Professional Documents
Culture Documents
Composites
Composites
Composites
DEFINITION
COMPOSITES are defined as a compound of two
or more distinctly different materials with
properties that are superior or intermediate to
those of individual constituents.
DENTAL COMPOSITES are highly cross linked
polymeric materials reinforced by dispersion of
glass, crystalline or resin filler particles and/or
short fibres bound to matrix by silane coupling
agents
Examples of natural composites are tooth enamel
and dentin.In enamel, enamelin represents the
organic matrix whereas in dentin the matrix
consists of collagen both of which having filler as
hydroxyapatite crystals.
In an effort to improve the physical properties of unfilled
resins Ray C. Bowen introduced a polymeric dental
restorative material reinforced with silica particles in
1962.
This became the basis for restorations and are termed as
COMPOSITES.
They are often termed as Dental Composites, Composite
Restorative Materials, Filled Resins,Composites
resins,Resin composites, Resin Based Composites, Filled
Composites
COMPOSITION
Composites involve a dispersed phase of filler particles
distributed with a continuous phase (Matrix phase)
Composites consist of
• Organic phase (continuous phase) – resin matrix
• Inorganic phase (dispersed phase) – filler particles
• Interfacial phase coupling agent
Organic Phase
• It consists of :
1) Monomers
2) Activator Initiator system
3) Inhibitors
4) UV light absorbers
5) Pigments and Opacifiers
Monomers
• They are either aromatic or aliphatic diacrylates
• Bisphenol A-Glycidyl methacrylate (Bis-GMA),
Urethane dimethacrylate (UDMA),Triethylene
glycol dimethacrylate (TEGDMA) are most
commonly used in dental composites
• In high molecular monomers particularly Bis-
GMA is extremely viscous at room temperatures.
• The use of diluent monomers is essential to attain
high filler levels and to produce a paste of
clinically usable consistencies which are mostly
low molecular wt less viscous TEGDMA
Monomers
• Binds filler particles together
• Provides “workability”
• Typical monomers
– Bisphenol A glycidyl methacrylate (Bis-GMA)
CH3
O O
CH2=C-C-O-CH2CH-CH2O -C- OCH2CHCH2O-C-C=CH2
CH3 CH3
Activator Initiator system
Microfiller -
.04 um
(marble)
Nanofiller -
.02 um (pea)
• 1 - 5 micron heavy-metal
(1-5 u)
glasses Polymer
matrix
• Fracture resistant
• Polishable to semi-gloss
• Suitable for Class 1 to 5
• Example: Prisma-Fil
Hybrids
• Popular as “all-purpose”
– AKA universal hybrid, microhybrids,
microfilled hybrids
• 0.6 to 1 micron average particle size
– distribution of particle sizes Silane-coated
silica or glass
• reduce stickiness
Hybrids
• Strong
• Good esthetics
– polishable
• Suitable
– Class 1 to 5
• Multiple available
Table of Properties
Property Traditional Microfilled Small Particle Hybrid
Compressive strength
250-300 250-300 350-400 300-350
(MPa)
Coefficient of Thermal
25-35 50-60 19-26 30-40
Expansion (10-6/ºC)
Different
Filler Particle Not
Shown
Not
Shown
Sizes
HYBRID HYBRID
(MIDIFILL) (MINIFILL)
Mixtures
Of Filler
Sizes
100 10-1 10-2 10-3 10-4 10-5 10-6 10-7 10-8 10-9 10-10
1m 1 dm 1 cm 1 mm 1 mm 1 nm 1Å
Dentinal Tubule
Width
IPS Target Atomic
Bacteria for Wear Dimensions
Resistance
Standard
Dentistry
Reference
CURING OF RESIN BASED COMPOSITES
• Chemical Activation: Initial method of curing
initiated by mixing two pastes just before use.
