DIRECT RESIN

RESTORATION

Dr. Mwikali Omenge

 content
 Components of composite
 Types and properties
 Fundamentals and direct technique
of composite resin restoration
 Longevity of composite restorations
 DEF
 Is a physical mixture of materials where
part of the mixture are chosen with the
purpose of averaging the properties of the
parts to achieve intermediate properties
 a single material may not have the the
appropriate properties for a specific dental
application

 Consists of a dispersed phase of filler

particles distributed in a continuous phase
of matrix
 Composition
 Components include:
① Resin matrix
② Fillers
③ Coupling agent/ organosilane
④ Coloring agent
⑤ Inhibitors
⑥ Activator-initiator system
 1. RESIN MATRIX
 The earliest resin was Bisphenol
glycidyl methacrylate (BISGMA) with
two phenol groups to provide rigidity
to the molecule and two hydroxyl
groups to provide intermolecular
bonding
 BISGMA - very viscous so other
molecules were developed
 Newer molecules included: UDMA
and TEGDMA
 CONT…
 Mixture of 2 of three resins provide viscosity
needed to binding of filler particles mostly
BISGMA: TEGDMA IN 3:1 ratio. Higher ratios of
TEGDMA increases polymerization shrinkage

 New developments:
 Matrix containing antibacterial agent Hydrophobic
monomer containing fluorinated dimethacrylate
having water sorption f 10% that of BISGMA
 Memory polymer which expands and shrinks
according to that of the tooth
 2. FILLERS
Role of fillers
1. Reduces CTE
2. Reduces polymerization shrinkage
3. Increases abrasion resistance
4. Decreases water sorption
5. Increases tensile and compressive strength
6. Increases fracture toughness
7. Increases flexure modulus
8. Provides radiopacity
9. Improves handling properties
10. Increases translucency
 Commonly used fillers
1. quartz:
 chemically made and extremely hard,
making it difficult to grind to fine particles
 Used in early composites, were difficult to
polish and also abraded opposing tooth
2. silica: used as pure silica, fused silica or
colloid silica: eg. silicon dioxide, boron
silicates and lithium aluminum silicates.
 Silica reinforces the composite and also
helps in light scattering and light
transmission
 Cont… fillers
 In some composites, quartz is partly
replaced with heavy metal particles
like zinc, aluminium, barium,
strontium, or zirconium.
 Form materials that are less hard
and so less wear on opposite tooth
 Recently, use of nanoparticles
(25nm) and nanoaggretates (75nm)
for a stronger material with better
polishability
 3. COUPLING AGENT
① Bond filler particles to the resin
matrix
② Allow more flexible polymer matrix
to transfer stresses to stiffer filler
particles
③ Provides hydrolytic stability by
preventing the water from
penetrating along the filler resin
interface
 Cont… coupling agents
 y-methacryloxypropyltrinethoxy
silane
 10 methacryloxydecyl triehoxysilane
(better suited as silane agent)
 COLORING AGENTS
 Aluminium oxide and titanium
dioxide
 Shade ranges from yellow to gray
 Different shades have different depth
of cure with light. Darker shades
and opaque should be applied
thinner and cured longer
 UV absorbers
 Is like the sunscreen of composite
 Aids in preventing discoloration
 Most commonly used is
benzophenone
 Initiator agents
 They activate the polymerization of
composites
 Commonly used photoinitiator is
camphoroquinone
 Inhibitors
 They inhibit the free radical
generated by spontaneous
polymerization of the monmers
 Eg. Butylated hydroxyl toluene
(0.01%)
 Chemical cure composite
 An initiator benzoyl peroxide and
accelerator – tertiary amine such as
dimethyl-p-toluine is added to
monomer
 Due to degradation of amines these
composites show discoloration over
time. To improve on this, more
stable activators like p-toluidine
sulifinic acid is used
 Chemical cure
 Use benzoin methyl ether (uv
activated) and camphoro-quinone
(visible light activated) as initiators

