d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 615–622

available at www.sciencedirect.com

journal homepage: www.intl.elsevierhealth.com/journals/dema

Review

Polyacid-modified composite resins (“compomers”)

and their use in clinical dentistry

John W. Nicholson ∗
Department of Chemical and Pharmaceutical Sciences, University of Greenwich, Medway Campus, Chatham, Kent ME4 4TB, UK

a r t i c l e i n f o a b s t r a c t

Article history: Objectives. This paper describes the chemistry and properties of polyacid-modified compos-
Received 20 April 2006 ite resins (“compomers”) designed for use in clinical dentistry, and reviews the literature in
Accepted 9 May 2006 this area.
Methods. Information has been obtained from over 50 published articles appearing in the
dental and biomaterials literature, with studies being principally identified through Med-
Keywords: Line.
Polyacid-modified composite resins Results. Published work shows that polyacid-modified composite resins constitute a discrete
Compomers class of polymeric repair material for use in dentistry. Their distinction is that they contain
Fluoride release hydrophilic components, and these cause water to be drawn into the material following
Strength cure. This triggers an acid–base reaction, and gives the materials certain clinically-desirable
Clinical performance properties (fluoride release, buffering capability) that are also associated with glass-ionomer
cements. The water uptake leads to a decline in certain, though not all, physical properties.
However, clinical studies have shown these materials to perform acceptably in a variety of
applications (Class I, Class II and Class V cavities, as fissure sealants and as orthodontic
band cements), especially in children’s teeth.
Conclusions/significance. Polyacid-modified composite resins constitute a versatile class of
dental repair material, whose bioactivity confers clinical advantages, and which are partic-
ularly useful in children’s dentistry.
© 2006 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Contents

1. Definition and distinctiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 616

2. Composition and setting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 616
3. Effect of water uptake. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617
4. Properties of compomers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 618
4.1. Mechanical properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 618
4.2. Fluoride release . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 618
4.3. Ion release . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 619
4.4. Buffering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 619

∗
Tel.: +48 208 331 9965; fax: +48 208 331 9805.
E-mail address: J.W.Nicholson@gre.ac.uk.
0109-5641/$ – see front matter © 2006 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.dental.2006.05.002
616 d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 615–622

5. Clinical applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 619

6. Clinical performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 620
7. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 620
Appendix A. Commercial compomer brands discussed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 620
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 621

