Resin composite

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Theory exam change in the
syllabus
 Instead of a first and second exam tests
there will be a Midterm exam
 Date:13/11/2008
 Time: 8.30-9.30
 Location: 10H 2,3,4 labs.

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Lecture title Areas of interest Midterm exam 8.30-9.30 am
13/11/2008 Location: 10H 2,3,4
Amalgam
25/9/2008
Composites Direct restoratives Metals and investments
9/10/2008 Indirect restoratives part 2
20/11/2008
• Liners
Glass ionomer •Fissure sealants Porcelains
16/10/2008 •Fillings
•Cerams
Cements Ceramics
27/11/2008 Others
•Surface preparations
Adhesive systems oAcid etchants
Irrigantsand lubricants
23/10/2008 oPrimers
oAdhesives
Endodontic and Intra-canalmedicaments
bleaching materials Obturation materials
Varnishes 4/12/2008
Cements Liners
30/10/2008 Cements
Fillings Implant materials
Metals: 18/12/2008
Wrought
Cast Finishing and polishing
Welding metals and fluxes Auxiliary and Temporary materials
Metals and
Investment: provisional restorative
investments part 1
•Refractory materials materials
6/11/2008
Binder 8/1/2009
oGypsum bonded
oPhosphate bonded
oSilica bonded Final Exam date assigned after this week

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Direct placement restorative
materials
 Esthetic materials are those materials that
are tooth colored.
 Direct placement materials, are placed
directly by the clinician in prepared teeth
without the need for extra-oral construction
of the restoration

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Direct restorative materials

 Composite
 Glass ionomer cements (GIC)
 Resin modified-GIC
 Compomers

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Composite resin

 Composite: mixture of two or more

components.
 Major components:
 Organic resin matrix
 Inorganic fillers
 Coupling agents (silane), join filler and matrix
 Pigments

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Components
 Resin matrix: chemically active component.
Fluid monomer then converts to a rigid polymer
by a radical addition polymerization reaction.
 Monomers used:
 bis-GMA (bisphenol A-glycidyl methacrylate).
Bowen’s resin
 UDMA (Urethane dimethacrylate)
 These resins are made of oligomers (organic
molecules) and low molecular weight monomers
(such as MMA, EDMA, TEGMA)
 In addition an inhibitor is added (hydroquinone)
 Resin matrix also contains initiators, activators
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 Fillers: silica, quartz, more recently silica based
glasses some containing barium, strontium etc.
 Properties affected by fillers:
 Strength
 Radiopacity (barium, strontium)
 Esthetics such as color, translucency
 CET
 Polymerization shrinkage

 Size of filler? Affects wear resistance and

polishability
 Ratio or weight of filler to resin matrix?

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Varity of filler size, A, Macrofilled.
B, Microfilled. C, Hybrid 9
 Coupling agents: what happens if bond
between resin and filler is weak:
 The material would be weak and susceptible
to creep and fracture and
 The interface between filler and resin will be a
source of fracture, stress will not be
distributed properly.
 Silane coupling agents: has a hydrophobic
end (methacrylate group) to bind the resin
and a hydrophilic end (OH- group) to bind
glass fillers

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Polymerization
 Monomers join polymers
 Initiators and activators cause the reaction to begin.
 Side chains on polymers cross-link to form stronger
material

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Polymerization techniques
1. Chemical cure (self-cure): 2-paste
system:
 Base: composite and benzoyl peroxide
as initiator
 Catalyst: composite and tertiary amine
activator
 Require manual mixing which may lead
to air bubbles incorporation.

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Continue,
2. Light cure: started with UV light to create
free radicals. UV was abandoned due to UV
causing burns and eye damage.
• Blue light (400-500 nm) is used instead.
Components that start to react once
subjected to the light:
1. Diketone (Camphoquinone source of free
radicals)
2. Organic amines
• Protection is needed for eyes

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Polymerization
3. Dual cure: 2-paste system containing
both types of initiators and activators.
Advantage: light starts the
polymerization rxn and the chemical
reaction continues in areas were light
can’t reach them.

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 Oxygen inhibited surface layer: sticky,
should be removed by a cotton pellet or
prevented by a matrix strip.

 Depth of cure: much better with blue light

(3-4 mm) compared to UV light units (2mm
maximum).

