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COMPOSITES

Seminar by :
Dr. Era Arora

INTRODUCTION
* The introduction of composite-
based resin technology to
restorative dentistry was one of
the most significant
contributions to dentistry in the
last century.
* The advantages of bonded
restorations include
conservation of sound tooth
structure, reduction of
microleakage, prevention of
postoperative sensitivity,
marginal staining and recurrent
caries, transmission and
distribution of functional stress
across the bonding interface to
the tooth.
* Bonded restorations also offer
the potential for tooth
reinforcement, cosmetic
restoration and recontouring of
teeth with little or no
preparation, and diminished
need for use of liners and
bases.
* Composites are also gaining
acceptance for restoration of posterior
occlusal areas & other high stress-
bearing sites & are used in a variety of
other dental applications such as pit &
fissure sealants, bonding of ceramic
veneers & cementation of other fixed
prosthesis.
* Today, improvements in formulations,
optimization of properties and the
development of new techniques for
placement have made the restoration
of direct composite more reliable and
predictable.
DEFINITIONS
* In materials & science, composite is
defined as a solid formed from two or
more distinct phases that have been
combined to produce properties
superior to or intermediate to those of
the individual constituents.
* Dental composite is defined as a highly
cross-linked polymeric material
reinforced by a dispersion of
amorphous silica, glass, crystalline, or
organic resin filler particles or short
fibers bonded to the matrix by a
coupling agent.

HISTORY
* 1871 silicates
* alumina-silica glass &
phosphoric acid
* very soluble
* poor mechanical properties
* 1948 - acrylic resins
* Polymethylmethacrylate
* Tooth like appearance
* Insolubility in oral fluids
* Ease of manipulation
* Low cost
* High polymerization shrinkage
* Excess thermal expansion
* Relatively poor wear resistance

HISTORY
* Early composites based on PMMA
- filler particles not bonded to resin
- defects between matrix & filler
particles
- leakage, staining & poor wear
resistance
* 1962 Bis-GMA resin developed by Dr.
Ray L. Bowen of American Dental
Association Research unit at National
Bureau of Standards
* 1955- acid etching technique described
by Michael Bunocore which was later
utilized for better bonding of composite
with enamel

HISTORY
* Curing of dental composites with blue
light was introduced in the 1970s.
* In 1970s composites were cured with
ultra-violet light.
* Light curing with visible light was
introduced in the 1980s.
* In the late 1990s, the plasma arc
curing unit was introduced as an
alternative for rapid light curing.
* In 1995 blue LED curing units were
produced.

HISTORY
Development of fillers through history
* 1989 Krause et al, chopped glass
fillers
* 1994 Goldberg, fiber reinforcement
* 1996 Bayne & Thomson, branched
fiber fillers
* 1999 Luo et al, nanoporous fillers
* 1999 Lawn, ceramic whiskers as
fillers

EVOLUTION OF
COMPOSITES
CLASSIFICATION OF
COMPOSITES
ADA No. 27 describes two types &
three classes of composites :
*Type 1 : Polymer based materials
suitable for restorations involving
occlusal surfaces
*Type 2 : Other polymer-based
materials
Class 1 : Self-cured materials
Class 2 : Light-cured materials
Group 1 : Energy applied
intra-orally
Group 2 : Energy applied
extra-orally
Class 3 : Dual-cured materials
CLASSIFICATION OF
COMPOSITES
BASED ON NATURE OF FILLER
PARTICLES
* Homogeneous
If composite consists only of filler &
uncured matrix.
* Heterogeneous
If composite has pre-cured filler
particles or other unusual fillers.

HISTORICAL
CLASSIFICATION
CLASSIFICATION OF
COMPOSITES - PHILLIPS
WILLEMS CLASSIFICATION
(1992)
* Densified composites; midway filled
Ultrafine midway filled
Fine midway filled
* Densified composites; compact filled
Ultrafine compact filled
Fine compact filled
* Homogeneous microfine composites
* Heterogeneous microfine composites
With splintered pre-polymerized
fillers
With agglomerated pre-
polymerized fillers
With spherical pre-polymerized
fillers
* Miscellaneous composites
With splintered pre-polymerized
fillers
With agglomerated pre-
polymerized fillers
With spherical pre-polymerized
fillers
With sintered agglomerates
* Traditional composites
* Fiber-reinforced composites
CHRONOLOGICAL
DEVELOPMENT OF
COMPOSITE
FORMULATIONS
FIRST GENERATION COMPOSITES
*Consist of macro-ceramic
reinforcing phases in an
appropriate resin matrix
*Highest mechanical properties in
lab testing
*Highest proportion of destructive
wear clinically
*Highest surface roughness
SECOND GENERATION COMPOSITES
*Colloidal & micro-ceramic phases
in a continuous resin phase
*Best surface texture
*Better wear resistance
*Strength & co-efficient of thermal
expansion are unfavourable

THIRD GENERATION COMPOSITES


*Hybrid composite with a
combination of micro and macro
ceramics as reinforcers
*Exist in a ratio of 75:25 in a
suitable continuous phase resin
*Properties are intermediate
between first & second generation
composites
FOURTH GENERATION COMPOSITES
*Also hybrid but these contain
heat-cured, irregularly shaped,
highly reinforced composite
macro-particles with a reinforcing
phase of micro-ceramics
*Highly technique sensitive
*Exhibit maximum shrinkage

FIFTH GENERATION COMPOSITES


*Hybrid resin system in which the
continuous resin phase is
reinforced with micro-ceramics &
macro, spherical, highly
reinforced, heat cured composite
particles
*Using many different sizes of
these spheres, in a
mathematically calculated
manner improves the packing
factor of the composite
*Improved workability

SIXTH GENERATION COMPOSITES


*Hybrids in which the continuous
phase is reinforced with a
combination of micro-ceramics &
agglomerates of sintered micro-
ceramics
*Highest percentage of reinforcing
particles
*Best mechanical properties
*Exhibit least shrinkage
NEWER
CLASSIFICATION
SYSTEM
Based on particle size
* megafill
* 0.5 - 2 millimeters

* macrofill
* 10 - 100 microns

* midifill
* 1 - 10 microns

* minifill
* 0.1 - 1 microns

* microfill
* 0.01 - 0.1 microns

* nanofill
* 0.005-0.01 microns
COMPOSITION
Current direct-placement composites
have four major components:
* a matrix phase that usually contains a
dimethacrylate resin
* polymerization initiators that are
activated either chemically or by
visible light
* a dispersed phase of fillers and tints
* a coupling phase that adheres the
matrix to the filler particles.

RELATION BETWEEN
INORGANIC FILLER AND
RESIN
ORGANIC RESIN
MATRIX
* The organic resin matrix is a high
molecular-weight monomer such as
bisphenol A glycidylmethacrylate
(bis-GMA) or urethane
dimethacrylate. bis-GMA, which
stands for
2,2-bis[4(2-hydroxy-3-
methacryloxypropoxy)phenyl]-
propane, is an aromatic methacrylate
developed by Rafael Bowen of the
National Bureau of Standards in the
early 1960s.
* Terminal methacrylate groups
provide sites for free radical
polymerization; it sets to a relatively
rigid polymer because it has two
benzene rings near its center.
ORGANIC RESIN MATRIX
* Disadvantages of bis-GMA
Questionable color stability
High viscosity which is the result of
its OH groups that form hydrogen
bond
To lower the viscosity, manufacturers
add low-molecular-weight monomers
like triethyleneglycol dimethacrylate
(TEGDMA) and ethyleneglycol
dimethacrylate (EGDMA) which reduce
the bis-GMA's viscosity, increase
crosslinking, and increase hardness.
* In 1974, Foster and Walker introduced
another difunctional resin, urethane
dimethacrylate (UDMA).
The major advantage of this resin is
its low viscosity, which facilitates filler
loading without the need to add low
molecular weight monomers.
The major disadvantages of this resin
are that it is more brittle and it
undergoes more polymerization
shrinkage than Bis-GMA, shrinking
about 5 to 9%. These properties may
be attributable to its shorter molecular
length.

ORGANIC RESIN MATRIX

* Manufacturers prefer Bis-GMA resins


because they have an aromatic
structure that increases stiffness and
compressive strength and lowers water
absorption.
* These larger molecules also undergo
less polymerization shrinkage than
smaller methacrylate-based
monomers.
INHIBITORS AND
STABILIZERS
* INHIBITORS
To prevent premature resin
polymerization, compounds
such as 4-methoxyphenol
(MEHQ) and 2,6-di-tert-butyl-4-
methyl phenol or butylated
hydroxytoluene (BHT) are
generally added in amounts of
about 0.1%.

* COLOR STABILIZERS
Chemically cured composites
may contain compounds such
as benzophenones,
benzotriazoles, or
phenylsalicylate that absorb
ultraviolet (UV) light and act as
color stabilizers. These
materials are not found in the
UV light-polymerized systems
because they can inhibit
polymerization.
FILLERS
* Filler particles provide
dimensional stability to
the soft resin matrix.
* The filler particles used in
composite resins vary in
size from less than 0.04
m to over 100 m.
* Filler particles reduce polymerization
shrinkage, decrease the coefficient of
thermal expansion, and increase
hardness.
* Common filler particles are crystalline
quartz; pyrolytic silica and glasses such
as lithium aluminum silicate, barium
aluminum silicate, and strontium
aluminum silicate.

FILLERS
* Opacity is controlled by adding
titanium dioxide pigments, and color is
achieved by adding metal oxides of
iron, copper, magnesium, and others.
* Quartz and heavy-metal glass are
commonly used fillers in conventional
macrofilled composites. Submicron
silica is the predominant filler in
microfilled composites.
QUARTZ
SILICA
* Silica dioxide and
agglomerated submicron
silica are used in making
microfilled composites or
are added to glass-filled
composites to produce hybrids.
* Silica dioxide particles (0.04 m) are
made from silicon through a heating
process that results in a fine ash.
Agglomerated silica is made by
precipitation of silica dioxide particles;
this increases their size, which reduces
surface area and increases filler
loading.

HEAVY METAL
GLASSES
* Owing to the clinical need for
radiopacity, radiopaque heavy-metal
glass fillers have replaced quartz in most
new macrofilled composites.

* The most common elements added to


increase radiopacity are barium,
strontium, zinc, zirconium, and
ytterbium.

* Bowen and Cleek invented barium glass


fillers in 1969.

* Barium fillers have a number of


advantages:

* Good radiopacity;

* Fine particle size average 0.4 to 0.6 m;


the size of enamel crystals, which makes
them more polishable and wear-resistant
(3) Good index of refraction relative to
resins (increases esthetics)
(4) Lower cost
(5) Ready availability in pre-ground fillers.

* The disadvantages of barium glass fillers


are that they are
* More soluble

* Softer

* More difficult to attach to the resin


matrix than some other fillers.

HEAVY METAL GLASSES


* Bowen invented strontium glass filler in
1980.
* Compared with barium glass, it is
stronger
less soluble
harder
more abrasive to enamel
more difficult to grind into fine
particles.
* Zirconium is harder than heavy-metal
glass but not as hard as quartz.
* Zirconium fillers can also be coated
with silica to improve attachment to
the matrix.

METHODS OF PARTICLE
FABRICATION
MILL GRINDING
* Milling is the traditional method of
grinding glass.
* In this process, glass particles are
crushed between two harder and
tougher surfaces.
* Mill grinding produces particles with
sharp edges.
* The major limitation of this method is
the impurities contributed by the
grinding wheels. These impurities are
difficult to remove and can destroy the
esthetics of the final composite.
METHODS OF PARTICLE
FABRICATION
AIR ABRASION
* In air abrasion, filler particles grind
themselves as they collide and fracture
in two forced streams of particles.
* The difficulty with this technique is that
as the particles get smaller they miss
each other more often. Hence, it takes
a long time to grind fine particles.
* The advantage is that larger particles
are quickly eliminated since they
readily collide with other particles.
* Particles created by fracture have
sharp edges.

METHODS OF PARTICLE
FABRICATION
ULTRASONIC INTERACTION
* In this method, glass particles collide in
suspension in a solvent undergoing
ultrasonic vibration.
* This method can produce small
particles from almost any filler.
* The disadvantage is that the process
takes considerable time.
* Particles produced by this process have
rounded edges because of the
mechanical effects of particle-to-
particle interaction.

METHODS OF PARTICLE
FABRICATION
EROSION
* Erosion grinding is based on the
solubility of glass particles in acidic
solutions.
* Erosion combined with vibration
(usually ultrasonic) makes particles
smaller at a rapid rate.
* These particles have rounded edges
and, depending on the chemicals used,
may have a porous surface.

EFFECTS OF FILLER
LOADING ON COMPOSITE
RESINS
Filler size and loading are associated
with three trends in composite resin
performance:
* The ability to polish increases as filler
particle size decreases.
* Wear resistance improves as filler
particle size decreases.
* Fracture durability generally increases
as the percent of inorganic filler
loading by volume increases.
EFFECTS OF FILLER
LOADING ON COMPOSITE
RESINS
*Polishability of a resin composite
is affected by the filler particle
size. Generally, the smaller the
average particle size, the easier it
will be to polish the resin.
*The physical properties of the
resin are affected by the amount
of filler in the resin composite.
Within practical limits, the greater
the percentage filler content, the
better the physical properties
because there is less matrix.
*Coefficient of thermal expansion,
water sorption, polymerization
shrinkage decreases while
modulus of elasticity, tensile
strength, and fracture toughness
increase.
*The fracture toughness increases
because the filler particles divert
cracks and more load needs to be
applied to get the cracks to move.

COUPLING AGENTS
*Coupling agents are used to help
bond resin matrix and filler
particles together.
*The primary purpose of bonding
filler particles to the organic resin
matrix via the silanating agent is
to improve the resin composite's
physical properties. The silane
agent does this by preventing
hydrolytic breakdown along the
filler/matrix interface which may
result in cracking of the resin and
by allowing stress transfer
between the filler and matrix.
*Coupling agents reduce the
gradual loss of filler particles from
the composite surface.
*Commonly used coupling agents
are epoxy, vinyl, and methyl
silanes.
*The single most commonly used
silane in dental composites is 3-
(methacryloyloxypropyl)
trimethoxysilane.
SILANES
* Most silanes are difunctional
molecules that, in theory, can
ionically bond to the inorganic filler
particles and simultaneously
chemically bond to the organic
matrix. The silane group on one end
bonds to the hydroxyl groups on the
filler particles via a condensation
reaction that produces a siloxane
bond. The methacrylate group on the
other end undergoes addition
polymerization with the resin
composite during light- or chemical-
activation of the resin.
* In reality, silanes probably work
mostly by reducing the surface
tension between the inorganic filler
and organic matrix.
* Silane-containing resins form a better
physical bond because the resin can
adapt to the irregularities of the filler
particles.

