Esthetic Biomaterials &

Principles - 2
Muhammad Amber Fareed
BDS (Lahore), MSc (London), PhD (Birmingham), 
FRACDS (Sydney), FDSRCPS (Glasgow), DipMedEdu (Cardiff)

Professor of Restorative Dentistry

College of Dentistry, Gulf Medical University
Ajman, United Arab Emirates

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Learning Outcomes
• Discuss the different esthetic restorative materials
• Understanding the importance of polymerization shrinkage
• Illustrate strategies used to reduce polymerization shrinkage stress
• Discuss the commonly used restorative materials (GIC, RMGIC, MTA,
Resin Cement) and the oral environment

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Resin-based Composites – Composition
1. Resin monomer – (bis-GMA, UDMA, TEGDMA,)
2. Reinforcing fillers – (macro, micro, nano, hybrid, etc)
3. Silane coupling agent – (bonds fillers and resin)
4. Optical modifiers – Composite Shade (TiO2, Al2O3 )
5. Initiator/Light-activator – (Camphorquinone)
6. Inhibitor – (Butylated-hydroxytoluene)

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Resin Composite - Filler Particles Benefits
• Filler particles reduce the amount of matrix (resin) materials to control
the shrinkage of the composite during polymerization.
• Provide the appropriate degree of translucency and are radiopaque
• Increase hardness and strength, also increasing viscosity (75 wt.%)
• Reduce wear, water sorption / staining and
• Reduce polymerization shrinkage and thermal expansion/ contraction
• Small filler particles are more polishable

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Composite Resin – Classification
1. According to the polymerization reaction initiation
Light cure  Camphorquinone (photo initiator)
Chemical cure 
Duel cure  both light and chemical cure, used as cement

2. According to the filler particle size

Micro-hybrid, nanohybrid, packable and flowable, low-shrinkage
composite (silorane technology), bulk-fill composite

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Composite Resin - Manipulative Variables
• Compsite resin should not be cured in thick section > 2mm,
• Curing light should be checked periodically with radiometer
• The closer the light, the greater the irradiance
• Major deficiency  inherent polymerization shrinkage (2.2%–2.4%)
• Substantial contraction gaps between the restorative material and the
cavity margin, can result in postoperative sensitivity and recurrent
caries.
• The shrinkage of composite resin materials cannot be avoided, but
the stress created by the shrinkage can be reduced

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Polymerization Shrinkage Reduction Tips
Reducing polymerization shrinkage stress  prevent microleakage
1. The incremental composite placement technique is recommended
(always keep C-factor in your mind)
2. Create a relatively thick primed layer with dentin bonding agent (low
modulus, deform slightly while curing composite to absorb stress)
3. Place a thin layer (0.5 mm) of flowable composite to (absorb stress)
4. Use of ‘soft-start’ polymerization prolong the composite curing time
5. Use a thin layer of resin-modified GIC under composite (RMGIC bond
to the tooth and have low modulus to absorb shrinkage stresses)

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Properties of Resin-based Composites
 Biocompatibility: Generally biocompatible but should be treated as
potentially harmful materials, handled with caution, pulp protection
 Depth of Cure
 Reduced exposure time and less depth of cure
 Light absorption and scattering reduce the power density and
degree of conversion with depth of penetration
 Degree of conversion –(typical 50-70% are achieved) and it depends
on resin composition; the irradiance of the light source; the light
transmission; concentrations of sensitizer, initiator, and inhibitor. Curing
depth is limited to 2-3 mm
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Resin Composites – Polymerization
shrinkage
 More resin, more shrinkage (micro hybrid shrink less than mircro-filled),
 Larger polymer/copolymer molecules less shrinkage
 More fillers less shrinkage, volumetric contraction is around 1.0-4.0%
 Shrinkage compromises the marginal seal at tooth-restoration interface
 Minimized with incremental technique (2 mm) while doing restoration.
 Post operative sensitivity in about 10% cases
 More likely due to micro-leakage or induced internal stress, which can
be minimized with better clinical skills (isolation, pulp protection,
incremental build-up)

