Dental

Direct and indirect esthetic

materials
restorative materials

Midterm exam
15/11/2011
Tuesday 12.15 pm
Location: 10H3,4, N2

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

Replacement
of amalgam

Re-contouring
a pig shaped
lateral
4

Uses

Maybe used for

cosmetic purposes

Out of necessity

Direct restorative materials

Composite
Glass

ionomer cements (GIC)

Resin modified-GIC
Compomers

Composite resin

Composite: mixture of two or more

components.
Major components:
Resin

matrix

Fillers
Coupling

agents (silane), join filler and matrix

Pigments

Components

Resin matrix:
bis-GMA

(bisphenol A-glycidyl
methacrylate).
UDMA (Urethane dimethacrylate)
These resins are made of oligomers
(organic molecules) and low molecular
weight monomers

Fillers: silica, quartz, glasses composed of

barium, strontium etc.
Why add fillers:
Add strength
Increase wear resistance
Reduce polymerization shrinkage

Size

of filler?
Ratio or weight of filler to resin matrix?
Coupling agent: silane, binds filler to matrix
and reduces wear.
Pigments: to produce different colors and
shades.
9

Varity of filler size, A, Macrofilled.

B, Microfilled. C, Hybrid

10

Polymerization

Monomers join polymers

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

11

Polymerization
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.

12

Polymerization
2.

3.

Light cure: blue light (400-500 nm) is

used to harden the composite.
Depth of cure? Depends on:
1.
2.
3.
4.

color and location of restoration

Thickness of the layer
Light intensity
Distance between light source and
restoration

13

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
cant reach them.

14

Classification of composites
1.
2.
3.
4.
5.
6.
7.
8.
9.

Macrofilled
Microfilled
Small-particle composite
Hybrid
Flowable
Pit and fissure sealant
Packable composite
Smart composite
Core build up composite

15

Macrofilled composites
First generation
Filler particle size 10-100 m
Difficult to polish
Stronger than composites with smaller
particles

16

Microfilled composites

Filler particle size 0.04 m 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

17

Small particle composite

Particle size 1-5 m
Used to be used for posterior restorations
but have been replaced by hybrid
composite

18

Hybrid composite

Mixture of macro and microfillers (75-80% by

weight)
Microhybrid composite: contains 2 particle sizes,
small 0.5-3 m and microfine fillers 0.04 m
Hybrids have high polishability and strength so
they can be used for anterior and posterior
restorations

19

Flowable composites

Low-viscosity, light cured

Can be lightly filled (40%),
or more heavily filled (70%)
Particle size 0.07-1 m
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

20

Pit and fissure sealants

Range from no filler to more heavily filled
composites similar to flowable composites
Low viscosity
Preventive material

21

Packable composites
Highly viscous
Heavily filled
Stiff and strong
Posterior restorations (as a substitute for
amalgam)
Shrink less due to higher filler content

22

Smart composites
Combat caries by having the ability to
release fluoride, calcium, hydroxyl ions
when acidity increases
Effectiveness has not yet been proven

23

Core buildup composites

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

24

Provisional restorative composites

Replace acrylic resin in constructing
provisional onlays, crowns and bridges
More expensive than acrylic, but wear
less, and shrink less, and produce less
heat when polymerized. Easier to repair
with flowable composite
However, they are more brittle than acrylic

25

26

Physical properties
Biocompatibility

Polished composites are tolerated by soft

tissue. Bonding agents protect pulp by
sealing tubules

Strength

Larger filler composites are stronger in

tension and compression

Wear

Lower filler content increases wear.

Composites wear more than amalgams

Polymerization
shrinkage

Composite

shrink away from cavity walls

Minimized by incremental placement.
Can cause postoperative sensitivity, &
pressure on tooth
27

Shrinkage outcomes

28

29

Thermal conductivity

Low thermal conductivity, close to that

of natural tooth structure

Coefficient of thermal Greater than tooth structure, causes

expansion (CTE)
debonding & leakage. Filler content
CTE
Elastic modulus
Determined by amount of filler. Filler
increases stiffness.
Water sorption
Radiopacity

resin content

water sorption

Barium, strontium radiopacity. Quartz

(radiolucent) used as filler in anterior
composites to improve shade
30

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
31

 Shade

guide: Some practitioners apply a

portion of composite on tooth surface and

cure it to observe the appropriate shade.
The tabs in the shade guide should be
moist and held adjacent to the tooth and
observed under different lights
Shelf life: follow manufacturer instructions
but as a general rule, avoid heat and light.
Average shelf life 2-3 years.

32

Isolation

33

Single paste, light activated composite

Instruments for placing composite
Syringe for injecting composite

Self-cure 2 paste composite,

and bonding agent bottle
34

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

35

36

 Etching

and bonding:

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).

37

Etching

Bonding and light curing

Etching and bonding

38

Acid etched enamel

39

Resin to resin bonding:

proper isolation, no
contamination is
necessary for proper
bonding of successive
composite layers. The
surface layer is a thin
layer of unpolymerized
composite (airinhibited), is removed
by polishing

Enamel etching

Bonding agent
Composite (bonds chemically
to bonding agent)
2nd layer of composite, etc.

40

Contaminants: After etching and bonding, dentine

surface should be kept contaminant free. Otherwise reetching for 10-15 seconds is necessary. Eugenol
containing cements should be avoided. Bonding agent
can be used to prevent sticking of composite to
instrument during filling.

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

41

Finishing and polishing: sandpaper discs,

fine, ultra-fine diamonds.Abrasive strips
and needle-shaped diamond burs are
used. Polishing pasts can also be used.
Surface sealers: unfilled resin maybe
added after cleaning and etching the
surface. It is thought to be useful to reseal
margins opened by polymerization
shrinkage, or surface porosities.

42

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

43

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: caused by operatory

light which should be moved away during placement of
composite.

3.

4.

Eye protection: light-shielding protective device,

glasses for patient.
Heat generation: may cause pulp irritation in deep
cavities (1 mm or less of dentine).
44

Light curing unit, protective glasses and shield

45

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 is small compared
to conventional GIC due to resin binding the glass fillers
after light activation.
Setting rxn occurs in 2 stages
Same as light-cured composite
Acid-base rxn
Bonding to tooth structure occurs as in composites

46

Indirect esthetic materials

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

47

Indirect composite
restorations

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

48

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.

49

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
50

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.

51

Indirect chair-side technique

Tooth preparation
Alginate impression
Poured in fast setting die stone or PVS die
material (sets in 2 minutes)
Composite restoration is made and light
cured
Adjustment and cementation

52

Shade taking

Patient
1. Hue
2. Chroma
3. value

Dentist

Assistant

53

Vita shade guide and shade selection

54

Guidelines for taking the shade:

Group

effort
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)

55

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.

56

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.

57

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.

58

Reference
Dental materials, clinical applications for
dental assistants and dental hygienists
Chapter 6

59