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 Depth of cure continue, : affected by:
 Type of composite e.g. shade of composite
 Position and depth
 Power and quality of light source (maximum
output at 460-480 nm)
 Curing time: follow instruction
 Method used in curing

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Light curing units
 Halogen light bulbs are used as a light source.
Light delivery probe or tip is glass or glass
encased in metal or plastic casing. Should be
covered in a disposable cover
 Cordless curing units
 Plugged into an electric outlet

 High intensity light units: curing time

 Plasma arc curing units (PAC)
 Argon laser units
 Blue light emitting diode (LED)

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 Plasma arc lamps: use a xenon bulb.
Require efficient cooling system due to high
energy output. Produce high intensity light so
shorter curing times and better curing depth.
Filters are needed to remove wavelengths
<400 & >500nm.
 Disadvantages:
 Specific wavelength so some composites may not
be sensitive to it
 Rapid curing so no stress relaxation and more
shrinkage

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 Laser: Argon laser: emit a blue light.
Advantages:
 Radiation is absorbed in a narrow wavelength
distribution which increases efficiency
 Can emit a collimated beam so it can travel long
distance without dispersion
 Heat production is minimized
 Disadvantages: more expensive than plasma arc,
rapid curing prevent proper stress relaxation.
Solved by using pulsed not continuous laser

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Continue
3. Light emitting diode: produce blue light over
a narrow wavelength band.
 Advantages:
 Uses a low current so portable re-chargeable
designs is possible
 No heat production
 Consistent output
 Quiet, there are no cooling fans
 Disadvantages for laser and LED is that
some initiators in composite maybe
insensitive to them due to their specific
wavelength output
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Polymerization shrinkage
 Composites shrink away from cavity walls
 May lead to breaking marginal seal leading to
sensitivity and recurrent cries
 May pull at tooth structure and lead to cracks
and sensitivity
 Depends on type of resin and amount of resin
 Bond between composite and dentine is weaker
than between enamel and composite

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How to overcome these problems?
 Incremental placement of composite (increment
no more than 2 mm)
 Slow curing or soft start curing method to allow
relaxation of stresses
 Using highly filled composites when possible
 Developing improved dentine bonding systems
 Using low modulus liners to at as stress
absorbers

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Classification of composites
1. Macrofilled (traditional)
2. Microfilled
3. Small-particle composite
4. Hybrid
5. Flowable
6. Pit and fissure sealant
7. Packable composite
8. Smart composite
9. Core build up composite

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Macrofilled composites
 First generation
 Filler particle size 10-50 µm
 Difficult to polish
 Stronger than composites with smaller
particles

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Microfilled composites
 Filler particle size 0.01-0.05 µm in diameter
 Volume of filler is 35-50% (smaller compared to
other composites due to the larger volume of several
small particles as opposed to one large particle of the
same weight)
 Lower physical properties, better polishability
 Methods to increase the number of fillers:
 Clumping microfillers together by heating or
condensing
 Ground pre-polymerized resin and microfillers to size
10-40 microns

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Hybrid composite
 Mixture of macro and microfillers (75-80% by
weight)
 Hybrid composite: contains 2 particle sizes,
large 15-20 µm and microfine fillers (colloidal
silica) 0.01-0.05 µm
 Small particle hybrid: 0.1-6 µm
 Hybrids have high polishability and strength so
they can be used for anterior and posterior
restorations.

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 Flowable composites
 Low-viscosity, light cured
 Can be lightly filled (40%),
or more heavily filled (70%)
 Particle size 0.07-1 µm
 Delivered into cavity using
a syringe
 Weaker and wear more
compared to hybrids
 Used for PRR
 Pit and fissure sealing
 Liners (cushion stress
caused by polymerization
shrinkage of overlying
composite)
 Class V
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Pit and fissure sealants
 Range from no filler to more heavily filled
composites similar to flowable composites
 Low viscosity
 Preventive material

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Packable composites
 Highly viscous which is achieved by:
 Higher filler loading
 Increasing filler particle size range
 Modifying particle shape (make them interlock)
 Modifying resin matrix to create stronger
intermolecular attraction so higher viscosity
 Adding dispersants which lower viscosity and allow
more filler loading
 Drawback: they appear opaque, not stronger
than hybrid composites, air maybe trapped when
composite is packed into cavity
 Suited for posterior restorations
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Smart composites
 Combat caries by having the ability to
release fluoride, calcium, hydroxyl ions
when acidity increases
 Effectiveness has not yet been proven

