Composite resin

Properties
Restoration technique

Composite resins
Are complex materials that contain:
1. An organic resin component = matrix
2. Inorganic filler
3. Coupling agent = silane -> unite the resin with
the filler
4. Initiator system -> activate the setting
mechanism
5. Stabilisers
6. Pigments

Composite resins
Classification
Dimension of the fillers
Macrofilled composite resins
Microfilled composite resins
Hybrid composite resins
Nanofilled composite resins
Filler content
Flowable
Packable
Polymerization type
Light cured
Self curing
Dual composite resins

Advantages of adhesion
Traditionally retention and stabilization required the removal of
sound tooth structure. Adhesive techniques do not require such
extended preparation.
Reduces microleakage which reduces 1 postoperative pain
2 staining at the restorations margins
3 occurrence of recurrent caries
Adhesive restorations better transmit functional stress along the
tooth-restoration interface and have the potential to reinforce
weakened tooth structure.
Allow reparation of deteriorated restorations and debonded
restorations to be replaced with minimal or no tooth preparation.
Adhesive restorations have expanded the ranges of possibilities for
esthetic restorative dentistry.

Adhesion to enamel
Etching enamel transforms the smooth enamel surface
into an irregular surface with a high surface free
energy.
Etching for 15 sec on permanent teeth provides
adequate microporosity for resin adhesion and sealing.
An acid gel is preferred over a liquid because it is easier
to control.
A bonding agent (unfilled resin with low viscosity) wets
the high surface free energy enamel and is drawn in
the microporosities by capillary attraction.
The bond between enamel and the material is
established by polimerization of the resin in the
microporosities.

Adhesion to dentin
Dentin has 70% wt hidroxiapatite, 12% water and 18%
organic material(colagen), the only pores available for
the resin to penetrate are the dentinal tubes
Structure of dentin consists in
- peritubular dentin hipermineralised and
- intertubular dentin hipominerlised (more colagen)
Tubules are filled with dentinal fluid it is a hydrated
tissue, highly hydrophilic, difficult for the hydrophobic
resin to penetrate
Dentin has a low surface free energy
Near the pulp peritubular dentin is 66%, intertubular
dentin 12% and water 22% on a cutting surface.

Smear layer
Definition: When a rotary or handheld instrument is
used on dentin it creates a special surface texture
called a smear layer that closes off the dentin tubules
This layer is lightly adhered to the dentin surface and
contains tooth cuttings, saliva, bacteria, and other
surface debris

Hybrid layer
Infiltrating a resin monomer into chemically conditioned
dentin is the key to resin bonding.
Nakabayashi and colleagues referred to this infiltration as
hybridization.
It involves resin penetration into both tubular and
intertubular dentin. Infiltration into the tubules accounts
for about one-third of the shear bond strength of the
dentin bond.
The remaining two thirds is achieved through resin
infiltration of the demineralized hybrid zone, and reaction
and association with the underlying unaltered dentin,
whose porosity and surface area contributes significantly to
interfacial toughness.

 Fusayama 1979 introduced the concept of dentin

etching
Application of acid to dentin results in partial or total
removal of the smear layer and demineralization of the
underlying dentin.
Besides demineralizing intertubular and peritubular
dentin, acids open the dentin tubules and expose a
dense filigree of collagen fibers, thus increasing the
microporosity of the intertubular dentin.
When primer and bonding resins are applied to etched
dentin, they penetrate the intertubular dentin, forming
a resin-dentin interdiffusion zone, or "hybrid layer.
They also penetrate and polymerize in the open
dentinal tubules, forming resin tags.

