COMPOSITES

By: Naghman Zuberi

COMPOSITE

Material with two or more distinct substances

metals, ceramics or polymers

Dental resin composite

soft organic-resin matrix

hard, inorganic-filler particles

polymer
ceramic

Most frequently used

esthetic-restorative material

Naghman Zuberi

Leinfelder 1993 2

COMPOSITES CHEMISTRY

Dental composite is composed of a resin matrix and filler

materials.
Coupling agents are used to improve adherence of resin to filler
surfaces.
Activation systems including heat, chemical and photochemical
initiate polymerization.
Plasticizers are solvents that contain catalysts for mixture into
resin.
Monomer, a single molecule, is joined together to form a
polymer, a long chain of monomers.
Physical characteristics improve by combining more than one
type of monomer and are referred to as a copolymer.
Cross linking monomers join long chain polymers together along
the chain and improve strength.

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RESIN MATERIALS

BIS-GMA resin is the base for composite. In the late 1950's,

Bowen mixed bisphenol A and glycidylmethacrylate thinned with
TEGDMA (triethylene glycol dimethacrylate) to form the first BISGMA resin. Diluents are added to increase flow and handling
characteristics or provide cross linking for improved
strength. Common examples are:
RESIN:BIS-GMA
bisphenol glycidylmethacrylate
DILUENTS:- MMA
methylmethacrylate
BIS-DMA bisphenol dimethacrylate
UDMA
urethane dimethacrylate
CROSS LINK DILUENTS
TEGDMA triethylene glycol dimethacrylate
EGDMA
ethylene glycol dimethacrylate

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COUPLING AGENTS

Coupling agents are used to improve adherence of resin to filler

surfaces.
Coupling agents chemically coat filler surfaces and increase
strength.
Silanes have been used to coat fillers for over fifty years in
industrial plastics and later in dental fillers. Today, they are still
state of the art.
Silanes have disadvantages. They age quickly in a bottle and
become ineffective. Silanes are sensitive to water so the silane
filler bond breaks down with moisture.
Water absorbed into composites results in hydrolysis of the
silane bond and eventual filler loss.
Common silane agents are:
vinyl triethoxysilane
methacryloxypropyltrimethoxysilane

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HEAT CATALYST

Polymerization of resin requires initiation by a free radical.

Initiation starts propagation or continued joining of molecules at double
bonds until termination is reached.
Heat applied to initiators breaks down chemical structure to produce
free radicals, however, monomers may polymerize when heat is applied
even without initiators.
Resins require stabilizers to avoid spontaneous
polymerization. Stabilizers are also used to control the reaction of
activators and resin mixtures.
Hydroquinone is most commonly used as a stabilizer.
Common heat based initiators are peroxides such as
benzoylperoxide
t-butylperoxide
t-cumythydroxyperoxide

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PHOTOCHEMICAL CATALYST

Early photochemical systems used were benzoin methyl ether which is

sensitive to UV wavelengths at 365 nm. UV systems had limited use as
depth of cure was limited. Visible light activation of diketones is the
preferred photochemical systems. Diketones activate by visible, blue
light to produce slow reactions. Amines are added to accelerate curing
time.
Presently, different composites use different photochemical
systems. These systems are activated by different wavelengths of
light. In addition, different curing lights produce various ranges of
wavelengths that might not match composite activation
wavelengths. This can result in no cure or partial cure. Composite
materials must be matched to curing lights.
Common photochemical initiators are:
Camphoroquinone
Acenaphthene quinone
Benzyl

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LIGHT CURING

Light curing can be

accomplished with:1) Quartz-TungstenHalogen
2) Plasma Arc Curing
3) Light Emitting Diode

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VISIBLE LIGHT ACTIVATION

Camphorquinone

most common photoinitiator

absorbs blue light

400 - 500 nm range

Initiator reacts with amine activator

Forms free radicals
Initiates addition polymerization
O
CH2=C-C-O-CH2CH-CH2O
CH3

OH

CH3
-C-

O
OCH2CHCH2O-C-C=CH2

CH3

OH

CH3

Bis-GMA
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CHEMICAL CATALYST

Chemical activation of peroxides produces free radicals. Chemical

accelerators are often not color stable and have been improved for this
reason.
The term self cure or dual cure (when combined with photo chemical
initiation) describes chemical cure materials.
Chemical composites mix a base paste and a catalyst paste for self
cure.
Bonding agents mix two liquids.
Mixing two pastes incorporates air into the composite.
Oxygen inhibits curing resulting in a weaker restoration.
Chemical accelerators include:
Dimethyl p-toludine
N,N-bis(hydroxy-lower-alkyl)-3,5-xylidine

