R E S E A R C H R E P O R T S

A problem w ith posterior com posites is an unacceptable wear level. One factor contributing
to inadequate wear resistance m ay be the w ay the restoration is surfaced or finished.
A clinical study was carried out to determ ine the influence of fin ish in g on the wear
rate o f a posterior com posite resin. Except fo r the first 30 days, the resistance to wear
was significantly higher for the unfinished group as com pared to those th at received
a conventional finish. The average difference in wear between the tw o groups was nearly
40 fim.

Effe ct of finishing on the in vivo wear rate

of a posterior composite resin

K ulaya R atan ap rid ak u l, D M D , MS

Karl F. L ein feld er, D D S, M S
J oe T h o m a s, D D S, M SD

T h e use of p o s te rio r co m p o site
resins as restorative m aterial has
g ro w n a t a n in c re a s in g rate .
Currently, nearly 30 different proprietary
m aterials are available. D uring the past
several y ears, th e se m a te ria ls h av e
im p ro v ed a p p re c ia b ly a n d as a resu lt,
som e c u rre n t fo rm u la tio n s e x h ib it an
average a n n u a l w ear rate of 25 jum or
less.
T o regulate clinical perform ance, the
C o u n c il o n D e n ta l M a te ria ls, I n s tr u ­
ments, an d E q u ip m e n t of the Am erican
D e n ta l A s s o c ia tio n h a s g e n e ra te d an
acceptance p ro g ram for p o sterio r com ­
posite resins.1C urrently, three p roprietary
com p o sitions have received p rovisional
acceptance. In addition, one other m ate­
rial (Ful-Fil, L. D. C aulk Co) has received
a r a ti n g of f u ll c o m p lia n c e w ith th e
acceptance program as a restorative agent
for prim ary as w ell as p erm anent teeth.
In spite of sig n ific an t im provem ents
in b oth physical an d m echanical c h a r­
ac te ris tic s, se co n d a ry ca ries a n d w ear
resistance are still m a jo r con cern s.2 In
g en e ral, th e p ro b le m s asso ciated w ith
seco n d ary caries can be c o n tro lle d by
the clin ic ian . T h e p ro b lem w ith wear,
how ever, is m o re u n d er the co n tro l of
the m anufacturer.
R ecen t stu d ies h av e sh o w n th a t the
am o u n t of wear, as well as the wear rate,
of p o ste rio r c o m p o site resin s d epends
on the size of the fille r p a rtic le .3 6 As
a rule, the m icrofilled com posite resins
are generally m ore w ear resistan t th an
those th a t contain filler particles in excess
of 1 /xm. F urth erm o re, by com parison,
m ic ro filled co m p o site resin s e x h ib it a
lin e a r w ea r ra te in w h ic h th o se th a t
contain larger filler particles (in excess
of 1 (im) u n d erg o a decreasing rate of
7-9
wear.
It has been speculated th a t the wear
rate m ay, in p a rt, be a ttrib u te d to the
m e ch a n ica l f in is h in g p ro ced u res done
im m ed ia te ly afte r in s e rtio n an d p o ly ­
m erization. Specifically, it is postulated
th a t th e ra p id ly ro ta tin g blades of the
finishing instru m en t generate num erous
m icrocracks in the subsurface. Such a
c o n d itio n w o u ld w ea k en th e su rface
s u p e rfic ia lly , m a k in g it less re s is ta n t
to wear. T h is study tested the hypothesis
that the finish in g process may influence
th e ra te of w ear, a t le a s t early in th e
clinical life of the restoration.
Methods and materials
F ifty -fo u r re s to ra tio n s w ere p la ce d in
pediatric patien ts by one clinician. T h e
ratio of Class I to Class II preparations
w as a p p ro x im a te ly eq u a l. S pecifically,
29 Class I a n d 25 Class II p reparations
were included in the study. O ne m aterial
(F u l-F il) w as used to restore all of the
te e th . O n ly p r im a ry firs t a n d seco n d
m o la rs in n o r m a l o c c lu s io n w ere
included.
All cavity p rep aratio n s were patterned
after those used for am algam restorations
in prim ary teeth. T h e cavosurface m a r­
gin s were n o t beveled. In each case all
o p e r a tiv e p ro c e d u re s w ere p e rfo rm e d
u sin g local anesthetic an d w ith a rubber
d a m . A ll C la ss II r e s to r a tio n s w ere
p re w e d g e d b e fo re p r e p a r a tio n . T h is
te c h n iq u e w as g e n e ra lly n ecessary to
e lim in a te o r m in im iz e lo o se o r o p e n
p ro x im a l contacts. After ap p lica tio n of
calcium hydroxide (Dycal, L. D. C aulk
Co) to the d en tin al surface, the enam el