INITIATORS OF
POLYMERIZATION
* Initiation systems start the
polymerization process through the
formation of a free radical, a compound
with a reactive unpaired electron.
* When a free radical collides with a
carbon double bond (C=C) in the resin
monomer, the free radical pairs with
one of the electrons of the double
bond, converting the other member of
the pair to a free radical, and thus the
reaction continues.
CHAIN REACTION OF A
FREE RADICAL
GENERATION OF FREE
RADICALS
Generation of free radicals is
brought about in four different
ways.
* In heat-activated systems, benzoyl
peroxide splits under heat exposure
and forms free radicals.
* In chemically activated systems, a
tertiary amine is used to split the
benzoyl peroxide into free radicals.
* In UV light-activated systems, a 365
nm UV light source splits benzoin
methyl ether (in amounts of 0.2%)
into free radicals without the
presence of tertiary amines.
* In light-cured systems, a light
source of 468 nm (+/- 20) excites
camphoroquinone (0.03 to 0.09%)
or another diketone into a triplet
state that interacts with a
nonaromatic tertiary amine, such as
N,N-dimethylaminoethyl
methacrylate (0.1% or less) The
camphoroquinone together with the
tertiary amine starts a free radical
reaction. Some manufacturers use
an aromatic amine because it is
more reactive and allows the use of
less camphoroquinone.

CHEMICAL REACTIONS
THAT PRODUCE FREE
RADICALS
CONVERSION RATE
* The polymerization process lasts until
most of a resins free monomers
become polymerized. The amount of
monomer converted into copolymer is
called the conversion rate.
* The conversion rate of a composite is
measured in a number of ways,
typically by infrared (IR) spectroscopy.
* For a single material, conversion,
hardness, and stiffness are directly
related to the rate and amount of
polymerization.

INITIATION SYSTEMS
HEAT CURING
Heat curing provides the highest
conversion rate and results in a resin
that is stiffer, more stain resistant, and
more fracture-resistant than resins cured
by other methods.
Heat curing is used to make pre-
polymerized filler particles for microfilled
composites and indirect composite
restorations, such as veneers, inlays, and
onlays, and facings for crown-and-bridge
restorations.
LIGHT CURING
The next most complete curing occurs
with light-activation, which is preferred
for direct composites.
Light-curing is efficient and results in a
uniform cure of the resin matrix.
AUTOCURING
Autocuring can result in the least uniform
cure, especially when thick composites
are mixed, since the final mix lacks
homogeneity on a molecular level.
Another factor lowering the conversion
rate is instability of the peroxide
initiators used in autocured composites.
Using very high amounts of autocuring
chemicals can greatly increase
conversion. However, this compromises
color stability and is appropriate only for
areas with low esthetic demands, such as
core material.

AUTOCURED SYSTEMS
* Autocured ie, chemically activated
systems, usually consisting of two
pastes, dominated the toothcolored
restorative field for many years. They
are still common in many parts of the
world.
* Autocured systems generate small
amounts of heat during curing and do
not need a light source.
* Their disadvantages include:
(1) a long setting time
(2) voids in the final restoration
(3) a higher probability of longterm
discoloration after placement.

ULTRAVIOLET LIGHT
ACTIVATING SYSTEMS
*The first light-activated systems,
introduced in 1970, used UV light,
which presented the advantages
of rapid cure; indefinite working
time, because no setting occurs
until the light source is applied;
and less composite waste.
*The disadvantages of UV light-
activated systems include:
(1) curing units require a 5-
minute warm-up period
(2) depth of light penetration is 1
to 2 mm at best
(3) maintaining the light at 100%
efficiency is difficult
(4) UV radiation can cause
corneal burns.
Another difficulty is that the loss of
UV efficiency cannot be
determined by looking at the unit.
Thus, a dentist cannot determine
if a composite has adequately
cured.
VISIBLE LIGHT-ACTIVATING
SYSTEMS
* The key advantages of visible light-
activated composites are:

* materials can be manipulated longer


and still have a shorter curing time (20
40 seconds or less
(2) earlier finishing

* better color stability.


* Other advantages include no lamp
warm-up time; less chance of voids and
air bubble incorporation; less waste of
materials; and use of halogen bulbs,
which maintain constant blue light
efficiency for 100 hours under normal
use.

* The disadvantages of visible light-


activated composites include:
(1) possible eye damage (retinal burns with
visible light systems),
(2) a maximum depth of light penetration of
about 3 mm,
(3) heat generation that could harm the
pulp, and
(4) the high purchase and maintenance
costs of curing lights. In systems using
flexible fiber-optic bundles, it is difficult
to maintain the efficiency of the light
cord,
* The mechanism of visible light-curing
uses a diketone, most commonly,
camphoroquinone. When this
photoinitiator absorbs blue light, the
molecule forms a free radical and starts
the polymerization process.

CURING UNITS
There are basically three types of
visible lightcuring units:

* Countertop units

* Gun-type units

* Fiber-optic handpiece attachment


units.

CURING UNITS
COUNTERTOP UNITS
*The countertop unit contains all
the functional parts in one box.
*A fiber-optic or fluid-filled cord
carries the light from the box to
the patient. Some of these units
have a control switch at the end
of the cord so the operator does
not have to leave the operating
field to activate the light source.
*The advantages of countertop
units are that the fan and working
parts of the unit are out of the
operating field and that they are
generally less expensive than
other designs.
*The disadvantages are that many
units lack a switch at the cord
end, and many models do not
have wide-diameter curing tips. In
addition, many countertop units
have fiberoptic cords that need
periodic replacement because of
fiber-optic bundle break down.

CURING UNITS
GUN-TYPE UNITS
*The second type of visible light-
curing unit has its light source in a
gun handle. The light passes
through a small fiber-optic cord or
glass rod that forms the barrel of
the gun. Generally, these units are
attached to an additional table-
top or wallmounted unit that
contains the necessary
transformers to operate the light.
This type of unit is activated at
the operator site.
*They typically have large
diameters of cure with good
intensity and are generally small
and easily made portable.
*Gun-type units have no fiber-optic
cords to replace since the gun
barrels are usually inflexible.
*The disadvantages of gun-type
units are the fan in the handle,
which can be noisy and become
warm with extended use; gun bulk
and weight (more bulky than fiber-
optic cord ends); and higher cost.

CURING UNITS
HAND-PIECE CURING
ATTACHMENTS
*The third type, the fiber-optic
handpiece curing attachment, is
generally adapted to existing
fiber-optic handpiece light
sources.
*Attachment units have curing tips
that are usually smaller than but
similar to those in countertop
units.
*Some of these units generate
considerable heat in the tooth,
owing to inefficient or missing
blue light filters.
*These units are less expensive,
especially if the fiber-optic
handpiece is already in place.
*They are small and require no
additional counter space.
*Their drawbacks include,
generally, a smaller diameter of
cure, less intense light source,
release of excessive heat (some
units), and periodic need for
replacement of fiber-optic cords.

CURING MODES
CURING TECHNIQUES
* Two categories of technique are
commonly used in curing polymers:
continuous and discontinuous.
* The continuous cure refers to a
lightcure sequence in which the light is
on continuously.
* There are four types of continuous
curing: uniform continuous cure, step
cure, ramp cure, and high-energy
pulse.
* Continuous curing is conducted with
halogen, arc, and laser lamps.
* The discontinuous cure is also called
soft cure, which commonly uses a
pulse delay.
* Soft-cure settings are available on
some halogen curing lights.

CONTINUOUS CURING
TECHNIQUES
UNIFORM CONTINUOUS CURE
* A light of constant
intensity is applied to a
composite for a specific
period of time.
* This is the most
familiar method of
curing currently used.

CONTINUOUS CURING
TECHNIQUES
STEP CURE
* In the step cure technique, the
composite is first cured at low energy,
then stepped up to high
energy, each for a set duration.
* The purpose is to reduce polymerization
stress by inducing the composite to
flow
in the gel state during the first
application.
* Disadvantages
* The reduction in shrinkage is small and
results in less composite polymerization
because the lower intensity light yields
lower energy levels.
* Results in an uneven cure, since the top
layer is more saturated with light and
thus more highly cured.
* Step curing is possible only with halogen
lamps; arc lamps and lasers cannot be
used because they work by applying
large amounts of energy over short
periods of time.

CONTINUOUS CURING
TECHNIQUES
RAMP CURE
* Light is initially applied at low
intensity and gradually increased
over time to high intensity.
* This allows the composite to cure
slowly, thereby reducing initial stress,
because the composite can flow
during polymerization.
* Ramp curing is an attempt to pass
through all of the different intensities
in hopes of optimizing a composites
polymerization.
* Very high energy applied over a short
period tends to cause dimethacrylate
monomers to attach to themselves,
resulting in shorter polymer chains and a
more brittle material with higher
polymerization shrinkage and more
marginal gaps.
* Ramp curing, with its dependence on low
intensity, is possible only with halogen
lamps; arc and laser lamps can generate
only large, nonvariable amounts of
energy.
CONTINUOUS CURING
TECHNIQUES
HIGH ENERGY PULSE CURE
* This technique uses a brief
(10 second) pulse of extremely high
energy (10002800 mW per cm2),
which is three to six times the
normal power density.
* This type of polymerization has not
yet been adequately examined,
and there are three areas of
potential concern:

(1) The rapid application of energy


might result in a weaker resin
restoration owing to the formation of
shorter polymers
(2) It is possible that rapid applications
of energy could reduce diametral
tensile strength
(3) There may be a threshold level at
which a resin has good properties,
and thus, higher energies would
result in more brittle resins.

DISCONTINUOUS CURING
TECHNIQUES
* In the discontinuous or soft-cure
technique, a low intensity or soft light
is used to initiate a slow polymerization
that allows a composite resin to flow
from the free (unbound) restoration
surface toward the (bound) tooth
structure.
* This reduces polymerization stress at
the margins and could reduce white
line or other marginal openings or
defects.
* To complete the polymerization
process, the intensity of the next
curing cycle is greatly increased, to
produce the needed energy for optimal
polymerization.

DISCONTINUOUS CURING
TECHNIQUES
PULSE DELAY CURE
*A single pulse of light is applied
to a restoration, followed by a
pause and then by a second
pulse cure of greater intensity
and longer duration.
*The lower-intensity light slows
the rate of polymerization,
which allows shrinkage to occur
until the material becomes rigid,
and is purported to result in fewer
problems at the margins.
*The second, more intense pulse
brings the composite to the final
state of polymerization.
*Pulse curing is usually done with
halogen lamps.

CURING LAMPS
Four types of lamps predominate in
clinical practice:
* Tungsten-halogen
* Plasma arc
* Laser
* Light-emitting diode (LED).
Halogen lamps have the flexibility to
apply energy at a range from low to
high and for various lengths of time.
Although appealing in concept, arc and
laser units invariably apply large
amounts of light and are therefore
appropriate only for continuous or
pulse curing; this limits their flexibility
for clinical applications.

TUNGSTEN HALOGEN
LAMPS
TUNGSTEN-HALOGEN
LAMPS
* Many halogen curing lamps use a
50-to 100-watt bulb to produce 500
mW of light that peaks at 468 nm.
* Halogen bulbs generate light
through the heating of tungsten
filaments to high temperatures. A
small percentage (< 1 percent) of
the energy is given off as light,
while most of the energy given off
is in the form of heat.
* A drawback of halogen bulbs is that
this generation of heat causes a
degradation of the components of
the curing unit over time. The result
can be a decline in the irradiance,
which compromises the curing
ability of the unit
* This approach yields an efficiency
rate of only 0.5%; the other 99.5%
of the energy is simply given off as
heat.
* Heat, unlike light, can be damaging
to a tooth and needs to be
controlled.
* Thus, more powerful curing lamps
need measures that reduce the
heat that can radiate from the tip of
the light guide.

PLASMA ARC LAMPS


PLASMA ARC LAMPS
* The plasma arc lamps used for pulse
energy curing usually have a 5-mm
spot size and a wide bandwidth
covering 380 to 500 nm. They yield a
power density up to 2500 mW/cm2.
* Plasma-arc lights are made up of two
electrodes in a xenon-filled bulb.
Current heats the plasma to several
thousand degrees Celsius. The heated
plasma gives off light and heat.
* The light intensity given off by plasma-
arc units is greater than that for
halogen-based units, which can
decrease curing time up to 75 percent.
The increase in light intensity and
decrease in curing time with plasma-
arc lights have been shown to enhance
polymerization shrinkage in some
studies.
* This is a tremendously powerful light
energy source that requires a wait time
(minimum 10 seconds) after each use
to allow the unit to recover.
* The high intensity of the lamp causes
silver to precipitate on the lamp
window, which degrades lamp output
over time. Argon bulbs, therefore, have
a relatively short shelf life.
* A large number of dental composite
manufacturers recommend that
dentists not use these lamps for curing
because of poor curing outcomes.

ARGON LASER
LASER
*Laser lights (argon-ion) emit
specific bandwidths of light at
about 454 to 466 nm, 472 to 497
nm, and 514 nm (usable blue
light).
*Lasers produce little heat,
because of limited infrared output.
*A major limitation of arc and laser
lamps is that they have a narrow
light guide or spot size. This
requires the clinician to overlap
curing cycles if the restoration is
larger than the curing tip. As soon
as overlapping is required, the
advantage of speed is greatly
diminished since each overlap
doubles the curing time. In
addition, overlaps need to be at
least 1 mm; so a 12-mm
restoration would have to be
overlapped three times with a 5-
mm spot size, and four times for a
3-mm spot size.

LIGHT-EMITTING DIODE
LIGHT-EMITTING DIODE
* Light-emittingdiodes use
junctions of doped
semiconductors for
generating light.
* The advantages of these
units are that the spectral
output falls between 400
and 500 nm so that no
filters are required. Because
the energy generated is not
in the form of heat, LEDs
have a longer lifetime, with
little degradation over time.
* They operate at 1 to 4 volts
and draw a current of 10 to
40 milliamperes. Their low
energy use makes them
ideal for battery-operated
curing lamps.
* Unlike halogen lamps, LEDs
emit a narrow bandwidth of
light, around 468 nm, and
have an efficiency of about
16%.
FACTORS THAT AFFECT
LIGHT-CURING OF
COMPOSITES
* The favorable properties of light-cured
composites depend on achieving a
complete cure of the resin matrix.
* Inadequate polymerization can result
in loss of biocompatibility, color shifts,
loss of retention, breakage, and
excessive wear and softness.
* Some of the most important factors to
consider in using and maintaining a
light-curing system are time, intensity,
temperature, light distance, resin
thickness, air inhibition, tooth
structure, composite shade, filler type,
accelerator quantity, heat, and room
light.