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Core buildup composites
 Heavily filled
 Replace lost tooth structure in teeth
needing crowns
 Colored to distinguish then from natural
tooth structure

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Properties
 Biocompatibility: potentially harmful
components, however once set, its well
tolerated.
 Leaching out of some components may
cause cytotoxicity and delayed
hypersensitivity

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Properties
 Water sorption and solubility: Sorption
depends on:
 Resincontent
 Bond between resin and filler
 Factors which may lead to high water sorption:
 Introduction of voids during placement

 High solubility leading to voids

 Bond failure between filler and resin

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Properties
 Coefficient of thermal expansion: Greater
than tooth structure, causes debonding &
leakage. Higher filler content reduces CTE

 Radiopacity: helps to detect caries around and

underneath composite fillings. Should be as
radiopaque as enamel

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Properties
 Color matching: causes of discoloration
1. Marginal discoloration
2. Surface discoloration
3. Bulk discoloration: due to chemical
breakdown of components and fluid
absorption

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Mechanical properties
 Compressive strength: Composites usually
fail under tension
 Diametral tensile strength: its an
alternative method to measure tensile
strength and used with brittle material

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 Hardness: indicates wear resistance,
improved by filler addition
 Wear: lower filler content increases
wear
 Abrasive wear
 Fatigue wear: lead to cracks forming below
the surface
 Corrosive wear : due to chemical attack and
erosion

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Indirect esthetic materials
 Inlays
 Onlays
 Veneers
 PFM
 All-ceramic
 Crowns with composite resin facing
 Indirect composites

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Dental laboratory composites
Indirect composite veneers, inlays, onlays:
Multiple placement of composites may be
problematic:
 Time consuming
 Difficulty to ensure good tooth to tooth contact
 Problems of marginal adaptation due to
shrinkage
 Risk f incomplete curing due to limited depth
of cure

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Indirect composite
restorations
 Veneers: can be
porcelain or composite.
Veneers are used to treat
staining, close diastemas,
lighten teeth color,
reshape crooked teeth.

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Indirect composite
 Inlays: constructed by a technician depending on
an impression taken by the dentist. Advantages:
 Bettertooth to tooth contact
 Optimal cure is assured
 Shrinkage problems are not totally eliminated
because of luting cement. Also bond between
luting cement and composite maybe
compromised

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 Indirect
composites: inlays,
onlays, veneers.
Preparation is done in
the clinic, followed by
an impression and
construction of the
restoration on a die,
then cementation in
the preparation. With
resin cements and
bonding agent.

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Laboratory processed composites
 Procedure:
 Preparation is performed by dentist
 Impression and bite registration
 Restoration construction
 Cementation
 Shrinkage occurs outside the cavity,
therefore less stress is created as
opposed to direct restorations

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 Restorative materials used:
 Conventional composite
 Fiber reinforced composite. Fiber source is carbon
Kevlar, glass fiber, polyethylene ( to improve
strength).
 Particle-reinforced composite: heavily filled (70-80%
by weight) with ceramic particles to improve wear
resistance.
 Fiber reinforced composites improve flexural
strength, toughness, stiffness. Uses: splints,
crowns, bridges removable dentures but clinical
experience is limited

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Clinical handling of composites

 Composite is used for all sorts of

restorative procedures from class I to
class IV.
 Selection criteria:
 Esthetic demands: Microfills and microhybrids
are suited
 Strength demands: in posterior teeth and
stress bearing areas, hybrids are more suited
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Suggested contraindications for
using composite
1. Large restorations: usually in molars
1. Greater polymerization shrinkage, so, difficult to achieve good
marginal seal
2. Possibility of bond breakdown with dentine leading to gap
formation and pain
3. Higher load, so more wear
2. Deep gingival preparations:
1. Marginal seal
2. Good adaptation
3. Depth of cure
4. Dentine cavity margin

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Contraindications
3. Lack of peripheral enamel: bond to dentine is
unreliable. Cavities due to erosion and
abrasion may still be successfully restored with
composite even if enamel is lacking since
these areas will not be subjected to high stress
4. onlays of load bearing cusps
5. Poor moisture control
6. Habitual bruxism/chewing

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 Shade guide: Some practitioners apply a
portion of composite on tooth surface and
cure it to observe the appropriate shade.

 Shelf life: follow manufacturer instructions

but as a general rule, avoid heat and light.
Average shelf life 2-3 years.