1. Definition and distinctiveness A key feature of compomers is that they contain no water
and the majority of components are the same as for compos-
Polyacid-modified composite resins, known trivially as com- ite resins. Typically these are bulky macro-monomers, such
pomers, are a group of aesthetic materials for the restoration as bisglycidyl ether dimethacrylate (bisGMA) or its deriva-
of teeth damaged by dental caries [1]. They were introduced tives and/or urethane dimethacrylate, which are blended
to the profession in the early 1990s [2], and were presented as with viscosity-reducing diluents, such as triethylene glycol
a new class of dental material designed to combine the aes- dimethacrylate (TEGDMA). These polymer systems are filled
thetics of traditional composite resins with the fluoride release with non-reactive inorganic powders, such as quartz or a
and adhesion of glass-ionomer cements. The trivial name was silicate glass, for example SrAlFSiO4 [5]. These powders are
devised from the names of these two “parent” materials, the coated with a silane to promote bonding between the filler
“comp” coming from composite, and “omer” from ionomer [3]. and the matrix in the set material [3]. In addition, compomers
The term polyacid-modified composite resin was originally pro- contain additional monomers that differ from those in con-
posed for these materials in 1994 [1] and has been widely ventional composites, which contain acidic functional groups.
adopted both by manufacturers and researchers since that The most widely used monomer of this type is so-called
time. However, it has been criticised on the grounds that TCB, which is a di-ester of 2-hydroxyethyl methacrylate with
it “. . . may over-emphasize a structural characteristic of no butane tetracarboxylic acid [5]. This acid-functional monomer
or little consequence” [3]. This is a somewhat strange crit- is very much a minor component and compomers also contain
icism, since to formulate these materials, manufacturers some reactive glass powder of the type used in glass-ionomer
have modified them specifically by the introduction of acid- cements [1].
functional macro-monomers. They are, therefore, without Despite the presence of these additional components, com-
question “polyacid modified”. Whether this modification con- pomers are similar to composite resins in that they are fun-
fers clinical benefits, or indeed whether these materials can damentally hydrophobic, though less so than conventional
usefully be considered to be distinctive materials is more composite resins. They set by a polymerization reaction, and
debateable. The conclusion of Ruse is that “. . . They are, after only once set do the minority hydrophilic constituents draw
all, just another dental composite” [3], but this seems to the in a limited amount of water to promote a secondary neu-
present author to be somewhat extreme, and there is consid- tralization reaction [5]. They lack the ability to bond to tooth
erable evidence that compomers possess characteristic prop- tissues [6,7], so require bespoke bonding agents of the type
erties, and are therefore distinct from conventional composite used with conventional composite resins [7], and their fluo-
resins. ride release levels are significantly lower than those of glass-
Nonetheless, polyacid-modified composite resins have ionomer cements [8,9]. Such low levels of fluoride release have
been studied widely, both in terms of their materials science been shown to compromise the degree of protection afforded
and their clinical applications. After more than a decade of by these materials in in vitro experiments using an artificial
research and clinical use, it is therefore timely to review their caries medium [10].
status. This paper does that, and has involved a comprehen- Polymerization in light-cured compomers has been studied
sive search of the literature using Medline® . It is not, however, using FTIR [3,11], as has the secondary neutralization pro-
merely a catalogue of publications, but is a critical review, cess [3,11,12]. The polymerization was followed by studying
based on the author’s many years of research on these mate- the rate of disappearance of the peaks at 1700–1730, 1630 and
rials. 1230–1320 cm−1 , all of which are associated with C C dou-
ble bonds [3,11]. It was found that these peaks disappeared
rapidly on exposure to light, so that reaction had proceeded to
2. Composition and setting a substantial extent by 150 s. Despite this, the degree of con-
version was only of the order of 50% or less after this time
As has already been stated, compomers resemble traditional [11]. Polymerization was found to continue after the light was
composite resins in that their setting reaction is an addition switched off, though at a slower rate, and to proceed for up to
polymerization [2]. It is usually light-initiated, and the initia- 60 h post-irradiation. This phase of the degree of polymeriza-
tor is camphorquinone with amine accelerator, and as such is tion, x, could be described by an equation of the form:
sensitive to blue light at 470 nm [2]. There is, however, at least
x = A + B ln t
one brand, designed for use as luting cement, Dyract Cem, that
is a two-paste system [4]. Cure is brought about as a result of where t is the time. For the material Dyract AP, values were
mixing the two pastes, each of which contains a component of A = 27.7 ± 0.3% and B = 2.15 ± 0.01%, whereas for Compoglass F,
the free radical initiator system. The set material, though, does A = 40.3 ± 0.1% and B = 1.98 ± 0.08% [11]. Depth of light penetra-
not differ in any fundamental way from those compomers that tion was found to be low, due to a combination of absorption
cure photochemically. by initiator molecules higher up in the specimen, and light
 d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 615–622
scattering. This led to the occurrence of fewer free radicals
at greater depths [11]. However, despite the observation that
polymerization continues for up to 60 h, these materials have
generally been found not to increase in strength beyond 24 h
even when stored under completely dry conditions [13]. On the
other hand, a study using diametral tensile strength to deter-
mine changes in mechanical properties showed that strength
of Dyract rose from 25 MPa at 1 h to 43 MPa at 24 h [14], a change
that is consistent with the continuation of polymerization well
after irradiation has been completed.
A detailed study of curing depth in compomers and some
representative composite resins has been published [15]. Sam-
ples were prepared in split stainless steel moulds and cured
for 40 s with a light of output 800 mW/cm2 . Depth of cure was
determined either by scraping away uncured material with a
plastic spatula from the end that was furthest away from the
light, or by using a penetrometer. Results showed that these
two techniques gave no significant differences in depth of cure
values [15]. Cure depths varied widely, depending on the brand
and shade of compomer and type of composite resin, but over-
all findings for compomers were broadly comparable to those
for composite resins. Thus, although there is a problem of light
penetration at greater depths, it is no worse than for conven-
tional composite resins, and does not lead to materials with
significantly different depth of cure characteristics.
Polymerization in compomers is associated with a con-
traction stress, as it is in conventional composite resins. This
has been studied in detail by Chen et al. [16], who showed
that the compomer F2000 (3M) had the relatively high maxi-
mum stress of 3.41 ± 0.09 MPa, whereas Dyract had a value of
only 1.27 ± 0.0 MPa. These values were similar to those found
for hybrid composites in dry conditions, but the differences
between them were considered important. It was suggested
that the rapid development and high value of contraction force
could be a possible cause of failure of the bond to the tooth [16],
and that Dyract might prove superior in maintaining a bond
with the cavity walls because of its low shrinkage stress.
To date commercial compomers have all been formu-
lated with carboxylic acid monomers. However, a report has
recently appeared of an experimental study that employed
a monomer with phosphonic acid functionality [17]. This
study involved the setting properties, mechanical strength,
wear characteristics and fluoride release of two experimental
formulations and compared them with the clinical material
Dyract AP. The acidic monomer employed, vinyl phosphonic
acid (VPA), was found to inhibit free radical polymerization, so
had to be used at very low levels. The formulation containing
the least VPA gave the better results, having a depth of cure
that compared with Dyract AP, and similar properties of com-
pressive and biaxial flexure strength and fluoride release. Both
VPA-containing formulations had superior wear behaviour to
Dyract AP, as assessed by a tooth-brush abrasion apparatus
using an aqueous slurry of pumice as the test medium. Over-
all, the study showed that VPA has the potential to be used in
the formulation of compomers, but that it conferred no partic-
ular advantages over the carboxylic acid monomers employed
to date [17].
The effect of volume filler fraction on mechanical prop-
erties of compomers has been studied [18]. Viscosity of the
uncured compomer paste was found to increase with increas-
617
ing filler content, but above 20–30% filler volume, there was
no improvement in either compressive strength or diame-
tral compressive strength. These findings are what would be
expected for a composite system and seem to have made a
very modest contribution to an understanding of the formu-
lation requirements of compomers.
3. Effect of water uptake
A distinctive feature of compomers is that, following the ini-
tial polymerization reaction [11], they take up small amounts
of moisture in situ, and this triggers an acid–base reaction
between the reactive glass filler and the acid groups of the
functional monomer [3,4]. Among other features, this pro-
