Restorative resins

Restorative resins

By Bibin bhaskaran

Index
Aesthetic restorative materials
Composite restorative materials Curing of resin-based composites Classification of resin based composites Composites for posterior restorations Use of composite for resin veneers Finishing of composites

Biocompatibility of composites
Repair of composites Survival probability of composites

History
20th century-silicates only tooth-colored aesthetic material.
Acrylic resins replaced silicates in1940s because of their

aesthetics insolubility in oral fluids low cost and ease of manipulation Excessive thermal expansion and contraction stresses develop Problem solved by addition of quartz Early composites based on PMMA not sucessful A major advancement made after introduction of bis-GMA by Dr ray l. bowen in 19 50,s

Composite restorative materials

Uses Restoration of anterior and posterior teeth To veneer metal crowns and bridges To bulid up cores Cementation of orthodontic brackets,maryland bridges,ceramic crowns,inlays ,onlays,laminates Pit and fissure sealants Repair of chipped porcelain restorations

Types
Based on curing mechanism Chemically activated Light activated

Based on size of filler particles Conventional 8-12 um Small particle 1-5 um

Microfilled
Hybrid

0.04-0.4 um 0.6-1.0 um

Dental composites
Dental composites They are highly crosslinked polymeric materials reinforced by a dispersion of glass,crystalline or resin filler particles or short fibres bound to the matrix by silane coupling agents Composition Resin matrix Filler particles Coupling agent
An activator-initiator system required to convert resin to soft moldable filling material to hard durable restoration

Resin matrixmostly blend of aromatic/aliphatic dimethacrylate monomers such as BISGMA,TEGDMA,UDMA.

Fillers Based on the type of filler particles composites are currently classified as microhybrid and microfilled products.

Benefits of fillers(1) reinforcement of the matrix resin, resulting in increased hardness, strength, and decreased wear (2) reduction in polymerization shrinkage (3) reduction in thermal expansion and contraction (4) improved workability by increasing viscosity (5) reduction in water sorption, softening, and staining (6) increased radiopacity

Important factors with regard to fillers that determine the properties and clinical application-

Amount of filler added

Size of particles and distribution

Index of refraction
Radiopacity Hardness

 Types of fillers used Ground quartz-

Makes restoration difficult to polish and cause abrasion of opposing teeth and restorations
Colloidal silica

Used in microfilled composites Thicken the resin

Glasses of ceramic containing heavy metals

Radiopacity Barium

Coupling agent
Bond filler particles to resin. Allows for transfer of stresses to stiffer filler particles. FUNCTIONS--Improve physical and mechanical properties. Prevent water from penetrating the resin-filler surface. 3-methoxy-propyl-trimethoxy silane most commonly used

Inhibitors
Inhibitors are added to the resin to minimise or prevent spontaneous or accidental polymerization of monomers

A typical inhibitor is butylated hydroxytoluene (BHT) used in concentration of 0.01 wt%

Optical modifiers
Dental composites must have visual shading and transluscency for a natural appearance.
Shading is achieved by adding pigments usually metal oxide particles

All optical modifiers affect light transmission through a composite.

Darker shades and greater opacities have a decreased depth of light curing ability.

titanium dioxide and aluminium oxide most commonly used.

Polymerisation mechanism
2 types
Chemically activated
Light-activated

Chemically activated composite system Two paste system Base paste benzoyl peroxide initiator Catalyst paste tertiary amine activator (N,N-dimethyl-p-toludine)

Light activated composite resins

Earliest system---Uv light activated system Limitations

Limited penetration of light into resin Lack of penetration through tooth structure

Visible light activated system-- Single paste system Photoinitiator Camphoroquinone Amine accelerator diethyl-amino-ethyl-methacrylate

Types of lamps used for curing

LED lamps. Using a solid-state, electronic process, these light sources emit radiation only in the blue part of the visible spectrum between 440 and 480 nm
QTH lamps. QTH lamps have a quartz bulb with a tungsten filament that irradiates both LTV and white light that must be filtered to remove heat and all wavelengths except those in the violet-blue range (400 to 500 nm).