Clinical principles of dentin bonding

Step 1. An acid is used to demineralize the dentin surface. It also removes
the smear layer.
This creates space within the collagen network that is roughly analogous
to the microporosities created by etching enamel.
Step 2. A dentin primer is placed over the demineralized surface. Dentin
primers are hydrophilic solutions (HEMA) that have both hydrophilic and
hydrophobic character (ie, they are coupling agents). These solutions
penetrate the demineralized collagen to improve bonding.
Step 3. An unfilled resin (an adhesive) is applied and penetrates the
microporosities. With single-component materials, the evaporation of the
volatile solvent converts the liquid from a primer to an adhesive.
Step 4. The bonding agent is polymerized

Generations of adhesives

1st Generation Cervident (SS White) bonded to enamel and dentin by

chelating Calcium
2nd Generation phosphorus esters of metacrylate. Enhanced surface
wetting and ionic interaction PO4 Ca 2+
3rd generation - etching dentin to remove the smear layer,
micromechanical retentions that enhance the bonding. Low bonding
strenght because of the use of hydrophobic bonding agents
4th Generation were introduced to be used on etched dentin; consist of
acid which is rinsed off, hidrophilic primer, unfilled resin as the bonding
agent
5th Generation to make use easyer for the dentists primer+bonding in one
bottle, or primer+acid, rinsed off and bonding which is light cured

washing

Three steps adhesives

Two steps adhesives

4th Generation

5th Generatiion

Primer

drying

Adhesive

Waiting 20

Polymerisation

Acid

Adhesive

Polymerization

primer

Etching
H3PO4 35% 15
sec.

washing

Two steps adhesives

One step adhesives - all in one

5th Generation

6th, 7th Generation

primer
adhesive

Etching
H3PO4 35% 15
sec.

Polymerization

acid
primer
+
adhesive
Rsine

Polymerization

Composite resin restorations

Placing and finishing

Indications
Class I and II
1. Small and moderate restorations, preferably with enamel margins
2. Most premolar or first molar restorations, particularly when esthetics is considered
3. A restoration that does not provide all of the occlusal contacts
4. A restoration that does not have heavy occlusal contacts
5. A restoration that can be appropriately isolated during the procedure
6. Some restorations that may serve as foundations for crowns
7. Some very large restorations that are used to strengthen remaining weakened tooth structure
(for economic or interim use reasons)
Class III,IV and V
8. Most class III, IV are appropriately restored with composite resin
9. Most Class V restorations that are in esthetic prominent areas are also appropriately restored
with composite.
Sealing pits and fissures
Direct veneers placing
The area of restoration should be appropriately isolated and the preparation should have
enamel margins.

Contraindications
1. When the operating site cannot be
appropriately isolated
2. With heavy occlusal stresses
3. With all the occlusal contacts only on
composite
4. In restorations that extend onto the root
surface

Composite resins
Advantages
1. Esthetics
2. Conservative tooth structure removal
3. Easier, less complex tooth preparation
4. Economics (compared to crowns and
indirect tooth colored restorations)
5. Bonding benefits
Decreased microleakage
Decreased recurrent caries
Decreased postoperative sensitivity
Increased retention
Increased strength of remaining tooth
structure
6. No thermal conductivity
7. No galvanic currents
8. Radioopacity

Disadvantages
1. Material related

Greater localized wear

Polymerization shrinkage effects
Biocompatibility of some components
unknown
2. Require more time to place
3. More technique sensitive
Etching, priming, adhesive placement
Inserting composite
Developing proximal contacts
Finishing and polishing
4. More expensive than amalgam
restorations
5. Secondary caries
6. Postoperative sensitivity

Composite resins
Properties:
Biocompatibility
Pulp response
HEMA is a recognized allergen
Fully polymerized monomers -> no pulp response
Unpolymerized monomers -> pulpal reaction ->inflammation
(reversible / irreversible)
Mikroleakage most significant hazard
Avoid dentine etching => open wide the dentinal tubes
=> Flow of liquid from dentinal tubes -> increase in wetness of dentinal
surface
Because mikroleakage -> sensitivity, caries, pulpal reaction
Strong GI base should cover the opened dentinal tubes