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 Dispensing and cross-contamination:
composites are usually dispensed in
syringes. Disposable small containers are
used to avoid cross-contamination. Once
composite is dispensed, it should be
covered with a light-protected container

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Single paste, light activated composite

Instruments for placing composite

Syringe for injecting composite

Self-cure 2 paste composite,

and bonding agent bottle
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 Matrix strips/ bands: Mylar strip is used in class III,
IV. Metal matrix bands are used for class II cavities
(curing is from an occlusal direction then after the band
is removed, light is directed from facial and lingual
aspects). Clear crown forms are used for build up
restorations. A wedge is also used to seal gingivally.
 Incremental placement: 2 mm thick is
recommended:
 To minimize polymerization shrinkage
 Allow curing light to properly penetrate and cure

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 Etching and bonding:
 Fourth and fifth generation bonding agents:
 Etching is achieved using phosphoric acid (34-37%).
After etching, tooth surface is washed and gently
dried, etched enamel will appear frosty white.
 Bonding agent is applied in a thin layer and light-
cured according to manufacturer instructions.
(remember micromechanical retention).
 Sixth and seventh generation bonding agents:
 Etching and priming is done in one application, and
no rinsing is required.

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 Contaminants: After etching and
bonding. Re-etching? Eugenol containing
cements should be avoided.
 Light-curing:
Should be held as closely as possible to
composite
20-40 seconds for thin layers
Thicker layers, darker shades, deeper
locations require more time
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 Finishing and polishing: sandpaper discs,
fine, ultra-fine diamonds. For gingival or
interproximal areas, scalpel knife, abrasive
strips and needle-shaped diamond burs
are used. Polishing pasts can also be
used.
 Surface sealers: unfilled resin maybe
added to reseal margins opened by
polymerization shrinkage, or surface
porosities.
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Precautions for light curing
1. Inadequate light output: monthly check on light
source, to examine output (using radiometers), any
scratches on light probes or darkening due to
disinfection.
2. Premature set of composites
3. Eye protection
4. Heat generation

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Light curing unit, protective glasses and shield

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Compomers
 Composites modified with polyacid (polyacid-
modified resin). The resin contains MMA and
polycarboxylic acid. Light activation chemicals
are included and also fluoride containing
glasses. Fluoride release?
 Setting rxn occurs in 2 stages
 Same as light-cured composite
 Acid-base rxn
 Bonding to tooth structure occurs as in
composites

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Compomers properties
 Fluoride release: lower than that of GIC or
resin modified glass ionomers.
 Adhesion: similar to composite but in low
stress areas acid etching maybe
discarded.
 Polymerization shrinkage: similar to
composite. Rate of water uptake is faster
 Weaker than composites, lower wear
resistance
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Compomers clinical applications
 Low stress bearing areas such as
abrasion lesions, proximal surfaces
 In primary teeth
 Long term temporary in permanent teeth
 Disadvantage due to hygroscopic
expansion, fracture of crowns when
compomers are use as luting agents

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 Shade taking

Patient
1. Hue
2. Chroma
3. value Dentist Assistant

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Vita shade guide and shade selection 66
 Guidelines for taking the shade:
 Group effort by dentist, assistant and patient
 Should be taken before preparation
 Taken before rubber dam placement
 Teeth should be clean, free of stains and moist
 Two different lights should be used (Metamerism):
dental offices usually have fluorescent light (blue), or
incandescent light (yellow). Natural light is a good
source except in morning or late afternoon (more
yellow and orange, and less green and blue)

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Continue,

A neutral background should be used (e.g. blue

apron)
 Female patients should be asked to remove
lipstick, and colorful clothes should be covered
 Several tabs are held close to patients teeth
and kept moist. Separate shades for cervical
part of the tooth might be necessary.

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Characterizing the shade
 Surface texture (affects light scatter from
tooth) and luster (the degree to which the
surface appears shiny) should be noted.
These two properties affect how the tooth
reflects light and scatter it.
 The amount of translucency (especially
near the incisal edge) should also be noted.

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Continue,
 Any surface characteristics should be
replicated if the patient demands that the
restoration matches existing teeth.
 A photograph of the patients teeth and
adjacent shade guide tab maybe helpful.

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Reference
 Introduction to dental materials. Chapter
2.2
 Dental materials, clinical applications for
dental assistants and dental hygienists.
Chapter 6

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