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Composit 3
Composit 3
Composit 3
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COSMETIC & R E S T O R AT I V E C A R E ABSTRACT
Background. Polymerization shrinkage
is one of dental clinicians’ main
concerns when placing A D A
J
direct, posterior, resin-
✷ ✷
N
CON
tions. Evolving improve-
IO
ments associated with
T
method to reduce
A
N
I
C
resin-based composite A UING EDU 3
materials, dental adhesives,
R TICLE
polymerization filling techniques and light
curing have improved their predictability,
restorations
improvement in newer-generation bonding agents technique that is associated with the use of a
and resin-based composite formulations has clear matrix and reflective wedges. It attempts to
occurred. The improved performance of resin- guide the polymerization vectors toward the gin-
based composites and the increasing demand for gival margin.
esthetics are encouraging more clinicians to dOblique technique. In this technique, wedge-
select resin-based composites for posterior resto- shaped composite increments are placed to fur-
rations.16-19 Although wear resistance of contem- ther prevent distortion of cavity walls and reduce
porary resin-based composites has improved sig- the C-factor. This technique may be associated
nificantly19-22 and good proximal contact and with polymerization first through the cavity
contour can be achieved,23-25 polymerization walls and then from the occlusal surface to direct
shrinkage remains the biggest challenge in direct vectors of polymerization toward the adhesive
resin-based composite restorations.26-29 surface (indirect polymerization technique).28,38
dSuccessive cusp buildup technique.39-41 In this
METHODS AND MATERIALS technique, the first composite increment is
Polymerization shrinkage is responsible for the applied to a single dentin surface without con-
formation of a gap between resin-based com- tacting the opposing cavity walls, and the resto-
posite and the cavity wall. This gap may vary ration is built up by placing a series of wedge-
TABLE 1
Buonocore62 in 1955, bonding to enamel has been degree of polymerization, however, make this
considered a reliable procedure. Bonding to light source’s effectiveness questionable.92-95 Blue
dentin, which was introduced more recently and light-emitting diode curing lights are being
has improved over the years, has become com- studied and may present another option for
monplace; early dentin-enamel adhesive systems, resin-based composite polymerization.96,97
or DAS, bond strength to dentin ranged from 1 to
10 megapascals,63 while contemporary DAS can DISCUSSION
achieve values of around 22 Mpa.64 Most composite placement techniques introduced
Two procedures widely used in bonding to in the past 20 years were based on the concept
tooth structure are the total-etch technique and that resin-based composite shrinks toward the
the self-etching technique (primers and adhe- light and employed this theory to attempt to
sives). The former is considered the gold favorably direct the vectors of polymerization.
standard for bonding and is achieved by etching Versluis and colleagues98 demonstrated that the
enamel and dentin with 30 to 40 percent phos- direction of polymerization contraction is more
phoric acid. Bonding and mechanical retention influenced by the quality of the adhesion and the
are ensured by the penetration of resin into the C-factor, than by the position of the light source.
microporosities of etched enamel and by the for- Losche99 pointed out that the optimal results
TABLE 3
A classical soft-start polymerization also may grammable time and intensity (VIP Light, Bisco
be used, but the advantages of this alternate Inc., Schaumburg, Ill.; Spectrum 800,
curing mode have not been thoroughly investi- Dentsply/Caulk, Milford, Del.).
gated. Mehl and colleagues80 and Ernst and col- Enamel buildup: proximal surface. In Class II
leagues88 found that the variable curing method restorations, the enamel proximal surface is built
can improve marginal integrity with different up first through the application of different
composites when cured with a soft-start polym- wedge-shaped composite increments using an
erization, while Friedl and colleagues112 and oblique layering technique while being careful to
Bouschlicher and colleagues113 did not find any avoid having a single composite increment be in
improvement using the same soft-start polymeri- contact with opposing cavity walls. Each com-
zation method. This result may be explained by posite increment is pulse-cured with a low-
the varied amount and concentration of photoini- intensity light for a short duration (depending on
tiators. Certain resin-based composites may the type of composite and depth of the prepara-
require shorter exposure time to get the same tion) followed by a waiting time of three minutes
degree of conversion while maintaining the same to allow for strain relief. During this three-minute
intensity. As a matter of fact, the gel point is waiting time, a thin layer of flowable composite is
anticipated even with a soft-start polymerization. applied to a single surface in the dentin pulp floor
Yoshikawa and colleagues110 recently demon- and axial wall of the preparation to reduce the
strated composite improved marginal adaptation C-factor and help avoid cusp deflection due to
using a soft-start polymerization; however, stress from polymerization (Figure 2). At this
enamel microcracks still were present and point, the resin-based composite restoration’s
unaffected. proximal surface and the flowable composite are
The pulse polymerization technique is based on cured together at once at a higher intensity using
the same principle as soft-start polymerization, a progressive curing technique (Table 3). Final
but it is applied with a different modality, which polymerization of the composite restoration’s
may be less technique-sensitive to composites’ proximal surface and the flowable composite is
chemical variation.114 Pulse polymerization should completed at higher intensity (Table 3). If more
be used not only in the enamel occlusal cavosur- than one tooth is to be restored at one appoint-
face margins, but also at the cervical enamel ment, another restoration can be started during
margin to reduce microcracks at this critical area. the three-minute waiting time following the pro-
To correctly apply this pulse-curing technique, cedure described previously.
