Filled resins, or composites

Resin composites are used to:

 Replace missing tooth structure and modify
tooth color and contour, thus enhancing
facial esthetics.
COMPOSITES ARE USED TO REPLACE MISSING TOOTH
STRUCTURE
development started first with
 Silicates, followed by
 Acrylic resins, then
 Resin composites.
 Silicates were introduced in 1871 and
were prepared from :-
 - Alumina-silica glass powder and

 - Phosphoric acid liquid.

 Silicates advantage:-
It has an:-
 Esthetically pleasing appearance
 Anti cariogenic feature.
 clinical failure of silicate cement was related
to :
1- Dissolution in oral fluids
2- Loss of translucency,
3- Surface crazing, and a
4- Lack of adequate mechanical properties.
 These deficiencies caused the demise of
silicates in the 1960s
 Self-curing acrylic resins were developed
in 1941 by German chemists.
 They used tertiary amines with benzoyl
peroxide to initiate methacrylate
polymerization reactions.
 Their discoveries lead to the development
of acrylic filling materials (eg, Sevriton) in
1948.
 The major problems with these materials
were high rates of polymerization shrinkage
(about 20 to 25%), poor color stability,
limited stiffness, high thermal expansion,
and lack of adhesion to tooth structure.
 The addition of inorganic fillers to synthetic
resin created composite or filled resin.
 addition of fillers improve resin physical
properties and reduce polymerization
shrinkage
 Improved properties were obtained with
these materials when the silicate glass
particles were precoated with polymer or
primed with silane.
 These materials were difficult to handle and
were superseded by Bowen’s Bis-GMA
composites.
 The development of composites about
1960 has resulted in improving clinical
performance i.e
 Higher mechanical properties, and
higher resistance to wear,
 lower thermal coefficient of expansion,
 lower dimensional change on setting,
 Development of bonding agents for
bonding composites to tooth structure
has also improved the quality of composite
restorations.
 Composites can be described as a
dispersed (filler) phase mixed into a
continuous (matrix) phase.
 Composites are physical mixtures (or
blends) of metals, ceramics, and/or
polymers.
 The goal is to blend the properties of
the parts to obtain intermediate
properties and to take advantage of
best properties of each phase
 Bowen introduced a resin in 1962
dimethacrylate resins it is the most
popular resin used in dentistry
synthesized by the reaction
between :-
 bisphenol A and glycidyl
methacrylate referred to as Bis-
GMA.
 Bis-GMA is a relatively long and rigid
difunctional monomer that allows for a
cross-linked polymer and low shrinkage
(about 4 to 6%).
 Bis-GMA is viscous, it helps to
strengthen the resin matrix. It is
usually mixed with a resin of lower
molecular weight, such as TEGDMA
(triethylene glycol dimethacrylate),
to reduce its viscosity and enable
filler loading.
 filler loading refer to the percentage of
inorganic filler present in the cured
composite it may range from 52% by wt for a
micro filled- 88%by wt for a heavily filled
hybrid composite.
INDICATIONS
 Anterior restorations
 Posterior restorations
 preventive resin
 conservative class 1 or 2
CONTRAINDICATIONS

 Large posterior
restorations
 Bruxism
 Poor isolation
ADVANTAGES

 Esthetics
 Conservation of tooth structure
 Adhesion to tooth structure
 Low thermal conductivity
 Alternative to amalgam
DISADVANTAGES