During mixing it is impossible to avoid
incorporating air into the mix thereby forming pores
that weaken the structure and trap oxygen which
inhibits polymerization during curing
Also with chemical activation the operator has no
control over the working time after the two
components have been mixed
So both insertion and contouring must be completed
quickly once the resin components are mixed
Light activation
• Light activation is the currently used technique to cure the
resin based composites so it has to be discussed at a stretch:
• Advantages :
Mixing not required so less porosity and staining and
greater strength
An alliphatic amine as an activator so greater color stability
Command polymerization on exp to blue light controls W.T
• Disadvantages :
Limited depth of cure ie 2mm or less
Poor access in posterior and interproximal areas
Variable exposure times with diff shades,longer exp times
for darker shades increases opacity
Sensitivity to room illumination forming a crust or skin
INTRAPULPAL HEAT,
INTENSITY
GINGIVAL IRRITATION
band-pass
band-pass
filter
filter
UV
IR
UV Visible CQ IR
WAVELENGTH (nm)
• Power Supply
• Cycle Timer (Circuit Board)
• Bulb / Reflector
• Filter
• Fan
• Fiber-Optic Train
Curing Lamps
• Curing lamps are hand held devices that contain the light
source equipped with a short rigid light guide madeof
fused optical fibers
• At present the most widely used light source is a quartz
bulb with a tungsten filament in a halogen environment
similar to those used in automobile head lights
• Precisely power supply heats the tungsten filament in the
bulb the output of which depends on voltage control and
operational characteristics
• Within the unit the light is collected by reflecting it from a
silverized parabolic mirror behind the bulb towards the
path down the fiberoptic chain to tip
• So imp to keep the mirror surface clean as it heats during
operation and cools in between condenses vapors from
mercury,bonding system solvents or moisture in operatory
• So it should be cleaned with alcohol swabs or with methyl
ethyl ketone
• Of the light produced only 0.5 % is useful for curing most
of it being converted to heat at some point of time so to
minimize heat two band pass filters UV and infrared are
placed in path of light just before fiber optic system which
eliminate significant amount of unnecessary light and
convert it to heat within the unit for which a fan is placed to
dissipate the unwanted heat
• Light passed through fiber optic bundle is emitted from the
tip some of which is lost through the fiber optic system.Also
high intensity is observed from the center of the bundle.So
tip should be free of cured resin and if necessary cleaned
with rubber wheel on slow speed
• Curing light output is monitored directly with a built in
radiometer or by trial curing of composite.
• Most modern units have a radiometer as part of it which
measures the no of photons per unit of area per unit of time
but does not discriminate the light energy that is matched
toinitiator.Generally QTH lamps have an output of 400 to
800 mW/cm2 and should not fall below 300 mW/cm2
• Shifting from a standard 11mm diameter tip to a small 3mm
tip increases the light output 8- fold.This increases the
chance that heat produced will raise the temperature of the
restoration and surrounding dentin to dangerous
levels.Increase more then 5 to 8oC causes cell death
• Ideally tip should be adjacent to the surface being cured but
this would cause tip to get contaminated by material being
cured.The intensity of light striking the composite is
inversely proportional to the distance from tip to composite
surface .So ideal is tip within 2mm of the composite to be
effective which may not be possible due to anatomy or
distance into prep extensions create geometric interference
• Distances of 5-6 mm are also encountered in fact distances
beyond 6mm for QTH lamps output may be less than one
third at tip so to permit closer approximation of the light to
composite Light transmitting wedges for interproximal
curing and light focusing tips for access to proximal boxes
• Smaller tips are very useful but may require more light
curing cycles to cover the same amount of cured area
• Filler particles tend to scatter light and darker colorants
absorb the light so no more than 1.5-2 mm increments be
light cured at a time.Smaller particles in range of 0.1-1um
interfere most with the light and maximize scattering.
• The intensity of the tip output generally falls off from the
center to edges producing a bullet shaped curing pattern
which may produce inadequate curing in regions as
proximal box line angles of Cl II restorations
• Most light curing requires a minimum of 20 secs for
adequate curing under optimal conditions of access.To
guarantee adequate curing has occurred it has become
common to post cure for 20 to 60 secs (curing again after
completion of the recommended curing procedure which
may improve surface layer properties like wear resistance
• Typical curing cycles of 20 secs are laborious and interests
in much shorter ones is strong
• Lamps with increased intensities opening the possibility of
reduced exposure times and greater depth of cure
• But light absorption and scattering in composites reduces
the power density and degree of conversion (DC)
exponentially with depth of penetration
• DC is measure of percentage of carbon-carbon double
bonds that have been converted to single bonds to form a
polymeric resin
The higher the DC better the strength, wear resistance, and
many other properties.A DC of 50-60 % for BIS-GMA
implies that 50-60 % of the methacrylate groups have
polymerized.
This does not imply that 40-50 % monomer molecules are
left in resin because of one of the two methacrylate groups
per dimethacrylate could still have reacted and could be
covalently bonded to polymer forming a pendant group
however conversion is controlled by many factors
Total DC within resins does not differ between chemically
activated and light activated having same monomer
formulations.
Conversion values of 50-70% are achieved at room
temperature for both types
DC is related to intensity of light and duration of exposure
decreasing considerably with depth
A curing light may only produce a 55 % degree of cure at
1mm into composite and even less at greater depths
The boundary between between somewhat cured and
uncured material is called the depth of cure and is of 5mm
for light Vita shades (A2 or A3)of material in which tip is
close to composite but in cases of poor access or darker
shades it is less and so materials placed and cured in
increments of 1.5-2mm and for darkest increments of 1mm.