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POLYMERIZATION

Initiation

production of reactive free radicals

Propagation

typically with light for restorative materials

hundreds of monomer units

polymer network
50 60% degree of conversion

Termination

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Craig Restorative Dental Materials 2002

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C=C

C=C

C=C

C=C
C=C

C=C

C=C

C=C

C=C

C=C
C=C
C=C
C=C
C=C

C=C
polymerization
C=C

C=C

C=C

C=C
C=C

C=C
C=C
C=C
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C=C
C=C
C=C

C=C

C=C
C=C
C=C
Ferracane

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COMPOSITE FILLERS

Fillers are placed in dental composites to reduce shrinkage upon

curing.
Physical properties of composite are improved by fillers, however,
composite characteristics change based on filler material, surface, size,
load, shape, surface modifiers, optical index, filler load and size
distribution.
Materials such as strontium glass, barium glass, quartz, borosilicate
glass, ceramic, silica, prepolymerized resin, or the likewise are used.

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FILLERS CLASSIFICATION

Fillers are classified by material, shape and size.

Fillers are irregular or spherical in shape depending on the mode of
manufacture.
Spherical particles are easier to incorporate into a resin mix and to fill
more space leaving less resin.
One size spherical particle occupies a certain space.
Adding smaller particles fills the space between the larger particles to
take up more space.
There is less resin remaining and therefore, less shrinkage on curing
the more size particles used in proper distribution.

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FILLERS CLASSIFICATION

Classification According to Size:MACROFILLERS ---- 10

TO 100 um
MIDIFILLERS
----- 1
TO 10 um
MINIFILLERS
----- 0.1 TO 1 um
MICROFILLERS ----- 0.01 TO 0.1 um
NANOFILLERS ----- 0.005 TO 0.01 um

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PLASTICIZERS

Dental composite is composed of a resin matrix and filler materials.

Coupling agents are used to improve adherence of resin to filler
surfaces.
Plasticizers are solvents that contain catalysts for mixture into resin.
They need to be non reactive to the catalyst & resin.

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PHYSICAL CHARECTERISTICS

Following are the imp physical properties:1) Linear coefficient of thermal expansion (LCTE)
2) Water Absorption
3) Wear resistance
4) Surface texture
5) Radiopacity
6) Modulus of elasticity
7) Solubility

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C- FACTOR

It is the ratio of the bonded surfaces to the unbonded or free surfaces in a tooth
preparation.
The higher the C-Factor, greater is the potential for bond disruption from
polymerisation effects.

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C- FACTOR

Sealants and Class V have C Factor of 1:5 where

as Class I has a C Factor of 5:1
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C Factor in Class I

C Factor in Class IV
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C Factor in Class II

Incremental Layering
Minimizes the C Factor

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INTERNAL STRESSES

Internal stresses can be reduced by,

1) Self start Polymerisation- A Dual Cured System
2) Incremental placement
3) Use of stress breaking liners such as:a)Filled Dentinal Adhesives
b)Resin Modified Glass Ionomer (RMGI)

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COMPOSITE CLASSIFICATION

Composite is classified by initiation techniques, filler size, and viscosity.

Laboratory heat process fillings are processed under nitrogen and
pressure to produce a more thorough cure.
Core build up materials are commonly self cure.
Dual cure composite is commonly used as a cementing medium under
crowns.
Viscosity determines flow characteristics during placement. A flowable
composite flows like liquid or a loose gel. A packable composite is firm
and hard to displace.

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Composite is classified by initiation techniques,

filler size, and viscosity

Heat cured composites are polymerized by application of heat.

Self cured composite means chemical initiation converting monomer to
polymer takes place.
Light cured composite means photochemical initiation causes
polymerization
Dual cure means chemical initiation is used and combined with
photochemical initiation so either and both techniques polymerize
composite.

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RADIOPACITY

One of the requirements of using a composite as a posterior restorative

is that it should be radiopaque.
In order for a material to be described as being radiopaque, the
International Standard Organization (ISO) specifies that it should have
radiopacity equivalent to 1 mm of aluminium, which is approximately
equal to natural tooth dentine.
However, there has been a move to increase the radiopacity to be
equivalent to 2 mm of aluminium, which is approximately equal to
natural tooth enamel.
A majority of the composites described as all-purpose or universal have
levels of radiopacity greater than 2 mm of aluminium

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INDICATIONS

1) Class-I, II, III, IV, V & VI restorations.