JADA, Vol. 118, March 1989 ■ 333

RESEARCH REPORTS
w a lls of th e c a v ity p r e p a r a tio n w ere
etched w ith a 37% solution of phosphoric
acid for 60 seconds. After the preparation
w as th o ro u g h ly w ash ed a n d d ried, an
enam el b o n d in g agent (Prism a Universal
B o n d ) w as u sed . A ll te e th w ere th e n
resto re d fo llo w in g th e m a n u fa c tu re r’s
recom m ended technique.
Finishing techniques
T w o different finish in g techniques were
included in the study: G ro u p 1 consisted
of those restorations th at were polym er­
ized, c o n to u re d , a n d su rfaced u sin g a
12-bladed carbide fin ish in g bu r and w hite
s to n e a n d a w a te r sp ra y . G ro u p 2
consisted of fillin g the p reparation w ith
c o m p o s ite re s in a n d d e v e lo p in g th e
an a to m ic a l form w ith a su itab le han d
in stru m e n t. T h e occlusal anatom y was
reproduced as closely as possible. At that
p o in t, the surface was polym erized and
the rubber dam removed. If n o occlusal
interferences were detected, the occlusal
surface w as n o t fin ish ed . T h o se re sto ­
rations that required occlusal adjustm ents
were surfaced w ith a carbide finishing
b u r an d w hite stone, and assigned to the
conventional fin ish in g group. T he second
g ro u p consisted of restorations that did
n o t use fin ish in g after polym erization.
V in y l p o ly s ilo x a n e im p re s s io n s
(Express, 3M D ental Products) were taken
o f each r e s to r a tio n im m e d ia te ly afte r
in se rtio n a n d a g a in once a m o n th for
th e f o llo w in g 6 m o n th s . T h e sam e
pro ced ure w as also do n e at the end of
1 year. T h e die stone casts were identified
on the base ac co rd in g to p a tie n t id en ­
tific a tio n , to o th n u m b e r, site, an d age
of the restoration u sing a num erical code.
T h is m e th o d p re v e n te d th e e v a lu a to r
fro m id e n tif y in g th e h is to ry o f the
restoration.
A ll casts w ere c o m p a re d w ith a set
of calibrated casts by tw o evaluators for
the purpose of determ ining quantitatively
th e lo ss o f m a te r ia l o n th e o c c lu sa l
surface.10 T h e standard casts represented
loss of a n a to m ic a l c o n to u r in a p p ro x ­
im ately 100-/um intervals from 0 to 500
Aim. A cast falling m idw ay between two
standard casts was given an interm ediate
v a lu e of 50 ixm. If, h o w ev er, th e cast
r e p re s e n tin g th e re s to ra tio n fell close
to, b ut did not m atch a given standard,
an in te r m e d ia te v a lu e of 25 (im was
assig n ed. T h e re so lu tio n c a p a b ility of
this system then is 25 /um." O n the basis
o f a sa m p le size of 50 sp ecim en s, the
standard error was show n to be 18 jtm.
E valuators read each of the seven casts
334 ■ JADA, Vol. 118, March 1989
for in d iv id u a l resto ratio n s b lin d ly an d
independently.
T h e casts m ade a t the tim e of resto­
r a tio n p la c e m e n t w ere u se d as th e
in d iv id u a l b a s e lin e s. T h is v a lu e w as
subtracted from each of the subsequent
m o n th ly values for each resto ratio n . A
t test was perform ed for each of the 1-
m o n th in te rv a ls , te s tin g th e fin is h e d
group again st the unfinished group. T h is
test was carried o u t for the data, separated
into evaluators’ findings and also pooled.
Inter-evaluator agreem ent was tested for
each g ro u p an d tim e in te rv al u s in g a
t test.
Results
T h e ra te s of w ear of th e p o s te rio r
com posite resin restorations, w hen sub­