 Dimethyl amino ethyl methacrylate

as activator

 Uv light activated hardly used

currently
 composite system
 The putty composite for light curing system or
the two paste system for chemical cure
composite
 Bonding system:
• unfilled acrylic monomer mixture that is similar to
matrix of composite
• Placed on to etched tooth surface to form 1-5um
film
• Mechanically interlocks with the etched surface to
seal the walls of prepared surface
• Co-polymerizes with the composite restorative
material
HISTORICAL DEVELOPMENT
1901: synthesis and polymerization
of methyl methacrylate
1930: use of PMMA as denture base
material
1944: first acrylic filling material
1951: acid etch technique
introduced by Buonocore
1956: Bowen investigated Bis-GMA
and silanized inorganic fillers
Cont… historical development
1962: Introduction of silane coupling
agent
1964: Marketing of Bis-GMA
composites
1968: Development of polymeric
coating on fillers
1973: UV cured dimethacrylate resins
1976: Introdn of microfilled
composites
1977: visible light cured
dimethacrylate resins
 Cont…
1996: Devnt of flowable composites
1997: devnt of packable composites
1998: devment of fiber reinforced ion
releasing composites and
ormocers
 Current composites
 Filler particle of silica coated with mono-
molecular film of silane coupling agent
whose one end is capable of bonding to
hydroxyl groups on the silica surface; and
the other end capable of copolymerizing
with double bonds of monomers in the
matrix phase

 For this reason, all composites are based

on silica containing fillers
 CLASSIFICATION
Basis:
1 Components, amounts and
properties of filler particles
2 Handling properties

3 Basis of matrix composition (BIS-

GMA or UDMA)
4 Polymerization method
Clasification by size of particles
 Conventional/ macrofilled
 Microfill:
 Hybrids: mixed range of particle size
where the largest particle size range
is used to define the hybrid type eg
minifill hybrid
 CONVENTIONAL
COMPOSITES
 75-80% inorganic filler by weight
 5-25um particle size
 Because of this they exhibit a rough
surface texture
 Easily accumulate plaque;
 Discoloration and wearing of occlusal
contacts
 Were the first to be developed in the
1980s
 MICROFILL:
 Produces a smooth lustrous finish
similar to that of enamel
 Silica particles of 0.04um-0.1um
diameter
 Inorganic filler content of 35%-60%
 Inferior physical and mechanical
properties compared to conventional
 Low modulus of elasticity hence good
for class V restorations
 Good translucency and low fracture
toughness
 HYBRID
 Made of glasses of different
compositions and sizes with particle
size diameter of <2um and up to
4um
 With 75-80% volume particles
 advantages
 Availability in various colors
 Different degrees of opaqueness and
translucency in different tones and
fluorescence
 Excellent polishing and texturing
properties
 Good abrasion and wear resistance
 CTE close to that of tooth structure
 Ability to imitate tooth structure
 Decreased polymerization shrinkage
 Less water sorption
 disadavantages
 Not appropriate for heavy stress
bearing areas
 Not highly polishable as microfilled
because of presence of larger filler
particles between smaller ones
 Loss of gloss occurs when exposed to
tooth-brushing with abrasive
toothpaste
 Nanofill and nanohybrid
composites
 Have average particle size less than
that of microfilled composites
 Introduction of these extremely
small filler and their proper
arrangement within the matrix
results in physical properties
equivalent to the original hybrid resin
composite
 Advantages of nanofill and
nanohybrid composites
1. Highly polishable
2. Tooth like translucency with excellent
esthetics
3. Optimal mechanical properties
4. Good handling characteristics
5. Good color stability
6. Stain resistance
7. High wear resistance
8. Can be used for both anterior and
posterior restorations and for splinting
teeth with fiber ribbons
 Microhybrid composites
 Developed from microfilled
composites
 Filler content of 56-66%
 Average particle size of 0.4-0.8um
 Incorporation of smaller particles
makes them better to polish and
handle than their hybrid counterparts
 High filler content makes than to
have improved physical properties
and wear resistance than microfilled
 RECENT ADVANCES IN
COMPOSITES
 Flowable composites
 Packable/condensable composites
 Giomers
 Compomers
 Ormocers
 Antibacterial/ ion releasing
composites
 Smart composites
 Expanded matrix resin composites
 Classification by Handling
characteristics
 Flowable composites:
• particle size and distribution like hybrid composites
but with reduced filler content thus low viscosity
• Used for pit and fissure sealants and small anterior
restorations; and I,III, IV and V restorations