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Resin Composites – Mechanical Properties
 Mechanical Properties depends upon filler contents, filler type,
efficiency of filler-resin coupling process and the degree of porosity in
the set composite
 Most composite have good mechanical properties but fail in tension
 Compressive strength of mircohybrid have higher than microfilled
 Strength generally increase with volume fraction of fillers
 Elastic modulus or stiffness = increase with increase in volume
fraction of fillers. Lower filler contents of microhybrid composite
result in elastic modulus to one-fourth to one-half compared to
highly filled microhybrid composite
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 Resin Composite Restoratives

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Bonding - Acid-etch Technique Functions
• Remove smear layer – Enamel (completely), Dentin (partially)
• Remove contaminants from enamel and dentine
• Create microporosities to generate high-energy tooth surfaces
• Promote wetting of adhesive monomers

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Factors Contributing in Bonding
• Good adhesive and bonding is achieved by:
1. Surface energy and wetting
2. Interpenetration (formation of a hybrid zone)
3. Micromechanical interlocking
4. Chemical bonding

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Bonding Agents - Mechanisms of Adhesion
• Adhesion bonding occurs either through chemical attraction and/or
micromechanical interlocking
• The fundamental mechanism of adhesion to tooth involves:
1) Removing hydroxyapatite to create micropores
2) Resin monomers infiltration in micropores and forming resin-tags
• Bonding with tooth structure requires three conditions:
1. Sound tooth structure must be conserved
2. Optimal retention must be achieved
3. Microleakage must be prevented
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 Acid-etch Technique – Enamel Etching
• Bruonocore first reported phosphoric acid for acid-etching
• Phosphoric acid (37%) removes the smear layer and about 10
microns of enamel to expose prisms of enamel rods
• Create a honeycomb-like, high-energy retentive surface
• The higher surface energy ensures that resin monomers will
readily wet the surface, infiltrate into the micropores, and
form resin tags
• Resin tags are 6 μm in diameter and 10 to 20 μm in length
• Stronger bonding occurs if the smear layer is removed to allow
resins to directly bond to the intact tooth hard tissue
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Acid-etch Technique – Dentin Etching
• Dentin etching (37% phosphoric acid) is more technique sensitive than enamel
• Dentine etching removes hydroxyapatite and expose a microporous collagen
• Etched enamel must be completely dry to form a strong bond
• Etched dentin must be moist to form a hybrid layer
• If insufficient water is present, the collagen network will collapse, no hybrid layer
• If too much water remains, resin infiltration cannot occur in the collagen network
• Priming step maintains a hydrated collagen network while removing excess water
• After dentin-etching hydrophilic resins can infiltrate into the dentin
• A hybrid layer structure forms very strong resin bonds through the
micromechanical interlocks at the resin–hybrid layer interface

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 Acid-etch Technique – Moist Dentin

Insufficient water - collagen network will collapse, too much water

resin infiltration cannot occur in collagen network to form hybrid-layer
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 Dentin-Bonding Agents – Composition
1. Etchants – 37% phosphoric acid (pH = 1-2) gel applied with brush
2. Primers – HEMA, phenyl-P, 10-MDP, 4-MET, 4-META, and MAC-10.
3. Solvents – Water, ethanol, and acetone
4. Adhesives – bis-GMA, TEGDMA, UDMA and HEMA
5. Initiators – photosensitizer (camphorquinone), co-initiator (tertiary
amine), a self-cure system (benzoyl peroxide), dual-cure system
6. Filler particles – Nanometer-sized silica fillers (20-40 nm)
7. Other ingredients – desensitizer, antimicrobial, fluoride, chlorhexidine
Scotchbond Universal by 3M is shown in the picutre
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Dentin-Bonding Agents – Classification
A. Etch-and-Rinse Adhesives
• Three Step (Fourth Generation)
1) Application of an acid-etchant
2) Application of the primer
3) Application of the bonding resin.
• Two Step (Fifth Generation)
1) Application of an acid-etchant
2) Application of combined primer and
adhesive resin into one
Prof MA Fareed
B. Self-Etch Adhesives
No separate etching step
• Two Step (Sixth Generation)
1) Application of an acidic monomer
(conditioning and priming)
2) Application of the bonding agent
• One Step (Seventh Generation)
1) A single step combines dentin
conditioner, primer, and bonding resin
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Enamel and Dentin-Bonding
1. Total-etch technique  enamel and dentin etched simultaneously
2. Selective-etch technique  ONLY enamel is etched selectively
3. Etch and rinse technique = total-etch technique (etchin + washing)
4. Self-etch technique  etching and bonding done together (no wash)
• Enamel-bonding agents  bis-GMA and TEGDMA
• Dentin-bonding agents  bis-GMA, TEGDMA, UDMA, HEMA, 10-MDP,
4-META