EXPOSURE
* Light-cured composites polymerize
both during and after visible light-
activation. These two curing reactions
are known as the light and dark
reactions.
* The light reaction occurs while light
from the curing unit penetrates the
composite.
* The dark reaction, also called post-
irradiation polymerization, begins
immediately after the curing light goes
off and continues for up to 24 hours,
even in total darkness, but most of it
occurs within 10 to 15 minutes post
cure

*The minimum curing time for a


light reaction for most composites
under a continuous curing mode is
20 to 40 seconds (using curing
units with the normal 400
mW/cm2 output).
*A classic study by Leung shows
that traditional light-cured
composites must be cured for at
least 40 seconds to initiate a
reaction that ensures the curing
will continue to completion.
*In all composites, maximum
hardness is achieved within about
24 hours.
*Some newer composites have
shorter light-curing times, but the
total time required for the resin to
completely set is about the same.
*Overcuring is not harmful but
does not improve a materials
properties.

* Regardless of how a composite is


cured, the dark reaction takes time and
greatly contributes to the overall
strength of the material.
* Generally, waiting 10 to 15 minutes
after curing before finishing a
composite improves the hardness by
20 to 30%.
* A waiting period prior to finishing can
improve wear properties significantly,
because the finishing process damages
the margins of a restoration. Damage
to the margins is greatest when a
composite is finished before it is fully
polymerized. A good way to minimize
finishing damage is to reetch and
reseal the margins with a glaze after
finishing.

INTENSITY
*The curing intensity of a 468 20
nm blue light has been about 400
mW/cm2 for many years. This is
the output of most curing units
and is referred to as the power
density. Problems occur when the
minimum intensity is not
achieved.
*There are four common causes of
decreased intensity:
*(1) as the bulbs in curing lamps
age, the intensity of bluelight can
decrease,
*(2) voltage drops can affect blue
light production,
*(3) sterilization of curing tips can
reduce light transmission, and
*(4) filters to increase blue light
transmission can degrade.

TEMPERATURE
* Light-cured composites cure less
effectively if they are cold during
application. Composites at room
temperature cure more completely and
rapidly. Composites should be held at
room temperature at least 1 hour prior
to use.
* Most curing lamps produce heat, which
speeds the curing process. However,
excess heat can result in pulpitis and
pulp death. The effect of heat from a
curing lamp on a tooth is not fully
understood, partly because there are
so many variables.

DISTANCE AND ANGLE


BETWEEN LIGHT AND
RESIN
* The ideal distance of the light source
from the composite is 1 mm, with the
light source positioned 90 degrees
from the composite surface.
* Light intensity drops off rapidly as the
distance from the light rod to the
composite increases. If the base of a
typical proximal box on a posterior
composite is 5 mm from the tip of the
light guide, adequate curing duration
for a given intensity can be determined
only by using a radiometer from the
same distance. Distance can still be a
problem if the lamp is placed against
the tooth, since a deep box increases
the distance the light must penetrate.
This is a good reason to use a lamp
that produces more than the minimum
400 mW/cm2 power density. With
many curing lamps, a higher power
density (of about 600 mW/cm2) is
required to ensure that 400 mW/cm2
reaches the first increment of
composite in a posterior box.
* To compensate for the loss of intensity,
cure for longer periods of time the
layers of composite that are at a
greater distance from the light rod.
Further polymerization can be achieved
by curing from the proximal surfaces
after finishing.

ANGLE AND PATH OF


LIGHT
* As the angle diverges from 90 degrees
to the composite surface, the light
energy is reflected away and
penetration is greatly reduced.
* This can be demonstrated by angling
the light rod against a radiometer and
watching the intensity values shown on
the meter drop.
* In molar preparations, the marginal
ridge of the adjacent tooth blocks light
when placed at an angle

THICKNESS OF RESIN
*Resin thickness greatly affects
resin curing. Optimum
polymerization occurs at depths of
just 0.5 to 1.0 mm, owing to the
inhibition of air at the surface and
the difficulty with which light
penetrates a resin.
*One classic study showed that 7
days after a 40- second curing
cycle, a 1-mm deep composite (of
light shade) is cured to 68 to 84%
of optimum hardness, as
measured by surface hardness.
*At 2 mm, this same composite has
only 40 to 60% of the desired
hardness. At 3 mm, it has only
34% of the hardness. Thus,
composites should be cured in
increments of not more than 1 to
2 mm. This assumes an optimum
light source and a composite that
is light in shade.

AIR INHIBITION
* Oxygen in the air competes with
polymerization and inhibits setting of
the resin.
* The extent of surface inhibition is
inversely related to filler loading.
* The undercured layer can vary from 50
to 500 m, depending on the reactivity
of the photointiators used.
* Unfilled resins should be cured, then
covered with an air-inhibiting gel, such
as a thin layer of petroleum jelly,
glycerin, and then re-cured.
* Some glazes have photoinitiators that
are sufficiently reactive to make this
unnecessary.
* In addition, curing through a matrix
increases surface polymerization
because the matrix reduces air
inhibition.

CURING THROUGH TOOTH


STRUCTURE
* It is possible to light-cure resin through
enamel, but this technique is just one-
to two-thirds as effective as direct
curing and is appropriate only when
there is no alternative.
* Such curing is possible through up to 3
mm of enamel or 0.5 mm of dentin, but
the clinician should double or triple
exposure times.
* When light-curing through tooth
structure, porcelain veneers, and other
barriers, it is advisable to use a high-
intensity light.

SHADE OF RESIN
* Darker composite shades cure more
slowly and less deeply than lighter
shades.
* At a depth of 1 mm, a dark composite
shade achieves just two-thirds of
optimum depth of cure achieved in
translucent shades.
* A brighter light reduces the amount of
time it takes to cure darker shades.
* Hence, when esthetics is not critical,
the lightest shade should be used.

TYPE OF FILLER
* Microfilled composites are more
difficult to cure than macrofilled
composites, which have larger quartz
and glass fillers.
* Generally, the more heavily loaded a
composite is with larger inorganic
fillers, the more easily the resin cures.
* However, extremely high loading can
make a composite opaque, which
actually increases the required
duration of exposure.

AMOUNT OF
PHOTOINITIATOR
* All photoinitiators deteriorate over
time. However, light-cured
composites are more stable than
chemically cured composites.
* Some lightcured composites lose
about 10% of their physical
properties when stored for 2 years at
room temperature.
* The maximum usable life span of a
lightcured composite is generally 3 to
4 years or more from the date of
manufacture, if stored at room
temperature.
* The major cause of decreased shelf
life for light-cured composite is
evaporation of critical monomers
from unidose containers.
* Autocured materials have shelf lives
of 6 to 36 months.
* The key to longevity is the catalyst
peroxide containing paste; some are
stabilized better than others.
* There are large variations in the shelf
lives of various auto- and dual-cured
composites.
* Most autocured composites have an
extended shelf life if kept under
refrigeration.
HEAT GENERATED BY
LIGHT-CURING UNITS
* The heat given off by a curing light
increases the rate of photochemical
initiation and polymerization reaction
and increases the amount of resin
cured.
* Excessive curing heat is thought to
cause no photochemical damage to
either the tooth or the composite.
* However, the heat generated in the
tooth during light-curing results in
higher intrapulpal temperatures, which
could be harmful.
* Deep layers of resin should be cured
thoroughly; cooling with a dry air
syringe may be helpful.

ROOM-LIGHT
POLYMERIZATION
* The working time of light-cured
composites depends on the operatory
light and the ambient room light to
which the composites are exposed.
* Differences in these light sources can
dramatically affect working time.
* Newer, faster-setting composites are
even more sensitive.

*Operatory lighting
Most operatory lights operate at
high temperatures that produce
spectrums in the blue range. This
spectrum is included to improve
the color selection of dental
restoratives, but it initiates curing.

*Incandescent lighting
Incandescent lights are low in blue
light and provide the longest
composite working time.

*Fluorescent lighting
In general, fluorescent lighting has
the shortest working time for
light-cured composites, because it
emits a large amount of blue light.
Color corrected tubes emit
considerably more blue light and
often have the shortest working
time of all lighting systems.

IMPROVING WORKING
TIME
Working time can be improved in two
ways:
1. Place the operatory light further from
the working field. Generally, doubling
the distance of the operatory light from
the patient greatly increases the
working time while still providing
adequate light for composite
placement.
2. Place an orange filter over the
operatory light.

CONFIGERATION FACTOR
* The most important consideration a
dentist has when placing a restorative
that shrinks on setting, like
composites, is the number of opposing
walls facing the restorative since these
margins can be opened when the
material shrinks.
* The c-factor (configeration factor) is a
term used for the ratio of the number
of walls bonded to unbonded.
* It is the reason different application
sequences are used when placing
composite resins.
* As the c-factor increases, ramp, step,
and pulse curing become effective
ways of reducing marginal openings
and cuspal strain from polymerization
shrinkage.

LIGHT GUIDES
* When the area of composite to be
cured is larger than the diameter of
the light tip, composite sections must
be overlapped at least 1 mm. Failure
to properly overlap during curing can
result in poorly polymerized areas in
the restoration.
* Curing time also must be increased
to compensate for the increased area
of resin.
* To avoid the time-consuming and
tedious process of overlapping, a
number of wide-diameter
attachments are available for many
visible light curing units. The
attachments are particularly useful in
curing composite veneers.
* Some wide diameter curing
attachments are adaptable to
existing curing units and emit more
light because of a larger curing tip on
the unit connector. Others, however,
spread the same narrow unit-
connector light source over a larger
diameter with the use of optics; most
of these have reduced light intensity.
This reduces the depth of cure, so
composite must be cured in thinner
layers.

LIGHT GUIDES
OCULAR HAZARDS OF
CURING LIGHTS
*The 468 to 480 nm wavelength of
light that polymerizes composite
resin is among the ranges of light
most damaging to the eyes.
*The study by Ham showed that
blue light causes retinal burns in
monkeys after exposures of less
than 1 second. As exposure
duration increased, the burns
became more severe. This
damage has been named solar
retinitis.
*Retinal burns appeared 48 hours
after light exposure and healing
occurred in 20 to 30 days. The
healed areas showed permanently
degenerative tissues. These
damaged tissues histologically
have the appearance of senile
macular degeneration. In other
words, the light exposure rapidly
aged the visual cells of the retina.
*Ham and Mueller showed that this
damage to the retina is
irreparable; the damaged rod and
cone photoreceptors cannot
regenerate.
OCULAR HAZARDS OF
CURING LIGHTS
*Researcher Ham considers 510
nm the minimal cutoff point for
severe eye damage.
*Shorter wavelengths, those
essential to cure composite, are
exponentially more dangerous
than longer wavelengths.
*For example, 441 nm, which is the
most damaging wavelength, is 2.5
times more damaging than 488
nm.
*Griess and Blankenstein have
shown that repeated exposure to
low levels of blue light produces
cumulative retinal injury in rhesus
monkeys. They found that the
additive effect of retinal damage
from multiple exposures was 91%
greater than single exposures
when the interval between
exposures was 1 day. Thus,
repeated exposures to even low
levels of blue light can be
extremely damaging.

EYE PROTECTION
*In most clinical situations, the
blue light in contact with the eyes
is reflected light. Many scientists
believe that reflected blue light is
less harmful to the eye, but just
how much safer it may be has not
been established by research.
*In any case, scientists recommend
that dentists wear protective
eyewear or shields when working
with visible light-curing lamps.
Any protective eyewear should
transmit less than 1% of
wavelengths below 500 nm.
*The best eye protection is to
completely avoid looking at the
curing light source. Covering the
curing site with a dark object
would be ideal.
*Some clinicians cover the curing
site with their hand. This may
prove an unsafe practice. In cell
research, blue light is used to
induce cancer growth; therefore,
skin exposure is highly
discouraged.

EYE PROTECTION
* A simple yet effective way to provide
shielding from curing lights is to cover
the curing field with the reflective side of
a mouth mirror. This prevents excess
blue light from reflecting back against
the restorative and improves curing. If
the mirror is not large enough, a folded
patient napkin easily covers most fields.
A slight amount of brightness will show
through the napkin and shows if the light
is on or off.
* If it is necessary to look at the light
source for placement, eye protection is
warranted. Unfortunately, most optical
glasses and plastic contact lenses
transmit blue light and near-UV light
radiation with little attenuation. A
number of colored plastic glasses and
handheld shields are available. Some of
these plastics (usually red and orange)
can block blue light. They can be cut and
made into custom shields. Over time,
they may need to be replaced, since the
organic dyes used to color plastic fade
with use.
* Colored protective lenses in glasses are
another option. The drawback is that
they require a 2- to 6- minute recovery
period before normal color perception
returns. This temporary distortion can
interfere with the ability to judge shades.

INDICATIONS
* Classes I,II,III,IV,V & VI restorations.
* Foundations or core buildups.
* Preventive resin restorations.
* Esthetic enhancement procedures
Partial & full veneers
Tooth contour modifications
Diastema closures
* Luting cements (for indirect
restorations)
* Temporary restorations
* Periodontal splinting

CONTRAINDICATIONS
* Failure to isolate the tooth
* Bruxism
* If all the occlusal load will be on the
restorative material.
* Restorations extending to root surface.

ADVANTAGES
* Esthetic
* Conservation of tooth structure
* Less complex when preparing the
tooth
* Insulative, having low thermal
conductivity
* Used almost universally
* Bonded to tooth structure, resulting in
good retention, low microleakage,
minimal interfacial staining & increased
strength of remaining tooth structure
* Repairable

DISADVANTAGES
* May have a gap formation usually
occuring on root surfaces
as a result of of the forces of
polymerisation shrinkage of the
composite material being greater
than the early bond strength of
the material to dentin.
* Are more difficult, time-consuming
&costly because :
Tooth treatment usually requires
multiple steps.
Insertion is more difficult.
Establishing proximal contacts, axial
contours, embrasures & occlusal
contacts maybe more difficult.
* Are more technique sensitive.
* May exhibit greater occlusal wear in
areas of high occlusal stress or when all
of tooths occlusal contacts are on the
composite material.
* Have a higher linear co-efficient of
thermal expansion, resulting in potential
marginal percolation if an inadequate
bonding technique is utilised.

TRADITIONAL RESIN
COMPOSITES(CONVENTIO
NAL)
*Filled 70% to 80% by weight (60%
to 70% by volume) with 20- to 50-
micron-size filler particles
*Disadvantages: roughness,
staining, discoloration
*Discoloration occurs because of
the presence of tertiary amines
which are converted by ultraviolet
light into yellowish quinones;
usually occurs at the 18- to 24-
month point
*Surface roughness increases with
the lifespan of the material
because of the "plucking" effect
caused by loss of filler particles
from the matrix
*Very infrequently used today
because of their poor polishability
and tendency to stain and discolor
*Examples: Adaptic (J&J), Concise
(3M ESPE)
SMALL PARTICLE FILLED
COMPOSITES
* Filled 70% to 80% by weight with 1- to
5-micron-size filler particles
* Good compressive and tensile
strengths, fracture resistant, polish
nicely
* Examples: PrismaFil (Caulk), Command
(SDS/Kerr)
* These resin composites are
recommended for large (2 mm or
larger) diastema closures and for Class
IV restorations because of their good
strength properties.

