Review: SureFil SDR flow+ Bulk Fill Flowable (Dentsply Sirona)

It has been said that “the highest type of efficiency is that which can utilize existing material to the best advantage.” (1) In dentistry, this is especially true when undertaking direct composite resin restorations. Today’s practitioner must effectively complete all of the required operative steps to mitigate the chance for premature composite resin failure (i.e., diagnosis, isolation, preparation, bonding, curing, finishing, and polishing).

In addition, these steps must also be completed with relative quickness to contend with issues such as practice overhead and insurance reimbursement. Efficiency in dental practice should therefore be considered not only as the ability of the operator to work quickly, but also competently. Ronald D. Jackson, DDS, recently commented, “Given today’s overhead per hour, dentists need material and technology advancements so that posterior composites can be placed faster, easier, and profitably without taking compromising shortcuts.” (2)

Historically, dentists spend a considerable amount of time during the composite resin procedure placing material in small increments, followed by light curing. With the introduction of bulk-fill composite materials, it is now possible to reduce procedural steps because greater increments of material can be used. One example of a bulk-fill material is SureFil SDR flow+ Bulk Fill Flowable (Dentsply Sirona), which features low polymerization stress and allows practitioners to place up to 4 mm of material per increment without negative sequelae (e.g., sensitivity, debonding, cuspal deflection; figure 1).

Bulk-fill composite resin materials come as flowables (e.g., SureFil SDR flow+) and more viscous pastes (e.g., SonicFill 2 [Kerr], Filtek Bulk Fill Posterior Restorative [3M ESPE]). Clinicians who seek lower viscosity materials are often focused on the material’s ability to adapt to preparations; however, not all flowable composite resins are truly “flowable.” Sometimes the ability to express the material out of a cannula qualifies these resins as flowable, but they may not flow into irregular cavity forms without additional agitation. My preference is for a low viscosity that allows the material to flow into small areas without agitation and that is self-leveling, so even when I use this bulk fill in maxillary teeth or place it against the force of gravity, the material will adapt to the cavity dimensions, self-level, and not slump or run.