Restorative

Resin(composite)
Dr Hamida Khatun
 History of Aesthetic Restoration:
20th century- silicates were only tooth colored aesthetic materials available for cavity
restoration but they become severely within a few year.
Acrylic resins replaced silicate in 1940’s because of their tooth like appearance,
insolubility in oral fluids low cost and ease of manipulation.
But their excessive thermal expansion and contraction cause further stresses to
develop at the cavity margins when hot and cold beverages and foods are consumed.
Problem solved by addition of quartz.
Early composite based on PMMA(polymethylmethacrylate) were not successful.
A major advancement made after introduction of bis-GMA by Dr. ray I. bowen in1950’s.
Types of aesthetic restoration: They are two types
A.Unfilled e.g. acrylic resins
B.Filled,e.g. composite resins
Unfilled acrylic resin:
Composition:
1.Powder
Polymethyl methacrylate as beads or grindings
Benzoyl peroxide (0.3 to 3%)- initiator
Color pigments
2.Liquid
Methyl methacrylate monomer
 Ethylene dimethacrylate (5%)– cross linking agent
Hydroquinone(0.060) inhibitor
The monomer is supplied in brown bottles, to protect them from ultraviolet light which can initiate
polymerization.
Manipulation: Monomer and polymer mix at dough stage is placed in the cavity. Pressure is applied
with a matrix strip to prevent it pulling away from the cavity margins while it contracts polymerization.
Properties:
 Low compressive and tensile strength and low modulus of elasticity.
 Low hardness and abrasion resistance.
 High polymerization shrinkage and coefficient of thermal expansion.
 It does not adhere to enamel and dentin
 Excellent matching with tooth color but tends to discolor and stain with use
Use: These materials are currently being used as temporary restorations.
Limitation:
 Recurrent caries and stains due to leakage of oral fluids at the margin of the
restoration.
 Easily abraded.
 Irritant to pulp.
 Composite Restoration: Dental composites are highly cross- linked polymeric materials
reinforced by a dispersion of glass, crystalline, or resin filler particles and short fibers
bound to the matrix by silane coupling agents.
Uses:
 Restoration of anterior and posterior teeth(directly or as inlays).
 To veneer metal crowns and bridges.
 To build up cores.
 Cementation of orthodontic brackets
 Pit and fissure sealant.
 Esthetic laminates.
 Repair of chipped porcelain restoration.
 Composition: Components of dental resin based composite:
1. Matrix: A plastic resin material that forms a continuous phase and binds the
filler particles, e.g.Bis- GMA,UDMA(Urethane dimethacrylate)
2.Filler: Reinforcing particles or fibers that are dispersed in the matrix, e.g. fused
or crystalline quartz, silicon dioxide, ceramic.
3.Coupling agent: Bonding agent that promotes adhesion between filler and resin
matrix.
4.Activator-initiator system
5.Inhibitors
6.Coloring agent.
Benefits of filler component:

Reduces the coefficient of thermal expansion.