2) Foundations or core buildups.
3) Sealant & Preventive resin restorations.
4) Esthetic enhancement procedures.
5) Luting
6) Temporary restorations
7) Periodontal splinting.

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CONTRAINDICATIONS

1) Inability to isolate the site.

2) Excessive masticatory forces.
3) Restorations extending to the root surfaces.
4) Other operator errors.

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ADVANTAGES

1) Esthetics
2) Conservative tooth preparation.
3) Insulative.
4) Bonded to the tooth structure.
5) repairable.

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DISADVANTAGES

1) May result in gap formation when restoration extends to the root

surface.
2) Technique sensitive.
3) Expensive
4) May exhibit more occlusal wear in areas of higher stresses.
5) Higher linear coefficient of thermal expansion.

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STEPS IN COMPOSITE
RESTORATION

1) Local anaesthesia.
2) Preparation of the operating site.
3) Shade selection
4) Isolation of the operating site.
5) Tooth preparation.
6) preliminary steps of enamel and dentin bonding.
7) Matrix placement.
8) Inserting the composite.
9) Contouring the composite.
10) polishing the composite.

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PRINCIPLES OF ANTERIOR
COMPOSITE RESTORATION

1. Smile Design
2. Color and Color Analysis
3. Tooth Color
4. Tooth Shape
5. Tooth Position
6. Esthetic Goals
7. Composite Selection
8. Tooth Preparation
9. Bonding Techniques
10. Composite Placement
11. Composite Sculpture and
12. Composite Polishing to properly restore anterior teeth with
composite:

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1. SMILE DESIGN

A dentist must understand proper smile design so composite

restoration can achieve a beautiful smile. This is true for
extensive veneering and small restorations.
Factors which are considered in smile design include:A. Smile Form which includes size in relation to the face,
size of one tooth to another, gingival contours to the upper lip
line, incisal edges overall to the lower lip line, arch position,
teeth shape and size, perspective, and midline.
B. Teeth Form which includes understanding long axis,
incisal edge, surface contours, line angles, contact areas,
embrasure form, height of contour, surface texture,
characterization, and tissue contours within an overall smile
design.
C. Tooth Color of gingival, middle, incisal, and
interproximal areas and the intricacies of characterization
within an overall smile design.
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2. COLOUR AND COLOUR

ANALYSIS

Colour is a study in and of itself. In dentistry, the effect of enamel rods,

surface contours, surface textures, dentinal light absorption, etc. on
light transmission and reflection is difficult to understand and even more
difficult replicate.
The intricacies of understanding matching and replicating hue, chroma,
value, translucency, florescence; light transmission, reflection and
refraction to that of a natural tooth under various light sources is
essential.

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3. TOOTH COLOUR

Analysis of colour variation within teeth is improved by an

understanding of how teeth produce color variation.
Enamel is prismatic and translucent which results in a blue gray color
on the incisal edge, interproximal areas and areas of increased
thickness at the junction of lobe formations.
The gingival third of a tooth appears darker as enamel thins and dentin
shows through.
Color deviation, such as craze lines or hypocalcifications, within dentin
or enamel can cause further color variation.
Aging has a profound effect on color caused by internal or external
staining, enamel wear and cracking, caries, acute trauma and density.

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4. TOOTH SHAPE

Understanding tooth shape

requires studying dental anatomy.
Studying anatomy of teeth requires
recognition of general form, detail
anatomy and internal anatomy.
It is important to know ideal
anatomy and anatomy as a result
of aging, disease, trauma and wear.
Knowledge of anatomy allows a
dentist to reproduce natural teeth.
For example, a craze line is not a
straight line as often is produced
by a dentist, but is a more irregular
form guided by enamel rods.

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5. TOOTH POSITION

Knowledge of normal position

and axial tilt of teeth within a
head, lips, and arches allows
reproduction of natural beautiful
smiles.
Understanding the goals of an
ideal smile and compromises
from limitations of treatment
allows realistic expectations of a
dentist and patient.
Often, learning about tooth
position is easily done through
denture esthetics.
Ideal and normal variations of
tooth position is emphasized in
removable prosthetics so a
denture look does not occur.

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6. ESTHETIC GOALS

The results of esthetic dentistry are limited by limitations

of ideals and limitations of treatment.
Ideals of the golden proportion have been replaced by
preconceived perceptions.
Limitations of ideals are based on physical,
environmental and psychological factors.
Limitations of treatment are base on physical, financial
and psychological factors.

