COMPOSITE RESINS

Presented by: Dr Kiran C

CONTENTS 
        

Introduction. History Composition Generations. Classification. Indications & contraindications. Advantages & disadvantages. Properties . Curing systems . Curing lamps .

INTRODUTION.
³A thing of beauty is a joy for ever´
In the current age of adhesive dentistry or micro dentistry, conservation of tooth structure is paramount. Rather than using extension for prevention as a treatment guideline, emphasis is now placed on restriction with conviction. The advent of composite resin restorative materials has led the way towards achieving this goal

Uses of synthetic resins in restorative dentistry has markedly increased in recent years due to increased demand of aesthetics.

‡ The composite system was then introduced in order to enhance certain properties and overcome some of the problems that had become evident in clinical performance of unfilled resins

They have largely replaced silicate cements and GIC in anterior restorations due high aesthetic value .

The composites themselves underwent many changes in formulation

.From the era of unfilled acrylic resins the restorative resin technology has come to the era of the advanced composite which include antibacterial composite and fiber reinforced composite.

thermal shrinkage and low wear resistance. large polymerization shrinkage. Introduced in 1962 by BOWEN to overcome the drawbacks of unfilled resins like low mechanical properties.  Also botanical term where clusters of flowers are clubbed giving a shape to a different flower.  composite ± Name origin-Latincomponere-put together. .

a solid formed from 2 or more distinct phases that have been combined to produce properties superior or intermediate to those of the individual constituents. crystalline or resin filler particles and short fibers bound to the matrix by silane coupling agents. According to Anusavice (11th ed) : In materials and science.Dental composites  Dental composites are highly cross linked polymeric materials reinforced by dispersion of glass.  .

Historical Background  Chronological development Of Composites Conventional Type I Conventional Type II Microfilled Organic Hybrid Flowable and Packable 1962 1968 1975 1978 1989 1996 .

INDICATIONS    Anterior restorations Esthetic restorations Conservative restorations  Preventive resin restoration Proximal slot restoration  .

· Full veneer · Diastema closure. IV. Sealants . Foundations or core buildups. Esthetic enhancement procedure · Partial veneers.           Classes I. Cements (for Indirect restoration) Temporary restorations. V & VI restorations.Contd«.. Periodontal splinting . III. II.

Contraindications  Uncontrolled bruxism Excessively wide preparations Inability to bond to tooth structure Poor operating field isolation    .

Placed in one appointment. . Strengthening effect on teeth. Repairable. Adhesion to tooth structure. Low thermal conductivity. No galvanic reactions. Conservation of tooth structure.Advantages          Esthetics. Less complex tooth preparation.

Exhibit greater occlusal wear in areas of high occlusal stress. . Life span is less. 2. May have a gap formation. 3. 6. Higher linear co-efficient of thermal expansion. time consuming and costly. Stain & discolor over time. 7. 4. Technique sensitive. More difficult. 5.Disadvantages 1.

9. Low # strength. 12.Generation & inhalation of dust during finishing potential health hazards for pt & dental staff. 10. Due to breakage of adhesive tooth bond. 13. . Leakage ± leading to secondary caries. Polymerization shrinkage causes bacterial leakage.8. 11. Increased plaque adhesion.Allergic reactions.

Generations of Composites 6 generations of composites (Marzoak) First Generation Of Composite Consist of macroceramic reinforcing phase Highest mechanical properties Highest surface roughness .

Second Generation of Composite  Colloidal and microceramic phase in continuous resin phase.  Wear resistance is better than first generation. .  Properties of thermal expansion and strength are unfavorable because of the limited % of reinforcers that can be added . exhibit best surface texture of all composite.

Third Generation     Is a hybrid composite combination of macro and micro(colloidal) ceramics as reinforcers They exists in ratio of 75:25 Properties are in between first and second generation . . Good surface smoothness and reasonable strength.

irregularly shaped highly reinforced composite macroparticles with a reinforcing phase of micro ceramics These are very technique sensitive Exhibit properties in between 1st and 2nd generation .Fourth Generation     Are also hybrid composite These contain heat cured .