 Technique sensitivity
 Polymerization shrinkage
 marginal leakage
 secondary caries
 postoperative sensitivity
 Decreased wear resistance
 Components of composite resin:-
1-An organic matrix
2- Inorganic filler
3-Coupling agent
4- Initiator system
5- Inhibitor
6- Pigments
 Resin matrices composed of :-
 Principal & diluent monomers.
 The principal monomers are high
molecular weight compounds that can
undergo free radical addition
polymerization to create rigid cross –
linked polymer.
 Most systems contain the high viscosity
aromatic monomer, Bis-GMA which was
synthesized by Bowen in the USA in
1960s. Or urethane dimetacrylate UDMA
 Diluents monomers are low Mwt.
Compound used to reduce viscosity of the
unpolymerised resin these are
 TEGDMA (triethylene glycol dimethacrylate),
 UDMA (urethane dimethacrylate), and
 EGDMA (ethyleneglycol dimethacrylate) are
commonly used to lower the viscosity of
composite resins.
 TEGDMA is the most common and comprises
10 to 35% of most macro filled composites and
30 to 50% of most micro filled composites.
 Inhibitors:-
 compounds such as monomethylether such as
 4-methoxyphenol and
 2,6-di-tert-butyl-4-methyl phenol or
 butylated hydroxytoluene (BHT)
 are generally added in amounts of about 0.1%.
 To prevent premature resin polymerization,
they provide shelf live and delay the
polymerization reaction thus allowing clinical
placement of composite
 Color stabilizers (ultarviolet light
absorbers)
 Chemically cured composites may
contain compounds such as
benzophenones, benzotriazoles, or
phenyl salicylate that absorb ultraviolet
(UV) light and act as color stabilizers.
thus prevent discoloration.
 These materials are not found in the UV
light-polymerized systems because they
can inhibit polymerization.
 Filler particles :-
1- reduce polymerization shrinkage,
2- decrease the coefficient of thermal
expansion, and
3- increase hardness.
 Common filler particles are
 crystalline quartz;
 pyrolytic silica (such as in Aerosil) ; and
 glasses such as lithium aluminum silicate,
barium aluminum silicate, and strontium
aluminum silicate.
 All of these materials have:-
 excellent hardness,
 chemical inertness, and
 a refractive index similar to that of commonly
used resin matrices.
 Opacity is controlled by adding titanium
dioxide pigments, and color is achieved by
adding metal oxides of iron, copper,
magnesium, and others.
 Unfortunately, many of these radiopaque
glasses are susceptible to erosion
Filler size and loading association with composite
resin performance:
(1) the ability to polish increases as filler particle size
decreases,
(2) wear resistance improves as filler particle size
decreases, and
(3) fracture durability generally increases as the
percent of inorganic filler loading by volume
increases.
(4) Fracture resistance increases as the interparticle
distance decreases because less distance reduces the
load-bearing stress on the resin and inhibits crack
formation and propagation.
FILLER PARTICLES
 Crystalline quartz
 larger particles

 not polishable
 Silica glass
 barium strontium
 lithium

 pyrolytic
 sub-micron
 Composites with smaller particles and
higher filler loading (less interparticle
distance) are more resistant to cracks.
 In addition, particles with smooth and
rounded edges distribute stress more
evenly throughout a resin and perform
with fewer cracks.
 Similarly, there is a direct linear relation
between the stiffness of a composite
(Young’s modulus) and the volume of
filler used
 Coupling agents are used to help bond resin
matrix and filler particles together; they are
also sometimes called adhesives.
 Coupling agents reduce the gradual loss of
filler particles from the composite surface.
 Commonly used coupling agents are
metacryloxypropyltrimethoxy silanes.
 silanes are difunctional molecules that, can
ionically bond to the inorganic filler particles
and simultaneously chemically bond to the
organic matrix .
 Chemical bond
 filler particle - resin matrix
 transfers stresses
 Organosilane (bifunctional molecule)
 siloxane end bonds to hydroxyl groups on filler
 methacrylate end polymerizes with resin
CH2 OH
Bis-GMA CH3-C-C-O-CH2-CH2-CH2-Si-OH
Bonds with resin Bonds with filler
O OH
Silane
 INITIATORS OF POLYMERIZATION
 Initiation systems start the polymerization
process through the formation of a free
radical,a compound with a reactive
unpaired electron.
 When a free radical collides with a carbon
double bond (C=C) in the resin monomer,
the free radical pairs with one of the
electrons of the double bond, converting
the other member of the pair to a free
radical, and thus the reaction continues
 Generation of free radicals is brought
about by
 In chemically activated systems, a
tertiary amine (that acts as an electron
donor) is used to split the benzoyl
peroxide into free radicals.
 In UV light-activated systems, a 365-
nanometer (nm) UV light source splits
benzoin methyl ether (in amounts of
0.2%) into free radicals without the
presence of tertiary amines.
 In visible light-cured systems, a light source
of 468 nm (±20) excites camphoroquinone
(0.03 to 0.09%) or another diketone into a
triplet state that interacts with a nonaromatic
(referred to as aliphatic) tertiary amine,.
 The camphoroquinone together with the
tertiary amine starts a free radical reaction.
Chemical Reactions that Produce Free Radicals*
iInitiator chemical reaction
Heat Benzoyl peroxide + heat = free radical
Chemical Benzoyl peroxide + 2% aromatic tertiary
amine = free radical
UV light 0.1% benzoin methyl ether + 365-nm
UV light source = free radical
Visible light 0.06% camphoroquinone + 0.1%
aromatic or 0.04% aliphatic tertiary amine +
468-nm (±20) visible light source = free
radical
 *Once free radicals are formed, polymerization begins.
CURING SYSTEMS
 1- Autocured systems ie, chemically
activated) systems,
 usually consisting of two pastes
 disadvantages include:
(1) a long setting time,
(2) voids in the final restorative (voids caused
by mixing typically account for 3 to 10% of the
volume, inhibiting polymerization and
increasing surface roughness), and
(3) a higher probability of long term
discoloration after placement
 2- Ultraviolet light-activated systems
 introduced in 1970, used UV light, which
presented the advantages of rapid cure;
indefinite working time, because no setting
occurs until the light source is applied; and
less composite waste.
 The disadvantages include:
(1) depth of light penetration is 1 to 2 mm at
best,
(2) maintaining the light at 100% efficiency is
difficult,
(3) UV radiation can cause corneal burns.

