What is the composition of composite

Resin based composites are tooth-coloured restorative materials. The main components are inorganic fillers, organic matrix, silane
coupling agents, initiator systems and pigments.

- 1) Pigments:
o give colour to the material and can be customized to match the tooth shade
- 2) Coupling agents:
o are materials that bond to both the filler & matrix components of composites (aka Difunctional surface-active
compounds)
o Silane coupling agents have a methoxy group to bond to inorganic fillers and carbon bonds to interact with the
resin oligomers in the matrix. They allow the transfer of stress from the organic matrix to the inorganic filler
particles.
- 3) Initiator systems:
o start the polymerisation reaction in the composite material by generating free radicals.
o These can be photoinitiators which are activated by light or chemically activated initiators
- 4) Inorganic filler particles:
o make up the dispersed phase of the resin-based composites, they control the viscosity and hence adaptability
of the material to the cavity preparation
o Fillers are added to give strength and reinforcement to the composites, by increasing compressive strength,
tensile strength, toughness and modulus of elasticity (rigidity). By adding fillers it also decreases the volume of
resin matrix and therefore reduces polymerisation shrinkage. Increased filler loading can also decrease the
coefficient of thermal expansion of composite, bringing it closer to that of tooth structure. By controlling
viscosity, fillers can affect the manipulation and workability of the composite. Filler loading also decreases
water sorption, and can provide radiopacity.
o Examples: glass/quartz, silica, zirconium
- 5) Organic resin matrix:
o makes up the continuous phase of composites and is mainly composed of dimethacrylae monomers.
o There are 3 main types of monomers used: Bis-GMA, UDMA, TEG-DMA. Bis-GMA has the lowest amount of
shrinkage, followed by UDMA, then TEG-DMA.

How can composites be classified

Composites can be classified in 5 different ways, depending on different properties.

- 1) By filler loading
o a) Homogenous – all fillers the same
o b) Heterogenous – fillers different sizes and shape, pre-cured composite pieces with resin and filler
- 2) By mode of cure
o Light-cured – free radical polymerisation activated by light (blue/visible), don’t require mixing, photosensitizer
& amine initiator
o Chemical cured – polymerisation initiated by chemical reaction, less control over working time, formation
oxygen inhibited later that inhibits reaction because oxygen is more reactive to a radical than monomer
o Dual cured – light + heat or chemical + heat, chemical aspects allows slow self-set which can be accelerated by
light (on demand), eliminates depth of cure issues
- 3) By filler particle size
o The smaller the particle, the better the wear resistance
o The larger the particle, the better the polishability
o a) Nanofilled
o b) Microfilled
o c) minifill
o d) midifil
o e) macrofil
o f) megafil
- 4) By particle distribution
o Midi-hybrid
o Mini-hybrid
o Nano-hybrid
- 5) By texture /manipulation
 o a) Flowable composite – lower viscosity
o b) Packable composite – condensable, increased strength, fibrous filler particles
o c) All-purpose composite

What are the major drawbacks of composite

- Polymerisation shrinkage
o Unavoidable, occurs upon polymerisation, highest in TEG-DMA
o Upon polymerisation there is decreased distance/free space between atoms when covalent bonds formed
between monomers
o Average shrinkage 2-3%
o Effects of shrinkage:
▪ Marginal failure, stress development at interface, de-bonding, staining, secondary caries & post-op
hypersensitivity
o Can be reduced by:
▪ Using incremental technique to allow more to be cured before addition (<2mm)

▪ Use of composite inlays

▪ Increase filler load to decrease proportion of matrix

▪ Chemical-cure to reduce stress

- No fluoride release
o Unlike GIC conventional composites are not ion-leachable & cannot release fluoride
o Can’t be used to remineralise
- Biocompatibility
o Cytotoxicity of some materials in un-cured composites, poses risk if composite is insufficiently cured or to
dental workers
o Bisphenol-A may act as xenoestrogen that mimics effects of estrogen
o May cause possible pulp inflammation, contact allergy, post-op sensitivity
o Can reduce by ensuring all composite is effectively cured
- Technique sensitivity
o More steps involved
o Application of etch, application of bonding agent
o Light curing (may leave unreacted monomers)
- Solubility, water sorption & water sensitivity
o Resin component of composites absorbs water
o Absorption can increase if poorly light cured (insufficient polymerisation)
o Moisture control needed during placement otherwise failure
o Volume increase expansion
o Will: decrease hardness & decrease wear resistance
o To reduce:
▪ Moisture control during procedure

