THE CLINICAL EVALUATION OF VOCO ADMIRA
FLOW BY THE PREP PANEL
F J T Burke & R J Crisp
Primary Dental Care Research Group
University of Birmingham School of Dentistry
St. Chad’s Queensway
Birmingham B4 6NN, UK
Tel 0121 237 2767
Fax 0121 237 2768
INTRODUCTION
Product:Admira flow
Description:Ormocer® restorative material
Manufacturer:Voco Gmbh
Anton-Flettner-Str. 1-3
D-27472 Cuxhaven
Germany
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INSTRUCTIONS TO EVALUATORS
Explanatory letters, questionnaires and packs of the material, were distributed in spring 2001. The practitioners were asked to use the material and return the questionnaire. The questionnaire is reproduced in Appendix 1.
THE EVALUATORS
Nine members were selected at random from the PREP panel. Two were female and the average time since graduation was 17 years, with a range of 8 to 30 years.
CLINICAL EVALUATION OF ADMIRA FLOW
BACKGROUND INFORMATION: REPLIES TO SECTION 1
78% (n= 7) of the evaluators stated that they had previously used a flowable composite or compomer, most commonly Kerr Revolution (4 users) and Dyract Flow (2).
The clinical applications for these materials were:
Class V cavities56% (n=5)
Base under composites56% (n=5)
Other uses included preventative resin restorations, repair of margin defects, and around pins placed for core build-ups.
Of the two evaluators who had previously not used a flowable material, one stated that they were “wary of shrinkage”.
EVALUATION OF THE KIT AND MATERIAL AFTER FAMILIARISATION- REPLIES TO SECTION II.
Evaluators rated the presentation of the kit as follows:
a)in terms of the completeness of the system:
Excellent Poor
4.1
5 1
b) in terms of the arrangement of the components
Excellent Poor
3.9
5 1
overall presentation
Excellent Poor
4.0
5 1
Suggestions made to improve the presentation of the Admira Flow kit included:
“ Include in Admira kit i.e not separate”
“ Box too big –easier to remove components and keep in drawer”
The result was as follows when the evaluators were asked to rate the instruction cards for Admira Flow:
ExcellentPoor
4.3
5 1
It was suggested by one evaluator that more pictures could be used to improve the instruction card. A further suggestion, as for the Admira instructions, was a clear large card with times for each etching and curing stage clearly printed.
All 100% of the evaluators stated that the syringes worked satisfactorily, with just one comment made that there were not enough tips in the kit.
EVALUATION OF VOCO ADMIRA FLOW IN CLINICAL USE: REPLIES TO SECTION III.
A total of 470 restorations were placed using Admira Flow, comprised as follows:
Class V124
Class III 40
Class I (base layer) 88
Class II (base layer)140
Preventative resin restorations78
When the evaluators were asked to detail the placement techniques used, the results showed that all Class I restorations and the majority of Class V restorations were placed freehand. A mixture of both techniques were used in the placement of Class II and III restorations.
The rating given by the evaluators and their DSA’s for dispensing and placement of the materials was as follows:
a) Admira Flow
ConvenientInconvenient
4.0
5 1
b) Admira Bond
ConvenientInconvenient
3.6
5 1
The result when the evaluators were asked to rate the viscosity of the material was as follows:
Too viscous Too thin
3.3
5 1
78% (n=7) of the evaluators stated that the restorations were easily finished and polished using their usual system. The remainder only used the material as a base layer.
Of these seven evaluators, 86% (n=6) stated that the material polished to a high gloss. The remaining evaluator stated that polishing was not needed as the cured restorations had a high gloss anyway.
89% (n=8) of the evaluators stated that the number of shades (3) of Admira Flow were sufficient. Suggestions made regarding the shades included:
“ Darker root shades needed”
“? A Pink shade as per Revolution for gingival recession areas”
When the evaluators were asked to rate the overall aesthetic Quality of the Admira Flow restorations, the result was as follows:
Excellent Poor
4.0
5 1
Comments made in relation to the aesthetic quality included:
“ Not the main reason for using this material but good aesthetics”
“ Poor translucency noted in Class V’s”
“ Noticed a ‘yellow’ tone after curing”
Comments made in relation to any difficulties experienced during placement and finishing included:
“ Too thin and hard to control” (3)
“ Good surface hardness”
The translucency/opacity of Admira Flow, in anterior use, was rated by the evaluators as follows:
Too translucentToo opaque
3.4
5 1
The ease of use of Admira Flow was rated as follows:
Easy to use Difficult to use
3.9
5 1
Further comments made in relation to the Admira Flow system included:
“ Of more clinical use than the more filled composite equivalent”
“ Very impressed by the material – used for fissure sealants and bonding porcelain veneers”
“ Pity a dentine bonding agent can not be incorporated so as to speed placement and limit opportunity for moisture contamination”
Comments made when the evaluators were asked about changes to the material essential for acceptability of Admira Flow included:
“ One viscosity does not suit all situations – how about availability in different viscosities?” (2)
“ Good as a lining but too fluid for conventional restorations”
“ Overall very good”
If the material was available in 6 shades at a cost of £60, 78% (n=7) of the evaluators stated that they would purchase.
Final comments included:
“ Little post-operative sensitivity and excellent retention”
“ Cross-infection is a worry as, though the application tips can be changed, the cartridges are not sterilisable”
DISCUSSION AND CONCLUSIONS
The Voco Admira Flow system has been subjected to an extensive evaluation in clinical practice by 9 members of the PREP panel in which 470 restorations were placed.
The system scored well in all the criteria evaluated. Though comment was made that in a system like Admira Flow with a variety of clinical applications one viscosity is not ideal, it achieved almost ideal median ratings for viscosity (3.3 on a visual analogue scale where 5= too viscous and 1 = too thin) as the system also did for translucency (3.4 on a visual analogue scale where 5= too translucent and 1 = too opaque).
That the material was well received is reflected in the 78% (n=7) of the evaluators who stated that they would purchase the Admira Flow system if available at £60 for a full range of 6 shades.
ACKNOWLEDGEMENTS
The authors wish to thank the members of the PREP panel for taking part in these evaluations and acknowledge the financial support of Voco Gmbh.