cess causes fluoride to be released from the glass filler to the
matrix, from where it can readily be released into the mouth,
and act as an anticariogenic agent [10,19]. Polymerization is
associated with contraction and the development of measur-
able stresses [16], and it may be that the sorption of water plays
some part in reducing these stresses in vivo.
The role of the reactive glass in the water uptake process
has been considered in one report [20]. A conventional com-
posite resin formulation was used as the matrix phase, with
filler being either an unreactive glass, Raysorb T-4000, or the
ionomer glass G338, whose composition and properties have
been described extensively in the literature [21–23]. In each
case, the glass was used both with and without a coating of
silane coupling agent (␥-methacryloxy propyl trimethoxysi-
lane). Results were as shown in Table 1.
The results show that silanation reduced the water uptake
for both of the glasses and also improved the strength. How-
ever, incorporating G338 rather than Raysorb T-4000 gave an
inferior material since it took up more water and was of
lower strength. Previous studies of water sorption by compos-
ite resins have shown that the water accumulates around the
filler particles [24], so that one conclusion of the study is that
G338 is more hydrophilic than Raysorb T-4000. This suggests
that it provides part of the driving force for water uptake by
compomers, and also that it is responsible for a decline in their
overall mechanical properties relative to conventional com-
posite resins.
Compomers are designed to absorb water [3,11], and are
able to up of the order of 2–3.5% by mass of water on soak-
ing [3]. This water uptake has been shown to be accompanied
by neutralization of the carboxylic acid groups, as shown by
changes in bands at 1705 and 1555 cm−1 . The former band
Table 1 – Properties of composite formulations
containing glass fillers (from Adusei et al. [20])
Filler Biaxial flexure Net water
strength (MPa) uptake (%)
Raysorb T-4000 104.8 (S.D. 11.0) 0.4 (S.D. 0.0)
(silane-free)
Raysorb T-4000 152.0 (S.D. 6.1) 0.1 (S.D. 0.0)
(silanated)
G338 (silane-free) 38.4 (S.D. 4.7) 1.0 (S.D. 0.1)
G338 (silanated) 68.0 (S.D. 6.0) 0.7 (S.D. 0.1)
618 d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 615–622
arises from the presence of carboxylic acid groups within the
material, and gradually reduces in intensity on exposure to
water. By contrast the latter band arises from the presence
of carboxylate salts, and shows a corresponding increase in
intensity with time [11,12]. Neutralization has been shown to
be controlled by rate of water diffusion [11] and is therefore
fairly slow.
Although compomers are designed to take up water in
order to promote a later neutralization, these processes have
been shown to have an adverse effect on many of their
mechanical properties. For example, Nicholson and Alsarheed
[25] showed that compressive strength of early compomer
formulations declined significantly on storage in physiologi-
cal saline solution, whereas Dahl et al. showed that flexural
strength of Dyract AP and Compoglass F declined on storage
in water [26]. In the latter case, the changes were striking, with
losses of between 30 and 40% after 3 months. This behaviour
differs from that of traditional dental composite resins, which
have been found to take up modest amounts of water, but
to show no significant changes in mechanical properties [26].
Huang et al. confirmed these differences using ultimate tensile
strength (UTS) determinations on hour-glass shaped speci-
mens [27]. When stored in water, Dyract AP showed a signif-
icant drop in UTS after 90 days and 180 days compared with
the 1-day result, whereas the composite resin Spectrum TPH
showed no changes. Dyract AP itself showed no such changes
when stored in silicone fluid for up to 180 days [27].
The most comprehensive study of the adverse effect of
water on compomers appears to be that of Adusei et al. [13]. In
this study, the compomers Dyract AP, F2000 and Compoglass
F were studied following storage under wet or dry conditions
of storage for up to 4 weeks, and their compressive, biaxial
flexure and diametral tensile strengths determined. In gen-
eral after 24 h, no differences were found under wet or dry
conditions for any of the materials, but by 4 weeks, for most
materials all measures of strength had tended to decline (see
Table 2). Hence, whichever means are used to characterise
strength, there is generally a decline associated with the with
water uptake and neutralization processes.
In one study the effect of ethanol on restorative materials
has been considered, as well as water, and it was found that
Table 2 – Losses in strength (MPa) after 4 weeks storage
for various commercial compomers [13]
Material/test Dry conditions Change in distilled
(significance) water (4 weeks)
Dyract AP
Compressive 213.1–206.0 (NS) 208.7–125.1 (p < 0.01)
Biaxial flexure 166.3–188.6 (NS) 166.8–137.0 (p < 0.01)
Diametral tensile 40.0–40.2 (NS) 35.1–23.9 (p < 0.01)
Compoglass F