▪ Increase filler loading to decrease water sorption

- Wear resistance
o Strength depends on ability of coupling agent to transfer stress between matrix & filler
o Wear resistance LOWER than tooth structure
o LOWER in larger restoration
o Can occur via:
▪ 2-body wear – direct contact with adjacent tooth structure

▪ 3-body wear – contact with other material such as food

o Effects: poorer longevity, reduced use in posterior restorations, increases susceptibility to fracture
o To reduce:
▪ Smaller particle filler size (increase wear resistance)

▪ More conservative prep to conserve more tooth structure

- Higher coefficient of thermal expansion than enamel/dentin
 o Coefficient of thermal expansion higher than enamel/dentin
o Under thermal changes will expand more than tooth structure
o Can cause stresses at cavity margin
o Can reduce by having higher filler loading (reduces coefficient closer to tooth structure)

Compare & contrast GIC & RMGI (composition, uses, advantages,

disadvantages)
Conventional GIC

- Composition:
o True GIC – chemical cure (e.g. Equiforte)
o 1) Water
o 2) Calcium-alumino-silicate glass: ion-leachable glass
o 3) Accelerators: Icatonic acid (gelation) & Tartaric acid (increase working time)
o 4) Polyacids: polycarboxylic/Polyalkenoic acids
- Uses:
o Non-stress bearing areas
o Class I & II in primary teeth
o Class V & III in permanent teeth
o Cementaiton of fixed prosthesis
o Temporary restorations
o ART
o Sandwich restorations
o C/I in: stress-bearing areas, Large Class II & IV, aesthetically important areas
- Setting Reaction:
o Acid-base reaction
o Polyalkenoic acid & glass component react, acid dissolves the glass to release ions
o Initial set: 3-4 min, continues for 24hours
o 2 phases – dissolution & gelation
- Adhesion to tooth:
o Chemical & micromechanical bonding to tooth structure, direct to tooth without adhesive
o Chemical – formation of ionic bonds between carboxylate groups on polyacid molecules & calcium ions in tooth
surface
o Micromechanical – polyacid component etches the tooth surface & creates microporosities
- Advantages:
o Strength: high compressive strength, low flexural strength
o Biocompatible: low pulp irritation, polyacrylic acid is weak so less irritation
o Low thermal diffusivity: won’t transfer heat throughout
o Coefficient of thermal expansion similar to tooth structure
o Fluoride: can remineralise demineralised dentin, fluoride from ion-leachable glass
o Direct bonding to tooth structure: chemical bonding & interaction with calcium and phosphate in tooth
- Disadvantages:
o Lower aesthetics: poor polishability, early H20 contamination will increase opacity
o Brittle – lower wear resistance
o Water sensitive: during first 24-48h, high solubility, ions can be eluted, needs to be covered
o Lower mechanical & physical properties than RBC – poor abrasion resistance, low compressive strength, low
fracture resistance

Resin-modified Glass Ionomer

- Composition:
o Resin component added, Light-cured (Fuji II LC)
o 1) ion-leachable glass: fluoro alumino silicate glass
o 2) water-soluble polyacids (polycarboxylic acid)
o 3) water
o 4) methacrylate monomers (hydrophilic), HEMA
o 5) photoinitiators
 - Setting reaction:
o Lower reaction speed than conventional GIC
o Acid base reaction – similar to GIC, begins upon mixing & continues after polymerisation reaction
o Free radical polymerisation – light or chemical cured
- Adhesion:
o Requires etching or conditioning
o Resin component may induce shrinkage
o Bond strength slightly compromised compared to GIC
- Uses:
- Advantages:
o Fluoride release (compared to composite)
o Light cured: increase working time, on demand setting
o Less moisture sensitive than GIC
o Strength: rapid development of early strength, improved wear resistance, better physical/mechanical
properties than GIC
o Aesthetics: better polishing, finishing & aesthetics, improved translucency
o Improved adhesion to tooth compared to RBC
o Thermal properties closer to tooth structure than RBC
- Disadvantages:
o Fluoride release slightly lower than GIC
o Water intake – HEMA increases water absorption compared to GIC, can cause volume expansion
o Less chemical bonding compared to GIC
o Polymerisation shrinkage
o Less compatible than GIC
o Temperature increase associated with polymerisation
o Depth of cure

Compare how enamel vs dentin is prepared for bonding

The purpose of bonding is to provide resistance to separation of an adherend from a restorative material, it allows stress to be
distributed along bonded interfaces and it seals the interface. Effective bonding can increase resistance to microleakage, decrease
risk of post-operative hypersensitivity, decrease risk of marginal staining and decrease risk of risk of secondary caries.