Light is also absorbed and scattered as it passes through
tooth structure especially dentin causing incomplete curing
in critical areas as proximal boxes so while attempting to
cure through tooth structure exposure time should be
increased by a factor of 2 to 3
• High intensity curing involves combination of increased
light output and a narrowed wavelength range for output
using more discriminating band pass filters or other means
• This goes well if initiator is coincident with the wavelength
range of the light source
• Heat is an important problem with this system.They do not
produce the same type of polymer network during curing
• Rapid polymerization produces more stresses and weakens
the bonding system layer against tooth structure As at
beginning only some monomer is consumed and system is
still a viscous liquid but as it progresses net volume
decreases and as long as it is liquid it deforms but as DC
reaches 10-20% the network creates a gel and beyond this
gel point shrinkage creates strain on network and
attachment area to bonding system, the stresses being
relieved afterwards but are deleterious at the time of curing
because of effects on restoration marginal walls
• Light curing influences the initiation process(of the 4 steps
:activation,initiation, propagation,termination)
• Increased light intensity increases the amount of effective
activation and subsequent number chains started.
• However there is a practical point at which it is no longer
useful to encourage activaiton
• The stages in polymerization occur quickly already.
• Activation and initiation occur in less than a second
• Early propagation rates are extremely fast 100000 to
1000000 reactions per second.
• So increased light intensity is useful only to push the degree
of conversion to high levels deeper within a material
• However amount of unreacted material is important as it
may diffuse out of system
• Current composites have two or more principal monomers
and they do not coreact equally.
• TEGDMA constitutes most of the unreacted monomer
• Keeping this in view many things have been attempted in
terms of technique and the armamentarium used for
composite restorations
One way to overcome limits of curing depth and other
problems with light curing is to go for dual cure resins
consisting of two light curable pastes one having BPO and
other containing an aromatic tertiary amine.When they are
mixed and exposed to light, light curing is promoted by
amine/CQ combination and chemical curing by amine/BPO
interaction esp in situation that does not allow sufficient
light penetration eg cementation of bulky ceramic inlays
Also extraoral heat or light can be used to promote a higher
level of cure eg. A chemical or light cured composite can be
used to produce an inlay on a tooth or die This can be cured
directly within the tooth or on die and transferred to an oven
where it receives additional heat or light curing
• Reduction of residual stresses :
In case of chemical cured resins internal pores act to relax
residual stresses that build up during curing(pores enlarge
during hardening and reduce the concentration of stresses at
margins).Also slower curing rate of chemical activation
allows a larger portion of shrinkage to be compensated by
internal flow among the developing polymer chains before
formation of extensive cross linking
• But for the light cured resins two approaches:
By altering the chemistry and/or composition of resin
system which is more desirable and intensive research
efforts are currently going to develop resins with low
shrinkage and low TE
Clinical techniques designed to offset the effects of
polymerization shrinkage:
Incremental build up and Cavity configuration: attempts to
reduce the so called C-Factor which is related to cavity
preparation geometry and is represented by ratio of bonded
to non bonded surface areas.
Residual polymerization stress increases directly with this
ratio.During curing shrinkage leaves bonded cavity surfaces
in a state of stress and nonbonded free surfaces(ie those that
reproduce the original external tooth anatomy) relax some
of the stress by contracting inward toward the bulk of
material
A layering technique in which the restoration is built up in
increments curing one layer at a time effectively reduces
polymerization stress by minimizing the C-factor ie thinner
layers reduce bonded surface area and maximize nonbonded
surface area thus minimizing the associated C-factor
Thus incremental build up overcomes both limited depth
of cure and residual stress concentration but adds to time
and difficulty of placing a restoration
Soft Start,Ramped curing and Delayed Curing:
Another approach is an initial low rate of polymerization
thereby extending the time available for stress relaxation
before reaching the gel point which is accomplished by a
soft start technique in which curing begins with low
intensity and finishes with a high intensity allowing high
initial level of stress relaxation during early stages and it
ends at max intensity once gel point has reached
This drives the curing reaction to the highest possible
conversion only after much of the stress has been relieved
Variations in this technique include ramping and delayed
curing
o Ramping means the intensity is gradually increased or
ramped up during exposure.This ramping consists of either
stepwise,linear or exponential modes.