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Bonding Agents

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GIC – Classification Based on Usage
• Type I: Luting crowns, bridges, and orthodontic brackets
• Type II a: Esthetic restorative cements
• Type II b: Reinforced restorative cements
• Type III: Lining cements and bases
• Pit and fissure sealant
• Metal modified GICs (cermet, miracle mix) for core-build-up
• Resin modified GICs (compomer etc) for core-build-up, restoration
• Prevention of caries, have high F-ions (Fuji VII)
• Atraumatic restorations (Fuji VIII)
• Pedodontics and geadiatric (Fuji IX)
 Dental Cements

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Clinical Applications and Indication of GIC
• Used as liner / Base under composite restorations
• Sandwich technique (GIC followed by composite)
• Permanent restorations for primary teeth
• Luting cement for indirect restorations (crowns, inlays, veneers)
• Retrograde filling material after surgical endodontic treatment (RCT)
• Temporary/intermediate restorative materials for permanent teeth , or
• Fissure Sealant for permanent teeth (low viscosity)
• Root Caries Cervical Restoration (Class-V)
• Core bulid-up materials
• Atraumatic Restoration
GIC Modifications – Resin-modificed
(RMGIC)
• Conventional GIC are moisture sensitive and have low early strength
• Hybrid materials containing the properties of both GIC and composite
were developed (Hybrid ionomer, dual cure, tri-cure, compomers)
• The monomers in hybrid glass-ionomer cements make the cements
more translucent
RMGIC – Compositon and Setting Reaction
• Available in capsules, two-paste system, and powder/liquid system
which contain water-soluble polymerizable monomers in a liquid
• RMGIC Powder  fluoroaluminosilicate glass particles, resin (bis-
GMA/HEMA), coupling agents (silanes), Initiators (light activation,
chemical or both), Benzoyl peroxide (Chem), Camphoroquinone (Light)
• RMGIC Liquid  Poly(acrylic acid) and copolymers solution, PAA is
modified with methyl-methacrylate or HEMA, Light activators (diethyl
aminoethyl methacrylate
• Setting Reaction  Dual-cure (acid-base and light activation setting
reaction) tri-cure (acid-base reaction, light-curing and chemical curing)
GIC + Composite = Compomer
• Compomer is available in a one-paste restorative system (water-free)
• Compomer, a combination of GIC and composite integrates the fluoride
releasing capability of GIC with the durability of composite
• Composition  non-reactive inorganic filler particles, reactive silicate
glass particles, sodium fluoride, a polyacid-modified monomer (e.g., di-
ester of HEMA with butane carboxylic acid and photo activators.
• Setting reaction  Set by a polymerization reaction, and then absorb
water from the saliva to initiate the slow acid–base reaction between
the acidic functional groups and silicate glass particles
• Compomer require a dentin-bonding because not self-adhesive (GIC)
Resin Cements
• Resin cements are low-viscosity versions of resin-based composites.
• Self-cured and dual-cured resin have two pastes (base and catalyst)
• Compositon  matrix of methacrylate monomers (HEMA, 4-META, MDP),
dispersed fillers, silane coating on the filler particle surfaces.
• Acid-etching and bonding is required for most same as composite
• Not all resin cement systems require a bonding agent (self-etch system)
• Polymerization (Setting)  Self-cure, light-cure or dual-cured (common)
• Used for cementing ceramic veneers and direct bonding of ceramic or
polymeric orthodontic brackets
• Most esthetic resin cements are light-cured as have better color stability
 Dental Cements

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Thank you!

Prof MA Fareed 31