For about a year, I've been following and working with VOCO's newest composite, GrandioSO 4U and today's post is my take after a fairly long time of studying it and using it.
In today's workflow environment doctors usually handle anterior and posterior restorations differently from a materials standpoint. The most common choice in the posterior is for some type of bulk fill material. The way bulk fill materials work is to be created with more translucency. It's the translucency that allows the curing light to reach deeper into the material for adequate photo polymerization. The drawback to that is that due to their inherent translucency, those materials also aren't quite as aesthetic. In the posterior, this doesn't normally affect the aesthetics. If the material is a relatively close shade match, the only people who will ever be aware of the translucency is another professional doing an exam.
In the anterior doctors normally reach for a highly aesthetic composite to provide outstanding cosmetic results. These materials are more opaque and don't have the concern about translucency. However, due to the opacity, light doesn't penetrate as deeply and that means layering is required... and sometimes several layers. The results can be incredible, however, the amount of time to layer and then sculpt and polish can take much longer than in the posterior.
The other technology that has become popular in the last 5-10 years is that of the "Single Shade" composite. These materials attempt to create optical effects that allow the tooth's natural shade to show through. This can be a good option for many cases, but what I've discovered in using them is that they work in around 85-90% of cases. However, it's that last 10-15% where the shade match isn't adequate that creates the stress. It's usually difficult or impossible to know for sure if there is a good shade match until after the composite is cured. Of course once the material is cured, the choice is to remove all the material or try to layer over it to get an acceptable result.
The other problem is inventory. Needing to keep one material for posterior and multiple brands and/or shades for the anterior is difficult to keep organized. This is especially true with shades that aren't used frequently. Those shades often end up somewhere in the office where they can sit unused until they expire.
What I'm excited to tell you about today is that VOCO has come up with something that addresses everything I've just mentioned... and it's name is GrandioSO 4U.
The incredibly smart people at VOCO set out to solve the problems that doctors are dealing with ... and more... as they worked to develop their latest composite... and I feel they succeeded beyond expectations. VOCO's newest composite, GrandioSO 4U handles these problems with several key features.
I mentioned translucency in this post and that property is key to this discussion. A translucent material allows some, but not all, light to pass through it. Translucency lets the photons from the curing light get much deeper into the composite for a much better depth of cure. That's why the property is so key to bulk fill materials. GrandioSO 4U has a unique way of dealing with this. VOCO has created what they are calling VTT (Visual Transformation Technology). This means the material is highly translucent when placed (for a reliable 4mm depth of cure) and then transforms to become more opaque and aesthetic during a 10 second curing cycle. The result is incredibly lifelike and aesthetic.
My one takeaway from this VTT is that you need to *trust the material*. Since the material has a different appearance when it's set, it may look like the shade doesn't match before curing. If the shade guide tells you that this is the shade, believe the shade guide and trust the material.
Since I'm discussing shades, I'd also like to point out that GrandioSO 4U uses a "Cluster Shade System". Rather than promising a single shade that will work in every case, GrandioSO 4U comes in 5 shades that cover the entire 16 shade range of the Classic VITA Shade Guide. This translates to only keeping an inventory of these 5 shades as opposed to 16 for other composites. Using the VOCO shade guide will give you the correct shade match for each case.
I was also impressed with the high filler percentage of this material. GrandioSO 4U has a 91% filler load. That means it holds up well over time, since there is more filler and less resin than other composites. This material's filler load is actually "record breaking" in that regard. The other benefit of this high filler load is less material shrinkage. All composites shrink when photo polymerized. That's just the science of light cured materials. However, since there is less resin in this material than any other composite, that also means less material shrinkage. VOCO's internal testing shows the polymerization shrinkage to be only 1.44% by volume. That's a tiny amount and it means less shrinkage stress. That means there is less stress on the margins which can lead to longer restoration life. I always think of the margin as "the trench warfare of recurrent caries" and having better margins means less chance of cariogenic microorganisms establishing a toehold.
VOCO also managed to create a modulus of elasticity that is very close to human dentin and enamel. That means that under occlusal loading, the material behaves much like natural tooth structure which can also mean stronger margins.
One other thing that impressed me, was the incredibly high radiopacity of GrandioSO 4U. The material has 900% radiopacity compared to the standard used in the industry. That means on bitewings, the restorations almost jump off the screen at you. This provides incredibly high contrast on your radiographs compared to other materials on the market.
I haven't mentioned polishing yet, but I should. This material polishes like a dream. The nanohybrid filler particles allow GrandioSO 4U to be finished with a polish that really has to be seen to be believed. Having a material that polishes easily and stays polished over time is important. Once again I'll bring up recurrent decay. When you can polish a restoration to give it a glass smooth polish, especially at the margin, the chance for recurrent decay is greatly reduced.
Wrapping up today's post, I know that many doctors think there isn't a tremendous difference between most composites. GrandioSO 4U is different in that regard. VOCO's research and development team has created a composite that I can confidently say IS different. They have created a material that is truly "universal". When you combine the features... a 4mm depth of cure, high aesthetics, high filler rate, low shrinkage, high radiopacity, AND a simple to use 5 shade system, you'll see that this material is a quantum leap forward. I have been placing it warm and it handles incredibly well. I love this material and I'm confident that you will too. Oh, one other thing I want to make clear. In the US the material's name is GrandioSO 4U and in other markets the name is GrandioSO Unlimited. Don't be confused by the different names if you are reading any research. They are the same product.
After spending quite a bit of time learning and using this material, I can confidently tell you that GrandioSO 4U is *highly recommended*!!!