Fifth Generation    Are hybrid systems in which the continuous resin phase is reinforced with macro. spherical heat cured composite particles The spherical shape improve their wettability Surface texture and wear of these composite is comparable to 2nd generation composite .

They have highest percentage of reinforcing particles They exhibit minimum shrinkage Wear and surface characteristics are very similar to 4th generation .Sixth Generation     Are hybrid composite in which the continuous phase is reinforced with a combination of micro ceramics and agglomerates of sintered macro ceramics.

classification of composites. 1)Based on matrix composition:   Bis-GMA UDMA (Urethane dimethacrylate) Bis-EMA    TEGDMA Other resins .

2}Based on polymerization method 1.light cured. Dual light cured. . 2. Self cured. UV light cured Visible light cured 3.

Chemical Cure Resins  Also know as Self or Auto Cure   Requires mixing Incorporation of air voids   Benzoyl Peroxide or Benzene Sulfinic Acid Aromatic tertiary amine  Color instability with time  Production of free radical species .

Ultraviolet Light Cure Resin   Benzoin alkyl (methyl) ether 365 nm UV light (EMR)     Minimal mixing required Slow reaction Long curing times 30 day shelf life after activation  Production of free radical species .

Visible Light Cure Resin    Camphorquinone Aliphatic tertiary amine 470     20 nm light (EMR) No mixing required Fast reaction Short curing time Long shelf lived  Production of free radical species .

Dual Cure Resins     Visible light cure reactants Self cure reactants Most require mixing Uses   Resin cements Cervical increments in Class II. or IV situations . III.

Free Radical Species    Highly reactive Unstable Attack and open C=C bonds in monomers  Vinyl polymerization Cause chain growth Cause chain crosslinking  Initiate polymerization   .

or lithium Ytterbium fluoride (YF3)  Source of fluoride ion  Not radiopaque .3)Based on Radiopacity  Radiopaque   Glasses with barium. strontium.

.Mega fill ± contains mega fillers (very large individual filler particles).Macrofill ± contains macrofillers (10-100Qm) .Midifill ± contains midifillers (1-10 Qm) .4) Based on filler particle size .

1 Qm) .01Qm) ..Micro fill.1-1Qm) .0050.Minifill ± contains minifillers (0.01 0.Nanofill ± contains nanofillers (0.contains micro fillers (0.

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   Hybrids . Homogeneous ± filler & uncured matrix material.Composites with mixed ranges of particle sizes. . Heterogeneous ± precured composites & unusual fillers.

6 .5)According to Anusavice (Phillips (Based on particle size of major filler).1Qm . Most commonly used & simplest one: - Traditional composites ± 8-12µm Small particle filled composites ± 1-5Qm Microfilled composites ± 0.04-0.4Qm Hybrid composites ± 0.

Traditional Composites .

Micro Filled Composites .

chemically cured. Single paste & liquid .supplied in syringes.base & reactor. Single paste system . Light activated.compomers. Chemically activated. .6) Based on mode of supply : 2 paste system . Disposable capsules .

.04Qm.7) According to Graham J. Hume : Type 1 ± Macrofilled composite resin (conventional / traditional composites) .Contain only macro filler particles. W.Exhibit unacceptable wear (both of itself and opposing tooth) Type 2 ± Microfilled composites resin. Mount. Fillers ± amorphous silica particles of 0.R. .

Known as small particle composites¶ .Contains combination of macro filler particles with a proportion of micro filler particles. . . .Type 3 ± Hybrid composite resin.most commonly used composite resins.

Classification based on area used   Anterior composites Posterior composites .8) Based on viscosity    Flowable composites. Medium viscosity composites. Packable composites. 9).

.1-10 . Classification according to Bayne and Heyman: Category        Particle size Megafill Macrofill Midifill Minifill Microfill Nanofill .1-2 mm .04-0.01-.10-100 .m .10).1 . m.01 .. ..005-.4 .0.m.m .

2. Polymerization inhibitors. Coupling agent. Inorganic phase (filler phase). Initiators & accelerators. . 3. 5. 4. Dental composites are composed of Organic phase (resin matrix). 6.Composition  1. Color shade pigments.