MICROFILLED RESIN
COMPOSITES
* Filled 35% to 50% by weight with
prepolymerized 0.02- to 0.04-micron-
size silicon dioxide filler particles
* Polish to high luster and produce
excellent esthetic results
* Should not be used in heavy stress-
bearing areas because they frequently
exhibit marginal chipping and bulk
fracture
* Because of their low fracture
toughness, they should not be used for
Class IV lesions

* Physical properties in general are


inferior to those of the small particle
macrofilled (fine particle) resins
because of their lower percentage
filler content; exceptions are their
compressive strength which can be
relatively high and two-body wear
resistance.
* Compared to other resin composites,
the microfilled resins have higher
coefficients of thermal expansion,
greater water sorption, greater
polymerization shrinkage, lower
moduli of elasticity, lower tensile
strength, and lower fracture
toughness
* The lower modulus of elasticity (i.e.,
greater flexibility) of microfills makes
them a good choice for Class V
lesions where tooth flexure may
occur.
* Failure of microfilled resin composites
often occurs at the interface between
the prepolymerized filler particles
and the matrix because bonding at
this interface is frequently poor.
* They also exhibit a reduced depth of
cure compared to small particle
macrofills or traditional resin
composites.
* Examples: Filtek A110 (3M ESPE),
Heliomolar RO (Ivoclar Vivadent), Epic-
TMPT (Parkell), Durafill VS (Heraeus
Kulzer), Renamel Microfill (Cosmedent),
Matrixx AM (Discus Dental), and
Amelogen Microfill (Ultradent)
* Because the filler particles in a
microfilled resin are so small, they have
from 1,000 to 10,000 times as much
surface area as filler particles in
conventional resins; the increased
surface area must be wetted by the resin
matrix and this results in a significant
increase in viscosity; this increase in
viscosity limits the percentage filler
content of the resin to about 35% to
50%.
* In an attempt to maximize filler loading
while minimizing increase in viscosity,
prepolymerized silicon dioxide particles
are used. This process involves the
addition of 0.04-micron-size silicon
dioxide particles to a heat polymerized
resin in concentrations of up to 60% by
weight. Following polymerization, the
monomer is ground into 5- to 50-micron
size pieces which, along with more 0.04-
micron silicon dioxide particles, are
added to the resin matrix. This
effectively maximizes percentage filler
content and minimizes increase in
viscosity. The weak link in microfilled
resins is the bond between the
prepolymerized filler and the organic
matrix. This makes them subject to bulk
fracture under high-load conditions.

HYBRID RESIN
COMPOSITES
* Filled 70% to 80% by weight with
0.04-micron and 1- to 5- micron-size
filler particles.
* Average particle size is usually about
0.6 microns.
* Some researchers make a distinction
between hybrids and microhybrids
(hybrids having an average filler
particle size of 1 micron or greater,
and microhybrids having an average
filler size of less than 1 micron)
* Are usually radiopaque
* Physical properties are intermediate
to those of conventional resins and
small particle macrofilled resins
* Fracture resistant
* Examples: Herculite XRV, Prodigy
(SDS/Kerr), TPH Spectrum (Caulk),
Filtek Z250 (3M ESPE), Renew (Bisco),
Synergy (Coltene Whaledent),
Virtuoso (Den-Mat), Vitalescence
(Ultradent), Charisma (Heraeus
Kulzer), Palfique Estelite (J. Morita),
Glacier (Southern Dental Industries),
and Venus (Heraeus Kulzer).
PROPERTIES OF
COMPOSITES
WORKING AND SETTING
TIMES
* For light-cured composites, initiation of
polymerization is related specifically to
the application of the application of
light beam to the material.
* About 75% of polymerization takes
place during the first 10 minutes.
* The curing reaction continues for a
period of 24 hours.
* Although the restoration can be
finished & is functional after 10
minutes, the optimum physical
properties are not reached until about
24 hours after the reaction is initiated.
* The setting times for chemically
activated composites range from 3 to 5
minutes.

POLYMERIZATION
SHRINKAGE
* Free volumetric polymerization
shrinkage is a direct function of the
amount of resin.
* This shrinkage creates polymerization
stresses as high as 13MPa between
composite & tooth structure. These
stresses can exceed the tensile
strength of enamel & result in stress
cracking and enamel fractures along
the interfaces.
* It has been demonstrated that light-
cured resin composites generate
higher polymerization shrinkage
stresses than chemically-cured
composites.
MEASURES TO REDUCE
POLYMERIZATION SHRINKAGE
* Develop dentin bonding agents that
are able to develop immediate bond
strengths that are greater than
those developed by polymerization
contraction & are equal to those
obtained to acid-etched enamel.
* Cover the bonded dentin surfaces
with an elastic cavity liner. This acts
as a shock-absorber & places a low
modulus material between the
relatively rigid dentin & resin
composite.
* Insert resin composites in
increments to reduce the volume of
the resin that is shrinking during
polymerization.
*The process of polymerization can
be characterized by pre- and post-
gel phases.
*Polymerization stress initially is
relieved by composite flow until it
reaches the so-called "gel point."
Before this point, the resin-based
composite is flexible and
accommodates to relieve stress.
After this gel point is reached, the
composite changes to an
unyielding state in which the
shrinkage stress is transmitted to
the tooth structure. It has been
observed that the longer the pre-
gel point time, the less the stress
in the post-gel phase.
*High-intensity energy output light
sources, such as plasma arc
curing lights or laser curing lights,
allow a reduction in
polymerization time by increasing
the polymerization rate. This
results in a decrease of the pre-
gel point time and may increase
the shrinkage stress.

THERMAL PROPERTIES
WATER SORPTION

* The higher the concentration of organic


matrix in a composite resin, the higher
the tendency for water sorption.
* Once a resin restoration is exposed to
water, it may absorb the solvent into
the restoration, causing a volumetric
expansion that partially compensates
for polymerization contraction.
SOLUBILITY
* The water solubility of composites
varies from 0.01 to 0.06 mg/cm2.
* Inadequately polymerized resin has
greater water sorption and solubility.

TENSILE STRENGTH
COMPRESSIVE STRENGTH
ELASTIC MODULUS
KNOOP HARDNESS
RADIOPACITY
WEAR
Abrasion
Heavily filled macrofilled composites
with large particles often have an
inherent polish that is abrasive to
enamel. These restorations need
special attention at recall prophylaxis
appointments to regain their acquired
polish. Mechanical cleaning devices,
destroy the surface finish and pit the
restoration. Coarse prophy pastes can
dull a composite restoration.

Erosion
Composites are susceptible to chemical
erosion. All resin systems have some
susceptibility to hydrolysis. Acidulated
phosphate fluoride (APF) can dissolve
the fillers and pit the surface of many
macrofilled composites. Laboratory
studies show that composites filled
with strontium glass and, to a lesser
extent, those filled with quartz are
dissolved during normal applications of
APF gels. Microfilled resins are the least
affected by APF. It is therefore prudent
to use non-APF fluorides on patients
with macrofilled composite
restorations.

White line margins


If a composite restoration has any
thin, knife-edge margins, a white
line at this margin may be
noticeable at placement. Microfills
generally produce more white
lines at the margins than do more
heavily filled materials. White
lines seen immediately after
placement are thought to be
related to finishing techniques
that cause the enamel tags to tear
as a result of the tension of
polymerization shrinkage.
Finishing burs cause the most
white line margins, whereas
micron diamonds and flexible
discs cause the least The exact
cause of white lines is not
established. Research suggests
that these margins stain. Because
of the large disparity in the
coefficient of thermal expansion
between the tooth and the
restoration, staining at an
unsealed edge is a longlasting
problem.

Pits
Pits are caused by porosity or air
incorporation. They are
sometimes hard to detect during
placement but become readily
apparent at recall, because they
stain easily. Aging is another
factor in pit formation. When
composites get old, they
sometimes dry out. This can result
in pitting throughout a restoration.
Light-cured materials are the least
porous. In general, highly viscous
materials are more likely to have
voids during placement, owing to
poorer adaptation during layering
and injection. Viscous autoset
composites are highly porous as a
result of air incorporation during
mixing. Powder-liquid systems are
the most porous of the composite
types; it is difficult to achieve a
consistently mixed paste.
Chipping
Chipping is common with larger
composites, such as veneers. In
general, microfills chip in large pieces
when stressed, which can cause a
shear failure. More heavily filled
materials tend to chip in small
increments that are easier to repair.
The most frequent cause of chipping
is excessive occlusion. Ideally, all
composite restoratives should be
cleared of any occlusal forces,
including protrusive and
parafunctional movements.

Cohesive fracture
Cohesive fracture is more common with
microfills than macrofills. Heavily filled
composites are the least likely to
fracture and should be considered as
replacements for more lightly filled
materials.

Color change
Light-cured composite resins are
generally colorstable. Most color
discrepancies are attributable to
incorrect shade selection. There
are three common explanations
for a color that appears too light:
* the tooth was allowed to
dehydrate before final shade
selection,
* there was a disparity between
the shade guide and the
composite restoration, and
(3) the composite was not
completely cured.
Composites lighten during curing
because of color transformation
of the camphoroquinones that
are activated during
polymerization. Therefore,
determining shade color based
on a partly cured composite is
likely to yield a shade that is too
light when the restoration is fully
polymerized.

BIOCOMPATIBILITY
* Williams has defined biocompatibility
as the ability of a material to perform
with an appropriate host response in a
specific application (Williams, 1990)
* In order for adverse effects to occur,
biologically active components must be
released from the material and then
diffuse to areas where responsive cells
exist.
* In addition, direct interaction at the
interface between restorative materials
and the tissues can lead to adverse
reactions.
* Adverse risks of resin composite
including allergy, cytotoxicity and
pulpal irritation.
* There have been many reports of
allergic reactions in dental personnel
working with restorative resin. Type IV
contact dermatitis was most frequently
diagnosed . Kanerva et al reported
dermatitis on fingertips and hands of
11 dental assistant and 6 dentists to 2-
hydroxyethyl methacrylate (HEMA), a
component in dentin adhesive. These
subjects experienced paraesthesis of
fingertips and allergic pharyngitis.
* Other symptoms like allergic reaction
around the eyes and
bronchioconstriction were also
reported.

* Furthermore, there is evidence that


components from resin composite
transverse the gloves and cause
allergic reactions.
* Munksgaard et al showed that low
molecular weight resin monomers
HEMA and TEGDMA transverse latex
gloves faster than higher molecular
weight dimethacrylates such as Bis-
GMA and urethane dimethacrylate
(UDMA).
* With the current evidence on allergic
effects of resin materials, it is
advisable that dental workers should
avoid direct contact with the material
as much as possible.
* Besides the allergic reactions reported in
dental personnel, there is also an
increasing number of allergic responses
to resin composite in patients.
* Nathanson and Lockhart reported a case
of allergic reaction following placement
of resin composite in a 30 year-old
woman. The clinical signs included
erythema, urticaria and vesiculation.
* Resin composite materials were also
reported to be the etiologic factor in
edema and vesicles on oral mucosa and
lips of a patient by Niinimaki et al.
* In addition oral lichenoid reactions have
been observed in soft tissues adjacent to
resin composite restoration in humans.
* However, compared to the incidence in
dental personnel, there is a lower
incidence of allergic responses in
patients. This may be due to the
insolubility of the materials after
placement or perhaps because proteins
in the keratin layer of the skin are more
likely to combine with chemicals to
induce sensitization.

* In addition to allergic responses, there are


many studies that have shown resin
composites are cytotoxic to cell cultures in
vitro. A study by Reichl investigated the
cytotoxic effect of composite component
HEMA and TEGDMA on human alveolar
epithelial cells by measuring the LDH level
released from these cells. Their rationale for
the study was monomers from the composite
can enter the lung by inhaled monomer
vapor, and the LDH enzyme level reflects the
influences on the membrane and the inside of
the cells. They found that both HEMA and
TEGDMA caused cytotoxic hazards; however,
whether the concentration released is large
enough to give rise to in vivo effects is not
yet clarified.
* Similarly, a study by Schedle et al looked at
the effect of resin composites on fibroblasts.
They found that cytotoxic effects in these cell
cultures were mainly caused by released
monomers during the setting period of
composites. The removal of leachable
components caused a 90% decrease in
toxicity.

* It has also been shown by several other


studies that cytotoxicity increases with the
increase of unreacted substance in the cured
material and decreases with light-curing time
of the resin.

* Furthermore, Rathbun et al demonstrated


that cytotoxicity of composites was reduced
after storage of the resin in organic solvents,
which also indicated that leachable
components were the cytotoxic vectors.

* Taken together, these studies comprise strong


indirect evidence that cytotoxic components
are released from resin composites into the
aqueous phase.
* The effect of composites on pulp tissue
has also been studied in detail. It is
believed that the cause of pulpal
sensitivity is probably due to the gap
formation secondary to polymerization
shrinkage, which leads to bacterial
leakage and pulpal inflammation.
* In support of the claim that bacteria from
leakage around composites are the main
cause of pulpal irritation, Brannstrom
reported that bacteria were a more
serious threat than chemical agents were
to pulpal irritation.
* Inokoshi et al concluded that micro
leakage of bacteria was responsible
when no etching of tooth structure was
done, resulting in poor bonding.
* In addition, others believe that
unpolymerized components from resin
composites, e.g. HEMA or TEGDMA are
aand may thus cause pulpal reaction
without bacterial infection. To support
this view, Qvist et al showed conclusively
that resin composites did cause pulpal
damage when placed onto deep or thin
acid-treated dentin in human teeth in
vivo, in the demonstrated absence of
bacterial microleakage.
* Fuks and Cleaton-Jones also
demonstrated marked pulpal
inflammation following resin composite
placement onto deep areas of acid
treated dentin.