o Delayed curing means restoration is initially incompletely
cured at low intensity and then the clinician sculpts and
contours the resin to correct occlusion and later applies a
second exposure for the final cure , the delay allowing
substantial stress relaxation to take place.The longer the
time available for relaxation lower the residual stress
In addition to the normal QTH lamps other types with high
intensity curing rate have been introduced with an intention
to decrease the curing time :
PAC lamps : uses a xenon gas that is ionized to produce a
plasma.The high intensity white light is filtered to remove
heat and to allow the blue light to be emitted
Argon laser lamps : Have highest intensity and emit at a
single wavelength. Lamps currently available emit light 490
nm
Curing depths equivalent to that of a 500 mW/cm2 QTH
lamp(2mm at 40 sec) have been demonstrated using an
exposure time of 10 sec with PAC lamps and 5 sec with
argon laser lamps
PROPERTIES OF COMPOSITES
• PHYSICAL PROPERTIES
• THERMAL PROPERTIES
• MECHANICAL PROPERTIES
• CLINICAL PROPERTIES’
PHYSICAL PROPERTIES
Working and Setting time :
• For light cured composites initiation of polymerization is
related specifically to application of light beam to material
• About 75% of polymerization occurs during the first 10
mins while the curing reaction continues for a period of 24
hours.Remaining 25% of available carbon double bonds
remain unreacted in the bulk
• If surface is not protected from air by transparent
matrix,polymerization is inhibited
• Although restorations can be finished and are functional
after 10 mins but optimum properties achieved 24 hours
after reaction is initiated
• Within 60-90secs after exposure to ambient light the surface
looses its capability to flow readily against tooth structure
POLYMERIZATION SHRINKAGE
5
50% Filler
25% Bis-GMA
65% 25% TEGDMA
4
SHRINKAGE (%)
Conversion
Porosity Formation
2 15-25% = (Internal Contraction)
Gellation
Bond Stretching
(External Contraction)
1
Flow
0
0 25 50 75 100
CONVERSION (%)
Polymerization Shrinkage :
• Composites shrink during hardening referred to as
polymerization shrinkage
• It produces internal stresses and causes pulling away of the
material from the cavity walls
• Most composites only can be practically cured to levels of
55-60% degree of conversion of reactive monomer sites
• In early stages,there are limited no of polymer chains and
they are not well connected but with 20% conversion
polymer network is sufficient to create a gel where the
system changes from behaving like a liquid that can flow to
a solid that has increasingly stronger mechanical properties
• So during the first 20% the shrinkage is accommodated by
fluid changes in dimension of system
• But after the gel pointshrinkage produces both internal
stresses within the network and stress along all the surfaces
of system
• Bounded surfaces of enamel and dentin may undergo some
local stress which could reduce the strength of the recently
forming bonding layer.Unbounded surfaces will
distort,when possible,to accommodate the stresses
• In early 80s when composites were less highly filled and
bonding systems were not as reliable or strong it was
possible that shrinkage stresses form composite curing
actually dislocated the newly bonded surfaces and created
marginal openings
• The consequences of this process were first analyzed by
Feilzer and others and described in terms of the ration
(Configuration factor or C-factor)
• C-factor:
It is the ratio of bonded surfaces to the unbonded surfaces in
the tooth preparation
It ranges typically for dental restorations form 0.1 – 5.0 with
higher values >1.5 indicating more likelihood of high
interfacial stresses.
Light cured composites develop higher stress than auto
cured analogues further high with higher energy curing light
Newer dentin bonding systems are designed thicker gto be
stress relieving so typical wall stresses on during curing
may actually be only 1-2 Mpa within acceptable range
Stresses both within cured composite and along walls
appear to be relived in few hours accelerated by water
absorption
Recently strong interest in oxirane & oxitane chemistry as a
method of designing controlled shrinkage composites
THERMAL PROPERTIES
Linear coefficient of thermal expansion :
• It is rate of dimensional change of material per unit change
in temperature
• The closer the LCTE of material to the LCTE of enamel,the
less chance there is for creating voids or opening at the
junction of the material and tooth
• LCTE of Tooth structure is ppm / oC
Unfilled resin is 72 ppm / oC
Composites 28-45 ppm / oC
• LCTE of composite is approx. 3 times that of tooth structure
• During extreme intraoral temperature changes and times
significant stresses are generated at the tooth restoration
interface where the composites are micromechanically
bonded
• If the interfacial bond fails microleakage may
produce unesthetic staining, pulpal sensitivity due to
dentinal fluid flow, pulpal irritation due to diffusion
of bacterial endotoxins and predisposition towards
recurrent caries
• Intraoral temperature changes of 20 to 30 oC that
involve only 20-30 secs may be insufficient to
produce significant temperature change in either
tooth structure or composites
• The more is the resin matrix higher is LCTE
Water sorption :
• It is the amount of water that a material absorbs over time
per unit surface area or volume
• Water absorption swells the polymer portion of the
composite and chemically degrades matrix into monomer or
other derivatives
• Materials with higher filler content exhibit lower water
sorption value.Those with fine particles have greater value
than those with microfine particles
Water solubility :
• It is loss of weight per unit surface area or volume due to
dissolution or disintegration of material in oral fluids over
time at a give temperature
• The value varies from 0.01-0.06mg/cm2
• Inadequately polymerized resin has greater solubility
manifested clinically by color instability.