 Reduces polymerization shrinkage.
 Increases abrasion resistance.
 Decrease water absorption.
 Increase tensile and compressive strengths.
 Increase fracture toughness.
 Provide radiopacity
 Improves handling properties.
 Increase translucency
 Function of coupling agent:
• Bonding of filler and resin matrix.
• Transfer forces from flexible resin matrix to stiffer filler particles.
• Prevent penetration of water along filler resin interface, thus provide hydrolytic stability.
Function of coloring agent: Coloring agent are used to produce different shades of
composite.
Function of Initiator: It activates the polymerization of composite. Commonly used
camphoroquinone.
Function of inhibators: it inhibit the free redical generated by spontaneous
polymerization of the monomer.
 Curing of resin based composite: The polymerization by the addition mechanism
that is initiated by free redicals.The free radicals can be generated by chemical activation
or heat or light. There are two types of resins
A. Chemically activated composite resin: This is two paste system
Base paste-benzoyl peroxide initiator
Catalyst paste-tertiary amine activator.
Setting: When the two pastes are spatulated, the amine reacts with the benzoyl peroxide
to form a free radicals which starts the polimarization.
• B. Light activated composite resins: These are single paste systems containing
Photo inhibitor: Camphoroquinone
Amine accelerator
 Setting reaction: Under normal light they do not interact. However, when exposed the
light of the correct wavelength the photoinitiator is activated and reacts with the amine to
form free radicals. Camphoroquinone has an absorption range between 400 and
800nm.This is in the blue region of the visible light spectrum.In some cases inhibitors are
added to enhance its stability to room light or dental operator light.
Curing lamps: Several tecniques have been used for curing of light cure composite
resins.The various types of light used in curing of composite are:
a.Tungsten-quartz halogen(TQH) curing unit.
b.Plasma arc curing(PAC) unit.
C. Light emitting diode(LED)unit
d. Argon laser curing unit
Polymerization shrinkage: Composite materials shrink while curing which can result in
formation of a gap between resin based composite and the preparation wall. It accounts for
for 1.67 to 5.68% of the total volume.
Polymerization shrinkage can result in:
 Postoperative Sensitivity
 Recurrent caries
 Failure of interfacial bonding
 Fracture of restoration and tooth
Polymerization shrinkage can be reduced by:
 Decreasing monomer level
 Increasing monomer molecular weight
 Improving Composite placement technique-Placing successive layers of wedge shaped
composite(1-1.5) decreases polymerization shrinkage.
 Polymarization rate-Soft start polymerization reduces polymerization shrinkage.
Polymarization of composite or Degree of conversion: It dependent on following factors:
Curing time:Curing time depends on different factors like shade of the composite, intensity of
light, temperature, depth of preparation, thickness of resin etc.
Shade of composite: Darker composite shades polymerize slower when compared to lighter
shades.
Distance and angle between light source and resin:The recommended distance between light
source and resin is 1mm.Intencity of light decreases as the distance increases.The angle of the
source should be at 90 degree to the resin.If angle diverges from 90 degree intensity of light
decreases.
 Temperature: Composite curing would be less if it is taken out immediately from
refrigerator. Composite should be at least kept at room temperature one hour
before use.
Resin thickness: It should be ideally .5to 1mm for optimum polimarization of resin.
Intensity of curing: Decrease the intensity of light affect the polimarization.
Composite 37% phosphoric acid

Bonding agent
Composite shade guide
Finishing and polishing materials for
composite restoration
 From left flat plastic,Carving instrument, bumisher, plugger,a
set of four nickel titanium instrument used for shaping and
Light cure machine placing composite
Flowable composite Use of flowable composite Condensable composite
•Classification of resin-based composites and indication for use:
Class of composite Clinical use
Traditional(large particles) High stress area(class I,II)
Hybrid(large particles) High stress areas requiring improved Polishability (Classes I,II,III,IV)

Hybrid(midifiller) High stress areas requiring improved Polishability ( classes III,IV)

Hybrid(minifiller) Moderate stress areas requiring optimal improved polishability(III,IV)

Packable hybrid situations in which improved condensability is needed (ClassesI,II)

Flowable hybrid situations in which improved flow is needed or where access is difficult
Homogeneous microfill Low stress and subgingival areas that require a high luster and polish
Heterogeneous microfill Low stress and sub gingival areas where reduced shrinkage is essential
Fig 1Preoperative view of the
mandibular molars Fig 2 Field isolation
with a rubber dam

Fig 4 The completed minimally

invasive class 1 cavity
preparation

Fig 3 Cavity preparation was done using

a small pearshaped tungsten carbide
 Fig8 The bonding adhesive
Fig 5 Etching was done for 20 Fig 6 Wet dentin surfaces after Fig 7 Bonding application was light cured 20 second
seconds with 37% thoroughly rinsing off the
phosphoric acid gel etching gel
Fig 9 Application of the first layer of
Fig 10 Through polymerization of
the composite
each layer of composite was done