*Therefore, with the given


evidence, it is presently believed
that pulpal response to
composites is combination of
bacterial microleakage and
diffusion of unset components.
*Resin-based dental filling
materials comprise a wide range
of chemically different materials.
However, they were shown to
release substances that may be
biologically active.
*At present, there seems to be no
unacceptable systemic health
risks associated with these
materials for most of the
population and possible local
adverse reactions can be
prevented by suitable measures.
*However, dental personnel
coming into close and frequent
contact with unset materials are
considered to be a risk group for
resin filling materials able to
diffuse through dentin.
* Recent studies provided evidence that TEGDMA
causes large DNA sequence deletions in the
genome of mammalian cells, as well as a quick
and nearly complete depletion of the
intracellular glutathione pool (Schweikl and
Schmalz, 1999; Engelmann et al., 2001, 2002).
Thus, released resinous compounds may cause
a great variety of chemical-biological
interactions, both in vitro and in vivo, which can
result in inflammation and cell death (Geurtsen
et al., 1998; Geurtsen, 2000). For instance,
human pulps capped with a dentin adhesive and
a composite resin initially revealed a
neutrophilic infiltrate and death of odontoblasts,
followed by a persistent inflammatory response
(Hebling et al., 1999).
* Generally, two main types of cell death are
differentiated, apoptosis and necrosis (Majno
and Joris, 1995). Apoptosis is an active and
physiological process characterized by various
phenomena such as cell shrinkage. There is
increasing evidence that the "apoptotic
machinery" exists in cells all the time, but in a
"switched off" state. A detrimental injury of the
cell, e.g., due to a toxic substance, can quickly
activate the apoptotic response, which rapidly
causes cell death. The clearance of the
remaining cell debris by phagocytes is also very
quick, thus avoiding an acute inflammatory
reaction (Hall PA, 1999). Recently, it was found
that the CD31-mediated detachment of
apoptotic leukocytes is disabled, making the
cells susceptible to macrophage ingestion
(Brown et al., 2002). Necrosis is generated by a
massive, lethal injury of the cells. In contrast to
apoptosis, necrosis generally sets off a tissue
inflammation associated with clinical symptoms,
which frequently leads to scar formation (Majno
and Joris, 1995).
* Little is known about the type of cell death
caused by toxic resinous dental materials. Some
scientists examined whether eluates of denture-
base acrylics induce apoptosis and/or necrosis in
immortalized cells, such as U-937 human
monoblastoid cells. Apoptosis and necrosis were
caused by the non-analyzed extracts in a dose-
and time-dependent manner (Cimpan et al.,
2000).

* During the past few years, numerous in vitro


studies have addressed adverse cellular
reactions caused by the most important
comonomer TEGDMA, which frequently leaches
from polymerized resins into aqueous
environments in high quantities and can be
found in all cell compartments (Spahl et al.,
1998; Engelmann et al., 2001). Besides growth
inhibition of various types of cultured primary
and immortal cells of different origins, specific
cellular injuries or a deleterious interference
with important metabolic pathways was found
(Geurtsen and Leyhausen, 2001).
* TEGDMA, for instance, induced large DNA
sequence deletions and micronuclei in vitro
(Schweikl and Schmalz, 1999; Schweikl et al.,
2001). Recently, it was found that sub-lethal
concentrations of this comonomer considerably
reduce the heat-induced HSP72 expression. But
HSP72 itself was not affected at the same time.
Analysis of these data indicates an alteration of
the cellular stress response without causing
apparent changes in the cell metabolism (Noda
et al., 2002). These findings supplement the
observation that "sub-lethal" TEGDMA amounts
can dramatically exhaust the cellular glutathione
pool, which subsequently results in a rapid and
significant decrease in intracellular
detoxification potency.
* There is evidence that abnormalities in
the reproductive system of wildlife are
caused by certain synthetic chemicals
released into the environment. It is
probable that similar abnormalities occur
in humans (Colborn et al., 1996). These
hazardous substances, that have mainly
estrogenic activity, are termed
endocrine-disrupting chemicals (EDCs).
Currently, the adverse effects of EDCs on
humans are poorly understood, and it is
important to identify potential EDCs
among the huge numbers of chemicals
and to construct a risk assessment of
these chemicalsHMBP is listed by the
Japanese Environment Agency (1998)
among "chemicals suspected of having
endocrine-disrupting effects". The
quantity of HMBP leached from
composites in the present study was far
less than the amount needed to show
estrogenicity in vivo, indicating that the
risk of potentially adverse effects in
humans is possibly negligible in a clinical
situation. The estrogenic effect of DMPA
in humans is also considered to be
negligible, since the reporter gene assay
demonstrated similar estrogenic activity
for DMPA and HMBP

MANIPULATION OF
COMPOSITES
ACID ETCHING
*The concept of bonding resins to
enamel was first conceived in the
late 1940s and early 1950s by the
Amalgamated Dental Company in
London.
*The first bonding agent was called
Sevriton Cavity Seal and was
developed in the late 1940s by Dr.
Oskar Hagger at Amalgamated
Dental.
*Dr. Michael Buonocore specifically
developed the acid etching
technique using 85% phosphoric
acid (H3PO4) in 1955, however
Silverstone refined the process
using a 35% concentration.
*Purposes:
1. increases surface energy which
promotes wetting and adhesion
2. chemically cleans the tooth
structure which also promotes
wetting and adhesion
3. creates micropores for
micromechanical retention. The
aim is to cause maximum enamel
dissolution with minimum
precipitation of calcium phosphate
salts.
* Some researchers have suggested that
concentrations of phosphoric acid
>30% are most effective because
concentrations <27% result in
formation of a dihydrate salt of calcium
(calcium phosphate dihydrate) which is
difficult to rinse from the enamel
surface and may prevent the resin
from penetrating into micropores.
* Maximum calcium dissolution has been
shown to occur with 30% to 40%
concentrations of phosphoric acid.
* Other acids including pyruvic and nitric
have been tested and found to be
effective etchants.
*Standard acid etching of enamel
involves the application of 37%
phosphoric acid for 15 seconds
with a 15-second rinse and a 15-
second drying; research indicates,
however, that a rinse time as
short as 1 second may be used
without adversely affecting bond
strength.
* Etching for 15 seconds produces
bond strengths equal to those
produced by 60-second etching
and does not adversely affect the
degree of leakage.
*If the etched area becomes
moisture contaminated, re-etch
for 10seconds to prevent
reductions in bond strength which
occur with contamination; these
reductions can be on the order of
50% to 70%.
*The depth of enamel dissolution
caused by acid etching is
approximately 10 to 15 microns.
Little correlation exists between
resin tag length and enamel/resin
bond strength.

Beveling the enamel margins of anterior


resin composite preparations is
recommended prior to etching to:
1. reduce microleakage
2. improve esthetics: by gradually
blending the resin composite into the
enamel
3. increase bond strength: transversely-
cut enamel, when etched, provides a
stronger bond to resin composite than
etched, longitudinally-cut enamel. This
occurs because the end of enamel rods
are more completely exposed to the
etchant and, therefore, more effective
etching is accomplished and more
retentive tags are produced.

DENTIN - RESIN BONDING


* Infiltrating a resin monomer into
chemically conditioned dentin is the
key to resin bonding. Nakabayashi and
colleagues referred to this infiltration a
hybridization.
* It involves resin penetration into both
tubular and intertubular dentin.
* Infiltration into the tubules accounts for
about one-third of the shear bond
strength of the dentin bond. The
remaining twothirds is achieved
through resin infiltration of the
demineralized hybrid zone, and
reaction and association with the
underlying unaltered dentin, whose
porosity and surface area contributes
significantly to interfacial toughness.

CLINICAL PRINCPLES OF
DENTIN BONDING
The application of a dentin bonding
system entails four basic steps.
Step 1. An acid is used to
demineralize the dentin surface. It
also removes the smear layer.
This creates space within the
collagen network that is roughly
analogous to the microporosities
created by etching enamel.
Step 2. A dentin primer is placed
over the demineralized surface.
Dentin primers are hydrophilic
solutions that have both
hydrophilic and hydrophobic
character (ie, they are coupling
agents). These solutions
penetrate the demineralized
collagen to improve bonding.
Step 3. An unfilled resin (an
adhesive) is applied and
penetrates the microporosities.
With single-component materials,
the evaporation of the volatile
solvent converts the liquid from a
primer to an adhesive.
Step 4. The bonding agent is
polymerized.
GENERIC DENTAL
BONDING STEPS
Step 1. Etch only the enamel for 10
to 20 seconds with phosphoric
acid.
Step 2. Condition dentin with a
suitable conditioner. Condition for
only 10 seconds if the etchant is
phosphoric acid, longer etch times
may increase sensitivity. In this
way, the enamel has a total etch
time of 20 to 30 seconds, and the
dentin has 10 seconds. As a
compromise, enamel and dentin
can be treated simultaneously for
15 seconds. With self-etching
primers, steps 1 and 2 are done
together with a single solution. It
is important not to over-etch the
dentin.
Step 3. Rinse the enamel and
dentin for 5 to 15 seconds.
Step 4. Air dry with a gentle stream
of air, or gently blot dry with a
cotton pellet..
Step 5. Apply as many coats of
primer as necessary to develop a
visible resin coating (glistening
appearance) on the dentin
surface. Autocured bonding
materials usually come in two
bottles and should be used with
autocured composites
Step 6. Evaporate solvents from
the enamel and dentin with a
gentle stream of warm air for 3 to
5 seconds. Then dry thoroughly
again to remove all residual fluid
from the enamel. This will not
affect the dentin since it is already
sealed and will not dessicate.
Step 7. Add an adhesive and thin
out with a dry brush or gentle
stream of air. The adhesive is
usually a higher viscosity resin
compared with the primer. Use an
autocured adhesive with an
autocured composite.
Step 8. Cure the adhesive for 10
seconds.

Step 9. Add the appropriate composite


resin in increments, working from the
enamel walls, until the dentin wall is
covered.
Step 10. After final placement and
curing, wait 10 minutes to allow the
dark reaction to occur. For most
composites, this reaction is 90%
completed in 10 minutes.
Step 11. Finish with appropriate rotary
instruments cooled with a water spray.
Re-etch, rinse, and dry thoroughly with
a warm air dryer.
Step 12. Add glaze, to seal any marginal
gaps created by shrinkage and
finishing. Many have extra accelerators
to reduce the effects of oxygen
inhibition. This is usually a higher
viscosity hydrophobic resin.

PLACEMENT AND
FINISHING
SHADE SELECTION
*Composite shade is selected by
working with a clean, moist tooth
prior to placement of a rubber
dam. Once teeth are isolated by a
rubber dam they dry out and get
lighter in color, making accurate
shade selection difficult.
Using a master shade guide system
*A number of shade guide systems
are commercially available.
*By far the most common is the
Vita Lumin system which breaks
shades first into hues and then
shows hues with increased
chroma and decreased value.
Vitas newer Vitapan system
breaks shades into value
(darkness), hue, and chroma
(color).
*Value is the most important
characteristic of a shade since it is
not light dependent.

Polymerization lightening
*Light-cured composites generally
lighten in color as they cure. This
is because they contain
camphoroquinone initiators, the
most common photoinitiators in
dental resins. These yellow-brown
compounds lighten during
polymerization.
*The camphoroquinone is
consumed in the setting reaction
and becomes part of the polymer.
The colored diketone ring changes
from dark yellow to clear when it
reacts with light and a tertiary
amine to form a free radical. Thus,
a composite cured for 15 seconds
may have a darker shade than
one cured for 60 seconds.
*Some manufacturers believe that
most of the quinone in composites
should react within a 60-second
curing cycle. Therefore, composite
cured for this length of time
should not undergo much
additional quinone change.

MATRIXING
* Many composite restorations are hand
sculpted and do not use a matrix or
crown form for contouring.
* Matrices are, however, used during
placement.
* The most common matrix is clear
Mylar.

DEAD-SOFT PLASTIC
Sandwich bag plastic, freezer wrap, and
other forms of soft plastic are ideal for
protecting adjacent restored teeth from
restoratives placed during the same
appointment.

DEAD-SOFT METAL
MATRIX
* A dead-soft metal matrix is a matrix
that retains a new shape. In contrast,
most metal matrices have memory
and return to their original shape.
* Dead-soft metal is helpful when
contouring. It is ideal for posterior
Class II composites, lingual matrixing
of light-curing composites, and glass-
ionomer cements. It is not desirable for
Class III and Class V areas since light
cannot pass through it for light curing.

Crown forms
Several crown forms are available. Some
forms have the advantage of being
thinner and more anatomically correct
than others. When crown forms are
used, their proximal surfaces are
disced to thin them in this critical area.
Custom crown forms
Custom forms can be made with any
polypropylene temporary splint
material. They must be made on stone
models that have been reproduced
from a diagnostic waxup. Use of a
custom form is a precise technique, but
it may not be time-efficient in
composite placement.

Class V matrix forms


Metal forms are ideal for glass-ionomer
cements. They are easily adapted to
gingival areas because they have no
handle and can be more easily picked
up with a piece of utility wax shaped to
the tip of an amalgam condenser.
Class V cure-through matrix forms
Cure-through matrix forms are designed
for lightcured composites and resin
ionomers. When heated in hot water,
they can be reshaped and adapted to a
tooth. These forms have a small handle
to aid in picking them up. A curing tip
can be placed against this handle to
hold the form in place during
composite curing.

PLACEMENT
INSTRUMENTS
* Clinicians use a variety of instruments
for placing composite, depending on
personal preference and the demands
of the restoration.
* When packing composite, always use a
convex condenser. Concave
condensers can increase voids,
whereas convex condensers help pack
a composite toward the cavity walls.
* An explorer is ideal for adapting
material, because its small surface
area limits the potential for composite
to stick to it.
* A half Hollenback or interproximal
carver is ideal for smoothing and
contouring composite.
* Mylar is ideal for pulling composite
proximally and shaping the proximal
surface.

CONTOURING PRIOR TO
POLYMERIZATION
* The primary goals of finishing are to
obtain a restoration that has good
contour, occlusion, smoothness, and
healthy embrasure forms.
* Tight margins should blend esthetically
into the tooths natural contours.
* Prepolymerization contouring is
essential for consistently successful
restorations. The amount of time
required to finish a restoration is
determined by how accurately the
tooth was contoured before curing.

COMPOSITE LAYERING
Visible light curing
*Composite layers are cured in 1-
and 2-mm increments with not
more than 5 to 10 minutes
elapsing between additions.
*When different classes of
composite are added in layers eg,
a microfill to a minifill or to a
heavily filled composite, an
unfilled bonding agent should be
placed between the layers to
improve adhesion.
*Layering with unfilled bonding
agents is even more critical when
composites with different resin
matrices (ie, from different
manufacturers) are used. An
unfilled bonding agent is a
minimally filled fluid composite
without solvents. A thin coat of a
flowable composite, air-thinned, is
an alternative that works as well
as an unfilled bonding agent.
*Do not use a dentin bonding
agent, because its components
could inhibit bonding and weaken
the composite.

Placing internal layers


Place the internal layers with a
composite syringe or with a
single-dose syringe system.
Layers should be added in
increments to approximately 0.5
mm below the final contours.
Packing with a convex condenser
is recommended.
Placing external layers
Sculpt the external layer with a
hand instrument. A Mylar strip can
be used proximally to distribute
the composite evenly to the
lingual surface to reduce voids.
Most of a restorations form,
shape, and surface smoothness
should be finalized before curing.
The Mylar strip is removed
carefully before curing, and a
proximal carver is used to
carefully smooth and shape areas
with poor access eg, gingival and
proximal margins.
SHADED VS. ANATOMIC
LAYERING
The majority of anterior restorative cases are
simple enough to be restored with one layer.
However, in those cases where a higher level of
esthetics is desired, such as larger Class IVs,
diastema closures and direct veneers, a multi-
layered process may be indicated. Layered
techniques may be divided into shaded and
anatomic placement.