MECHANICAL PROPERTIES
Strength :
• Compressive strength and tensile strength of composite is
higher than silicate and ASPA
• The flexural strength of various composites are similar
Modulus of elasticity :
• It is the stiffness of the material.A material having a higher
modulus is rigid conversely that having lower value is more
flexible.
• The microfill composite with greater flexibility may
perform better in Cl V restoration than a more rigid hybrid
• Particularly true fo Cl V restorations with heavy occlusal
forces where stresses concentration exists in cervical area
Bond strength :
• The bond strength of composites to etched enamel
and dentin is typically between 20 and 30 Mpa
• Composites can be bonded to existing composite
restoration, ceramics and alloys when the surface is
roughened and primed appropriately
• Bond strength to treated surfaces are typically
greater than 20 Mpa
CLINICAL PROPERTIES
Degree of conversion :
• It is the measure of the percentage of consumed carbon
carbon double bonds
• It is related to both the intensity of light and duration of
exposure
• It decreases considerably with depth into a composite
material
• Most composites can practically be cured only to level of
55-65 %
• The vast majority of current composite employ
camphoroquinone as a photoinitiatior and it absorbs photons
of light energy predominantly at 474 nm
• Most light curing requires min of 20 secs for adequate
curing and for complete curing post curing of 20-60 secs
CHEMICAL PROPERTIES
Curing Light
3. DEPTH-OF-CURE
0 mm
1 Z100
2
65% 3
4
45%
2. SHAPE-
25% OF-CURE
1. DEGREE-OF-
CONVERSION
FACTORS AFFECTING CURE
Equipment + Procedural + Restorative Factors
Clean Reflector
Check Bulb
and Reflector
Wear resistance :
• It refers to material’s ability to resist the surface loss as a
result of abrasive contact with opposing tooth
structure,restorative materials,food bolus or tooth picks
• The wear of composite is affected by :
Filler particle size,shape and content
Location of restoration in dental arch
Occlusal contact relationship
• Types of wear
Wear by food (Contact free area wear /CFA)
Impact by tooth contact in centric(Occlusal cont. area wear)
Sliding by tooth contact in function(Funct. cont. area wear)
Rubbing by tooth contact interproximally
Wear from tooth brush or dentifrices
COMPOSITE WEAR
5 Wear Types:
CFA = food bolus wear
OCA = impact wear
FCA = sliding wear
PCA = sliding wear
TBA = abrasive wear
1st Premolars
30%
40% 2nd Premolars
100%
FOOD BOLUS 1st Molars
300 R2 = 0.99
MACRO
PROTECTION
LATE
ENAMEL
WEAR
200
MIDDLE
WEAR
100
MICRO
PROTECTION EARLY
WEAR
1 2 5 10 20
TIME (years)
SC Bayne
Surface texture :
• Restoration close to the gingival tissues requires surface
smoothness for optimum gingival health
• Size and composition of filler particles determines the
smoothness of restoration
• Midifill composites with larger particles show more surface
roughness than microfill having smaller filer size particles
Radio opacity :
• Aesthetic restorative materials should be sufficiently
radiopaque so that the radiolucent margin of recurrent caries
around or under the restoration can be more easily detected
• Most composites contain radiopaque filer such as Barium
glass to make the material radiopaque
Fluoride release :
• Conventional composites lack fluoride releasing abilities
• Fluoride releasing composites are available containing some
filler particles with releasable fluoride, long tem fluoride
release is quite low
• Incorporation of inorganic fluoride has resulted in increased
fluoride release but with creation of voids in matrix as the
organic fluoride leaches out
• Dispersion of leachable glass or soluble fluoride salts into
polymer matrix water soluble diffusion of fluorides from the
composite into local environment.Most of fluoride is during
the setting reaction with a small long term fluoride release
• Addition of organic F salts like Methacrylol fluoride –
Methyl methacrylate acrylic amine –HF salt, t- butylamine
ethyl methacrylate HF and recently terbutyl ammonium
tetrafluoroborate
CLINICAL CONSIDERATIONS
Color matching
Interfacial staining and secondary caries
Wear
Marginal integrity
Fracture
Post operative sensitivity
Color matching :
• Color matching not only depends on initial color match but
also on relative changes that occur with time.Both
restoration and tooth structure change color with age
• Assessment is made with tooth properly
hydrated.Temporarily drying the tooth structure makes it
appear lighter and whiter in color because of dehydration of
enamel
• With time chemical changes in matrix polymer makes
composite to appear more yellow which is accelerated by
exposure to UV light,oxidation,and moisture.