Compressive 110.9–93.8 (NS) 82.7–95.9 (NS)
Biaxial flexure 167.9–174.5 (NS) 149.1–129.2 (p < 0.05)
Diametral tensile 36.4–50.6 (p < 0.01) 36.7–26.1 (p < 0.01)
F2000
Compressive 213.1–172.5 (p < 0.05) 208.7–147.8 (p < 0.05)
Biaxial flexure 172.4–188.9 (NS) 155.4–157.4 (NS)
Diametral tensile 37.8–45.4 (NS) 35.4–24.9 (p < 0.01)
the compomer Dyract Posterior was weakened [28]. Evaluation
was by the shear punch test, with specimens stored at 37 ◦ C
for 1 week in air, in distilled water, or in 75% ethanol–water.
Dyract Posterior was found to give a significantly lower shear
punch strength compared with the control stored in dry air in
both water and 75% ethanol.
Not all physical properties have been found to show a
decline with long term storage in water. Both microten-
sile strength and surface hardness appear to be unaffected.
According to Mendonca et al., microtensile strength increased
slightly but significantly for Dyract AP after 6 months in water,
and did not decline to any extent for Dyract, Freedom or F2000
[29] after the same storage period. In a study of surface hard-
ness, Bayinder and Yildiz [30] showed that the hardness of
the compomers Hytac and Dyract did not change significantly
after 60 days storage in water.
4. Properties of compomers
4.1. Mechanical properties
There have been numerous studies of mechanical properties
of compomers, and typical values have been reported for a
range of properties, including compressive, biaxial flexure and
diametral tensile strengths, fracture toughness and surface
hardness. In general these properties do not differ much, if at
all, from those of conventional composite resins.
One mechanical property of compomers that does dif-
fer significantly from those of conventional composite resins
however is fracture toughness. In a study of three compomers
and three conventional composites, single-edged notched
specimens were used to determine fracture toughness, fol-
lowing 1 week storage in water [31]. For composites fracture
toughness fell in the range 1.75–1.92 MPa m1/2 , whereas for
compomers it fell in the range 0.97–1.23 MPa m1/2 . The authors
of this study concluded that, in view of this reduced resistance
to crack propagation, compomers should not be used in stress-
bearing areas.
4.2. Fluoride release
Compomers are designed to release fluoride in clinically ben-
eficial amounts. Fluoride is present in the reactive glass filler,
and becomes available for release following reaction of this
glass with the acid functional groups, triggered by moisture
uptake. In addition, commercial compomers contain fluoride
compounds such as strontium fluoride or ytterbium fluoride,
which are capable of releasing free fluoride ion under clini-
cal conditions, and augment the relatively low level of release
that occurs from the polysalt species that develops. Fluoride
release occurs to enhanced extents in acidic conditions [32,33],
and in lactate buffer has been shown to be diffusion-based
[32]. A plot of cumulative fluoride release against square root
of time was found to remain linear for up to 169 h, and to fol-
low the equation:
√
M=a+b t
throughout this time. SEM examination of the materials
exposed to lactate buffer showed that they developed voids
 d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 615–622
and other surface irregularities, and these clearly assist fluo-
ride release from these compomers.
Other equations have been used to describe fluoride release
profiles from compomers. Xu and Burgess [33] have suggested
two possible equations, one for high-fluoride releasing com-
pomers, which gives the release as:
[F]c = [F](I) (1 − exp(−bt) + ˇt)
On the other hand, for most compomers, and also fluoride-
releasing composite resins, a better equation is:
[F](I)
[F]c = + ˛t
t1/2 + t
These authors also demonstrated that fluoride-releasing abil-
ity of compomers can be regenerated by using a topical flu-
oride agent. High-release compomers appear to have greater
recharge capacity than low-release ones [33].
The conventional way of determining fluoride release is
to employ an ion-selective electrode, and to treat the sam-
ple solution with an equal volume of the decomplexing TISAB
(total ionic strength adjustment buffer). This liberates fluo-
ride from any potential complexes, and enables to full amount
of fluoride to be determined. However, in this study [34], the
amount of fluoride without TISAB was also determined, thus
obtaining a value for the “free” fluoride in the samples. Results
obtained are shown in Table 3, and demonstrate that, though
the total fluoride release is greater in acidic conditions, the
amount of free fluoride is much less.
The authors speculated that the complexation was caused
by the elevated levels of aluminium released under acidic con-
ditions. As an example, for Compoglass F, aluminium concen-
tration rose from 4.68 ppm in water to 104 ppm in lactic acid
solution. Aluminium is known to form complexes of the type
AlF2 + and AlF2+ [35] and these have been widely assumed to