Visible light-activated systems
3-

 uses a diketone, most commonly,

camphoroquinone. When this photoinitiator

absorbs blue light, the molecule forms a free
radical and starts the polymerization process.
 advantages includes:

(1) materials can be manipulated longer and

still have a shorter curing time (20–40 seconds
or less vs. minutes for autocured composites),
(2) earlier finishing, and
(3) better color stability.
 Other advantages include

 no lamp warm-up time;

 less chance of voids and air bubble
incorporation;
 less waste of materials;
 and use of halogen bulbs, which maintain
constant blue light efficiency
 disadvantages of visible light-activated
composites include:
 (1) possible eye damage (retinal burns with
visible light systems),
 (2) a maximum depth of light penetration
of about 3 mm,
 (3) heat generation that could harm the
pulp, and
 (4) the high purchase and maintenance
costs of curing lights.
 4- Dual cure:
 Start with light activation and continue
chemically.
 To be continue…………………
 FACTORS THAT AFFECT LIGHT-CURING OF
COMPOSITE
 Are:-
1- Time,
2- Intensity,
3- Temperature,
4- Light distance,
5- Resin thickness,
6- Air inhibition,
7- Tooth structure,
8- Composite shade,
9- Filler type,
10- Accelerator quantity,
11- Heat, and room light.
 Exposure:-
 Light-cured composites polymerize both
during and after visible light-activation.
 These two curing reactions are known as the
“light” and “dark” reactions.
 The light reaction occurs while light from the
curing unit penetrates the composite.
 The dark reaction, also called post-irradiation
polymerization, begins immediately after the
curing light goes off and continues for up to 24
hours, even in total darkness, but most of it
occurs within 10 to 15 minutes post cure
 .
 The minimum curing time for a light
reaction for most composites under a
continuous curing mode is 20 to 40 second
 In all composites, maximum hardness is
achieved within about 24 hours
 the dark reaction takes time and greatly
contributes to the overall strength of the
material.
 Generally, waiting 10 to 15 minutes after
curing before finishing a composite
improves 1- the hardness by 20 to 30%.
2- wear properties significantly, because
the finishing process damages the margins
of a restoration.
 The ideal distance of the light source from
the composite is 1 mm, with the light
source positioned 90 degrees from the
composite surface.
 Resin thickness greatly affects resin
curing. Optimum polymerization occurs
at depths of just 0.5 to 1.0 mm, owing to
the inhibition of air at the surface and the
difficulty with which light penetrates a
resin.
 The working time of light-cured
composites depends on the
operatory light and the ambient
room light to which the
composites are exposed.
 Differences in these light sources
can dramatically affect working
time.
 Working time can be improved in two
ways:
 1. Place the operatory light further from
the working field. Generally, doubling the
distance of the operatory light from the
patient greatly increases the working time
while still providing adequate light for
composite placement.
 2. Place an orange filter over the operatory
light.
 Effects of oxygen incorporation
 Polymerization is retarded in the
presence of Oxygen, When resins come in
contact with air it develop an un
polymerised surface layer as the result of
diffusion of atmospheric oxygen into the
liquid resin. The undercured layer can
vary from 50 to 500 µm (or more),
depending on the reactivity of the
photointiators used. air inhibited layer is
thin in VLC.
 The extent of surface inhibition is inversely
related to filler loading.
 Darker composite shades cure more slowly
and less deeply than lighter shades
 Air inhibition reduces compressive
strength by 30% in a macrofill and by 35% in
a microfill.
 It also reduces fatigue strength by 20%
 Resin bonding agents:-
 Unfilled resin-bonding agents have a
chemistry similar to the composite
produced by the same manufacturer.
 They diluted by additional monomers to
provide lower viscosity so that they will
readily wet the surface of acid etched
enamel or glass-ionomer cement to
improving adhesion.
 Intrinsic stains
 The aromatic tertiary amines are reactive
compounds, and the oxidation of excess amine in
a cured polymer cause intrinsic discoloration.
 These amines are commonly used in large
amounts in autocured systems, and in small
amounts in some light-activated systems.
 The color stability of light-cured composites is
further improved by the use of aliphatic amines.
These amines are nonaromatic and, therefore,
considerably less reactive; they result in less
intrinsic discoloration
 Extrinsic stains
 External discoloration is usually superficial and
is associated with restoration roughness.
However, water-soluble stains can discolor
composite throughout a resin matrix.
 Heat generation
 less heat is generated by autocured systems
than by light-cured systems.
 The type of light source also influences heat
generation in light cured systems.
 Heat adds kinetic energy to a curing system and
increases conversion.
CLASSIFICATION SYSTEM
(LUTZ& PHILLIPS)