 Packable/ condensable composites:

• are amalgam alternatives for class I and II
restorations
• Less stickiness and higher viscosity
 Flowable composites
 Introduced in dentistry late 1996
 Filler content is 60% by weight
 Silica with particle size 0.02-0.05um
 Low filler loading responsible for
decreased viscosity
 Good for pits and fissure sealants
 Have poor mechanical properties
 advantages
1. Low viscosity
2. Improved marginal adaptation of posterior
composites by acting as an elastic, stress
bearing laer over which composite is placed
3. High wettability of tooth surface
4. High depth of cure
5. Penetration into every irregularity of prep
6. Ability to form layers of minimum thickness so
eliminates air entrapment
7. Radiopaque
8. Availability in different colors
9. Minimal tooth prep required
10. Flows into narrow pits and fissures
 Disadvantages of flowables
1. More susciptible to wear in stress
bearing areas
2. Weaker mechanical properties
3. Higher polymerization shrinkage
4. Sticks to the instruments so difficult
to smoothen the surface
 Indications of flowable
composites
1. Preventive resin restorations
2. Small pits and fissure sealants
3. Small angular class V lesions
4. Repair of ditched amalgam margins
5. Repair of small porcelain fractures
6. Inner layer of class IIs for sealing of gingival margins
7. Resurfacing of worn out composites and GICs
8. Repair of enamel defects
9. Repair of crown margins
10. Repair of composite resin margins
11. Luting of composite and porcelain veneers
12. Class 1 restorations
13. Tunnel restorations
14. Small class II restorations
15. As base or liner
 CONDENSABLE
COMPOSITES
 Developed to improve compressive,
tensile and edge strength and
handling properties of composites
 Principle: they can be pushed into
the posterior teeth preps and has
greater control over the proximal
contour of class II preps
 Based on polymer rigid inorganic
matrix material (PRIMM)
 CONT.. Condensable
composites
 Resin and ceramic inorganic fillers
which are incorporated in silanated
network of ceramic fibers
 Fibers made of silicon dioxide and
alumina which are fused to each
other at specific sites to form a
continuous network of small
compartments
 Filler content is 48-65% with particle
size 0.7-20um
 Cont… packable
 Consistency is like freshly triturated
amalgam
 Each increment can be condensed
like amalgam and can be cured to a
depth of 4mm
 Indications of packable
composites
 Stress bearing areas
 Class II restorations as they allow
easier establishment of physiological
contacts
 advantages
1. Increased wear resistance because of presence
ceramic fibers
2. Condensability like silver amalgam restorations
3. Greater ease in achieving good contacts
4. Better reprodn of occlusal anatomy
5. Deeper depth of cure due to light conducting
properties of individual ceramic fibers
6. High flexural modulus
7. Decreased polymerization shrinkage due to
presence of ceramic fibers
8. Reduced stickiness
9. Physical and mechanical performance like of
amalgam
 disadvantages
1. Difficult of adaptation of one
composite layer to another
2. Difficult handling
3. Poor esthetics in anterior teeth
 Organic modified Ceramic
(ORMOCER)
 An organically modified non-metallic
inorganic composite material
 A 3-dimentionally cross-linked
copolymer
 First introduced as a dental
restorative material in 1998
 Cont…
 Composed of 3 main units:
1. Organic molecular segment
containing methacrylate groups
which form a highly cross-linked
matrix
2. Inorganic condensing molecules to
make 3D network which is formed
by inorganic poly-condensation, and
forms the backbone of ORMOCERS
3. Fillers
 polymerization
 Self-cure/ chemical cure:
• By a chemical reaction
• Amine accelerators used to increase rate of
polymerization but they cause discoloration after
3-5 years
 Ultravioloet light cured: safety of curing
system
 Visible light cure systems: replaced the UV
light cured and are the most popular today
 Dual cured: combined self curing and light
curing
 Light curing variables
 quartz tungsten halogen (QTH) curing unit
 Plasma arc curing unit (PAC)
 Laser curing units
 Light emiting diode (LED) curing units
 PAC light and laser curing units (3-10 sec
curing cycle)