occur, for example in glass-ionomer cements [36]. However, an
alternative suggestion has been made by Billington et al. [37],
who have suggested that complexation as monofluorophos-
phate is also a possibility, and they note that phosphorus
levels released by glass-ionomer cements are also typically
elevated under acidic conditions. This is also possible for com-
pomers, as their glass filler components are similar to those
used in glass-ionomers, and they, too, show elevated phospho-
rus release under acidic conditions.
Table 3 – Free and total fluoride concentrations in
solutions in which compomers had been stored (from
Ref. [34])
Material/ Free fluoride Total fluoride % free
conditions fluoride
Compoglass F
Neutral 2.8 4.5
Acidic 0.5 15.5
Dyract AP
Neutral 19.1 21.3
Acidic 0.3 21.3
F2000
Neutral 2.2 6.2
Acidic 0.2 15.5
619
4.3. Ion release
Ion release by compomers has been studied by Sales et
al. [32] and by Nicholson and Czarnecka [34]. Both stud-
ies compared neutral and acidic conditions, and both con-
cluded that release of other ions occurred to a greater extent
in the acid conditions compared to the neutral ones. The
study by Nicholson and Czarnecka is more comprehensive,
and shows that compomers release sodium, calcium, stron-
tium, aluminium, phosphorus and silicon in both acidic and
neutral conditions, with release levels of all of these ions
being greater in acidic conditions compared with neutral ones
[33].
4.4. Buffering
Compomers have been found to change the pH of lactic acid
storage solutions in the direction of neutral [38], and to be
repeatable when samples were exposed to fresh lactic acid at
weekly intervals over a period of 6 weeks. This behaviour, so-
called buffering, has been observed for glass-ionomer cements
[39], but was not found for conventional composites [38]. It
is therefore a property conferred by the acid–base compo-
nents of the compomer. Four compomers were used in the
study, namely Dyract AP, Compoglass F, Hytac and Ana Com-
pomer, and all increased to pH of the storage solutions by at
least 0.26 pH unit. This is less than was observed for glass-
ionomers, and as with glass-ionomers, was associated with
erosion of the specimens. Buffering has been suggested as
being desirable under clinical conditions, since the ability of
reduce the acidity of caries-producing acids (mainly lactic)
would be expected to reduce the development of caries in vivo
[40]. So far, this suggestion is merely speculative, but what
is clear from these findings is that compomers share some
potentially important chemical features with glass-ionomer
cements, and this makes them distinct from conventional
composites.
5. Clinical applications
Compomers are designed for the same sort of clinical applica-
tions as conventional composites. These include Class II [40]
and Class V [41,42] cavities, as fissure sealants [43], and as
bonding agents for the retention of orthodontic bands [44].
They have been widely used and studied in children’s den-
tistry, though not exclusively so. Their fluoride release, how-
ever, is seen as a useful feature for use in paedodontics, and
certain brands have been produced that are specifically aimed
at children. For example in America there is a dual-cure com-
pomer known as MagicFil produced by Zenith Dental of Engle-
62.2
3.2 wood, New Jersey [45] that is available in four bright colours
with glitter inclusions, and in Europe there is a similar mate-
rial known as Twinky Star produced by Voco GmbH in Germany
89.7
1.4 [46].
Clinical results have been reported for all of these poten-
tial applications of compomers, and in general findings are
35.5
1.3
positive [47]. They are considered in more detail in the next
section.
620 d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 615–622
6. Clinical performance
Right from the time they were first launched, compomers
have shown acceptable clinical performance in a variety of
clinical applications [48–50]. However, wear characteristics of
early materials were poor [51] and there were concerns about
their durability. Despite this, the early results were promising
[48,52], and more recently, results with newer formulations
have also been good.
Typically, compomers have been evaluated against the so-
called Ryge criteria [53]. These are designed to standardise
the criteria against which dental restorative materials are
evaluated in vivo, and include features such as discoloration,
marginal integrity, adaptation and anatomic form. These are
scored on a simple scheme, typically ranging from alpha (the
best) through bravo and charlie in declining order [53].
For example, an evaluation of Dyract AP after 2 years clini-
cal placement showed mainly alpha grades on all Ryge criteria
[54], with only minor amounts of marginal discoloration and
some loss of marginal integrity. Wear was noted to be accept-
able, and to have improved by comparison with early com-
pomer formulations [54].
Compomers have been widely used in Class V restora-
tions. For example, the compomers Dyract AP, Compoglass