Enamel – Acid etching

- Acid etch is composed of 37% phosphoric acid, and is applied to enamel to prepare it for bonding
- Aim is to remove peripheral hydroxyapatite layer (10 micron)
o Expose collagen matrix, remove smear layer
- Also to create microporosities/irregular surface
o Increase surface energy, better wettability, allows bond to spread over surface
o Favours resin infiltration (via resin tags)
o Increase micromechanical retention
- The smear layer forms due to cavity preparation, consists of sealed tubules and micro-organisms
- Needs to be removed as it may interfere with adhesion

Dentin – dentin conditioner

- Dentin conditioner composed of 10% polyacrylic acid (weak acid)

- Applied to dentin & dissolves inorganic structure (smear layer)
o Leaves collagen mesh
- Allows the infiltration of adhesive resin into the collagen fibrils
- During the conditioning process there is formation of a hybrid layer
o Forms between adhesive & dentin
o Intermediate layer of resin, collagen & dentin produced by the etching of dentin and infiltration of resin
o Transition layer between resin & tooth that locks the substances together on molecular level
- During conditioning of dentin have to keep it somewhat moist 🡪 use primers
o Too wet = re-expanded collagen network, where resin cannot fully replace water in collagen
o Too dry = collapse of dentinal tubules & become impermeable

What are the key components of a bonding system

 - 1) Etchants
o Materials such as polyacrylic acid that alter the dentin surface
o Remove smear layer to increase micromechanical interlocking
- 2) Primers
o Materials such as HEMA that improve the wettability of the adherends
o They are composed of hydrophilic monomers in solvent and act to maintain an open collagen network to
facilitate bonding, interact with moisture present in tooth
o They can be incorporated into the surface of the substrate
o Hydrophobic ends bond to adhesive resin
- 3) Solvents
o Enhance wetting
o Can be acetone/ethanol which are components in wet bonding where they will substitute for water
o Can be water based which engage in dry bonding and facilitate water removal from tooth structure
- 4) Adhesives
o Mainly hydrophobic Dimethacrylate monomers that fill the interfibrillar space of the collagen network
o Adherent (the material) 🡪 Adhesive (adhesive resin) 🡪 Adherend (tooth structure)
- 5) initiators
o Light-cured or Dual-cured or Chemical initiator

Classify the different dentin bonding systems, explain their composition and mechanism

Etch & Rinse Systems

- Etching and rinse systems are the conventional adhesive strategy, with 3-step currently seen as the gold standard for
adhesive systems. They aim to remove the smear layer, remove superficial hydroxyapatite and create an irregular surface
on tooth structure to promote micromechanical adhesion. The main components of etch & rinse systems are:
o Etchant
o Primer – hydrophilic functional monomers
o Bond – hydrophobic adhesive resin which impregnates into dentinal tubules and helps for the hybrid layer
between adhesive and the tooth surface
- Based on total removal of the smear layer
- Etch and rinse systems have excellent bonding to enamel, however, are technique sensitive and have a risk of over-drying
or over-etching the tooth surface which can cause post-operative hypersensitivity
- Etch and rinse systems can e classified as either 2-step or 3-step
- Three-step:
o Referred to as the total etch system. First the tooth is etched using acid, then primer is added to the surface,
followed by an adhesive resin which impregnates into the partially decalcified dentin. This system is preferred
when lots of enamel remains, it forms good bond strengths, however is limited by its technique sensitivity and
risk of excessive drying
- Two-step:
o This step completely removes the smear layer as with 3-step, first is the application of etch, then application of
a self-priming resin
o It has good bond strength and is easier due to the reduced number of steps

Self-Etch Systems

- Self-etch systems contain acidic monomers that can simultaneously etch and prime the tooth. Instead of completely
dissolving the smear layer, these monomers can modify the smear layer and dentin products and incorporate them into
the hybrid layer. The aim of these systems is to eliminate the etch and rinse step or incorporate it into other steps. These
systems can be classified by their pH into mild, intermediate or strong. The main components include:
o Self-etching primer: aqueous solution of acidic hydrophilic monomers that etch & prime tooth
o Adhesive – hydrophobic resin that is light cured
- Advantages:
o Reduced technique sensitivity (eliminating need to rinse, condition, dry)
o Reduced chair time
o Collapse of collagen network prevented because monomers infiltrate as they demineralise
o Smear layer & smear plugs not remove – therefore potentially reduce post-op sensitivity
- Self-etch systems are recommended in preparations with a large amount of dentin, as they may prevent over-etching
compared to etch & rinse systems. They are less technique sensitive and minimise the number of application steps
- Self-etch systems are reported to have slightly lower bond strength to enamel compared to etch & rinse systems
- Two-step:
o Self-etching primer – pH of the monomers low enough to remove the smear layer
 o Adhesive bond
- One-step
o Etchant + Adhesive + bond all combined together
o Doesn’t require any mixing