je c te d to th e tw o d iffe re n t fo rm s of
treatm ent, are show n in F igure 1. T h e
u p p e rm o st curve (G ro u p 1) rep resen ts
the cum u lativ e loss of m aterial d u rin g
a 12-m onth period in con ju n ctio n w ith
c o n v e n tio n a l f in is h in g te c h n iq u e s .
V alues are p re se n te d m o n th ly fo r th e
first 6 m onths an d then again at 1 year.
T h e low erm ost curve (G roup 2) repre­
sen ts th e c u m u la tiv e loss of m a te ria l
w h e n n o f in is h in g m e th o d w as u sed
subsequent to polym erizing the surface.
T h ere is a su b stan tial difference in the
am p litu d e of the two curves.
M ean values for each m onthly period,
except the first m onth, were statistically
significant (P < .05). T h e m ean differ­
ential for the two com posite restoration
f in is h in g m e th o d s a v e rag ed a p p r o x i­
m ately 60 ¿um.
Discussion
T h e w ear rate of m ost subm icron p o s­
terior com posite resins is linear. T ypical
exam ples include H erculite, H eliom olar,
and Visio Dispers. T h e same is not true,
however, for those co n tain in g larger sized
filler particles. In general, the wear rate
fo r su c h m a te ria ls as ty p ifie d in th is
study decreases as a function of time.
A d ec reasin g w ear rate, p a rtic u la rly
d u rin g the first few m o n th s of service,
could be attrib u ted to a n um ber of factors.
T h e firs t m ay be re la te d to c u s p /r e s ­
to ratio n contact. Specifically, the closer
th e a n ta g o n is t cu sp to th e co m p o site
resin re sto ra tio n ’s occlusal surface, the
greater the stress of m astication. Increas­
in g the distance th ro u g h wear of co m ­
p o site re sin s h o u ld d ecrease th e c o n ­
c e n tr a tio n of stress a n d th e re fo re th e
rate of wear.
T h e wear rate may also be attributed
to the relative sm oothness of the surface.
T h e existence of m in u te surface irre g ­
u la ritie s as g en erated by th e fin ish in g
in s tru m e n t m ay create a c o n d itio n of
u n e v e n stress d is tr ib u tio n d u r in g
m astication.
O n e of th e m o st s ig n ific a n t facto rs
co n trib u tin g to the h ig h early wear rate
m ay be the m an n er in w hich the occlusal
surface is contoured an d finished. R apidly
r o ta t in g in s tru m e n ts su c h as sto n e s,
co arse d ia m o n d s, a n d p a ra lle l-b la d e d
fin is h in g burs generate a great deal of
su rface energy. It is p o ssib le th a t th is
energy is su fficien t to g en erate m ic ro ­
cra ck s o n a n d b elo w th e r e s to r a tio n
surface. C onceivably, these u n d esirab le
defects extend below the finished surface
by as m uch as 50 fim or more. T h is m e­
chanically weakened m aterial w ould be
less resistan t to ab rasio n o r w ear th an
the m aterial beyond it.
It m ig h t be a rg u e d th a t th e slo w er
wear rate of the no fin ish in g g ro u p could
h av e b ee n ca u se d by lig h te r o c c lu sa l
contact w ith the antag o n ist tooth. H o w ­
ever, m ore th an half of the restorations
in the n o -fin ish in g g ro u p had occlusal
contacts sim ilar to those in the conven­
tio n a l f in is h in g g ro u p . F u rth e rm o re ,
in those cases where the occlusal contacts
w ere lig h t or m is s in g , th e o c c lu s io n
com m only ad ju sted itself to eventually
reestablish contacts.
T h e u se of p r im a ry te e th w as w ell
s u ite d fo r th is c lin ic a l stu d y . M o st
im p o r ta n tly , th e o c c lu sa l a n a to m y is

