Inspired to Deliver Conservative Dentistry
Inside Dentistry provides the latest in endodontics, implantology, periodontics, and more, with in-depth articles, expert videos, and top industry insights.
August 1, 2021
Volume 17, Issue 8, August 2021
Page(s): p. 50
Delfín Barquero, DDS
When Delfín Barquero, DDS, opened his private prosthodontics practice in San José, Cost Rica, he had one thing in mind—or, rather, one person. Barquero had studied under Edward McLaren, DDS, MDC, at the UCLA School of Dentistry and considered him a mentor. Later, Barquero served as a translator for McLaren when he lectured in Latin America, and he particularly admired McLaren's passion for minimally invasive dentistry. "Being so close to such an influential leader in dentistry and discussing bonding, veneers, and porcelain with him had a powerful impact on me," Barquero says. "He was the inspiration for how I built my practice around bonding and ceramics, which allows me to be as conservative as possible with my patients."
Barquero explains that he rarely fabricates crowns unless a patient presents with a fractured crown that needs to be replaced. If he is restoring a tooth for the first time, he prefers to deliver veneers or direct composite restorations. "Today's materials give us the power to be really conservative," he says.
For Barquero, one of the most exciting aspects of materials has been bioactivity. Upon first learning about it, he began researching the topic extensively. "I discovered Pulpdent and their philosophy," he says. "They offered many of the answers that I had been trying to find, and if there were any answers that they did not have, they were pursuing them in the development of their restorative materials."
The first Pulpdent product that Barquero used was ACTIVA™ BioACTIVE-RESTORATIVE™, an esthetic, bioactive composite that delivers advantages of glass ionomers in a strong, resilient, resin matrix that will not chip or crumble. "It is a dual-cure restorative material that provides a number of advantages," he says. "In Latin America, we frequently treat patients with deep cavities. The bioactive characteristics of this material, including the transfer of calcium and phosphate ions, helps to mimic the properties of enamel and dentin."
More recently, Barquero was introduced to Pulpdent's ACTIVA™ Presto™, a unique, light-cure stackable composite that holds its shape without slumping for controlled placement. ACTIVA Presto facilitates remineralization through the diffusion of bioavailable calcium, phosphate, and fluoride in the same manner as ACTIVA BioACTIVE-RESTORATIVE, and the material is available in a variety of shades that are easy to place with user-friendly 1.2 mL syringes. Strong, tough, durable, and wear- and fracture-resistant, ACTIVA Presto is a universal composite for all classes of restorations.
"Certain situations arise in which you just need a stackable composite," Barquero says. "ACTIVA Presto is the perfect complement to ACTIVA BioACTIVE-RESTORATIVE. Both are hydrophilic and facilitate the diffusion of bioavailable calcium, phosphate, and fluoride ions, but ACTIVA Presto is easier to manage. I can create great occlusal anatomy with ACTIVA Presto."
Barquero explains that his material selection typically depends upon the depth of the preparation. In situations with less depth, he uses ACTIVA Presto because it is easier and more efficient. For a very deep cavity, he places ACTIVA BioACTIVE-RESTORATIVE first and then ACTIVA Presto on top. "These materials work well with each other," he says. "The transfer of ions in the saliva goes from the ACTIVA Presto to the ACTIVA BioACTIVE-RESTORATIVE. That is my preferred method for posterior restorations."
ACTIVA Presto contains no Bis-GMA, Bisphenol A, or BPA derivatives, which Barquero notes is extremely important. "Extensive literature has shown that a weak link in adhesive dentistry is when the bonding agent and restorative materials are affected by water in the tubules," he says. "Water can deteriorate the chemical bond of dental adhesives and composites. Pulpdent avoided any possible problems related to Bis-GMA by removing it altogether. According to estimates, the average life span of a composite restoration today is 5.7 years, and that is sad. My grandfather restored teeth with gold restorations that lasted 45 years. Considering the technology that we possess, we should be doing better dentistry. With the Pulpdent ACTIVA materials, water is no longer the enemy; it is now our associate because it transfers ions, and hydroxyapatite is formed from the calcium, phosphate, oxygen, and hydrogen."
Once placed, ACTIVA Presto penetrates and integrates with the tooth structure to provide margin-free adaptation to teeth. Its patented rubberized resin absorbs stress and resists wear, fracture, and chipping, even in thin areas on bevel margins.
"Hydrophilic materials can absorb ions from the saliva to continually recharge; that is the answer," Barquero says. "Gaps between the enamel and composite are no longer present, and the rubberized characteristics make it less likely to break."
With the ability to create a perfect fit without compromising on strength as well as to provide the potential for mineralization with beneficial ions, Barquero is empowered to provide his patients with the type of conservative dentistry that his mentor always emphasized. "If I use materials that are inactive or passive, I am not helping my patients," Barquero says. "With ACTIVA Presto, we are providing protection via both the restorative material and natural processes."
Key Points
• A unique stackable composite that holds its shape without slumping for controlled placement.
• Offers strength, durability, wear- and fracture-resistance, and versatility for all classes of restorations.
• Mineral-enriched and dynamic, it releases and recharges calcium, phosphate, and fluoride to support the natural remineralization process.
• Easy to place with user-friendly 1.2 mL syringes.