* The shaded technique has been available for


several years and consists of the clinician
determining the shade with a shade guide from
the middle third of the tooth. The dentist then
selects three corresponding composite resins to
be placed in three successive layers. Typically,
dentin, enamel and translucent
composites all in the same shade are selected
and placed. Many composite systems use this
technique (e.g., Esthet-X, Dentsply/Caulk; Venus,
Heraeus Kulzer).
* However, recently introduced systems now
provide an anatomic technique in addition to
the traditional shaded concept (e.g., 4
Seasons, Ivoclar Vivadent). Anatomic
techniques are based on the layering process
often used by dental laboratory technicians to
create a restoration. In the anatomic
technique, a highly chromatic dentin shade is
matched to the existing dentin and a colorless
enamel is then placed to replace the enamel
layer. A final translucent layer may be added
as necessary.

* Layered techniques can provide excellent


esthetics in complex cases. Potential
disadvantages of both techniques include a
steeper learning curve, higher expense, and use
of some shades not on the typical Vita shade
guide

FINISHING AND
POLISHING

* The purpose of finishing and polishing


should be to achieve the best possible
surface with the least restorative
damage and marginal leakage.
* For most direct dental restoratives,
finishing is dependent on the hardness
and polishability of the matrix and
fillers that compose the material.
* There are two kinds of polish: acquired
and inherent. The acquired polish is the
surface placed by the operator. The
inherent polish is the surface the
material naturally reverts to through
mastication and erosion. This surface is
largely determined by the size and
solubility of the dispersed phases of
the material used i.e. fillers, fibers.

Wet or dry finishing


* Dry finishing is very harmful to most
restoratives. The heat and friction
generated can open dentin margins,
particularly dentincomposite margin.
Dry finishing should be reserved for
microfilled composite resins because
they contain only resin fillers, which
melt and produce an artificial smear
layer of resin that enhances the
surface gloss.
* Wet finishing, the technique used for
most composites, reduces heat and
friction, and thus, reduces surface
damage to the body and margins of
the restoration.

FINISHING
INSTRUMENTATION
Rotational abrasive, dry
The dry rotational abrasive
technique uses diamonds, white
stones, discs, or dry rubber points
to soften and cut away particles
and the matrix with the aid of the
heat and friction that is produced
in dry finishing. This method
should only be used on materials
that will soften or melt from the
heat of finishing (eg, microfills).
Rotational abrasive, wet
The wet rotational abrasive method
uses diamonds or other abrasives,
such as aluminum oxide discs,
with water or a water-soluble
lubricant. Examples are micron
diamonds or white stones with
water spray, or discs used wet or
with a water-soluble lubricant that
reduces heat and chipping.
Rotational abrasive, erosive
The erosive rotational abrasive method
uses pastes to soften and erode the
attachment between larger particles
and the matrix. The pastes that are
used with soft rubber cups generally
contain submicron aluminum oxide
particles. These should be prepared in
a thin slurry to smooth small-particle
(15 m) and submicron (<1 m)
composites. Examples of these pastes
are Herculite (Kerr, Orange, California)
and Prisma Gloss (LD Caulk, Milford,
Delaware).

BURS
DIAMONDS
FINISHING DISCS
Sof-Lex Discs (3M Dental Products,
St. Paul, Minnesota) are popular
flexible composite finishing discs.
The abrasive is aluminum oxide. A
soft backing allows these discs to
curve to the tooth. The discs
provide a smooth, even finish by
selectively removing the raised
projections from the resin surface.
Using all four grits in sequence
provides the best finish.
Micro-Fill Composite Finishing Discs
(E.C. Moore Co., Inc.) rapidly and
grossly reduce any composite, but
because the discs are rigid, they
cannot give the best final polish
on most composite resins.
Flexidiscs (Cosmedent, Chicago,
Illinois) are available in four grits.
These discs are 16 mm in
diameter and fit a standard
Moores mandrel. They are thin,
making them ideal for proximal
areas, but are less flexible than
Sof-Lex Discs. Flexidiscs cause
more surface scratching on
microfills and smallparticle
hybrids than do Sof-Lex Discs.
Super-Snap Discs (Shofu Dental
Corp., Menlo Park, California) are
more rigid than Sof-Lex Discs and
not as rigid as Moores discs.
Super-Snap Discs are thin and
easy to use in interproximal areas.
Because the mandrel is mounted
behind the disc, there is no metal
hub. This gives excellent access in
hard-to-reach areas and reduces
the possibility of the mandrel
damaging the restoration. Super-
Snap Discs were introduced in
1983 and come in two diameters:
8 mm and 12.5 mm. When used in
proper sequence, Super-Snap
Discs provide a finish that appears
clinically as smooth as that
achieved with any other system.
The grit is on only one side of the
disc, so two discs are needed to
change the grit from the face to
the back.
RUBBER WHEELS, CUPS &
POINTS
Soft rubber
Burlew wheels have an intermediate grit
that is good for initial contouring and
smoothing.
Medium rubber
Centrix polishing cups come in two grits
and are suitable for gross and final
finishing. LD Caulks Enhance
polishing cups and points are useful for
a combination of gross and final
finishing, especially in posterior and
occlusal areas. Shofu polishing cups
and wheels provide smoother finishes
than microfine diamonds and burs.
Vivadent polishing cups and wheels are
excellent for characterizing microfilled
resins. The cups and wheels cut rapidly
yet leave a smooth surface. The gray
wheels are used for gross reduction,
whereas the green wheels are used for
final finishing. Studies show that
wheels and discs produce a finish
quality nearly as good as that of
flexible discs. They are available in a
range of shapes.
Hard rubber
Ceramic discs (Shofu) have abrasive
points for gross reduction and rubber
points for final finishing. They are
available in a number of different
shapes.

PROXIMAL FINISHING
STRIPS
Proximal finishing strips are ideal
for enamel discing before cutting
a preparation, and for finishing a
restoration after final contouring.
Metal strips
Metal strips cut almost all tooth
and restorative materials evenly.
They are excellent for gross
interproximal reduction,
particularly as a first step in
interproximal finishing. They must
be used carefully, because they
easily remove tooth structure as
well as composite. The major
disadvantage of metal strips is
cost. However, they are
autoclavable and can be reused
Plastic strips
Available in two grits, one for
finishing and one for polishing.
The strips provide a smooth
surface on microfilled composites
and are tear resistant.

POLISHING PASTES
Aluminum oxide
A thin mixture of aluminum oxide
powder can be used on microfilled
composites and some smallparticle
hybrids. In conventional macrofilled
composites, pastes may induce
plucking by preferentially removing
resin from around the macrofiller
particles. The grit in the polishing
material should be smaller than the
inorganic filler size of the composite.
Prisma Gloss (LD Caulk) improves the
polish achieved with extra-fine discs.

POSTERIOR COMPOSITES
The major benefit of a posterior
composite is that it allows the
practitioner to place a conservative
initial restoration, one that preserves
considerably more tooth structure than
an amalgam restoration. The typical
amalgam restoration occupies 25% of
the occlusal surface, whereas the
typical composite restoration occupies
5%. Posterior composites generally are
indicated for initial carious lesions in
lowstress-bearing areas.

Advantages
*Posterior composites can perform
well in highly esthetic and
conservative preparations.
*They bond to enamel with an
excellent seal and can hold
weakened cusps together.
*They can be placed in stress-
bearing restorations, which makes
them ideal for lengthening cusp
tips; however, adequate
resistance-form is critical to
protect the restoration from shear
forces.
*They have low thermal
conductivity, no galvanism, and
eliminate the possibility of
mercury toxicity.
*Their cost is not affected by
fluctuations in precious metal
prices.
*In terms of placement, composites
have a shorter setting time, can
be polished during the placement
appointment, and are easily
repaired.

Disadvantages
* Posterior composites are susceptible to wear
or breakage, especially in large stress-bearing
restorations.

* They have no caries inhibiting properties, a


poor coefficient of thermal expansion, less
stiffness than other restoratives, and a
greater tendency to fracture than amalgam.

* Placement is technique-sensitive and requires


hands-on training. Restoring with composite
also takes longer than restoring with
amalgam.

* Owing to leakage and flexure, composite


restorations show increased potential for
pulpal irritation, especially when used by a
clinician who does not understand each
component of the materials. Small, well-
protected areas are the best locations for
these restorations.

* Extreme care must be used to ensure


marginal integrity, since microorganisms are
the major cause of recurrent caries and pulpal
sensitivity. A void at the margin could result in
postoperative sensitivity, recurrent caries,
and rapid failure of the restoration.
* Even with careful placement, inherent
polymerization shrinkage makes it difficult to
maintain a tight seal in preparations with
opposing margins eg, margins on the mesial
and distal boxes.

Polymerization shrinkage
* Polymerization shrinkage is of critical
concern with posterior restorations
because of the potential for gaps.
* Composites shrink 1.2 to 4.5% by
volume and 0.2 to 1.9% by linear
measure.
* Polymerization forces are generally 2.8
to 7.3 MPa, which is considerably less
than the tensile strength of enamel (20
to 40 MPa).
* Enamel bonding procedures help
compensate for this shrinkage by
directing it away from the margins; but
polymerization shrinkage generally
results in marginal gaps in posterior
composites.

Sensitivity
* Postoperative sensitivity is of particular
concern with posterior composite
restorations.

* There is evidence that patients are more


likely to experience postoperative sensitivity
to biting with composite restorations (19%)
compared with amalgams (3%).

* Although a variety of factors can cause or


contribute to sensitivity in these restorations,
tooth movement and stress under function
increase the likelihood of problems.
* Cuspal strain results from the constant
movement of weakened cusps under function
and can result in pain during chewing as well
as enamel crazing near the gingiva.

* This problem is less severe with smaller


composite restorations. Inadequate stiffness
is of particular concern with large composites.

* Few composites are able to stabilize


weakened cusps. Although large composite
restorations show improved fracture
resistance, they do not prevent cuspal
movement.

Longevity
*An average amalgam and a
properly placed composite last
between 5 and 10 years. Small
non stress-bearing posterior
composites last considerably
longer. These are typically used in
conjunction with occlusal sealants.
The sealant portion of the
restoration may require small
repairs over time.
*The 5-year failure rate of all
posterior composites is 9.2%,
according to one study. The
causes were wear (0.4%), caries
(3.2%), fractures (2.8%), and
other (2.8%).
*Some studies show the wear rate
of posterior composites decreases
over time.
*Composites should be used in
conservative preparations and
mainly kept out of occlusion.

FLOWABLE COMPOSITES
* These are low-viscosity composite resins,
making them more fluid than conventional
composite resins. The percentage of
inorganic filler is lower and some
substances or rheological modifiers which
are mainly intended to improve handling
properties have been removed from their
composition.
Their main advantages are:

* high wettability of the tooth surface,


ensuring penetration into every
irregularity;

* ability to form layers of minimum


thickness, so improving or eliminating air
inclusion or entrapment high flexibility, so
less likely to be displaced in stress
concentration areas (cervical wear
processes and cavitated dentine areas);
* radio- opaqueness and
* availability in different colours.
The drawbacks are:

* high curing shrinkage, due to lower filler


load, and

* weaker mechanical properties.


Some of the indications for these materials
are:

* applications in class V restorations,


* cervical wear processes and minimal
occlusal restorations

* as liner materials in class I or II cavities or


areas of cavitated enamel.

PACKABLE/CONDENSABLE
COMPOSITES
* Condensable composites are composite
resins with a high percentage of filler.
The packable characteristics are derived
from inclusion of elongated fibrous filler
particles of about 100 microns in length
& textured surfaces that interlock &
resist flow.
The advantages are:
* condensability (like silver amalgam),
* greater ease in achieving a good contact
point and
* better reproduction of occlusal anatomy.
* Their physical and mechanical behaviour
is similar to that of silver amalgam,
bettering that of hybrid composites
however, according to follow-up studies,
their clinical behaviour is similar to that
of hybrid composites.
Their main disadvantages are
* difficulties in adaptation between one
composite layer and another,
* difficult handling and
* poor aesthetics in anterior teeth.
Their main indication is Class II cavity
restoration in order to achieve a better
contact point owing to the condensation
technique.

INDIRECT COMPOSITES
In an effort to address the
disadvantages of the direct
adhesive restoratives such as
technique sensitivity, anatomic
form, polymerization shrinkage,
wear and interproximal contacts,
the indirect composite resins were
introduced. These materials were
also seen as having advantages
over PFM and all ceramic
restorations. PFM restorations
require a metal substructure,
although reliable and time-tested,
they are often considered as
esthetic as the all-ceramic or
indirect composite restorations. It
is difficult to obtain the
translucency seen in natural teeth
when using a metal substructure.
While the all-ceramic restorations
are more translucent than PFM,
they have other problems, such as
abrasion of the natural dentition
and they are not easily repaired.

FIRST GENERATION
*The first generation of the
compositebased indirect
adhesive restoratives were
introduced in the early 1980s.
These included Visio-Gem (ESPE)
and Dentacolor (Kulzer) followed
in 1987 by Concept (Ivoclar).
These materials were developed
in an effort to overcome the
polymerization shrinkage and
accelerated wear experienced
with the direct adhesive
restorative materials. These new
materials offered the advantages
of chairside repair, esthetics,
improved anatomy and
interproximal contact along with
ease of fabrication. However, this
first generation of materials
suffered from low flexural
strength, low modulus of elasticity
and low resistance to wear
abrasion. These poor physical
properties were the result of low
filler load and high matrix load.

SECOND GENERATION
* It was not until the mid-1990s that the
second generation of indirect composite
restorative were introduced. These new
materials included Artglass (Heraeus-
Kulzer), BelleGlass HP (Kerr), Targis
(Ivoclar), Colombus (Cendres et Mataux)
and more recently, Sinfony (ESPE).
* The effect of heat curing these newer
composite materials on the degrees of
conversion was demonstrated by
Ferracane and Condon in 1992. They
demonstrated that heat treatment, in
addition to a 60-second light cure, will
increase the degree of conversion. This
increase in degree of conversion will
improve the fracture toughness of the
indirect composite materials.
* This second generation of materials
incorporated ceramic fillers with mean
particle sizes of less than 1 m of smaller
diameter, silanized and with a narrow
distribution. The filler is commonly
barium silica. They have a high filler load
(70-80% by weight and 50-60% by
volume) and they have a lower resin
content (approximately 33% resin matrix
by volume.) The filler volume and filler
load correlate with the strength of a
composite resin. The higher filler load will
help reduce the polymerization
shrinkage, while it increases the modulus
of elasticity.