Universal/Multimode

- These are one-bottle systems such as Scotchbond universal bonding agent that can act as:
o Self-etch
o Etch & Rinse 🡪 total etch or selective etch
- They aim to reduce the complexity of adhesive application and therefore reduce technique sensitivity
- These systems contain functional monomers of 10-MDP that provide chemical adhesion to tooth structure by interaction
of phosphate groups with hydroxyapatite and calcium in the tooth structure. These systems have been observed to have
inferior bond strength, in some cases additional selective etching of enamel is required to improve bond strength.

Enumerate clinical limitations of resin-based restorative composites.

Discuss one main limitation in details
 Polymerisation shrinkage:
o Polymerisation shrinkage occurs as a result of the polymerisation reaction as the monomers form
bonds between each other resulting in reduced distance/increased free space
o Polymerisation shrinkage result in
 Stress developing at the restoration-tooth interface
 Increased post-operative sensitivity
 Marginal-seal failure
 Marginal leakage
 De-bonding
 Staining at the margins
 Recurrent caries
o Polymerisation shrinkage cannot be completed eliminated, however can be reduced by
 Incremental insertion of composite resin
 Use of inlays
 Increase filler load to reduce proportion of matrix
 Correct light curing time
 No fluoride release
o Unlike GIC and RMGIC, composite resin does not release fluoride, hence cannot be used to
remineralise tooth structure in high caries risk pts
 Biocompatibility
o Cytotoxicity of uncured composite resin could result in
 Post-operative sensitivity
 Pulp inflammation
 Contact allergy from HEMA
o Determined by
 Type of composite
 Method and efficiency of cure
 Remaining dentine thickness
o Can be avoided by properly curing the composite
 Solubility, water sorption, water sensitivity
o Organic matrix is subject to water sorption
o Water sorption occurs from
 Suboptimal moisture control during composite resin placement
 Suboptimal curing of the composite resin
o Water sorption results in
 Volume increase and expansion
 Damage to coupling agent (silane)
 Decreased hardness
 Decreased wear resistance
 Staining
 Decreased polymerisation shrinkage
 o Water sorption can be reduced by
 Optimal moisture control during insertion of composite resin
 Proper curing of the material
 Increased filler load to reduce proportion of matrix
 Wear resistance
o Lower than that of the natural tooth
o Lower in larger restorations
o It is dependent on the ability of silane to transfer stress between matrix and fillers
o Occurs via
 2-body wear: direct contact between restoration and adjacent tooth
 3-body wear: contact with 3rd material e.g. food
o Results in
 Reduced material longevity
 Increased susceptibility to fracture
o Wear resistance can be increased by
 Smaller filler particle size
 More conservative cavity preparation
 Coefficient of thermal expansion
o Higher than that of natural tooth
o Results in stress at cavity margin
o Can be reduced by higher filler loading

Compare between the effect of acid etching on enamel and dentine.

Explain the differences
 Enamel etching:
o 37% phosphoric acid applied to the prepared enamel for 20-30 seconds and then it is washed off
o Enamel etching creates 5-25um microporosities in the enamel prisms allowing for the adhesive resin
to penetrate them creating ‘resin-tags’- finger like projections of adhesive resin into the enamel
prisms
o Depending on the maturity and mineralisation of the enamel different etching patterns can be
achieved
 Type I: honey-comb pattern, dissolution of prism cores without dissolution of prism
peripheries
 Type II: cobblestone, peripheral enamel is dissolved, but the core is left intact
 Type III: mixture of type I and II
 All patterns give equally adequate bond strength
 Dentine etching:
o Dentine etching can either be with 37% phosphoric acid (total etching system), or a self-etching
primer (selective etching system) which contains a milder acid
o Total etching
 During total etching dentine the smear layer, collagen, and minerals are removed at a depth
of 5um
 Dentinal fluid droplets seep out of the tubules creating a wet surface
 Drying of the dentine results in the removal of the dentinal fluid and the subsequent
collapse of the collagen forming a dense structure that cannot be penetrated by the
adhesive resin
 Primer is applied to penetrate the collapsed dentine tubules and rehydrate them so they
can be penetrated by the adhesive resin forming resin-tags- finger like projections of
adhesive resin into the dentine tubules
o Selective etching
 During selective etching, self-etching primer modifies the smear layer, and removes collagen
and mineral at a dept of 0.5-1um
 Hydrophilic primer retains the open dentinal tubules allowing for adhesive resin to
penetrate them forming resin tags
Explain the differences between resin composites, resin-modified glass
ionomers, and conventional glass ionomers in term of bonding to dental
hard tissue
 Resin composite
o Resin composite forms micromechanical bond with enamel and dentine via the process of etching
o Etching creates microporosities in the enamel prisms which are penetrated by the adhesive resin
forming hybrid zone (demineralised/resin coated dentine) and resin-tags
 Conventional glass ionomer cement
o Chemical bonding achieved by ongoing ion-exchange between carboxylate groups on the polyacid
molecules and calcium ions on the tooth surface
o Microchemical bonding as a result of the etching form the polyacrylic acid forming micro-porosities
on the tooth surface
 Resin modified glass ionomer cement
o Bonding of RMGCI to dental hard tissue is the same as that achieved by GIC
o Chemical bonding achieved by ongoing ion-exchange between carboxylate groups on the polyacid
molecules and calcium ions on the tooth surface
o Microchemical bonding (superior to that of GIC) as a result of the etching form the polyaklenoic acid
forming micro-porosities on the tooth surface