 Photo initiator is usually camphoroquinone and

curing requires a minimum of 20 sec under
optimal conditions of access, then postcure for
another 20-60 sec to improve the surface
layer properties such as wear resistance
 PLACEMEMENT OF
COMPOSITE RESTORATION
Steps:
① Pulp protection

② Acid etching

③ Applying of bonding agent

④ Placement of matrix

⑤ restoration
 1. Pulp protection
 If cavity is too deep into dentin
Calcium hydroxide lining and GIC
base
 ZoE hinders polymerization of
methacrylate groups and is thus
contraindicated
 GIC reduces chances of 20 caries
 2. Acid etching
 Done after isolation of the tooth
 Preferably use gel etchants. Avoid
use of liquid etchant where it may
gravitate to the gingival tissues
 Apply with a brush and leave for 10-
15 sec
 If gel one may apply with the needle
and syringe
 Etch longer in deciduous and
fluorosed teeth
 Applying bonding agents
 Currently primer and bond are in the
same bottle
 Bonding agent applied with a micro-
brush
 Only one layer on enamel then
spread by lightly blowing onto it.
Two layers on dentin
 Cure lightly for 10 sec
 Proper moisture control otherwise if
contamination, re-etch
 PLACEMENT OF MATRIX
 Necessary to achieve contour of the
tooth where necessary. (none in
class Vs and on labial surfaces)
 Stabilize matrix with wooden wedge
 Matrix may be
• Metal matrix
• Polyester strip
 Matrix should be slightly above the
occlusal margin and below the
gingival margin before placement of
the wedge
 RESTORATION
 Composite to be manipulated by
teflon coated instrument

 Clean instrument with cotton after

every use

 Don’t touch instrument with wetness

or with hands amid usage
 Anterior restoration
 Ensure that your well visualize the
gingival wall. This may necessitate
use of retraction code or pushing of
rubber dam and stabilising it
 First layer of 1mm, cure for 20 sec
then other increments of 1-1.5mm
 Last layer to be cured for 40 sec to
1m
 FAILURE IN COMPOSITE
RESTORATIONS
Signs that a composite restoration is
failed:
① Discoloration at the margins
② Marginal fracture
③ Recurrent caries
④ Post-op sensitivity
⑤ Gross fracture of the restoration
⑥ lack of maintaining contact
⑦ Accumulation of plaque around the
restoration
 Causes of failure of composite
restorations
1. Incomplete excavation of caries:
interferes with bonding of composite
to tooth structure and so recurrent
caries. Left over ZOE on walls
results to similar failure
2. Incomplete etching or failure to
remove residual etchant from
enamel tags.
 Cont…
3. Non uniform coat of bonding agent
4. Lack of isolation hence moisture
contamination. Isolation by rubber
dam or cotton rolls. Gingival
retraction cord where necessary
5. Touching of composite with fingers:
It leads to contamination of the
composite
 Cont…
6. Bulk placement of composite:
inefficiency in curing
7. Insufficient curing of composite:
cure from all sides and for sufficient
length of time
8. Failure to finish and polish and high
spots left on occlusal surfaces
 Guidelines to minimize failure
1. Maintain cavity prep as small as possible
as possibility of bulk composite to failure
is high
2. Avoid sharp internal line angles
3. Line/ base deep cavities
4. Strict isolation
5. Avoid inadequate curing
6. Use small increments
7. Create proper contact areas
8. Finish and polish composite properly
 references
 Pickard’s manual of operative
dentistry
 Text book of operative dentistry.
Vimal Sikri
 Art and Science of Operative
dentistry – Sturdevant’a
 Textbook of operative dentistry –
Nisha Garg
 assignment
 Compomers
 giomers