• Self cured ones under go more yellowing while newer
visible light cured systems containing high filler contents
and are modified with UV absorber and antioxidants
making it more resistant to color change
• However tooth structure undergoes a change in its
appearance over time because of dentin darkening from
aging.Aged tooth appears opaque and darker yellow.Dentin
is more likely to change color more rapidly most rapidly
during middle age (35 to 60 years)
• Bleaching which is very popular complicates the process of
trying to establish and maintain good color match of an
anterior restoration .If bleaching occurs as a treatment of
fixed duration restorative procedures should be postponed
until after teeth have assumed a stable lighter shade
(probably after 2 weeks).Bonding done 48 hrs after bleach
• Also gradual transition in color and translucency between
restoration and tooth structure.This goal is accomplished by
beveling the enamel, which blends the color difference
associated with margin over approx 0.5-1mm rather than
making it abrupt
Interfacial staining and secondary caries :
• Marginal leakage leads to accumulation of subsurface
interfacial staining that is difficult to remove and creates a
marked boundary for the restorative appearance
• Proper beveling and etching of enamel results in good
resistance to interfacial staining.
• As long as margins are well bonded and no marginal
fractures occurs resistance to secondary caries should be
good
• Most secondary caries occurs along proximal or cervical
margins where enamel is thin, less well oriented for
bonding, difficult to access during the restorative procedure
and potential subject to flexural stress as well.Rarely
secondary caries are evident along margins on occlusal
surfaces or non cervical aspects of other surfaces
Wear :
• The principal concern for posterior composites is that
occlusal wear could occur at a high rate and continue over
long periods of time, exposing underlying dentin and
leading secondary caries or sensitivity
• Evidence of composites actually wearing to point of
exposing underlying dentin is only minimal and after many
years of service worn restorations can be repaired simply by
rebonding a new surface onto the old composite to replace a
worn or discolored surface
Marginal integrity :
• It is very good under most circumstances.Clinical
appearance is affected by the nature of margin.Butt joint
margins emphasize composite wear more than beveled
margins.
• Butt joint margins of well bonded margins of well bonded
restorations wear more slowly and create meniscus
appearance against the enamel
• However as beveled margins wear thinner edges of material
are produced that are more prone to fracture
Fracture :
• Bulk fracture of posterior is rare
• Microfill composites are more prone to fracture at occlusal
contact areas
Post operative sensitivity :
• Causes of post operative sensitivity are :
Operative trauma:Deep cavity preparation with excessive
dry cutting at ultra high speed
Previous insults:Cumulative effects of repeated episodes of
pulpal irritation may often results in chronic to sub acute
pulpal inflammation and final necrosis
Undercure: of either composite material or protective base
may result in skin effect a hard fully cured outer layer and a
relatively soft under cured inner layer
Hyper occlusion :If a high spot is left on composite
restoration the tooth will become hypersensitive within a
few days
Polymerization contraction : May place the cusps under
tension thereby disturbing fluid balance in dentinal
tubules.Same shrinkage may draw the base away form the
dentinal interface thus resulting in a contraction
gap,microleakage and subsequent bacterial invasion causing
post operative pain and sensitivity
Indications of composites
Aesthetic restorations of Class I,II,III,IV,V,VI cavities
Foundation or core build ups
Sealants and conservative composite restorations
Aesthetic enhancement procedures
Partial veneers
Full veneers
Tooth contour modifications
Diastema closure
Cement for indirect restorations temporary restorations
Periodontal splinting
Contradictions of composites
In areas of heavy occlusal stresses
Sites that cannot be isolated
In patients who are allergic or sensitive to
composite resin
Advantages of composites
• Aesthetic restoration
• Conservation of tooth structure (as less extension,uniform
depth not necessary,mechanical extension not required)
• Less complex when preparing tooth
• Insulative, low thermal conductivity
• Used almost universally
• Bonded to tooth structure resulting in good retention, low
microleakage, minimal interfacial staining and increased of
remaining tooth structure
• Repairable
Disadvantages of composites
• Gap formation occurs on root surfaces due to forces of
polymerization shrinkage of composite being greater than
initial bond strength of material to dentin
• More difficult, time consuming, costly than amalgam
• Tooth treatment usually requires multiple steps
• Insertion is more difficult
• Establishment of proximal contacts,axial
contours,embrasures,and occlusal contacts more difficult
• More technique sensitive
• Exhibits wear in areas of high occlusal stress or when all
contacts are on compostie
• High LCTE resulting in marginal percolation if improper
bonding technique is used
Extended applications for composites
• Anterior veneers
• Porcelain bonding
• Core build up
• Posterior restorations
• Orthodontics
• Pit and fissure sealants
Anterior veneers :
• Application of anterior cosmetic veneers to mask hypoplasia
or discoloration has become an integral part of dentistry
• Composites placed in a thin layer over etched enamel and
sculpted to provide enhanced tooth form or esthetics
• Lower viscosity composites for direct application against
etched enamel have been developed which is diff to control
• Those with filler content less than 20 wt% formulated with
opacifiers added iv a variety of shades to block out stained
enamel
• Tinted composites with added color modifiers are also
available in varied shades such as yellow,brown,blue,black
and pink to provide characterization for an anterior veneer
• These shade modifiers are all photoinitiated and although
they require additional exposure to light, can be cured as
they are applied to gain desired esthetic effect
• By layering these composites either under or between
applications of composites life like color characteristics can
be developed
• Labial veneers can also be made indirectly on a model with
newer materials in which the degree of polymerization can
be increased with higher energy light sources,vaccum
chambers,and applied heat.Then the prefabricated veneer is
luted to the etched enamel surface with a lower viscosity
composite cement.
