220 Chapter 8—Introduction to Composite Restorations
procedures, they may be good materials for restoration of
teeth with root-surface caries because of their inherent poten-
tial anti-cariogenic quality and adhesion to dentin. Similarly,
because of the potential for sustained fluoride release, glass
ionomers may be indicated for other restorations in patients
exhibiting high caries activity.36 Because of their low resistance
to wear and relatively low strength compared with composite
or amalgam, glass ionomers are not recommended for the
restoration of the occlusal areas of posterior teeth. Glass
ionomer cements also have been widely advocated for perma-
nent cementation of crowns.
Today, most glass ionomers also are available in encapsu-
lated forms that are mixed by trituration. The capsule contain-
ing the mixed material subsequently is placed in an injection
syringe for easy insertion into the tooth preparation.
Resin-Modified Glass Ionomers
In an effort to improve the physical properties and esthetic
qualities of conventional glass ionomer cements, resin-
modified glass ionomer (RMGI) materials have been devel-
oped (Table 8-1). RMGIs are probably best described as glass
ionomers to which resin has been added. An acid-base setting
reaction, similar to that of conventional glass ionomer cements,
is present. This is the primary feature that distinguishes these
materials from compomers (see the next section). Addition-
ally, the resin component affords the potential for light-curing,
autocuring, or both. RMGIs are easier to use and possess
better strength, wear resistance, and esthetics than do conven-
tional glass ionomers. Their physical properties are generally
inferior to those of composites, however, and their indications
for clinical use are limited. Because they have the potential
advantage of sustained fluoride release, they may be best indi-
cated for Class V restorations in adults who are at high risk
for caries and for Class I and II restorations in primary teeth
that would not require long-term service.37
Compomers (Polyacid-Modified Composites)
Compomers probably are best described as composites to
which some glass ionomer components have been added. Pri-
marily light-cured, they are easy to use and gained popularity
because of their superb handling properties. Overall, their
physical properties are superior to traditional glass ionomers
and RMGIs, but inferior to those of composites. Their indica-
tions for clinical use are limited. Although compomers are
capable of releasing fluoride, the release is not sustained at a
constant rate, and anti-cariogenicity is questionable.
Table 8-1 Tooth-Colored Materials
Resin-Modified
Conventional Glass Ionomer
Glass Ionomer Compomer Composite
High fluoride Low fluoride
release release
Low strength High strength
Poor esthetics Excellent esthetics
Low wear High wear
resistance resistance
Important Properties of Composites
The various properties of composites should be understood
for achieving a successful composite restoration. These prop-
erties generally require that specific techniques be incorpo-
rated into the restorative procedure, either in tooth preparation
or in the application of the material. The various property
factors are presented here, with additional information pro-
vided primarily in online Chapter 18 but also in Chapters 9
through 12.
Linear Coefficient of Thermal Expansion
The LCTE is the rate of dimensional change of a material per
unit change in temperature. The closer the LCTE of the mate-
rial is to the LCTE of enamel, the lower the chance for creating
voids or openings at the junction of the material and the tooth
when temperature changes occur. The LCTE of modern com-
posites is approximately three times that of tooth structure.38
Bonding a composite to etched tooth structure reduces the
potential negative effects as a result of the difference between
the LCTE of the tooth structure and that of the material.
Water Sorption
Water sorption is the amount of water that a material absorbs
over time per unit of surface area or volume. When a restor-
ative material absorbs water, its properties change, and its
effectiveness is usually diminished. All of the available tooth-
colored materials exhibit some water absorption. Materials
with higher filler contents exhibit lower water absorption
values than materials with lower filler content.
Wear Resistance
Wear resistance refers to a material’s ability to resist surface loss
as a result of abrasive contact with opposing tooth structure,
restorative material, food boli, and such items as toothbrush
bristles and toothpicks. The filler particle size, shape, and
content affect the potential wear of composites and other
tooth-colored restorative materials. The location of the resto-
ration in the dental arch and occlusal contact relationships
also affect the potential wear of these materials.
Wear resistance of contemporary composite materials is
generally good. Although not yet as resistant as amalgam, the
difference is becoming smaller.39,40 A composite restoration
offers stable occlusal relationship potential in most clinical
conditions, particularly if the occlusal contacts are shared with
the contacts on natural tooth structure.
Surface Texture
Surface texture is the smoothness of the surface of the restor-
ative material. Restorations in close approximation to gingival
tissues require surface smoothness for optimal gingival health.
The size and composition of the filler particles primarily
determine the smoothness of a restoration, as does the mate-
rial’s ability to be finished and polished. Although microfill
composites historically have offered the smoothest restorative
surface, nanohybrid and nanofill composites also provide
surface textures that are polishable, esthetically satisfying, and
compatible with soft tissues.