig. 3 Showing the large oval nature of the root.
Fig. 4 Based on the size of the canal, 3 posts from Bisco’s D.T. Light Post System were utilized to maximize the flexural strength within the canal.
Fig. 5 The posts were then cleansed, silanated and bonded prior to placement.
Fig. 6 Once etching was completed (which is an optional step), the universal bonding agent was scrubbed for 20 seconds, air dried and light cured. As stated earlier, though Visalys®Core has the ACT, I prefer to use for my canal hybridization, a universal bonding agent that is light cure/dual and self-cure to ensure 100% hybridization. It is also especially important to add curing time to ensure maximum conversion for the hybrid layer and approach light curing as close to the root as possible and from a variety of different angles.
Fig. 7 Demonstrates the length of the canal tip that is attached to the Visalys®Core dual barrel syringe.
Fig. 8 The canal tip is inserted to the depth of the canal, and the Visalys®Core material is slowly and easily injected into the canal. The technique is to slowly withdraw the syringe and then insert the posts in the order that was predetermined when trying them in.
Fig. 9 Once the posts are fully inserted, initial tac-curing occurs.
Fig. 10 Placement of additional Visalys®Core material and again tac curing. I believe it is best to allow the material to self-cure, given the large C Factor within the canal space. Final light curing occurs after the preparation is completed.
Fig. 11 The final preparation.
This case shows the many benefits of Visalys® Core. Beyond the Active Connect Technology, Bisphenol A free formulation and radio-opacity, the handling characteristics of; easy extrusion force, ideal flow, and ideal stacking all add to the ideal characteristics we all look for in a core build up material.
This material represents a unique addition to the core buildup material category and is certainly one that has earned the “Catapult Vote of Confidence.”