Fig 11Completed occlusal

Fig 12Finisging of composite with an egg
anatomy before rubber dam
shaped 30 bladed tungsten fine finishing bur
removed
Fig 13 Polishing the restorations using a silicon carbide brush Fig 14 After one month recall
• Conventional/traditional/microfilled composite:
• Composition:
• Ground Quartz most commonly used filler
• Average size: 8—12 micrometer
• Filler loding-70-80% weight or 50-60 vol%
• Properties:
• Compressive strength: Four to five times greater than that of unfilled resin(250-
300MPa)
• Tensile strength :Double than of unfilled acrylic resin(50-65 Mpa)
• Elastic modulus: Four to six times greater(8-15 Gpa)
• Hardness: Considerably greater(55kHN) than that of unfilled resin.(KHN-Knoop
hardness number)
• Coefficient thermal expansion: High filler-resin ratio reduces the CTE significantly.
• Esthetics-
• Polishing result in rough surface
• Selective wear of softer resin matrix
• Tendency to stain
• Radiopacity-
• Composites using quartz as filler are radiolucent
• Radiopacity less than dentin
 Clinical considerations:
• Polishing was difficult
• Poor resistance to occlusal wear
• Tendency to discolor
• Rough surface tends to stain
• Inferior for posterior restorations
• Microfilled composites:
• Develop to overcome surface roughness of conventional composites
• Composition:
• Smoother surface is due to the incorporation of microfillers.
• Colloidal silica is used as a microfiller
• 200-300 times smaller than the average particle in traditional composites
• Filler particles consist of pulverised composite fiiier particles
• Properties:
• Inferior physical and mechanical properties to those of traditional composites
• 40-80% of the restorative material is made up of resin.
• Increase surface smoothness
• Compressive strength:
• 250-350Mpa
• Tensile strength:
• 30-50Mpa, lowest among composites
• Hardness-
• 25-30KHN
• Thermal expansion coefficient: Highest among composite resins
• Clinical considerations
• Choice of restoration of anterior teeth.
• Greater potential for fracture in class 4 and class 2 restorations.
• Chipping occurs at margins.
• Small particles composite: Introduced in an attempt to have good surface smoothness and to
improve physical and mechanical properties of conventional composites.
• Composition-