FIBER-REINFORCED
SUBSTRUCTURE
This second generation of indirect
composite resins may be combined
with fiber-reinforced substructure. This
technology was used for periodontal
splinting as well as temporary bridge
reinforcement to its introduction as a
reinforcement for indirect composite
restoratives. The fibers used for this
purpose are composed of carbon
Kevlar, polyethylene and glass fibers.

LABORATORY PROCESSED
COMPOSITE INLAYS &
ONLAYS
* The physical properties of composite
restoration are improved when the
composite is free of voids & the resin
matrix is maximally polymerized.
Generally well cured restoratios are best
accomplished in dental laboratory either
under pressure, vacuum, inert gas,
intense light, heat or a combination of
these conditions.
INDICATIONS
* Maximum wear resistance is desired from
a composite restoration
* Achievement of proper contacts &
contours
* Ceramic restoration is not indicated
because of cost or concerns about wear
of opposing dentition
ADVANTAGES
* Control of polymerization shrinkage
* Enhanced physical properties compared
to direct composites
* Contacts & contours are better created
* Improved control over marginal
adaptation
* Lesser technique sensitive

CLASSIFICATION
Based on method of curing
* Superficial inlays
* Conventional cured inlays
* Secondary cured inlays

* SUPERFICIAL INLAYS
The inlays are cured at elevated
temperature & under pressure in one
stage the composite employed is heat
cured. eg. SR ISOSIT system which is a
homogeneously filled composite
containing 55% by weight radiolucent
colloidal silica plus 20% radiopaque
lanthanum fluoride. The inlays after
shaping on a die are subjected to heat
& pressure polymerization at a
temperature of 120 degrees, 6 bar
pressure for 10 min.
* CONVENTIONAL CURED INLAYS
Only one mode of curing is employed
eg. EOS system where the inlay is
cured by light only.
* SECONDARY CURED INLAYS
Initial curing at room temperature by
light followed by additional curing by
heat & light eg. COLTENE BRILLIANT
AESTHETIC SYSTEM in which secondary
curing is done under high intensity
light at 120 degrees for 7 min. This
system incorporates a 0.5mm hybrid
composite containing 78.5% glass fiber
. The inlay is built upon increments &
light cured on a laboratory fabricated
die & further polymerized in the
COLTENE D 1500 light heat curing oven
for 7 min at a temp 0f 120 degrees.

COMPOMERS
*Compomers are defined as
polyacid-modified resins. These
materials are basically light-cured,
low fluoride releasing composite
resins. The difference between
compomers and composites is
that the compomers monomers
contain acidic functional groups
that can participate in an
acid/base glass ionomer reaction
following polymerization of the
resin molecule. The term
compomers is the result of the
hybridization of the words
composite and glass ionomer.
However, they are not glass-
ionomer materials. A true glass-
ionomer must be a two-
component system or else the
acid/base reaction would take
place immediately. Conventional
glass-ionomers must be mixed
just prior to use. With the
compomers, there is a single
component system which cannot
contain any water in order to
prevent a premature glass-
ionomer reaction.
A resin polymerization takes place with
the compomers after the material has
set completely. The glass-ionomer
reaction may then occur in the presence
of water. Water is a necessary medium
for the acid/base reaction. In the
presence of water from the oral cavity,
the acid functional groups, which are
attached to the monomer units, and
have now become part of the
polymerized material are able to react
with the base (glass) to stimulate the
glass ionomer reaction. Fluoride is
released as a result of this reaction. The
level of fluoride release from the
compomers is significantly lower than
what is seen for conventional glass-
ionomers or RMGIs. When they were
introduced, acid etching was not required
by the manufacturers. This was seen as
an advantage over the use of composites
along with the suggested fluoride
release. It was subsequently
demonstrated that the use of an acid
etched procedure significantly improves
both the retention and marginal leakage
of the compomers
In summary, compomers:
* Consist of a paste containing Ca, Al, F
silicate glass filler in dimethacrylate
monomers with acrylic acid like
molecules;
* Are set by polymerization of C=C of
methacrylate (delayed acid/base
reaction between glass and acid
molecules);
* Promote adhesion to teeth, mediated
by the adhesive.
* Offer good strength, biocompatible, low
solubility
* Have higher wear than composite,
lower F release than conventional
glass-ionomers and packable
composites.

REQUIREMENTS OF
POSTERIOR COMPOSITES
As posterior restoratives
composites need to meet the
following requirements: (Roulet
JF, 1988). The material should:
1. Have a wear resistance
equivalent to amalgam.
2. Provide an impermeable
marginal seal and ideal marginal
adaptation.
3. Demonstrate a radiopacity
greater than enamel.
4. Demonstrate predictable
longevity.
5. Be dimensionally stable.
6 .Allow technically simple
working procedures.
7.Allow quick and exact finishing
procedures without tooth
destruction.
8.Be esthetic.

Similarly, the Council on Dental


materials. Instruments and
Equipment, of the American
Dental Association (ADA Council
on Dental Materials, Instruments
and Equipment, 1989)
specifically recommended that
posterior composite restorations
demonstrate the following
characteristics. The material
should
1. Have a good resistance to wear
and abrasion.
2. Permit precise adaptation to
the cavity margin.
3. Provide adequate resistance to
degradation by water and other
solvents.
4. Be radiopaque.
5. Have reasonable handling
characteristics.
RESIN MATRIX OF SOME
POSTERIOR COMPOSITES
(Manufacturers data)
CHEMICAL COMPOSITION,
SIZE & DISTRIBUTION OF
FILLERS
RECENT ADVANCES
IN COMPOSITES
(RESIN MATRIX)
LIQUID CRYSTAL
MONOMERS
* The polymer is based on liquid crystal
monomers.

* When carefully selected, these


monomers can actually expand on
polymerization, offsetting the natural
shrinkage that occurs when liquid
monomers are converted to solid
polymers.

* This material is almost rigid when put


into the tooth but malleable enough for
the dentist to work with, and it hardens
when exposed to bright blue light .

* In polymers, liquid crystal-containing


monomers align themselves generating a
self-enforcing effect which can be further
enhanced by molding, extrusion, etc.

OXY BISMETHACRYLATES
* Stansbury (1990) reported on the
synthesis of a series of
cyclopolymerizable monomers described
as "oxy bismethacrylates".
* These dimethacrylate monomers could
be reacted to a degree of conversion of
90%, suggesting that they undergo
cyclopolymerization with a 40%
reduction in curing contraction compared
with TEGDMA resins with similar DC.
* When mixed with Bis-GMA and an
appropriate filler, composites with tensile
strength comparable with that of
conventional composites were produced.
* A series of difunctional
oxybismethacrylates, such as the
oligomer of ethoxylated bis-phenol A
diacrylate (OEPBA) (Stansbury, 1992),
has been synthesized and used to
produce light-cured composites with
properties similar to those of ethoxylated
Bis-GMA composites.
* The benefit of these new resin composite
systems is that they show enhanced
toughness and less curing shrinkage than
conventional Bis-GMA-based composites.
However, the differences are probably
too small to be reflected in a clinical
improvement.

SPIRO-
ORTHOCARBONATES
* Stansbury (1992) has
synthesized spiro-
orthocarbonate monomers
(SOCs) which expand during
polymerization through a
double-ring-opening process.
* These monomers contain
methylene groups capable of
free radical polymerization,
making them useful as
additives to dimethacrylates.
* The task is to cause sufficient
double-ring-opening to produce
enough expansion to counter
the free radical polymerization
shrinkage of the
dimethacrylates, all within a
reasonable time frame for
clinical application.

* Byerley et al. (1992) and Eicket ai


(1992) recently reported on the
synthesis of new SOCs polymerized
with epoxy resins via cationic UV
photo-initiation.
* These alicyclic SOCs contain four rings
attached to a central spiro carbon, and
expansion is again achieved by a
double-ring-opening mechanism.
* The cationic initiator used is (4-
octyloxyphenyl) phenyliodonium
hexafluoroantimonate, with
chlorothioxanthone as a sensitizer.
* The mixing of 5% of the SOC in an
epoxy base produced a resin with
substantial tensile strength and
modulus, acceptable water sorption
and solubility, and a slight expansion.
* Increased concentrations of the SOC
produced greater expansion and
slightly stronger polymers, but water
sorption and solubility were high due to
incomplete reaction of the SOC.
However, the results of these studies
are encouraging, and work is
continuing.
SILORANES
* Cycloaliphatic epoxy resins (also
called oxiranes), formulated with
polyols, such as polytetrahydrofuran,
have been investigated and proposed
as photocurable, cationic
polymerized resins for dental
composites with nearly one-half of
the polymerization shrinkage of Bis-
GMA-based resins.
* These resins also have the advantage
of no air-inhibited layer and high
strength, but relatively high water
sorption.
* Guggenberger and Weinmann
recently discussed similar
alternatives to dimethacrylates for
dental composite matrices. They
described a family of molecules
called siloranes, the name being
derived from the combination of
siloxanes and oxiranes.
* These molecules polymerize by
cationic photoinitiation and produce
dental composites with comparable
properties and slightly reduced
shrinkage compared to Bis-GMA-
based materials.

METHYLENE-
BUTYROLACTONE
* Stansbury and Antonucci
(1992) have also synthesized
methylene-butyrolactone
(MBL), the cyclic analog of
methyl methacrylate, in order
to increase the Degree of
Conversion and improve the
stability of composites.
* Because MBL is more reactive
than MMA, the addition of 10 wt
% to a Bis-GMA/TEGDMA resin
produced composites with
slightly improved strength and
a significant increase in DC.
* Furthermore, IR spectroscopy
showed that the MBL was
almost completely reacted in
the polymerization process.
These results warrant the study
of other multifunctional
Lactones.

POLYBUTADIENE
* Lee (1999) reported on the use of
20micrometer aggregrates of
polybutadiene rubber polymer
adsorbed onto deformed silica and
added to BISGMA/TEGDMA resin.
* The aggregates acted as strain
absorber & reduced shrinkage by as
much as 25%.

ANTICARIOGENIC
COMPOSITES
* Imazato & others (1994) developed an
antibacterial monomer, MDPB
(methacrylolyl dodecyl pyridinium
bromide) to be added to dental resins.
* This methacrylated monomer can
polymerize assuring that the
antibacterial portion of the molecules
becomes permanently affixed to the
resin matrix.
* Composites containing MDPB have been
shown to inhibit the growth of s.mutans.
* Recently, an antimicrobial material HALO,
was added to a commercial composite &
showed antibacterial behaviour against
s.mutans and A.viscosus that lasted for
upto 10 weeks.
* Light curable antibacterial, composites,
consisting of 80 wt% of a strontium
fluoroaluminosilicate glass dispersed in
methacrylate monomers have been
produced. The monomers contained 40-
100 wt% of a 10 wt% chlorhexidine
diacetate (CHXA) They have been shown
to have slower rates of biofilm growth on
their surfaces. Both polymer and
bacterial microleakage were prevented
with a 90 wt% HEMA/CHXA restoration in
the bovine dentine due to swelling
compensation for polymerisation
shrinkage in combination with
antibacterial release.

RECENT ADVANCES
IN COMPOSITES
(FILLERS)
FIBER-REINFORCED
COMPOSITES
* FRCs are structural materials with
two different constituents
* Reinforcing component strength &
stiffness
* Matrix supports reinforcement &
provides workability
* Reinforcing components
Polyethylene, glass, carbon fiber
* Fibers unidirectional (long,
continuous & parallel), braided,
woven fibers
* Typically fibers are 7-10 microns in
diameter and span the length of
prosthesis
* Type of fiber depends on how it is
intended to be used, glass fibers for
dental lab products, polyethylene for
chair side applications, carbon/glass
for posts
* Fibers are either pre-impregnated by
manufacturer or resinated by
clinician or lab technician

*Reinforcement with fibers has


shown to impart strength and
toughness to a number of dental
materials.
*The term continuous fibers is used
to describe fibers that are either
aligned or in mesh or other forms,
and that extend continuously
through a major portion of the
composite.
*Continuous fibers are
differentiated from chopped fibers
and whiskers in that chopped
fibers and whiskers are
discontinuously distributed in the
matrix.
*Continuous fibers are used in the
reinforcement of denture base
resins, bridges, splints, retainers,
orthodontic arch wires, fixed
prosthodontic appliances and
fixed partial dentures.

* FRCs are heterogeneous & anisotropic


i.e. their properties depend strongly on
the direction in which they are tested
relative to fiber orientation. Properties
are highest for parallel oriented fibers &
least for perpendicular fibers.
* The properties of a FRC are largely
dependent on properties & volume of
fiber. When highest mechanical
properties are required in a single
direction large volumes of high strength
unidirectional fibers are desirable. If
esthetics are not critical carbon fibers
can be used. If transluscency is required
glass fibers should be preferred.
* The primary advantage of FRCs is their
flexural strength. Flexural modulus
ranges from 28-34 Gpa. Flexural strength
is 600-1000 Mpa which is 10 times
greater than dental resin alone. Fiber
reinforcement also adsorbs damaging
energy or breakage and internal crack
propagation, to reduce the possibility of
minor or catastrophic failure of over-
stressed composites. Strength and
modulus are even related to improved
wear properties.

NANOCOMPOSITES
* As the name implies, these include
constituents that are mixed on a
nanometer-length scale.
* Conventional materials have grains
varying in size anywhere from 0.1 mm to
a few millimeters. A micron is a
micrometer or a millionth (10-6) of a
meter, while a nanometer (nm) is one
thousand times smaller (10-9). A
nanomaterial has at least part of its
grains on the order of 1-100 nm. As the
average size of an atom is on the order
of 1-2 angstroms () in radius and one
nanometer comprises 10 , in one nm
there may be 3-5 atoms, depending on
their atomic radii.
* Practically all nano-materials are
composites whose features often have
properties dramatically different from
their bulkscale counterparts.
* When polymeric, nanoalloys offer
improvements in several of the
properties of thermoplastics including
tensile strength, modulus, barrier
properties as well as resistance to wear,
erosion and corrosion.
* The nanoscale dispersion of sheet-like
inorganic silicate particles in a polymer
matrix allows it to exhibit a surprising
optical clarity along with increased
strength, stiffness, thermal stability,
reduced permeability and flame
retardancy.