PAC lamps. PAC lamps use a xenon gas that is ionized to produce a plasma. The high-intensity white light is filtered to remove heat and to allow blue light (400 to 500 nm) to be emitted.
Argon laser lamps- have the highest intensity and emit at a single wave length.lamps currently avaialble emit 490 nm

Depth of cure and exposure time

Light absorption and scattering in resin composites reduces the power density and degree of conversion (DC) with depth of penetration
Intensity can be reduced by a factor of 10 to 100 in a 2-mm thick layer of composite which reduces monomer conversion to an accceptable level. The practical consequence is that curing depth is limited to 2- 3mm Light attenuation vary from one type of composite to other depending on opacity,filler size,filler concentration and pigment shade

 Darker shades require long curing time

When polymerising resin through tooth structure exposure time should be increased by a factor of 2 3 to compensate for reduction in light intensity

For halogen lamps light intensity can decrease depending on quality and age of light source,orientation of light tip,distance between light tip and restoration and presence of contamination,such as composite residue on light tip
Despite the many advantages of light cured resins,there is still need for chemically cured composites for eg chemicaly cured materials can be used with reliable results as luting agent under metallic restorations.

Dual curing and extra oral curing

One way to overcome problems associated with light curing is to combine chemical curing and light curing components in same resin.
Air inhibition and porosity are problems associated with dual-cure resins

Extra-oral heat or light can be used to promote a higher level of cure

For eg light cured or chemical cured composite for inlay can be cured directly within the tooth or die and then transferred to oven to receive additional heat or light curing

Degree of conversion
DC is a measure of percentage of carbon-carbon double bonds that have been converted to single bonds to form polymeric resin
The higher the DC the better the strength,wear,resistance

Conversion values of 50%-70% are achieved at room temperature for both types of curing system

Reduction of residual stresses

2 approaches Reduction in volume contraction by altering the chemistry of resin system Clinical techniques designed to offset the effects of polymerisation shrinkage

Incremental buildup and cavity configuration

One technique is the attempt to reduce the so called C-factor(configuration factor) which is related to the cavity preparation geometry
A layering technique in which restoration is built up in increments,reduces polymerisation stress by minimising the Cfactor. Incremental technique overcomes both limited depth of cure and residual stress concentration.

Soft started,ramped curing and delayed curing

Variations on this technique include ramping and delayed cure.
In ramping the intensity is gradually increased or ramped up during the exposure which consists of either step wise,linear or exponential modes.

In delayed curing restoration is initialy cured at low intensity and after contouring the resin to correct occlusion second exposure for final cure is done.
The longer the time available for relaxation,lower the residual stress

High intensity curing

High intensity lamps could provide savings in chair time.
However high intensity, short exposure times cause accelerated

rates of curing, which leads to substantial residual stress build up.

Class of composite Traditional(large particle) Hybrid(large particle)

Particle size

Clinical use

Based on indications High and use 1-50m stress areas

1, 1-20 m 2, 0.04 m silica 1, 0.1-10 m glass 2, 0.04 m silica High stress areas requiring improved polishability Cl (1/2/3/4) High stress areas requiring improved polishability Cl (3,4) Moderate stress areas requiring optimal polishability Cl (3,4) Situations where improved condensability is needed Cl(1,2) Situations where improved flow is needed Cl(2) Low stress and subgingival areas that require high polish and luster Low stress and subgingival areas where reduced shrinkage is

Hybrid (midifiller)

Hybrid (minifiller/SPF) Packable hybrid Flowable hybrid Homogenous microfill Heterogenous microfill

1, 0.1-2 m glass 2, 0.04 m silica Midifiller /minifiller hybrid,but with lower filler Midifiller hybrid,but with finer particle size 0.04 m silica 1, 0.04 m silica 2, prepolymerised resin

Conventional / traditional /macrofilled composite

Composition-

Ground quartz most commonly used filler Average size : 8- 12 m Filler loading - 70-80 weight % or 50 60 vol %

Properties
Compressive strengthFour to five times greater than that of unfilled resins ( 250-300 Mpa)
Tensile strengthDouble than of unfilled acrylic resins (50 65 Mpa) Elastic modulusFour to six times greater (8-15 Gpa) Hardness

Considerably greater (55 KHN) than that of unfilled resins

Coefficient of thermal expansionHigh filler resin ratio reduces the CTE significantly.