• Smaller size fillers used

• Colloidal silica-present in small amounts(5wt%) to adjust paste viscosity
• Heavy metal glasses, Ground quartz also used
• Filler content -65-70% vol or 80-90%
• Properties: Due to higher filler content the best physical and mechanical
properties are observed
• Compressive strength-
• Highest compressive strength-
• Highest compressive strength(350-400Mpa)
• Tensile strength-
• Double that of microfilled and 1.5 times greater than that of traditional
composites(75-90 Mpa)
• Hardness-
• Similar to conventional composites(50-60 KHN)
• Thermal expansion coefficient:
• Twice that of tooth structure
• Esthetics:
• Better surface smoothness than conventional because of small and highly packed
fillers
• Radiopacity-
• Composites containing heavy metal glasses as fillers are radio-opaque which is an
important property in restoration of posterior tooth
• Clinical considerations
• In stress bearing areas such as 4 and class 3 restorations
• Resin of choice for aesthetic restoration of an anterior teeth
• For restoring subgingival areas
• Hybrid composite: Developed in an effort to obtain even better smoothness than that
provided by the small particle composite.
• Composition-
• 2 kinds of fillers-
• Colloidal silica-present in highest concentration 10-20wt%
• Heavy metal glasses- constituting 75%
• Average particle size 0.4-1.micrometer
• Properties
• Range between conventional and small particle
• Superior to microfilled composites
• Compressive strength-
• Slightly less than that of small particle composition(300-350Mpa)
• Tensile strength-
• Comparable to small particle(70-90Mpa)
• Hardness-
• Similar to small particle(50-60KHN)
• Esthetics-
• Competitive with microfilled composite for anterior teeth
• Radiopacity-
• Presence of heavy metal glasses makes the hybrid more radiopaque
than enamel.
• Clinical considerations:
• Used for anterior restoration including class 4 because of its smooth
surface and good strength
• Widely employed for stress bearing restorations
• Flowable Composites
• Modification of SPF and hybrid composites
• Reduced filler level
• Clinical consideration-
• Class 1 restorations in gingival areas.
• Class2 posterior restorations where access is difficult.
• Fisher sealants.
• Composites for posterior restorations:
• Amalgam choice for restoration for posterior teeth
• Mercury toxicity and increase esthetic demand.All types of composite
• Except flowable composites
• Conservative cavity preparation
• Meticulous manipulation technique
• Packable composites:
• Elongated fibrous,filler particles of about 100micrometer.
• Time consuming
• Inferior in strength when compared to amalgam
• Problems in use of composites for posterior restoration
• In class v restoration where gingival margin is located in cementum or dentin.
• Marginal leakage
• Time consuming
• Composites wear faster than amalgam
• Indications-
• Esthetics
• Allergic mercury
• To minimize thermal conductivity
• Indirect posterior composites
• Introduced to overcome wear and leakage.
• Polimerised outside the oral cavity and luted with resin cement
• For fabrication of inlays and onlays
• Different approaches for resin inlay construction-
• Use of both direct and indirect fabrication systems
• Application of heat,light, pressure or combination
• Combined use of hybrid and microfilled composites
• Biocompatibility of composites :Concern about the biocompatibility of restorative materials
usually relate to the effects on the pulp from two aspects:
• (1)The inherent chemical toxicity of the material.
• (2)The marginal leakage of oral fluid.
• Chemical toxicity of the material:
• The chemical insult to the pulp from composite is possible if components leach out or diffuse
from the material and subsequently reach the pulp. Adequately polymerized composites are
relatively biocompatible because they exhibit minimal solubitily, and unreached species are
leached in very small quantities. From a toxicological point of view,these amounts should be too
small to cause toxic reactions.However, from a immunological point of view, under extremely rare
conditions, some patient and dental personnel can develop an ellergic response to these
materials.Inadequately cured composite materials at the floor of the cavity can serve as a
reserviour of diffusible components that can induce long term pulp inflammation.This situation is
of particular concern for light activated materials. If a clinician attempts to polimarize too thick a
layer of resin or if the exposure time of the light is inadequate,the uncured or poorly cured
material can release leachable constituents to the pulp
• The second biological concern is associated with shrinkage of the composite
during polymerization and the subsequent marginal leakage. The marginal
leakage might allow bacterial growth, and these microorganisms may cause
secondary caries or pulp reactions, therefore the restorative procedure must be
designed to minimize polymerization shrinkage and marginal leakage.
• Repair of composite:
• Composite may be repaired by placing new materials over the old composite.
This is a useful procedure for correcting defects or altering contours on existing
restorations. The procedure for adding new material differ, depending wheather
the restoration is freshly polymerized or weather it is an old restoration

When a restoration has just been placed and polymerized, it may still have an oxygen-
inhibited layer of resin on the surface. Additions of new composite can be made
directly on this layer because it represents, in essence, an excellent bonding substrate.
Even after the restoration have been polished, a defect can still be repaired by adding
more material. A restoration that has just been cured and polished may still have 50%
unreacted methacrylate groups to co- polymerize with the newly added material
• As the restoration ages, fewer and fewer unreacted methacrylate groups remain,
and greater cross linking reduces the ability of fresh monomer to penetrate into
the matrix.The strength of the bond between the original material and new resin
decreases in direct proportion to the time that has elapsed between
polymerization and addition of new resin.In addition polished surface expose
filler surfaces that are free from silane.Thus the filler surface area does not
chemically bond to the new composite layer.Under the most ideal condition, that
is the addition of a silanated bonding agent to the surface before the addition of
new composite, the strength of new composite is less than half the strength or
the original material.
• Final contouring,finishing and polishing of composite restoration:
• The main objectives of contouring,finishing and polishing of final restoration are to:
• Attain optimal contour
• Remove excess composite material
• Polish the surface and margins of composite restoration.
• For removal of composite excess ,usually burs and diamonds are usually used. Surgical
blade is used to remove proximal overhangs in the accessible area.For areas which
have poor accessibility,composite strips can be used.
• Final finishing and polishing of a composite restoration can be done with finishing
diamond points.Polishing is done using rubber polishing points, adrasive discs or
pumice impregnated points.
• Contact areas may be finished by using a series abrasive fining strips threaded
below the contact point so as not to destroy the contact point.