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.

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.

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.