Composite resins
Polymerization contraction /shrinkage
Towards the light source for light cured CR
Towards the centre of the bulk restoration for self
curing CR

Shrinkage

Mikroleakage
Cusp deflection ->fracture

C-factor

 Polymerization shrinkage -> overcame

Layering technique decreases the thickness
of the composite resin layer
- decreases the ratio
bonded/unbonded surface
Form of light curing two steps

Clinical steps for composite resins

placement
1. Shade selection and selection of composite resin
2. Isolation
3. Tooth preparation
4. Placement of matrix and wedging
5. Acid etching 30 sec for enamel and 15 for dentin
6. Rinse the enamel and dentin for 5 to 15seconds.
7. Air dry with a gentle stream of air, or gently blot dry with a cotton
pellet.
8. Apply as many coats of primer as necessary to develop a visible
resin coating (glistening appearance) on the dentin surface.
Autocured bonding materials usually come in two bottles and
should be used with autocured composites.

9. Evaporate solvents from the enamel and dentin with a gentle stream of warm

air for 3 to 5 seconds. Then dry thoroughly again to remove all residual fluid
from the enamel. This will not affect the dentin since it is already sealed and
will not dessicate.
10. Add an adhesive (or an unfilled resin) and thin out with a dry brush or
gentle stream of air. The adhesive is usually a higher viscosity resin
compared with the primer. Use an autocured adhesive with an autocured
composite.
11. Cure the adhesive for 20 seconds.
12. Add the appropriate composite resin in increments
13. After final placement and curing, wait 10 minutes to allow the dark reaction
to occur. For most composites, this reaction is 90% completed in 10
minutes.
14. Occlusal adjustment
15. Finish with appropriate rotary instruments cooled with a water spray. Reetch, rinse, and dry thoroughly with a warm air dryer.
16. Add glaze (which is an unfilled sealant) to seal any marginal gaps created by
shrinkage and finishing. Many have extra accelerators to reduce the effects
of oxygen inhibition. This is usually a higher viscosity hydrophobic resin.

Shade selection
Is performed on a clean, moist tooth prior to
placement of a rubber dam
After isolation teeth becomes dryer and
lighter
For shade selection a shade guide is used
Most common Vita shade guide - color,
translucency, value, hue and chroma
Often after polymerization a shade shift
occurs

The logical configuration of the shades makes working with VITAPAN 3D-MASTER very easy. The shade
selection is a logical progression of three simplified choices - the desired shade is found very
quickly:
In the first step of the shade taking procedure the value (lightness) is determined. Select the value level
from the five value groups (levels 1 - 5) that is closest to the value of the tooth to be compared. Pull
out the medium shade sample (M) from the selected value group.
In the second step the chroma (levels 1 2,3) is determined. Select the color sample of the selected M
group that is closest to the tooth to be compared.
In the third step the hue (L, M, R) is determined. Check whether the natural tooth displays a "more
yellowish" (L) or "more reddish" {R) shade than the color sample of the M-group that has been
selected in the second step. Now the best matching shade sample is determined and the
information is recorded in the color communication form.

Tips for shade taking.

Hold shade guide to the patient's mouth at arm's length.

When taking a shade it is important not to use a direct source of light but to work under
diffuse lighting. Ideal are natural daylight or suitable daylight lamps.
Make a swift selection; always accept your first decision.
When determining the shade, ask your patient not to wear bright colors or lipstick

Placement of matrix and wedging

A matrix system should be used for every
proximal restoration
Several matrix systems are available clear plastic matrix,
ultrathin Tofflemire metal matrix, thin sectional matrix.
If the clear matrix are used the curing of composite resins
can be performed from facial and lingual aspect as well
as from gingival and proximal assuring a better
polymerization of each increment and allowing a more
favorable direction of the polymerization shrinkage.
They are thicker then the thinnest metallic matrix and
because of their poor rigidity they are difficult to insert
through the contact point

 If a metallic matrix system is used the curing of

composite resin can be done only from occlusal
They are easier to place, maintain their shape
better and can be burnished against the adjacent
tooth to provide a tight contact point
Because they surround the entire tooth, light
curing is done only from occlusal, the proximal
parts of the restoration are cured once more
from facial and lingual after removal of the matrix
system.