• Weakest portion of the bonded interface is the bond
between the precured composite veneer and freshly applied
composite cement which may leak and require repair
Porcelain bonding :
• Porcelain bonding systems have been developed to lute
indirect anterior veneers to etched enamel and also to place
a composite restoration that replaces fractured porcelain
• When broken porcelain is being repaired the interface must
be roughened to increase surface texture and to create some
mechanical locking
• These lasted for short periods frequently as they were
generally in full incisal function and those with least use
had best prognosis
• Porcelain veneers can be bonded to enamel with similar
techniques and a low viscosity composite cement which is
more successful as a larger surface area of porcelain is
available and is generally roughened by a HF treatment
during fabrication
Core build ups :
• Modifications have been made to alter the viscosity and the
setting time of highly filled composites to formulate core
materials that will closely adapt to pins and posts
• They are usually chemically initiated so that they can be
inserted with a syringe enclosed in a metal or celluloid
crown form or matrix and cured in bulk.This is why these
materials have slightly prolonged working time
(approaching 2 mins) and a relatively quick snap set
• Since they are highly filled composites they provide
optimum resistance to deflection forces and shear stresses
• Also highly colored or opaque materials so that there will be
a visible interface at the composite-tooth junction during
final cavity preparation
Posterior restorations :
• Indications:
Primary indication is aesthetics
Need for conservative preparations but not used for cuspal
coverage or better not to use for restorations exceeding 1/3rd
the buccolingual width of the tooth
Use of composites to decrease thermal conduction
• Many composite formulations for posterior applications like
one is microfine filler sintered into macrosized particles to
improve wear resistance while another has hydrophobic
resin matrix to reduce water sorption with the hope that
failure of silane coupling agent be reduced
• The packable/condensable composites introduced in late
1990s derive from inclusion of elongated fibrous filler
particles of about 100 um in length and/or textured surfaces
that tend to interlock and resist flow
• This causes the uncured resin to be stiff and resistant to
slumping yet moldable under force of amalgam condensing
instruments(pluggers).
• Rough surfaces and blends of fibrous and particulate filler
produce a packable consistency and enable it to be used
• At present they have not yet proven to be an answer to the
general need for highly wear resistant,easily placeable
posterior resins with low curing shrinkage and a depth of
cure greater than 2mm
• It is still uncertain in dental profession whether a 250 um
loss of substance truly represents a clinically acceptable
restoration that adequately supports occlusal function.Also
the wear being greatest in occlusal functional contact
• Limited to Cl-I,II in premolars with minimal B-L extension
• Indirect posterior composites:
Indirect composites for fabrication of onlays are
polymerized outside the oral cavity and luted to the tooth
with a compatible resin cement which has been said to
reduce the wear and leakage and overcome some limitations
of resin composites
Several different approaches for resin inlay construction:
o Use of both direct and indirect fabrication methods
o Application of light,heat,pressure,or a combination of these
o Combined use of hybrid and microfilled composites
Fabrication process for direct composite inlays requires
application of a separating medium to the
tooth(glycerin,agar sol) resin pattern is then formed,light
cured and then removed.Rough inlay then exposed to light
for more 4 to 6 mins or heat activated at 100oC for 7 mins
after which the preparation is etched and the inlay is
cemented in to place with a dual cure resin and then
polished
Composite systems are also available as indirect
products.Indirect inlay resins require an impression and
fabrication of inlay in lab,in addition to conventional light
and heat curing,lab processing may employ heat 140oC and
pressure 0.6Mpa ofr 10 mins.The potential advantage of
these materials is somewhat higher degree of
polymerization is achieved improving physical properties
and wear resistance
Polymerization shrinkage does not occur in prepared teeth
and so induced stresses and bond failures are reduced which
reduces the potential for leakage.Also repairable in mouth
and not abrasive to opposing tooth structure like ceramics
Orthodontics :
• Lower viscosity filled composites are also being used for
the cementation of orthodontic brackets to the facial
surfaces of both anterior and posterior teeth.