clinicians should use a light-curing unit with pro- Progressive curing technique. To completely fill
the dentin, wedge-shaped composite increments Since enamel and dentin are different sub-
are placed using the stratified layering technique strates, they should be restored with different
in which a higher chroma is placed in the middle resin-based composite materials. Cervical and
of the preparation and a lower chroma is placed occlusal enamel are restored using a microhybrid
close to the cuspal walls41,115 (Figure 2). Each com- resin-based composite that has a wear pattern
posite dentin increment is cured using a progres- and modulus of elasticity closer to that of enamel
sive curing technique (40 seconds at 300 milli- than other resin-based composites. Dentin has a
watts per square centimeter instead of a modulus of elasticity lower than enamel and the
conventional continuous irradiation mode of 20 use of an intermediate elastic layer may be indi-
seconds at 600 mW/cm2) (Table 3). Lower light cated.126-128 The combination of a filled adhesive
intensity and longer curing time have resulted in and a flowable composite may help create an elas-
an improvement in marginal adaptation while ticity gradient between the dentin and the micro-
maintaining the excellent physical properties of hybrid composite; thus, the flowable composite
the composite.77,78 may improve the effectiveness of the dentin
Enamel buildup: occlusal surface. The restora- bonding agent in counteracting the polymeriza-
tion is completed when the final composite incre- tion stress at the restoration-dentin interface.
ments are layered onto the enamel cavosurface Hannig and Friedrichs125 and Belli and
Figure 3. Preoperative occlusal view of tooth no. 3. Figure 4. Tooth no. 3 after a rubber dam was placed,
caries was removed and the cavity preparation was com-
pleted with a gingival butt joint and no bevel either on
the axial or occlusal surface.
Figure 6. Enamel’s and dentin’s glossy appearances after Figure 7. A sectional matrix, plastic wedge and G-ring
application of a fifth-generation, 40 percent filled placed to reconstruct the proximal surface.
ethanol-based adhesive system.
A B
Figure 10. A and B. Tooth no. 3 after wedge-shaped composite increments of A3.5, A3 and A2 shades of the microhy-
brid composite (PermaFlo, Ultradent Products Inc., South Jordan, Utah) were used to reconstruct dentin.
Figure 11. Tooth no. 3 after Pearl Neutral enamel shade Figure 12. Postoperative occlusal view of tooth no. 3.
of the microhybrid composite (Vitalescence, Ultradent
Products Inc., South Jordan, Utah) was used to build up Class I and II restorations. J Esthet Dent 1999;11(3):135-42.
the occlusal surface according to the successive cusp 15. Garber DA, Goldstein RE. Porcelain and composite inlays and
90. Deliperi S, Bardwell DN, Papathanasiou A, Kastali S. In vitro mental methods (abstract 3544). J Dent Res 1999;78:548.
evaluation of composite microleakage using differing methods of polym- 110. Yoshikawa T, Morigami M, Tagami J. Environmental SEM
erization (abstract 1293). J Dent Res 2001;80:197. observation on resin tooth interface using slow-start curing method
91. Rueggeberg F. Contemporary issues in photocuring. Compend (abstract 38). J Dent Res 2000;79:148.
Contin Educ Dent 1999;20(supplement 25):S4-S15. 111. Belli S, Inokoshi S, Ozer F, Pereira PN, Ogata M, Tagami J. The
92. Blakenau R, Erickson RL, Rueggeberg F. New light curing effect of additional enamel etching and flowable composite to the inter-
options for composite resin restorations. Compend Contin Educ Dent facial integrity of Class II adhesive composite restorations. Oper Dent
1999;20(2):122-35. 2001;26(1):70-5.
93. Fleming MG, Maillet WA. Photopolymerization of composite resin 112. Friedl KH, Schmaltz G, Hiller KA, Markl A. Marginal adapta-
using the argon laser. J Can Dent Assoc 1999;65:447-50. tion of class V restorations with and without ‘softstart-polymerization.’
94. Brackett WW, Haisch LD, Covey DA. Effect of plasma arc curing Oper Dent 2000;25(1):26-32.
on the microleakage of Class V resin-based composite restorations. Am 113. Bouschlicher MR, Rueggeberg FA, Boyer DB. Effect of stepped
J Dent 2000;13(3):121-2. light intensity on polymerization force and conversion in a photoacti-
95. Peutzfeldt A, Sahafi A, Asmussen E. Characterization of resin vated composite. J Esthet Dent 2000;12(1):23-32.
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2000;16:330-6. of composite microleakage using differing methods of polymerization.
96. Mills RW, Jandt KD, Ashworth SH. Dental composite depth of Am J Dent (in press).
cure with halogen and blue light emitting diode technology. Br Dent J 115. Vanini L. Light and color in anterior composite restorations.
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97. Kurachi C, Tuboy AM, Magalhaes DV, Bagnato VS. Hardness 116. Grundy JR. Finishing posterior composites. An SEM study of a
evaluation of a dental composite polymerized with experimental LED- range of instruments and their effect on a composite and enamel.
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