 Esthetics

Polishing result in rough surface Selective wear of softer resin matrix Tendency to stain
Radiopacity

Composites using quartz as filler are radioluscent Radiopacity less than dentin

 Clinical considerations

Polishing was difficult Poor resistance to occlusal wear Tendency to discolor Rough surface tends to stain Inferior for posterior restorations

Microfilled composites
Developed to overcome surface roughness of conventional composites

CompositionSmoother surface is due to the incorporation of microfillers. Colloidal silica is used as the microfiller 200300 times smaller than the average particle in traditional composites Filler particles consists of pulverised composite filler particles

Properties
Inferior physical and mechanical properties to those of

traditional composites
40 80 % of the restorative material is made up of resin Increased surface smoothness

Areas of proximal contact- Tooth drifting

.

Compressive strength250- 350 Mpa. Tensile strength30- 50 Mpa. Lowest among composites Hardness 25- 30 KHN. Thermal Expansion Coefficienthighest among composite resins

Clinical considerations
Choice of restoration for anterior teeth.
Greater potential for fracture in class 4 and

class 2 restorations.
Chipping occurs at margins.

Small particle composite

Introduced in an attempt to have good surface smoothness and to improve physical and mechanical properties of conventional composites.

Composition Smaller size fillers usedColloidal silica - present in small amounts ( 5 wt % ) to adjust paste viscosity Heavy metal glasses . Ground quartz also used Filler content 65 70 vol % or 80 90 %

Properties
Due to higher filler content the best physical and mechanical properties are observed

Compressive strength-

Highest compressive strength (350 400 Mpa )

Tensile strength-

Double that of microfilled and 1.5 times greater than that of traditional composites ( 75- 90 Mpa )

 Hardness

Similar to conventional composites ( 50 60 KHN)

Thermal expansion coefficient-

Twice that of tooth structure

Esthetics

Better surface smoothness than conventional because of small and highly packed fillers
Radiopacity

Composites containing heavy metal glasses as fillers are radio-opaque which is an important property in restoration of posterior teeth

Clinical considerations
In stress bearing areas such as class 4 and class 2 restorations Resin of choice for aesthetic restoration of anterior teeth For restoring sub gingival areas

Hybrid composite
Developed in an effort to obtain even better surface smoothness than that provided by the small particle composite.
Composition

2 kinds of fillersColloidal silica present in higher concentrations 10 20 wt % Heavy metal glasses Constituting 75 % Average particle size 0.4 1.0 m

Properties
Range between conventional and small particle
Superior to microfilled composites Compressive strength-

Slightly less than that of small particle composite(300 350 Mpa )

Tensile strength-

Comparable to small particle (70 90 Mpa )

Hardness

Similar to small particle ( 50 60 KHN )

 Esthetics

Competitive with microfilled composite for anterior restoration

Radiopacity

Presence of heavy metal glasses makes the hybrid more radio-opaque than enamel

Clinical considerations
Used for anterior restorations including class 4 because of its smooth surface and good strength

Widely employed for stress bearing restorations

Flowable composites
Modification of SPF and Hybrid composites.
Reduced filler level Clinical considerations-

Class 1 restorations in gingival areas. Class 2 posterior restorations where acess is difficult. Fissure sealants.

Composites for posterior restorations

Amalgam choice of restoration for posterior teeth
Mercury toxicity and increased esthetic demand. All types of composites except flowable composites Conservative cavity preparation Meticulous manipulation technique.

Packable composites
1990s
Elongated fibrous,filler particles of about 100m Time consuming Inferior in stength when compared to amalgam

Problems in use of composites for posterior restoration

In class 5 restoration where gingival margin is located in cementum or dentin. Marginal leakage Time consuming Composites wear faster than amalgam

Indications
Esthetics Allergic to mercury To minimse thermal conduction

Indirect posterior composites

Introduced to overcome wear and leakage.
Polymerised outside the oral cavity and luted with resin cement For fabrication of inlays and onlays.

Different approaches for resin inlay constuction Use of both direct and indirect fabrication systems Application of heat,light,pressure or combination Combined use of hybrid and microfilled composites

Uses of composites for Resin veneers

These resins are polymerized by visible light in violet blue range or by combination of

heat and pressure.