Classify and discuss the differences in dentine bonding systems

 Etch and rinse system
o Etch and rinse system include 2 or 3 step systems
o 3 step system: etch, primer, bond e.g. Optibond
 37% phosphoric acid is applied to the enamel and dentine for 20-30 seconds to remove the
smear layer and then washed off
 Tooth is slightly air-dried
 Primer is applied to dentine to reopen the dentinal tubules
 Bond is applied, air dried and cured for 10seconds
 Advantages:
 Deeper depth of microporosities achieved in the enamel (5-25um), and deeper
penetration of the dentinal tubules (5um)
 Excellent bond strength and durability due to the depth of penetration achieved
 Disadvantages:
 Risk of over-drying (desiccation) of dentine resulting in pulp irritation
 Very technique sensitive due to the three separate steps
 Use of strong acid which activates dentine collagen degradation resulting in bond
failure over time
o 2-step system: etch, then primer and bond in one e.g. Prime and Bond
 Disadvantages:
 Hydrophilic component in the primer may cause suboptimal water evaporation,
therefore it is more prone to hydrolytic degradation and water sorption
 Use of strong acid which activates dentine collagen degradation resulting in bond
failure over time
 Self-etching system
o 2-step system: etch and primer in one, bond e.g. Clearfil
 Self-etching primer used to modify smear layer
 Enamel can be selectively etched if necessary
 Advantages:
 Since cavity is air dried prior to the placement of the bond there is a decreased
risk of water sorption and hydrolytic degradation
 Milder acid used to achieve adequate dentine demineralisation without activating
collagen degradation
o One-step: etch, primer and bond in one e.g. Scotch bond
 Enamel can be selectively etched if necessary
 Advantages:
 Less technique sensitive as requires application of one solution only
  Still achieves adequate bonding strength
 Milder acid used to achieve adequate dentine demineralisation without activating
collagen degradation
 Universal system
o One-step: etch, primer and bond in one e.g. Scotch bond
 Enamel can be selectively etched if necessary
 Advantages:
 Less technique sensitive as requires application of one solution only
 Still achieves adequate bonding strength
 Milder acid used to achieve adequate dentine demineralisation without activating
collagen degradation

Smear layer significantly affects bonding to dentine, discuss this statement

 The mechanical removal of tooth structure with rotary instruments during cavity preparation results in the
accumulation of enamel/dentine debris and organic matter on the enamel and dentine surfaces- smear layer
 The presence of the smear layer compromises the bonding ability of restorative materials such as composite
resin and GIC to tooth structure
 In dentine, the smear layer physically prevents the dentinal tubules to partake in the bonding process
 For bonding to occur, the smear layer must either be removed or modified to become a part of the bonding
interface
 The smear later can be removed with etchants
o 37% phosphoric acid for composite resin restorations
o Self-etching primers (acidic monomers) for composite resin restorations
 Self-etchants diffuse into the smear layer and increase its permeability so that it can be
incorporated into the hybrid zone
o 20% polyacrylic acid for GIC or RMGIC restorations