relatively sim ple w hen compared w ith
perm anent d en tition . By com parison,
the incline planes are considerably less
steep and the development of anatomical
form with m inim al occlusal interferences
is appreciably easier to generate than
with permanent teeth.
It is also im portant to note that the
wear rate of posterior com posite resins
in primary teeth is the same as it is in
permanent teeth. Therefore, the results
obtained in this study cou ld lo gically
be projected to permanent dentition.
T he results of this study dramatically
demonstrate that conventional grinding
of the occlusal surface contributes sig­
n ifica n tly to a red u ction in the wear
resistance of the restoration. Regardless
of the tim e that the restorations were
evaluated for w ear, the d ifferen tial
betw een the tw o co n d itio n s was su b ­
stantial. Scanning electron micrographs
of in vitro specimens subjected to similar
surface treatments reveal an interesting
pattern. Those subjected to conventional
surfacing exhibited a greater degree of
subsurface microcracking. If the surface
finishing of com posite resins results in
a weakened substructure, then perhaps
the fin ish in g process itself sh ou ld be
evaluated.
A nother approach to reducing early
wear may be to develop a wear-resistant,
surface-penetrating sealant capable of
flow ing into the subsurface defects. After
polymerizing and bonding to the walls
Ratanapridakul-Leinfelder-Thom as : EFFECT OF FINISHING ON WEAR RATE OF COM POSITE RESIN ■ 335
of the microcrack, the resin matrix would
be refortified, m aking the surface more
wear resistant. If successful, the overall
wear rate, at least in itia lly , w ou ld
decrease, and the lon gevity of the res­
toration would increase.
Conclusions
T h e elim in a tio n o f co n v en tio n a l fin ­
ishing procedures on the occlusal surface
resulted in a su bstan tial reduction in
wear. Although not feasible as a routine
clinical approach, the results did suggest
that the fin ish in g procedures used to
fin a lize the restoration may be q u ite
important. Perhaps in this regard, a series
of diamond instruments as described by
Lutz and others,12 with decreasing particle
size should be used.
-----------------J1ÎOA ----------------
I n fo r m a tio n a b o u t th e p r o d u c ts m e n t io n e d in
th is article m ay b e a v a ilable fro m the authors. N either
th e a u th o r s n o r th e A m erica n D e n ta l A sso c ia tio n
h as an y com m ercial interest in any o f th e products
m en tion ed .
Dr. R atanap ridak u l is a graduate stud en t, depart­
m en t o f p ed iatric d entistry, U n iv ersity o f A labam a
at B ir m in g h a m . Dr. L e in fe ld e r is A lu m n i/V o lk e r
P r o fe s s o r o f C lin ic a l D e n t is t r y a n d d ir e c t o r o f
B io m a t e r ia ls C lin ic a l R e s e a r c h , U n iv e r s it y o f
A la b a m a at B ir m in g h a m , U n iv e r s ity S ta tio n , B ir­
m in g h a m , A L 35294. Dr. T h o m a s is p ro fesso r o f
p ed ia tric d en tistry , d ep a rtm en t o f c o m m u n ity and
p u b lic h ea lth d en tistry , U n iv ersity o f A la b a m a at
RESEARCH REPORTS
B ir m in g h a m . A dd ress re q u ests fo r rep rin ts to Dr.
L einfeld er.
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E q u ip m e n t. E x p a n sio n o f the accep ta n ce p ro g ra m
fo r d e n ta l m a teria ls, in s tr u m e n ts a n d e q u ip m e n t:
c o m p o s ite resin m a teria ls for o c c lu sa l C lass I a n d
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