F and F2000 were evaluated for use in this application over
a 2-year period [54]. This study concluded that, after this
time, all three materials showed an acceptable level of clin-
ical performance. Not all compomer materials have proved
so acceptable: in a 1-year study of Class V restorations, the
material Freedom scored “bravo” or “charlie” for all the exam-
ined criteria (colour match, marginal discoloration, caries,
anatomical form, marginal integrity and surface texture),
whereas F2000 scored mainly “alpha” [41]. This shows that
compomers are not all the same, but have properties which
vary between brands, according to precise details of their
formulation.
Colour stability has been found to be somewhat of a prob-
lem with compomers in a few studies. This is not entirely
surprising, given that they are designed to take up water,
which is likely to alter appearance through a change in refrac-
tive index, and also to carry with it coloured chemical species
(stains) from certain foodstuffs such as coffee and red wine.
In a 3-year study of Class V restorations of Dyract, Demirci
et al. [42] found that all Ryge criteria were good, except those
relating to colour change, i.e. colour stability and marginal dis-
coloration. In both of these there were significant changes [42].
A 5-year study essentially confirmed this finding [55], and sug-
gested that the performance of Dyract was superior to that of
the resin-modified glass-ionomer cement Vitremer [55]. This
superiority of compomers over resin-modified glass-ionomers
has been reported by others [56] and seems to be a general
observation in appropriate clinical applications.
Compomers have been used as fissure sealants [43], and a
clinical study examined the teeth of children aged between 7
and 10 years sealed by the compomer Dyract Seal. Sealed teeth
were examined post-operatively at 3, 6, 12 and 24 months, and
were also evaluated by the Ryge criteria. In general Dyract Seal
behaved as well as a conventional composite resin sealant,
except on the criterion of marginal integrity, showing that this
material was acceptable for its clinical application, at least of
the 24 months period of the study [43].
Compomers have also been used for Class I [40] and Class II
restorations [49]. In the Class I study, they were used in com-
posite laminate restorations, and were shown to perform as
well as conventional composite resins [40]. In the Class II study,
they were studied over 7 years in children aged between 3.6
and 14.9 years. Again performance was indistinguishable from
that of conventional composite resins.
Lastly, compomers have been employed as cements for
orthodontic bands and there have been a number of full stud-
ies of compomers in this application [48,57]. Results have
been generally extremely good for compomers, except in the
realms of taste, as determined by the patient, and in which
compomers scored less well than glass-ionomers. Thus, com-
pomers have been shown to have acceptable performance as
materials for use in orthodontic band retention, though the
final choice of cementing agent could be left to patients. If they
found the taste of the compomer particularly objectionable,
a resin-modified glass-ionomer could be used equally effec-
tively instead.
7. Conclusions
Compomers have been developed as distinctive materials for
use as repair materials in clinical dentistry. The presence in
them of minor amounts of both acid-functional monomer
and basic ionomer-type glass confers new properties; namely
the ability to draw in moisture to trigger an acid–base reac-
tion, leading to the capacity to release fluoride and buffer
acidic environments. However, these clinically desirable fea-
tures come at a price, since water uptake has been shown in
several studies to be associated with reductions in strength
over periods of only a few weeks of up to 40% in some
instances. Conversely, clinical studies have shown that these
materials perform well in a variety of applications: Class I,
Class II and Class V restorations, as fissure sealants, and as
orthodontic band cements. Overall, the major conclusion from
these clinical results is that compomers perform well, and
are suited to their suggested uses in dental restoration. The
reduction in strength due to water uptake does not seem to
be important clinically and these materials are suited to use
in vivo.
Appendix A. Commercial compomer brands
discussed
Brand Manufacturer
Ana Compomer Nordiska Dental, Sweden
Dyract Dentsply, Konstanz, Germany
Dyract AP Dentsply, Konstanz, Germany
Dyract Cem Dentsply, Konstanz, Germany
Dyract Posterior Dentsply, Konstanz, Germany
Dyract Seal Dentsply, Konstanz, Germany
Compoglass Ivoclar-Vivadent, Liechtenstein
Compoglass F Ivoclar-Vivadent, Liechtenstein
 d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 615–622
F2000 3M-ESPE, St. Paul’s, Minnesota, USA
Freedom SDI, Bayswater, Victoria, Australia
Hytac 3M-ESPE, Seefeld, Germany
MagicFil Zenith, Englewood, New Jersey, USA
Twinky Star Voco, Cuxhaven, Germany
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