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7. COMPOSITE SELECTION

Esthetic dentistry is an art form. There are different levels of

appreciation so individual dentists evaluate results of esthetic
dentistry differently. Artistically dentists select composites
based on their level of appreciation, artistic ability and
knowledge of specific materials. Factors which influence
composite selection include
A- Restoration Strength,
B- Wear
C- Restoration Color
D- Placement characteristics.
E- Ability to use and combine opaquers and tints.
F- Ease of shaping.
G- Polishing characteristics.
H- Polish and colour stability

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8. TOOTH PREPARATION

Tooth preparation often

defines restoration strength.
Small tooth defects which
receive minimal force require
minimal tooth preparation
because only bond strength is
required to provide retention
and resistance.
In larger tooth defects where
maximum forces are applied,
mechanical retention and
resistance with increased
bond area can be required to
provide adequate strength.

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9. BONDING TECHNIQUES

Understanding techniques to bond composite to dentin and enamel

provide strength, elimination of sensitivity and prevention of microleakage.
Enamel bonding is a well understood science. Dentinal bonding,
however, is constantly changing as more research is being done and
requires constant periodic review.
Micro-etching combined with composite bonding techniques to old
composite, porcelain, and metal must be understood to do anterior
composite repairs.

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10. COMPOSITE PLACEMENT

TECHNIQUE

Understanding techniques which

allow ease of placement,
minimize effects of shrinkage,
eliminate air entrapment and
prevent material from pulling
back from tooth structure during
instrumentation determine
ultimate success or failure of a
restoration.
It is important to incorporate
proper instrumentation to allow
ease of shaping tooth anatomy
and provide color variation prior
to curing composite.
In addition, a dentist must
understand placement of various
composite layers with varying
opacities and color to replicate
normal tooth structure.

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11. COMPOSITE SCULPTURE

Composite sculpture of cured

composite is properly done if
appropriate use of polishing strips,
burs, cups, wheels and points is
understood.
In addition, proper use of
instrumentation maximizes esthetics
and allows minimal heat or
vibrational trauma to composite
resulting in a long lasting
restoration.

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12. COMPOSITE POLISHING

Polishing composite to allow a smooth or textured surface shiny

produces realistic, natural restorations.
Proper use of polishing strips, burs, cups, wheels and points with water
or polish pastes as required minimizes heat generation and vibration
trauma to composite material for a long lasting restoration.

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DIRECT POSTERIOR
COMPOSITES

Composites are indicated for Class 1, class 2 and class 5 defects on

premolars and molars. Ideally, an isthmus width of less than one third
the intercuspal distance is required.
This requirement is balanced against forces created on remaining tooth
structure and composite material. Forces are analyzed by direction,
frequency, duration and intensity. High force occurs with low angle
cases, in molar areas, with strong muscles, point contacts and
parafunctional forces such as grinding and biting finger nails.
Composite is strongest in compressive strength and weakest in shear,
tensile and modulus of elasticity strengths. Controlling forces by
preparation design and occlusal contacts can be critical to restorative
success.
Failure of a restoration occurs if composite fractures, tooth fractures,
composite debonds from tooth structure or micro-leakage and
subsequent caries occurs. A common area of failure is direct point
contact by sharp opposing cusps. Enameloplasty that creates a three
point contact in fossa or flat contacts is often indicated.

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Tooth preparation requires adequate access to remove caries,

removal of caries, elimination of weak tooth structure that could
fracture, beveling of enamel to maximize enamel bond strength,
and extension into defective areas such as stained grooves and
decalcified areas.
Matrix systems are placed to contain materials within the tooth
and form proper interproximal contours and contacts. Selection
of a matrix system should vary depending on the situation.
Enamel and dentin bonding is completed. Composite shrinks
when cured so large areas must be layered to minimize negative
forces.
Generally, any area thicker than two millimeters requires
layering. In addition, cavity preparation produces multiple wall
defects.
Composite curing when touching multiple walls creates dramatic
stress and should be avoided.

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Anterior and Posterior Matrix Systems

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Composite built in layers replicate tooth structure by

placing dentin layers first and then enamel layers.
Final contouring with hand instruments is ideal to
minimize the trauma of shaping with burs.
Matrix systems are removed and refined shaping and
occlusal adjustment done with a 245 bur and a flame
shaped finishing bur. Interproximal buccal and lingual
areas are trimmed of excess with a flame shaped
finishing bur.
Final polish is achieved with polishing cups, points,
sandpaper disks, and polishing paste.

