Restorative

Resin(composite)

Dr Hamida Khatun

ROLL:
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:

Powder Liquid
 Polymethyl methacrylate as beads or grindings Methyl methacrylate monomer
 Benzoyl peroxide (0.3 to 3%)- initiator Ethylene dimethyl-acrylate (5%)– cross linking agent
 Color pigments 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 di-methacrylate)
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 inhibitors: it inhibits the free radical generated by spontaneous polymerization of the
monomer.

Curing of resin-based composite: The polymerization by the addition mechanism that is initiated by free
radicals. 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
free radicals which starts the polymerization.

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 photo-initiator 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 techniques 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.
• Polymerization rate-Soft start polymerization reduces polymerization shrinkage.

Polymerization 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 polymerization of resin.
• Intensity of curing: Decrease the intensity of light affect the polymerization.

Composite 37% phosphoric acid Composite shade guide

Bonding agent Finishing and polishing materials for Light cure machine

composite restoration

From left flat plastic, carving instrument, burnisher, plugger, a set of four nickel titanium instrument
used for shaping and placing composite

(Left)Flowable composite
Use of flowable composite
(right)

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 Polish ability
(Classes-I, II, III, IV)
Hybrid (mid filler) High stress areas requiring improved Polish ability
(classes III, IV)
Hybrid (mini filler) Moderate stress areas requiring optimal
improved polish ability (III, IV)
Packable hybrid Situations in which improved condensability is
needed (Classes I, II)
Flowable hybrid situations in which improved flow is needed or
where access is difficult
Homogeneous micro-fill Low stress and subgingival areas that require a
high luster and polish
Heterogeneous micro-fill 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 3 Cavity preparation was done using a small

pear-shaped tungsten carbide burs

Fig 4 The completed minimally invasive class 1 cavity preparation Fig 5 Etching was done for 20
 seconds with 37% phosphoric acid gel

Fig8 The bonding adhesive was Fig9

Application of the 1st layer of the

light cured 20 second composite

Fig 7 Bonding application

Fig 11Completed occlusal anatomy before rubber

Fig 13 Polishing the restorations using a silicon carbide brush
dam removed

Fig 12 Finising of composite with an egg shaped 30

bladed tungsten fine finishing bur

Fig 14 After one-month recall

Conventional/traditional/micro-filled 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:

a. Polishing result in rough surface

b. Selective wear of softer resin matrix
c. Tendency to stain

• Radiopacity:

a. Composites using quartz as filler are radiolucent

b. 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

Micro-filled composites:
Developed to overcome surface roughness of conventional composites

Composition:
• Smoother surface is due to the incorporation of micro-fillers.
 • Colloidal silica is used as a micro-filler
• 200-300 times smaller than the average particle in traditional composites
• Filler particles consist of pulverized composite filler 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: 30-50 MPa, lowest among composites
• Hardness: 25-30 KHN
• 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(350-400Mpa)
• Tensile strength-
• Double that of micro-filled 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 micro-filled 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 micro-filled 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.

• Class 2 posterior restorations where access is difficult.
• Fissure 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.
• Polymerized 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 micro-filled 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 solubility, 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 allergic response to these
materials. Inadequately cured composite materials at the floor of the cavity can serve as a
reservoir 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 polymerize 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 whether the restoration is freshly polymerized or
whether 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, abrasive 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.