The integrity of restoration-tooth margin is essential for a successful

restoration. Summarise the differences in marginal preparation and
bonding between resin composites, and GIC based restorations
 Composite resin
o A healthy margin of at least 2mm is needed as composite resin cannot bond to unsound tooth
structure
 Composite binds better to enamel than dentine, however most often there is more dentine
exposed than enamel in large cavity preparations
o The direction of enamel prisms is also important as bonding requires resin tags to be formed between
enamel prisms and adhesive resin, hence it is important that the margin coincides with the long axis
of the enamel rods so that adequate penetration can be achieved
 Bevelling of enamel may be required to increase enamel surface area and expose more
enamel rods to partake in the bonding process
o Restoration-tooth bond involves the hybrid zone which is made of demineralised dentine coated with
resin.
 Excess polymerisation shrinkage can result in stress being applied at the hybrid zone
resulting in bond failure and de-bonding of the restorative material from the tooth structure
 Contamination during the bonding procedure can result in excess water being present on
the dentine which will result in hydrolytic breakdown of collagen and resin, eventually
resulting in de-bonding
 De-bonding at the restoration-tooth margin can result in the marginal microleakage and the
development of secondary caries via the penetration of oral bacterium
 GIC
o Bond between tooth and restoration involved both chemical bond (ion exchange between
carboxylate groups and calcium ions) and micromechanical bond (polyacid forms micro porosities in
the tooth surface)
o No need for complete removal of demineralised enamel/dentine as GIC can bond to it
 o Even if a GIC restoration is to fail, the failure is within the restoration itself and not at the ion-
exchange layer (margin) hence the chemical bond remains intact, and the integrity of the restoration-
tooth margin is retained

Discuss and compare the mechanical challenges between class I, II MOD,

and V restorations
 Class I
o Restorations involving the pits and fissures (occlusal surface) of posterior teeth
o Class I restorations for composite resin restorations result in a c-factor of 5 (5 bonded surfaces and
only 1 unbonded surfaces). High polymerisation shrinkage stress can result if composite resin is not
incrementally placed in the cavity.
o High compressive masticatory forces resulting in wear as a 2 or 3-body wear as the restoration comes
in direct contact with the adjacent tooth or any 3rd material between the restoration and the adjacent
tooth e.g. food
 Class II
o Restorations involving the interproximal surfaces of posterior teeth
o High compressive masticatory forces due to the occlusal extension of the restoration resulting in wear
(2 or 3-body wear)
o Tensile forces on the marginal ridges and cusp tips if involved
o For composite resin restorations, the c-factor is 2 (4 bonded to 2 unbonded surfaces) which may
result in high polymerisation shrinkage stress on the marginal walls is the composite is not placed
incrementally
 Class V
o Restorations involving the gingival third of buccal or lingual aspects of anterior or posterior teeth
o Class V restorations are subjected to large forces if the pt grinds
o No compressive forces are the restoration is not on the occlusal surface of the teeth hence do not
come in contact with adjacent teeth during mastication
o Large C factor (5) associated with composite resin restorations (5 bonded to 1 unbonded surfaces)
hence large polymerisation shrinkage stress may be experienced

The position of cavity margins relative to gingival line is critical. Discuss

this in term of marginal preparation, restorative material selection, and
bonding
 Restorative materials such as composite resins and GIC based are sensitive to moisture during their setting
reaction, hence if the cavity margin is too close to the gingival line, then optimal moisture control may be very
hard to achieve
 RMGIC are less sensitive than conventional GIC, hence moisture control is not optimal
 Moisture contamination during the setting reaction of GIC will result in the prevention of cation dissolution
hence weakened chemical bond between the tooth and restorative surfaces
 Similarly, moisture contamination during etching and bonding process for a composite resin restoration may
result in the breakdown of the hybrid zone due to hydrolysis of the resin matrix and dentine collagen

Summarise the biological, mechanical, chemical, and clinical challenges of

a direct filling restorative material
 Biological
o Cytotoxicity
o Irritation
o Allergy
o Antimicrobial
o Therapeutic
 Mechanical
o Deformation- change in length before and after load is applied
  Tensile force leads to elongation
 Compressive force leads to shortening
 Shear force tends to tearing
 Elastic deformation is reversible or temporary: the deformation only occurs when the force
is applied
 Plastic deformation is irreversible: the deformation remains even after the force is
o Fatigue/fracture
 When a material is subjected to stress below the yield stress in a repeated manner for many
times (cyclic loading) the strength of the material may be reduced leading to failure
 Fatigue is progressive fracture under repeated loading or it is the stress at which a material
fails under repeated loading
o Wear/abrasion
o Stress/strain
 Stress
 Reaction to the external applied force per unit area
 Equal in intensity and opposite in direction to the external force per unit area
 Tensile stress results when the body is subjected to two sets of forces directed
away from each other in the same straight line- elongation
 Compressive stress results when the body is subjected to two sets of forces
directed towards each other in the same straight line- shortening
 Shear stress results when the body is subjected to two parallel sets of forces
directed towards each other not in the same straight ling (tangential)- tearing
 Strain
 Change in length per unit length
o
 Chemical
o Corrosion
o Degradation
o Reactions
o Interactions
o Release
 Technical/clinical
o Manipulability
o Sensitivity
o Applicability
o Reliability
o Availability