NANOPARTICLES FOR
COMPOSITES
PROCESS TO MAKE
ORGANIC SILICA
NANOPARTICLES

* Most nanocomposites are formulated


with nanomer and nanocluster filler
particles.
* Nanomers are discrete
nonagglomerated particles 20 to 75
nm in diameter. Nanoclusters are
loosely bound agglomerates of nano-
sized particles.
* The agglomerates act as a single
unit, enabling high filler loading (79%
by weight) and giving the composite
high strength. Most nanocomposites
contain a combination of non-
agglomerated 20-nm-size nanosilica
filler and aggregated zirconia/silica
nanocluster (primarily 5- to 20-nm
size) filler. The cluster particle size
ranges from 0.6 to 1.4 microns.
* The combination of nanomer-sized
particles and the nanocluster
formulations reduces the interstitial
spacing of the filler particles. This
reportedly provides increased filler
loading, better physical properties,
and longer retention of surface polish
compared to composites containing
only nanoclusters.
FLUORIDE RELEASING
COMPOSITES
* 3 approaches are utilized for
incorporating fluorides in composite
resins (Arends & others 1995)
* Addition of water soluble fluoride
salts
* Matrix bound fluoride
* Fluoride releasing filler system

* Ytterbium fluoride is used in several


products (i.e., Heliomolar RO,
Helioprogress, and Tetric from
Ivoclar), and substantial fluoride has
been shown to be released from
these materials for up to five years
(Arends and Ruben, 1988).
* A recent study examining in situ
demineralization and fluoride release
from these composites demonstrated
that enamel demineralization
decreased as fluoride release
increased (Dijkman et al, 1993). By
extrapolation of the data, the authors
predicted that a composite that
released 200-300 microgram/cm2
fluoride over a one-month period
would completely inhibit secondary
caries under plaque conditions. This
amount is approximately 40-50 times
as much as that released by
Heliomolar RO.
* Therefore, despite the fact that these
fluoridated composites release
significant amounts of fluoride, their
present ability to prevent secondary
caries is questionable, and
improvements in technology will be
required to increase the level of
fluoride release.
* Dijkman et al. (1993) showed
that a composite with a fluoro-
aluminum silicate filler released
an order of magnitude more
fluoride than Heliomolar, and
that the fluoride release rate
increased in a linear manner
with time.
* This was hypothesized to be
due to the greater water
solubility of the silicate filler in
comparison with ytterbium
fluoride.
* Though this may enhance
fluoride release, a filler with
dramatically increased water
solubility may eventually
compromise the properties of
the composite in the oral
environment

*Fluorinated monomers and


oligomers which are more
hydrophobic than existing base
monomers have been synthesized
(Antonucci et al, 1993).
*Composites made from fluorinated
monomers have been shown to
have greater strength than
conventional Bis-GMA-based
materials after storage in water,
due to the hydrophobic nature of
the fluoride additive (Kawaguchi
et al, 1989).
*These resins and composites are
not as heavily plasticized by water
as a result of the reduced water
sorption.
*A recently synthesized fluorinated
monomer has also been shown to
produce composites with
improved creep resistance,
presumably a result of its reduced
water uptake (Culbertson et al,
1993)

ORMOCERS
* Ormocer is an acronym for organically
modified ceramic technology.
* Ormocer materials contain inorganic-
organic copolymers in addition to the
inorganic silanated filler particles.
* It is synthesized through a solution and
gelation processes (sol-gel process) from
multifunctional urethane and
thioether(meth)acrylate alkoxysilanes.
* Alkoxysilyl groups of the silane permit
the formation of an inorganic Si-O-Si
network by hydrolysis and poly-
condensation reactions. The
methacrylate groups are available for
photochemical polymerization.
* The filler particles are 1-1.5 m in size
and the material is 77% filler weight and
61% filler volume.
* Ormocers are described as 3-
dimensionally cross-linked copolymers.
The abundance of polymerization
opportunities in these materials allows
Ormocers to cure without leaving a
residual monomer, thus having greater
biocompatibility with the tissues.
* Ormocer was formulated in an attempt to
overcome the problems created by the
polymerization shrinkage of conventional
composites because the coefficient of
thermal expansion is very similar to
natural tooth structure.
* Laboratory testing of Ormocer
materials suggests a
significantly lower wear rate
compared with composites.
* On the other hand, Cattani-
Lorente et al found that the
shrinkage of Ormocer was
equal to that of hybrid
composites despite having less
filler content. The authors
attributed their findings to the
difference in the resin matrix of
Ormocer.
* As a result, it was suggested
that the advantages of
Ormocer include low shrinkage,
high abrasion resistance,
biocompatibility, and protection
against caries.
CEROMER
*The term ceromer stands for
Ceramic Optimized Polymer and
was introduced by Ivoclar to
describe their composite Tetric
Ceram.
*This material consists of a paste
containing barium glass (< 1 m),
spheroidal mixed oxide, ytterbium
trifluoride, and silicon dioxide (57
vol%) in dimethacrylate
monomers (Bis-GMA and urethane
dimethacrylate.
*They are set by a polymerization
of C=C of the methacrylate. They
must be bonded to tooth
structure.
*The properties of the ceromers
are identical to those of
composites and they exhibit
fluoride release lower than
conventional glass-ionomers or
compomers.

SMART COMPOSITES
* This class of composites was introduced
as the product Ariston pHc in 1998.
* Ariston pHc is an ion-releasing composite
material. It releases fluoride, hydroxyl,
and calcium ions as the pH drops in the
area immediately adjacent to the
restorative material.
* The drop in pH values is the result of
active plaque which results in a
corresponding increase in the release of
functional ions.
* Smart composites work based on the
newly developed alkaline glass filler
which will reduce secondary caries
formation at the margin of a restoration
by inhibiting bacterial growth. This
results in a reduced demineralization and
a buffering of the acid produced by
caries forming microorganisms.
* The paste consists of Ba, Al, and F
silicate glass filler (1 m) with ytterbium
trifluoride, silicon dioxide and alkaline Ca
silicate glass (1.6 m) in dimethacrylate
monomers: it is filled 80% by weight and
60% by volume.
* The use of an adhesive to tooth is not
recommended. However dentin should
be sealed to reduce sensitivity.
* The fluoride release from this material is
claimed by the manufacturer to be lower
than conventional glass-ionomers but
more than that of compomers.
AMORPHOUS CALCIUM
PHOSPHATE BASED
COMPOSITES
* In the early 1990s a bioactive mineralion-
releasing composite was developed based
on a polymer matrix phase derived from
ambient polymerization of acrylic
monomers and a filler phase consisting of
amorphous calcium phosphate (ACP).

* When the ACP was stabilized by


pyrophosphate it was possible to take
advantage of ACPs relatively high solubility
and obtain substantial release of Ca2+ and
PO4 ions.

* Moreover, the levels attained from these


releases were sustainable and could
promote the recovery of mineral
deficiencies in tooth structures in vitro.

* However, P2O7 4- stabilized ACP-filled


composites are relatively weak because
ACP does not act as reinforcing filler in a
manner similar to that of commonly used
silanized glass fillers.
* The introduction of silica or zirconia into
stabilized ACP fillers by low temperature
solgel techniques is a possible route to
synthesize hybrid ACP fillers with improved
reinforcing ability and mechanical strength
without adversely affecting their mineral
ion-release capability.

* Additionally, surface treatment of the fillers


with organofunctional silanes and/or
zirconyl methacrylate can enhance
chemical ACP/matrix bonding without
weakening the interface in a composite
formulation.

POLYMER
HYDROXYAPATITE
COMPOSITES
*Polymer-hydroxyapatite
composites have been developed
as dental restorative materials.
*Hydroxyapatite (HA) may be
suitable as filler for resin based
dental composites because it is a
natural component of dental
enamel and dentine.
*It has been investigated that HA is
highly resistant to moisture. Water
exposure may decrease the life of
resin composites by hydrolysis
and microcrack formation.
Excessive water uptake can
promote breakdown causing a
filler-matrix debonding.
*Studies have been conducted on
the water absorption behaviour of
HA with different polymers such
as Bis-GMA, TEGDMA, HEMA,
MMA, PDMS etc. These studies
found that the introduction of the
HA reduced the water uptake of
the bone cement and dental fillers
when used with these polymers.
CALCIUM
METAPHOSPHATES
* With the possible exception of the
microfills, virtually any dental
composite may prove to be abrasive to
enamel. The development of fillers that
are softer than current glasses would
be clinically beneficial because they
should be less abrasive to opposing
teeth.
* Calcium metaphosphate (CMP)
ceramics offer one potential filler
material that meets this criterion. The
major advantage to the use of the
CMPs is a softer surface texture as a
result of their less brittle nature. Many
calcium phosphate ceramics have been
tried as fillers for composites, but their
use has been seriously limited by a
high refractive index.
* Recently, Antonucci et al. (1991)
prepared calcium metaphosphates with
improved refractive indices. These
minerals exist in vitreous as well as
crystalline form. Composites made
from the ground vitreous CMP in Bis-
GMA absorbed substantial amounts of
water and were very weak. The
crystalline form of the mineral
produced better composites, but they
were still considerably weaker than
commercial materials, possibly due to
the difficulty in coupling the CMP to the
resin matrix with silane-coupling
agents.

GLASS INSERTS
* An alternative to conventional
composites has been developed (Bowen
et al, 1991) known as "Megafilled"
composite restorations are produced by
filling the bulk of the cavity preparation
with beta-quartz glass inserts.
* The inserts are surrounded by lightcured
composite, which bonds to the insert via
a silane coupling agent.
* The inserts are produced in a variety of
shapes and sizes to fit most cavity preps.
* When fitted into the cavity, they
minimize the volume of shrinking
composite and reduce curing contraction
(George and Richards, 1993).
* It is claimed that one of the advantages
of insert systems is the better marginal
adaptation of insert/composite
restorations compared to mere
composite restorations: the integration of
inserts reduces the polymerization
shrinkage stress and lowers the overall
coefficient of thermal expansion.
* In vitro data indicate that adapting the
insert size to the most precise fit
produces a quality of marginal
adaptation comparable to that of
ceramic inlays. Inserts also facilitate
the establishment of a proximal
contact. With respect to wear, no
significant differences are detected
between composite and insert
restorations.
* The bond between insert and
composite is susceptible to
contamination during operative
procedures. Short-term clinical
investigations confirm in vitro findings
regarding improved marginal
adaptation and increased wear
resistance. Long-term controlled
clinical studies are in progress, but
data are not yet available.
* Based upon the present in vitro and in
vivo data it can be concluded that the
insert technology shows promising
results, but further investigations
regarding, for example, stability of the
insert/composite bond, fracture
resistance of the overall restoration,
and wear behavior are necessary to
predict the clinical success of this
alternative restoration procedure.

CAD/CAM RESTORATIONS
* Until recently, CAD/CAM restorations
were all milled from porcelain. Now,
composite blocks are available which
may become a more "user-friendly"
material for the CAD/CAM user. One
such material has been marketed by
3M-Paradigm MZ100.
* Laboratory-processed composites
have been shown to have improved
physical properties by virtue of a
higher conversion percentage of
monomer to chain-linked polymer.
Heat and pressure have been shown
to do the same in laboratory-
processed restorations.

* Also, by milling the restoration out of


polymerized material, there is no
chance for polymerization shrinkage
during insertion of the restorative
material.
* As far as placement, finishing,
polishing, and maintenance,
composite as a material is much
easier to manipulate in the intraoral
environment. This is particularly true
for CAD/CAM, since the resultant
composite restoration can be more
easily anatomized and polished, if
desired by the dentist.
RECENT STUDIES ON
SILANIZATION
*Craig and Dootz (1993) reported
that a mixture of silanes may be
used to improve the properties of
composites. They added a fluoro-
alkyl silane to MPS (1:3) for Zr-
silicate fillers. The resultant
composites had 20% greater
tensile strength and 60% less
water sorption than composites
with MPS alone.
*Recently, Mohsen and Craig
(1995) demonstrated that
silanation at three times the
amount necessary to provide
uniform coverage of a zirconia-
silica filler gave the best
properties.
SELECTION OF
COMPOSITE
*A clinician must consider a
number of factors in selecting a
composite resin restorative
material.
*A resins composition in terms of
filler loading and particle size
determines its ability to provide
any of three functions: support,
form and contour, and surface
finish.
*The heavy filled hybrids, because
of high loading and strength, are
best for support; the minifills and
small-particle composites are best
for form; and the various types of
microfills are best at providing a
lasting, smooth finish.
*In large restorations, a heavy
filled composite is used for
stiffness and strength, followed by
a microfilled composite for a
smooth finish. The submicron
hybrid and radiopaque microfilled
composites are clinically
acceptable for both contour and
finish in small to moderate-sized
restorations in areas bearing
minimal stress.

* The nature of the restoration work, in


terms of its location and size, is decisive
in the choice of one material or another.
For fillings requiring high mechanical
performance (class IV cavities with
occlusal function, large class I,
combination or complex class II, class VI)
the most suitable composite is that with
the highest inorganic load; in the case of
the posterior sector it should be radio-
opaque.
* Restorations in anterior teeth are
aesthetically more demanding, so
composites with other properties are
indicated in these cases: good polishing,
suitable opacity for a natural look or
fluorescence. Polishing depends on
particle size and composites with
submicronic fillers or nanoparticles are
ideal.
* It should be remembered that materials
can be combined, as in the case of a
large class IV restoration, where a high-
load densified composite (generally
hybrid) covered by a microfine
(microfiller) composite in the vestibular
area would be indicated.
* Cervical lesions, both in the posterior and
in the anterior region, are best filled with
highly polishing materials in order to
avoid plaque accumulating on them; the
material must also respond well to
flexural stresses.
REPAIR OF COMPOSITE
RESTORATIONS
* Composites may be repaired by
placing new material over the old
composite. This is a useful procedure
for correcting defects or altering
contours on existing restorations. The
procedures for repair differ,
depending on whether the
restoration is freshly polymerized or
is an old one.
* A freshly placed restoration can be
repaired by adding new composite
directly because of presence of
oxygen-inhibited layer on the surface
which is an excellent bonding
substrate. The restoration may still
have more than 50% unreacted
methacrylate groups to copolymerize
with newly added material.
* As the restoration ages, fewer
unreacted methacrylate groups
remain & greater cross-linking
reduces the ability of fresh monomer
to penetrate into the matrix. In
addition, polished surfaces expose
filler surfaces that are free from
silane. Thus the filler surface area
does not chemically bond to the new
composite layer. Therefore, a layer of
silane bonding agent should be
added before addition of new
composite.

CONCLUSION
Nowadays, composites have
unquestionably acquired a
prominent place among the filling
materials employed in direct
techniques. Their considerable
aesthetic possibilities give rise to
a variety of therapeutic
indications, which continue to
grow as a result of the great
versatility of the presentations
offered; also, these materials
conserve the tooth structure
better because they are retained
by adhesive methods rather than
depending on cavity design.
Nonetheless, it should not be
forgotten that they are highly
technique-sensitive, hence the
need to control certain aspects:
correct indication, good isolation,
choice of the right composite for
each situation, use of a good
procedure for bonding to the
dental tissues and proper curing
are essential if satisfactory clinical
results are to be achieved.

THANK
YOU

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