Flowable composites, first brought to the dental market place in the mid nineties, have proved to be uniquely serviceable restorative materials in a wide variety of clinical circumstances. Their lower viscosity and superior wetting characteristics allow for a more intimate adaptation to tooth structure, which can result in lesser rates of microleakage and a lower incidence of voids on application. I primarily use flowables as a base under extensive restorations and in the first stage of core build-ups around endodontic posts.1,2 However, these resins have many other clinical indications, including the definitive restoration of class V lesions, sealing of extended occlusal grooves post fissurotomy and the luting of translucent prosthetics, among others.
A relative newcomer to this category of dental products is Grandio Flow by the German manufacturer Voco. I have been using this material since 2006 and it is now my flowable composite of choice. A radiopaque nano-hybrid resin composed of about two-thirds inorganic fillers by volume in a methacrylate matrix, Grandio Flow cures under conventional halogen lights (and from my experience in less time than other flowables I have previously used) and can be polished with standard discs or points. Voco states that Grandio Flow can be used with any light-cured bonding agent.
Clinically, Grandio Flow’s physical properties are what make it so appealing to use. Its viscosity is somewhat higher than that of most flowables, in terms of stability after placement within the preparation. Yet it leaves very little in the way of “strings” hanging out when the delivery tip is withdrawn, especially with uppers— an unfortunate trait I have observed with the other more viscous flowable composites I have used in the past. This ability to coalesce with tooth structure sans any undue stiffness, allows it to spread smoothly toward well defined margins without exceeding them, while still maintaining a fairly uniform thickness if judiciously applied. The fact that higher viscosity flowables are closer to traditional composites in terms of polymerization shrinkage is also a plus.3 Significantly increased shrinkage (as can occur with the lowest viscosity flowable resins) can cause post operative sensitivity in some patients, a headache that all dentists can do without.
The packaging and delivery system of Grandio Flow are quite informative and convenient, respectively. The package insert provides comprehensive information about the product, including clinical usages, compositional makeup, physical properties, MSDS listing and treatment techniques. Its language is clear and to the point, without any significant omissions. The delivery syringe functions smoothly, but does require a little extra effort, as you might expect with a more viscous flowable. The syringe’s plunger comes with a notching system that indicates remaining volume, with one just before the thumb pad on its shaft that denotes the “empty point.” This helps prevent running out of material mid procedure, something that has happened to me more than I care to admit. The metal tips on plastic hubs included in the packaging bend easily using hemostats, or even on a countertop, to accommodate odd angles in the mouth. They do not crimp when carefully adjusted in this manner and, therefore, avoid impeding the flow.
My experience with Grandio Flow has been nothing but positive. I find it simpler to use than the other flowable composites I have employed in the past, without having an adverse effect on the quality of the clinical performance. Its ease of handling will make your clinical procedures more efficient, both from a time and cost perspective, while improving clinical outcomes. If you try it, I think you’ll find that Grandio Flow is just what the doctor ordered.
1 McArdle BF. Using flowable composite as a base for amalgam restorations. Dent Today. 2002 Mar;21(3):46-9.
2 McArdle BF. Enhancing the retention of prefabricated metal posts and resin cores. J Am Dent Assoc. 2000 Oct;131(10):1470-1.
3 Labella R, Lambrechts P, Van Meerbeek B, Vanherle G. Polymerization shrinkage and elasticity of flowable composites and filled adhesives. Dent Mater. 1999 Mar;15(2):128-37.
Review Synopsis
Product
VOCO Grandio Flow
The Good
Clinically, Grandio Flow’s physical properties are what make it so appealing to use.
The Bad
None stated.
The Bottom Line
Simpler to use than other flowable composites without having an adverse effect on the quality of the clinical performance.