• Enamel is acid etched in the usual manner and each bracket
is applied directly to the surface in the desired position
• High modulus fine composites resist stress better than
unfilled or microfine composites so most orthodontic
composites are fine particle or hybrid composites
Pit and fissure sealants :
• Pit and fissure sealants were first proposed in 1960s which
prevent tooth preparation and restoration techniques fro the
elimination of caries prone pits and fissures on occlusal
surfaces of teeth
• Pits and fissures that are not self cleansing are caries prone
• The objectives of these materials is to eliminate the
geometry that harbors bacteria and to prevent nutrients
reaching bacteria in base of pit and fissure
• Since they have modest wear resistance,contact area wear
and food abrasion may quickly wear it away from naturally
self cleansing areas where it is not needed although key
areas remain occluded
• The principal feature of sealant is adequate retention
• Sealant is applied only after gross debridement isolation and
acid etching of surfaces.And can’t be applied so precisely
that there is no excess extending onto self cleansing areas of
occlusal surfaces.
• So it is important the material is adjusted as needed
following placement so that it does not interfere with
normal occlusal contacts or disrupt occlusal paths,once
removed from self cleansing areas rest blocks the non
cleansing area
• Classification and History:
They can be self curing and visible light curing
Early ones were based on methyl methacrylates or
cyanoacrylates
Most contemporary are unfilled or lightly filled and based
on difunctional monomers such as used for matrix of
composites
Principal monomer of this system BIS-GMA is diluted with
lower mol wt species like TEGDMA to reduce the viscosity
with addition of colorants such as titanium dioxide
• Composition,Structure and properties :
Primary clinical property is flow into small access
spaces:Penetration coefficient that is relative rate of flow in
a standard sized orifice.Penetration is a function of capillary
action and viscosity.
If a site is well cleaned,etched,rinsed and dried than acrylic
monomer can wet the surface reasonable well even if the
opening is small it will draw the material by capillary action
if the viscosity is low long enough.
Complete penetration is not absolutely critical only if the
neck region is occluded it is clinically acceptable
Glass ionomers were explored for pit and fissure
applications but lacked sufficient abrasion resistance ,were
brittle and prone to fracture
Traditional composites are not good sealants as they do not
penetrate into pits and fissures readily due to high viscosity
but instead useful in treating such caries
Newer low viscosity versions composites,flowables have
been used for this purpose had good wetting,sufficient
flow,adequate abrasion resistance,god fracture resistance.
Properties are like the resin matrix of composites.No
evidence that water sorption,chemical degradation,or other
events observed with composites detract from longevity of
these materials
However one controversy of BIS-GMA degrading into BPA
which was found to be estrogenic although many flaws in
the report as misidentification of TEGDMA as BPA
Also measured levels of monomer released from sealents
was unusually high but it was not noted that air inhibited
superficial layer of resin had not been removed by wiping
with cotton roll before sampling which is generally wiped
away or lost during the first few chewing strokes and this is
not the actual cured sealant material
• Clinical considerations:
Prevention of occlusal caries at defects depends simply on
exclusion of bacteria or their nutrients
Many say as long as pits and fissures remain completely
sealed there is 100% prevention of caries at those sites.
The ideal time to apply sealants is soon after occlusal
surfaces erupt into the oral environment but with with
partial eruption difficult to maintain isolation (cotton
rolls/absorbent wedges)
Sealants also have been applied to smooth surfaces to try to
eliminate caries but are abraded by food and/or brushes
Another important consideration is degree to which children
and adolescents are susceptible to caries.The one who are at
greater caries risk are the most benifitted.Older patients with
decreased salivary flow are also good candidates
Also used to repair or seal leaking or failing dental
restorations
It is now accepted that sealants provide outstanding service
when done properly for very low costs.In societies
committed to dental care this is a core strategy for early
management of caries
FINISHING AND POLISHING
SURFACE ROUGHNESS = Ra
Original Average up-and-down geometry =
rough
surface 20 mm 2 mm 0.2 mm
COARSE
finished FINE
finished Polished