Uses

Veneers for masking tooth discoloration Used as performed laminate veneers

 Advantages

Ease of fabrication Predictable intra-oral reparability Less wear of opposing teeth or restorations
Disadvantages

Leakage of oral fluids Staining below veneers

Susceptible to wear during tooth brushing

Techniques of insertion
Chemically activated resins
Correct proportions dispensed Rapid spatulation with plastic instrument for 30 sec Avoid metal instruments Inserted with syringe or plastic instrument Cavity slightly overfilled Matrix strip placed to apply pressure and to avoid air inhibition

Light activated resins Single component pastes Working time under control of operator Hardens rapidly once exposed to curing lights

Limited depth of cure

Incremental build up High intensity light used Exposure time not less than 40 60 sec

Resin thickness not greater than 2.0-2.5mm

Caution High intensity light causes retinal damage

Acid etch technique

Most effective way of improving marginal seal between resin and enamel
Mode of action Creates microporosities by discrete etching of enamel Etching increases surface area Etched enamel allow resin to wet the tooth surface better

When polymerised forms resin tags

Acid used37% phosphoric acid

Dentin bonding agents

Supplied as - kit containing primers/conditioners and the bonding liquid.

Primers/conditioners-

Remove the smear layer and provides opening of dentinal tubules. Provides modest etching of inter-tubular dentin.

Classification
First generation
Use glycerophosphoric acid dimethacrylate. Main disadvantage-low bond strenghth.

Second generation
Developed as adhesive agents for composites. Bond strength 3 times more.

Disadvantage short term adhesion.

bond hydrolysed eventually. Eg Prisma,Universal bond,Mirage bond.

Third generation
Had bond strengths comparable to that of resin to etched enamel. Complex use-requires 2-3 application steps. Eg Tenure,Scotch Bond 2,Prisma.

Fourth generation

All bond 2 systems. Consists of 2 primers (NPG-GMA and BPDM). An unfilled resin adhesive(40%BIS-GMA,30%UDMA,30%HEMA). Bonds composite not oly to dentin but to most surfaces like enamel,casting alloys,amalgam,porcelain and composite.

Fifth generation
Most recent product. More simple to use. Only single step application. Eg 3M Single Bond,Prime and Bond(Dentsply).

Indications for use

For bonding composite to tooth structure.
Bonding composite to porcelain and various metals like amalgam,base metal and noble metal alloys.

Desensitization of exposed dentin or root surfaces.

Bonding of porcelain veneers.

Sandwich Technique
Composite does not bond adequately to dentin.
Bond to dentin improved by placing GIC liner between composite and dentin.

Indications
Lesions where one or more margins are in dentin.

eg cervical lesions.
Class II composite restorations.

Cores
If half or more of clinical crown is destroyed.
Must be anchored firmly to tooth. Pin-retained cores mostly used. Amalgam and composite resins . Composited more favored.

Advantages Easily molded into large cavities. Polymerise quickly. Crown preparation done at same appointment.

Disadvantage
Dimensionaly not stable Greater microleakage

Finishing and polishing

Started 5 min after curing
Initial contouring with knife or diamond stone Final finishing with rubber impregnated abrasives or aluminum oxide discs Best finish obtained on setting against matrix strip

Biocompatibility
Relatively biocompatible. Inadequately cured composites serve as reservoir that can induce pulpal inflammation Shrinkage of composite leading to marginal leakage and secondary caries Bisphenol A precursor of bis-GMA Xenoestrogen Reproductive anomalies

Survival probability of composites

Judged on longterm clinical trials
Survival rates of composites after 7yrs was 67.4% Amalgam 94.5% Glass ionomer was 64% after 5 yrs. Glass ionomer/composites avoided in class II restorations

Recent Advancements
Nano-Composites

The decreasing of filler particles size from micronlevel to nanometer level leads to the change of Distribution of filler particles in a matrix.
Charge carriers transport between particles. Conductivity of filler particles themselves.

Advantages
High adhesion of nanoparticles to polymer matrix result in the enhanced strength of nanocomposites

Small size of nanoparticles ensures small size of pores in the case of exfoliation of a matrix from filler particles which resulted in increased strength
Introduction of small amount of nanoparticles to polymer significantly enhance the adhesion of polymer to different substrates. Optically more transparent in comparison to conventional composites

Summary
Amalgam continues to be the best posterior restorative material :- Ease of use. Low cost. Wear resistance. Freedom from shrinkage during setting. High survival probabilities

References
Anusavice K.J Phillipsscience of dental materials ,11th

Edition Saunders publication.

Craig.R.G, Dental Materials, 8th edition, Elsevier

publications.

OBrien.W.J, Dental materials and their selection, 3rd

edition, Quintessence publications.

Smith.B.G Clinical Handling Of Dental Materials , 2 nd edition,Heinemann publications.