 Based on particle size

 Traditional
 microfilled
 small particle
 Hybrid
 TRADITIONAL (MACROFILLED)
 Developed in the 1970s
 Crystalline quartz
 produced by grinding or milling
 large - 8 to 12 microns
 Difficult to polish
 large particles prone to pluck
 Poor wear resistance
 Fracture resistant
 Examples: Adaptic, Concise
 Suitable for Class 3, 4, and 5
 MICROFILLS
 Better esthetics and polishability
 Tiny particles
 0.04 micron colloidal silica Ground polymer
with colloidal

 increases viscosity silica (50 u)

 To increase filler loading Polymer

matrix with
 filler added to resin colloidal silica

 heat cured
 ground to large particles
 remixed with more resin and filler
 MICROFILLS
 Lower filler content
 inferior properties
 increased fracture potential
 lacks coupling agent
 lacks radiopacity
 Linear clinical wear pattern
 Suitable for Class 3, 5
 exceptions with reinforced microfills
 Class 1 or 2
 SMALL PARTICLE
 1–5 micron heavy-metal Silane-coated
silica
Silane-coated
or glass

glasses
silica(1-5
or glass
u)
(1-5 u)

 Fracture resistant Polymer

matrix
Polymer
matrix

 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
 maximizes filler loading
 microfills added Polymer
 improve handling matrix with
colloidal
silica
 reduce stickiness

Phillip’s Science of Dental Materials 2003

 HYBRIDS
 Strong
 Good esthetics
 polishable
 Suitable
 Class 1 to 5
 Multiple available

Click here for table of hybrids

 NEWER CLASSIFICATION SYSTEM

 Based on particle size  Most new systems

 megafill  minifillers
 0.5–2 millimeters
 macrofill  Newest trend
 10–100 microns  nanofillers
 midifill
 1–10 microns
 trimodal loading
 minifill  prepolymerized
 0.1–1 microns
 microfill
 0.01–0.1 microns
 nanofill
 0.005–0.01 microns

Bayne, JADA 1994

 PERFORMANCE FACTORS

 Material factors
 biocompatibility
 polymerization shrinkage
 wear resistance
 polish mechanisms
 placement types
 mechanical & physical properties
 BIOCOMPATIBILITY
 Tolerated by pulp
 with good seal
 Rare allergic reactions
 HEMA
 Cytotoxicity
 short lived
 not a chronic source
 Degree of cure important
 decrease free monomer

Phillip’s Science of Dental Materials 2003

 Shrinkage
 2–7%
 marginal gap
formation
 POLYMERIZATION SHRINKAGE

 Significant role in restoration failure

 gap formation
 secondary caries formation
 marginal leakage
 post-operative sensitivity
 Counteract
 lower shrinkage composites
 incremental placement
 COMPOSITE VARIANTS
 Packable
 Flowable
 PACKABLE COMPOSITES
 Marketed for posterior use
 increase in viscosity
 better proximal contacts?
 handle like amalgam?
- alteration of filler in
 shape
 size
 particle distribution
 Similar resin chemistry and filler volume
Click here for table of packable composit
PACKABLE VS. HYBRID COMPOSITES

 Mechanical properties similar

 Wear properties similar
 Curing depths similar
 proximal contacts similar
 denser feel

Click here for more details

Choi, J Esthet Dent 2000
Peumans, Dent Mater 2001
 FLOWABLE COMPOSITES

 Marketed
Percent Filler Loading
 class 1, 3, 5
80
 liner Aeliteflo

Weight Percent
70
 Particle size similar 60
50
FloRestore

to hybrid 40 Revolution
30
composites 20
+Ultraseal
10 Prodigy
 Reduced filler 0
content
 reduces viscosity
Bayne, JADA 1998
Click here for abstract
 FLOWABLE COMPOSITES
 Clinical applications
 preventive resin restorations
 small Class 5
 provisional repair
 composite repair
 liners??
 There are several factors that must be
evaluated before purchasing a visible
lightcuring unit:
1. Power density
2. Maximum diameter of curing tip
3. Uniformity of power over the diameter of
the curing tip
4. Longevity of adequate light spectrum
once the unit is turned on
5. Heat generation within the tooth
6. Ease of use of controls and timer
7. Durability of curing tips to sterilization
8. Dependability of unit
9. Size and portability of unit
10. Voltage regulation
11. Price:performance ratio
EXAMPLES OF THE LARGE SELECTION OF LIGHT GUIDES
AVAILABLE FROM DEMETRON
Thank You