Discuss how the variations in dispersed fillers in resin-based composite

systems could affect the properties and clinical related characteristics
 Composite based resin restorative materials are made of a polymer matrix and inorganic fillers (glass, quartz,
silica, zirconium) bonded to one another by coupling agents (silane)
 Functions
o Mechanical reinforcement (without fillers the matrix would be too weak to withstand mastication
forces)
o Reduce polymerisation shrinkage
o Reduce coefficient of thermal expansion and contraction
o Improve viscosity to improve workability
o Radiopacity
o Reduce water sorption
o Improve fracture toughness preventing crack propagation
o Reduces elastic modulus to allow greater distortion without failure
 Composite can be classified based on the
o Method of filler loading- % of filler added to the matrix to change the properties of the composite
 Homogenous- particles of the same size
 Heterogenous- particles of difference size and shapes
o Particle size
  Micro- smaller size but reduced % of filler
 Hybrid- larger size but increased % filler
o Particle distribution
 Midi
 Mini
 Nano
 Physical properties
o Polymerisation shrinkage
 Microfilled 2-4% > hybrid 1-1.7%
o Thermal diffusion
 Microfilled > hybrid
o Water sorption
 Microfilled > hybrid
 Mechanical properties of composite
o Compressive strength
 Microfilled< hybrid
o Modulus of elasticity
 Microfilled is ¼- ½ that of dentine
 Hybrid is similar to that of dentine
o Hardness
 Microfilled < hybrid
o Wear
 Microfilled< hybrid
 Filler loading
o Reinforcement
 Increased mechanical and physical properties with increased % of filler loading
o Reduction of polymerisation shrinkage
 Increased filler loading reduces the proportion of matrix
o Reduction in coefficient of thermal expansion and contraction
 Increased filler loading reduces the proportion of matrix and since expansion of
ceramic/glass is less than that of polymers coefficient of thermal expansion and contraction
is reduced
o Control of workability/viscosity
 More filler= thicker the paste hence makes workability harder
o Decreases water sorption
 Organic matrix tends to more susceptible to water sorption, increasing % filler loading
decreases proportion of matrix hence decreasing water sorption
 Water sorption interferes with coupling agent resulting in increased wear and staining
o Radiopacity
 Radiopacity is important for the radiographic detection of leaking margins, secondary caries,
poor proximal contacts, wear of proximal surfaces
 Heavy metal filler particles can alter the radiopacity of the composite
 Filler size
o Smaller filler size
 Advantages
 Greater wear and polishability
 Less superficial stains
 Disadvantages
 Decreased fracture toughness
 More flexible hence more prone to tearing
 Increased thermal expansion
 More scattered light hence lower depth of cure (small increments needed)
o Larger filler size
 Advantages
 Increased fracture toughness
 Decreased thermal expansion (more similar to that of natural tooth structure)
 Less scattered light= better depth of cute (larger increments can be used)
 Disadvantages
 Decreased polishability
 Increased superficial stains
Enumerate and discuss the differences between GIC restorations in terms
of composition, key properties, and limitations
 Conventional/true GIC
o Powder: calcium fluoro-alumino-silica glass
o Liquid: polyacrylic acid
o Water based acid-base setting reaction
 Polyacrylic acid attacks the fluoro-alumino-silica glass cation release formation of
carboxylate groups cations form salt-bridges between polyacid chains formation of
silica hydrogel
 Initial setting reaction (dissolution) 3-6mins:
 Silica hydrogel formation
 Cations form salt-bridges with polyacrylic acid (calcium polyacrylate)
 Water protection needed as moisture contamination prevents cation dissolution
 Maturation (gelation) >24hours:
 Alumino-polyacrylate cross-linkage
 Prevention of water loss (desiccation) by applying resin based hydrophobic
protective coat and light curing it
o Strong chemical bond formed between the calcium from hydroxyapatites and carboxylate groups
from GIC at the ion-exchange layer
 Polyacrylic acid also forms microporosities on the tooth surface resulting in some
micromechanical bonding
o Advantages
 Fluoride release
 Coefficient of thermal expansion is very similar to that of natural tooth structure
 Chemical bonding to tooth structure so even if filling fails, risk of secondary caries is low as
ion-exchange layer remains intact
 No polymerisation shrinkage
 High biocompatibility with the pulp
o Disadvantages
 Poor aesthetic
 Poor physical properties (poor abrasive resistance, low compressive strength, low fracture
resistance)
 Very water sensitive during and after setting reaction
o Clinical uses
 EQUIA FORTE- standard restorative GIC
 Class I in permanent teeth
 Class V in more anterior teeth
 Advantages
o Aesthetic
o Strong
 FUJI BULK- standard restorative GIC
 Class I deciduous teeth
 Class V and root surface of posterior teeth in high caries risk pts
 Class II open sandwich restorations in permanent teeth
 Advantages:
o Acid resistant
 Disadvantages:
o Uneasthetic
o Not as strong as EQUIA FORTE
 SDI RIVA SILVA- cermet cement e.g. long-term temporary restorations
 FUJI VII- true GIC
 Weak temporary restorations
 Surface protectant e.g. fissure sealants
 Advantages:
o High fluoride release hence can be used in high caries risk pts
 Disadvantages:
 o Unaesthetic (white or pink)
 Resin modified GIC
o Powder: calcium fluoro-alumino-silica glass, strontium, aluminate, or barium can be added to give
radio-opacity)
o Liquid: polyaklenoic acid + HEMA (hydroxyethylmethacrylate)+ water+ photo and chemical initiators
o Acid-base reaction followed by free radical polymerisation setting reaction resulting in metal
polyalkenoate salt hydrogel plus polymer network
 Polymer gives initial set and polycarboxylate salt precipitation gives the final set
o Micromechanical retention through the microporosities formed by polyaklenoic acid. Some chemical
bond between the calcium from hydroxyapatite and carboxylate groups
o Advantages:
 Improved aesthetics compared to conventional GIC
 Improved physical properties compared to conventional GIC (increased compressive
strength, diametrical tensile strength. Flexural strength, fracture toughness)
 Reduced water sensitivity compared to conventional GIC
 Rapid strength development due to the polymerisation reaction
 Improved acid resistance
o Disadvantages:
 Polymerisation shrinkage
 Increased water sorption due to HEMA (hydrophilic properties)
 Cannot be placed under direct occlusal load due to plucking out of glass particles from resin
matrix
 Not as acid resistant as new conventional GIC
 Reduced fluoride release
o Clinical uses
 FUJI II LC- Class V
 Luting cements
 Compomers
o Poly-acid modified composite
 Incorporation of GIC glass particles (carboxylate groups) in water-free polyacid liquid
monomer
 Not GIC as they are not water- based
o After setting, they absorb water from saliva, and only then initiate an acid-base reaction
o ‘Advantages’:
 Fluoride releasing capabilities of GIC with mechanical properties of composite
 Radioopaque
o Disadvantages
 Poor mechanical properties
 Staining
 Weak fluoride release
 No chemical bond to tooth structure
o Clinical indications
 Restorations of deciduous teeth
 Luting cements

