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Tooth colored Restoration

Tooth-Colored Materials
A. Composite resin B. Glass ionomer cement (GIC) C. Compomers A. Composite resin- refers to a three dimensional combination of at least two chemically different materials with a distinct interface separating the components. - It is referred as type II direct filling resin in the ADA’s.

-Becoming the most widely accepted material of choice by dentists and patients because of their esthetic qualities and new advances in their strength. -Composite: mixture of two or more components.

Major components of composite resin:
 Organic 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)

 Inorganic fillers-Add the strength and characteristics necessary for use as a restorative material.  Inorganic fillers     Quartz Glass Silica Colorants

 Coupling agents-strengthens the resin by chemically bonding the filler to the resin matrix.  Coupling agents used:   Organosilane compound Chemical bond.

 Pigments- provide shading and opacity.

Classification of Composite Resin Restorative Materials
1 Conventional 2. Microfilled 3. Small particle 4. Hybrid

1. Conventional Composite
 -This resin is also referred as “Traditional” and “Macrofilled” because of the relatively large size of filler particles (8-12µm).  The most commonly used filler for these materials is ground quartz. Advantages: - These composites are more resistant to abrasion than unfilled acrylic resins. -Macrofilled composites provide greater strength surface. Disadvantages: -These composites suffer from roughening of surface that develops as a result of abrasive wear of the soft matrix that leaves the more resistant hard particles elevated. - Difficult to polish because of its large particles which is prone to pluck. - These restorations also have a tendency to discolor.  They are suitable for class III, class IV and class V.

2. Microfilled Composites
 The inorganic Filler particle size 0.02-0.04 µm in diameter. Commonly used filler is colloidal silica.  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 resulting to lower properties of the composite and increase viscosity.

 These are methods to increase the number of filler loading.   Filler added to resin Clumping microfillers together by heating or condensing or heat cured  Ground pre-polymerized resin and microfillers to size 10-40 microns or into large particles.  Advantages: - By these methods microfilleds are in wide use today because of their smooth surface they have become the resin choice for esthetic restoration of anterior teeth, particularly in non-stress bearing situations. - They are easily polish compare to Macrofilled. Disadvantages: - Lower filler content - Increased fracture potential in stress-bearing situation such as Class IV and Class II.  They are suitable for Class III and Class V. 3. Small Particle Composites  The average filler size that characterizes these materials is in the 1 to 5µm range, but the distribution usually is fairly broad or contains heavy metal glasses.  The broad particle size distribution facilitates high filler loading, and small particle composites generally contain more inorganic filler (80 wt. % and 70 vol. %). Remixed with more resin and filler.

Advantages: - With the increase filler content, there is improvement in virtually all properties. The resistance is improved. - The surface smoothness of these resins is improved by the use of small and highly packed filler. Disadvantages: - Because of the improved strength of these composites and higher filler loading, they are suggested for applications in which large stresses and abrasion might be encountered.  Small particles composite are suitable for class 1 to 5.

4. Hybrid composites
 Hybrid composites contain both macrofill and microfill particles.  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.  Hybrid are suitable for doing Class I to Class V.

Indications for Using Composite Resins
     Withstand the environments of the oral cavity. Be easily shaped to the anatomy of a tooth. Match the natural tooth color. Be bonded directly to the tooth surface. Anterior and Posterior restorations

Contraindications for using composite Resins
   Large restorations: usually in molars Deep gingival preparations 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  Habitual bruxism/chewing

Advantages of Composites Resins
     Esthetics Conservation of tooth structure Adhesion to tooth structure Low thermal conductivity Alternative to amalgam

Disadvantages of composite resins
  Technique sensitivity Polymerization shrinkage o marginal leakage o secondary caries o postoperative sensitivity  Decreased wear resistance

Polymerization mechanism of composite resin
 The process in which the resin material is changed from a plastic state into a hardened restoration.  Self or Auto-Cured – Chemically activated materials are supplied as two pastes. – – –  Base: composite and benzyl peroxide as initiator Catalyst: composite and tertiary amine activator Require manual mixing which may lead to air bubbles incorporation. Light-Cured - 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.

B. Glass Ionomer Materials (GIC)
 Glass ionomer is a versatile material with chemical properties allowing it to be a restorative material, liner, bonding agent, and permanent cement.

Properties of Glass Ionomer Cement (GIC)
 Glass • •  Ceramic particles Glassy matrix

Acrylic acid

  

Tartaric acid Maleic acid Metal-reinforced glass ionomer • Silver-tin alloy + Glass ionomer of Glass Ionomers

Indications for Using Glass Ionomers
     Primary teeth. Final restorations in non-stress areas. Intermediate restorations. Core material for a buildup. Long-term temporary restorations.

Qualities of Glass Ionomers
 The ability to chemically bind to the teeth.  No need to prepare the tooth structure as extensively as for preparing for an amalgam or composite resin.  The release of fluoride after its final setting.

C. Compomers
 Composite + GIC = Compomer  Composites modified with polyacid (polyacid-modified resin). The resin contains MMA and polycarboxylic acid. Light activation chemicals are included and also fluoride containing glasses.  Setting reaction occurs in 2 stages o Same as light-cured composite o Acid-base reaction

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

Initial Clinical procedures for these restorative materials  Preparation of the operating site, cavity preparation.  Shade taking
Guidelines for taking the shade: o Taken before rubber dam placement o Teeth should be clean, free of stains and moist o 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. o Female patients should be asked to remove lipstick, and colorful clothes should be covered o Separate shades for cervical part of the tooth might be necessary.

 Isolation of the operating site with rubber dam or cotton rolls  Etching:

o Etching is achieved using phosphoric acid (34-37%). After etching, tooth surface is washed and gently dried, etched enamel will appear frosty white.  Matrix strips/ bands: o 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.

 Application of Bonding agent:
o Bonding agent is applied in a thin layer and light-cured according to manufacturer instructions.

 Insertion of composite: o Esthetic demands: Microfills and microhybrids are suited o Strength demands: in posterior teeth and stress bearing areas, hybrids are more suited  Finishing procedures.