Placement of composite resin

Incremental technique = layering prevents the
polymerizing shrinkage of the material
First layer
The gingival margin is the place where secondary caries
occur more often
First layer is placed on the gingival wall 1mm
Light cured from occlusal or from proximal
Methods to improve marginal adaptation:
1. application of warmed composite resin decrease the
viscosity
2. application of flowable composite resin

Additional increments
Additional layer of 2mm thickness are placed
If a metallic matrix system is used the oblique
incremental technique is used
After removal of matrix additional light
curing from facial and lingual is appropriate

Additional increments
If a clear matrix band is used vertical incremental technique
or oblique incremental technique can be used
Composite resin is cured from facial or lingual
better marginal adaptation
no cusp deflection
With exception of the first layer the
other layers should not touch both
walls( facial and lingual)
simultaneously
prevents cusp deformation

Providing a tight contact point

Prewedging
Burnishing the metallic matrix against the
adjacent tooth
Conical light tip
Use of prepolymerized
composite balls
Matrix hold in position
during polymerization with a plastic instrument

Position of the light curing unit 90 degrees

Distance as close as possible

Finishing and polishing

Respect the waiting time of 10 minutes before
finishing
Finishing of the restoration is performed with
fine diamonds or multifluted carbide burs
attached to the air turbine

Rebonding
Finishing procedures affect the surface of the
restoration
Finishing eliminates the superficial layer of the
restoration with the best physical properties
Finishing procedures can exacerbate gaps
occurred during polymerization
All accessible restoration margins are etched and an
unfilled resin is applied
Rebonding reduces wear and enhance marginal
adaptation can be redone yearly

Sectional Band

Sectional bands have B-L as well as In-G contours

They tend to be soft and easily distorted they are used
only for class II composite

Composite resin placement on anterior teeth

Placing composite resin on anterior teeth

by using a silicone guide
1. 1.1 and 1.2 after
traumatic fracture

2. Clinical mock-up to
simulate the final
aspect after restoration

3. Impression of the
mock-up with
kneadable silicone and
fabrication of a silicone
impression

4. Sectioned impression
and use of the
impression as a silicone
guide

Placing composite resin on anterior teeth

by using a silicone guide
5. Impression of the mock-up
with kneadable silicone and
fabrication of a silicone
impression

6. Sectioned impression and

use of the impression as a
silicone guide

Placing composite resin on anterior teeth

by using a silicone guide
7. Beveling the margins

8. Note the dimensions of

the bevel under the
rubber dam

Placing composite resin on anterior teeth

by using a silicone guide
9. Etching
10. Application of
primer+ bonding
11. Polymerization

Placing composite resin on anterior teeth

by using a silicone guide
12. Application of an
increment of enamel
material to the silicone
impression

13. Positioning the silicone

impression coated with
composite resin and light
polymerisation of this
increment which restores
the palatal and incisal
enamel

Placing composite resin on anterior teeth

by using a silicone guide
15. Application of dentine material
and contouring the mamelons. This
Increment should overlap the
fracture line and mask it by
extending to roughly half of the
bevel.

Placing composite resin on anterior teeth

by using a silicone guide
16. The approximal edges
are modelled with the
enamel material

17. Modelling of the final

enamel layer of the
teeth with the help of a
spatula

Placing composite resin on anterior teeth

by using a silicone guide
18. Light curing the
restoration
19. Removal of the excess
with the diamond bur
20. Basic shaping of the
teeth with flat area and
vestibular slopes using
the abrasive disc SofLex Pop On (3M Espe)

21. Approximal polishing

with polishing strips
polishing paste and
dental floss