Failure of resin-dentine bonded interface is a multifactorial process.

Briefly discuss this statement
 Types of resin-dentine bonded interface failure
o Cohesive failure- failure of adherent or adhesive itself
o Adhesive failure- failure between the adhesive and adherent
o Multiple failure- cohesive + adhesive failure
  Resin-dentine bonded interface is achieved through the etching and bonding process of dentine. Adhesive resin
penetrates the dentinal tubules (resin-tags) forming a hybrid zone (bonded interface)
o Suboptimal removal of the smear layer or the demineralisation of dentine will result in sub-optimal
bond formation
o Presence of excess/residual water in dentine will result in hydrolytic breakdown of both the resin and
the collagen
o Suboptimal infiltration of the resin adhesive will result in tearing of unsupported collagen, micro-gap
porosities and sensitivity
o Over-etching of dentine results in the activation of matrix metalloproteinases (endo-peptides)
resulting in the collagenolytic breakdown of collagen and resin
 Fracture of the collagen fibrils reducing bond strength
 Void creation by hydrolytic breakdown of collagen and resin
 Polymerisation shrinkage resulting from the light curing of resin based restorative material produce
polymerisation shrinkage stress on the hybrid zone
o Excessive polymerisation shrinkage stress may cause the hybrid zone to fail
 Composite resin not inserted in incremental lines
 High c-factor (ratio of bonded to unbonded tooth surfaces)

Summarise factors affecting the clinical success and serviceability of direct

tooth restoration
 Location of the restoration
 Nature of the cavity preparation (optimal resistance, retention, and convenience features)
 Type of restorative material chosen to restore cavity
 Following manufacturer’s instructions
 Optimal technique performance in preparing the cavity and restoring it
o Optimal cavity preparation with no excessive removal of tooth structure and no unsupported enamel
left behind
o Optimal moisture control during tooth preparation (etching and bonding, tooth surface cleaning) and
restoration placement