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Polishing and Polishing Kit

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INDIRECT POSTERIOR
COMPOSITES

Indirect laboratory composite is indicated on teeth that required large

restorations but have a significant amount of tooth remaining. It is used
when a tooth defect is larger than indicated for direct composite and
smaller than indicated for a crown. A common situation is fracture of a
single cusp on a molar or a thin cusp on a bicuspid. Force analysis is
critical to success as high force will fracture composite, tooth structure
or separate bonded interfaces. High force is indicated on teeth furthest
back in the mouth for example, a second molar receives five times
more force than a bicuspid. Orthodontic low angle cases and large
masseter muscles generate high force. Sharp point contacts from
opposing teeth create immense force and are often altered with
enameloplasty.
Indirect composite restorations are processed in a laboratory under
heat, pressure and nitrogen to produce a more thorough composite
cure. Pressure and heat increase cure while nitrogen eliminates
oxygen that inhibits cure. Increased cure results in stronger
restorations. Strength of laboratory processed composite is between
composite and crown strength and requires adequate tooth support.

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Indirect Composite Restoration

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TOOTH PREPARATION

Tooth preparation requires removal of existing restorations and caries.

Thin cusps and enamel are removed in combination of blocking out
undercuts with composite, glass ionomer, flowable composite or the
likewise material.
Tooth preparation requires adequate wall divergence to bond and
cement the restoration and ideally, margins should finish in enamel.
The restoration floor is bonded and light cured.
Bonding agent is light cured to stabilize collagen fibers and avoid
collapse during restoration placement. A base of glass ionomer or
composite is used if thermal sensitivity is anticipated.
Restoration retention is judged by bonded surface area, number and
location of retentive walls, divergence of retentive walls, height to width
ratio and restoration internal and external shape.
Resistance form, reduction of internal stress and conversion of potential
shear and tensile forces is accomplished by smoothing sharp areas and
creating flat floors as opposed to external angular walls.

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TOOTH PREPARATION

Impressions are taken of prepared teeth, models poured and composite

restorations constructed at a laboratory. Temporaries are placed and a
second appointment made.
At a second appointment, temporaries are removed and a rubber dam
placed. Restorations are tried on the teeth and
adjusted. Manufacturers directions are followed. In general, bonding is
completed on the tooth surfaces and bonding resin precured.
Matrix bands are placed prior to etching to contain etch within prepared
areas. Trimming of excess cement where no etching has occurred is
easier.
Composite surfaces are silinated and dual cure resin cement
applied. Restorations are seated, excess resin cement is wiped away
with a brush and then facial and lingual surfaces are light
cured. Interproximal areas are flossed and then light cured. Excess is
trimmed with hand instruments and finishing flame shaped burs.
The rubber dam is removed and occlusion adjusted. Surfaces are
finished and polished.

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COMPOSITE WEAR

There are several mechanisms of composite wear including adhesive

wear, abrasive wear, fatigue, and chemical wear.
Adhesive wear is created by extremely small contacts and therefore
extremely high forces, of two opposing surfaces. When small forces
release, material is removed. All surfaces have microscopic roughness
which is where extremely small contacts occur between opposing
surfaces.
Abrasive wear is when a rough material gouges out material on an
opposing surface. A harder surface gouges a softer surface. Materials
are not uniform so hard materials in a soft matrix, such as filler in resin,
gouge resin and opposing surfaces. Fatigue causes wear. Constant
repeated force causes substructure deterioration and eventual loss of
surface material. Chemical wear occurs when environmental
materials such s saliva, acids or similar agents affect a surface.

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COMPOSITE FRACTURE

Dental composite is composed of a resin matrix and filler

materials. The resin filler interface is important for most physical
properties.
There are three causes of stress on this interface including: resin
shrinkage pulls on fillers, filler modulus of elasticity is higher than resin,
and filler thermo coefficient of expansion allows resin to expand more
with heat. When fracture occurs, a crack propagates and strikes a filler
particle. Resin pulls away from filler particle surfaces during
failure. This type of failure is more difficult with larger particles as
surface area is greater. A macrofill composite is stronger than a
microfill composite.
Coupling agents are used to improve adherence of resin to filler
surfaces. Modification of filler physical structure on the surface or
aggregating filler particles create mechanical locking to improve
interface strength. Coupling agents chemically coat filler surfaces and
increase strength. Silanes have been used to coat fillers for over fifty
years in industrial plastics and later in dental fillers. Today, they are still
state of the art.

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SILANE COUPLING AGENT

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REPAIRING CHIPPED PORCELAIN BRIDGE

Chipped Edge of Porcelain Pontic

Silane and Bonding is Applied

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Porcelain is Etched with HF Acid

Repaired in Light Cured Composite

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