222 Chapter 8—Introduction to Composite Restorations
Another approach to reducing polymerization shrinkage polymerization shrinkage, are expected to make light-curing
stress with composites is to use a different polymer as the
matrix. Typical hybrid composites using BIS-GMA or UDMA
as the matrix shrink approximately 2.4% to 2.8%. Microfilled
and flowable composites shrink considerably more because
they are less highly filled. One product, Filtek LS (3M ESPE,
St. Paul, MN) uses a silorane polymer matrix and the linear
shrinkage of this composite is approximately 0.7%. These
materials have very different chemistry compared with con-
ventional composites and require dedicated bonding systems.
The efficacy of such materials will be determined by ongoing
clinical trials.
Method of Polymerization
The method of polymerization of a composite may affect the
technique of insertion, direction of polymerization shrinkage,
finishing procedure, color stability, and amount of internal
porosity in the material. The two polymerization methods are
(1) the self-cured method and (2) the light-cured method
using visible light. Self-cured materials require mixing two
components, a catalyst and a base, which then react to cause
the material to polymerize. Because the components are
mixed, the risk for air inclusion in the mixture and internal
porosity is greater. Also, the working time to insert the self-
cured material is restricted by the speed of chemical reaction
and can result in the need for increased finishing time because
limited contouring can be done before setting occurs. The
color stability of self-cured materials also is lower because of
the eventual breakdown of tertiary amines, the polymerization-
initiating chemical ingredients. The direction of polymeriza-
tion shrinkage for self-cured materials is generally centralized
(toward the center of the mass). It is theorized that this may
help maintain marginal adaptation to prevent microleakage.
Light-cured materials require the use of light-curing units
or generators. The use of light sources may cause retinal
damage unless appropriate precautions are taken to avoid
direct, prolonged exposure to the light source. Light-cured
materials do provide increased working time during insertion
of the material, however, and may require less finishing time.
They also exhibit greater color stability and less internal
porosity. Effects of polymerization shrinkage can be partially
compensated for by an incremental insertion (and curing)
technique. In some clinical situations, however, positioning
the light source close enough to the material is difficult or
compromised. Despite these disadvantages, almost all con-
temporary composites are of the light-cured type.
Interest in improving the light-curing methods continues to
grow. In addition to the classic quartz, tungsten, or halogen
light-curing systems, plasma arc curing systems have been
available for rapid polymerization of light-cured materials.
These provide high-intensity and high-speed curing compared
with the quartz, tungsten, or halogen systems. However, they
also significantly increase the stresses from heat generation
and polymerization shrinkage. Light-curing systems using
blue light-emitting diodes (LEDs) are predominantly used
today. Blue LED light-curing units are more efficient, more
portable, and more durable than the systems noted
previously. All of these efforts have been made to develop
a light-curing system that is consistent and faster and produces
a stress-free cured material. These features, along with
the development of composites with less volumetric
more successful and more economical and to possibly result in
restorations with better bonding and improved properties.
General Considerations for
Composite Restorations
A composite restoration is placed as follows: (1) The defect is
removed from the tooth; (2) the prepared tooth structure
is treated with an appropriate enamel and dentin adhesive;
and (3) a filled restorative material (composite) is inserted,
contoured, and polished. A successful composite restoration
requires careful attention to technique detail, resulting in
gaining the maximum benefit of the material’s properties and
appropriate bonding of the material to the tooth (the main
advantage of composite is its ability to be bonded to the
tooth). The fundamental concepts of adhesion of a restorative
material to tooth structure are presented in Chapter 4.
This section summarizes general considerations about all
composite restorations. Information for specific clinical
applications is presented in Chapters 9 through 12. In select-
ing a direct restorative material, practitioners usually choose
between composite and amalgam. Consequently, some of the
following information provides comparative analyses between
those two materials.
Indications
Directly placed composite can be used for most clinical appli-
cations. Limiting factors for a specific clinical use are identi-
fied in later chapters. Generally, the indications for use are as
follows:
1. Class I, II, III, IV, V, and VI restorations
2. Foundations or core buildups
3. Sealants and preventive resin restorations (conserva-
tive composite restorations)
4. Esthetic enhancement procedures:
Partial veneers
Full veneers
Tooth contour modifications
Diastema closures
5. Cements (for indirect restorations)
6. Temporary restorations
7. Periodontal splinting
Isolation Factors
For a composite restoration to be successful (i.e., to restore
function, to be harmonious with adjacent tissues, and to be
retained within the tooth), it must be bonded appropriately
to the tooth structure (enamel and dentin). Bonding to the
tooth structure requires an environment isolated from con-
tamination by oral fluids or other contaminants; such con-
tamination prohibits bond development. The ability to isolate
the operating area (usually by using a rubber dam or cotton
rolls) is a major factor in selecting a composite material for a
restoration. If the operating area can be isolated, a bonding
procedure can be done successfully. This would include the
use of a composite or an RMGI restoration and the bonding
of an indirect restoration with an appropriate cementing