.BOWENS RESIN. Introduced by BOWEN in 1960 . High molecular weight monomer.Organic Phase (matrix phase)  BISGMA: (bisphenol A glycidal methacrylate). Formed by reaction between a molecule of ethylene glycol of bisphenol A & glycidyl methacrylate.

Mixture of 3 parts of BISGMA 1 part of TEGDMA   . Has polymerization shrinkage of 5%.difficult to blend & manipulate. High water sorption. DRAWBACK: Highly viscous .

commonly used with epoxy resins.  . Spiro Ortho Carbonates ± expanding matrix. Recently Expanding Matrix Composites are introduced to compensate for the polymerization shrinkage.

Inorganic Phase: Fillers
1. Ground Quartz, 2. Colloidal Silica, 3. Glass or Ceramic Containing Heavy Metals. 
Tricalcium phosphate, Zirconium dioxide, Fillers containing fluoride Yittrium trifluoride. yitterbium trifluoride.

Silica Glass (SiO2) 


Beach sand and ordinary glass Crystalline quartz 


Larger particles Not polishable Sub micron particles Engineered aluminum silicates Radiopaque Polishable 



Pyrolytic silica 

Barium, strontium, lithium 
  

All have good optical properties

Alumina Glass (Al2O3) 

Crystalline corundum 
  

Like a sapphire and ruby gemstones Very hard Not polishable Opacifier due to optical properties

Combination Glass 
   

Sodium-calcium-alumino-fluoro-silicate glass Glass ionomer cement Compomers Engineered mishmash of glasses Source of fluoride ion

milling . 50-85 wt%.grinding .Present in 30-70 vol%. . precipitation process. Produced .

5. Decreases water sorption .Properties enhanced by addition of fillers: 1. . Reduced the co-efficient of thermal expansion. Increase in modulus of elasticity. Reduces the polymerization shrinkage. 4. 3. Improved mechanical properties. softening & staining. 2.

Adhesive bonding to filler and resin matrix is produced by coupling agent.Coupling agents  Adhesive bonding of the filler is essential for strength and durability of the composites. .

   Most commonly used are organosilanes. Others such as Ti. . MECHANISM: In presence of water the methoxy group are hydrolyzed to silanol group that can bond with other silanols on filler particles by formation of siloxane bond. zr vinyl silanes can be used.

2.Provide hydrolytic stability by preventing water from penetration along the filler resin interface.Stress absorber at filler resin interface. . 3.Properties 1.Impart improved physical & mechanical properties.

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. ) Functions ± extend storage lifetime for all resins. ensure sufficient working time.01 wt%. A typical inhibitor is butyloted hydroxytoluene (BHT). ( 0.Inhibitors : These are added to the resin systems to minimize or prevent spontaneous or accidental polymerization of monomers.

:  Activator ± Initiator System Both mono & dimethacrylate monomers polymerize by additional polymerization mechanism initiated by free radicals. microwave). Free radicals can be generated by chemical activation/by external energy activation (heat.  . light.

Mixed . Activator ± N.Chemically Activated Resins:     Supplied in 2 pastes. N dimethyl toludine (aromatic tertiary amine).amine reacts with BP to form free radicals and additional polymerization is initiated. Initiator ± benzoyl peroxide. .

Supplied as single paste contained in a light proof syringe. 2 types of light activated composites U-V light activated.Light Activated resins   a. b. . Visible light activated.

U-V Light Activated: Initiator ± benzoyl peroxide. DISADVANTAGE: 1. 2. Lack of depth curing. . Activator ± UV light of wave length 360nm. 3. Health hazards. Slow decrease in intensity of uv light.

2 wt%).Visible light activated: Initiator ± camphoroquinone(0. Accelerator ± tertiary amine (dimethyl amino ethyl methacrylate) ± 0. b. Improved depth of cure.15% Activator ± visible light of wavelength 460480nm. Controllable working time. ADVANTAGES: a. .

0010. .Coloring Agents:    To provide natural appearance dental composites must have visual shading and translucency that are similar to corresponding properties of tooth structure.007%) are usually used. Achieved by various pigments. Metal oxides of minute quantity are used. aluminum oxide (0. Titanium dioxide .

Solubility. Radiopacity. 3. 7. 5. Modulus of elasticity. . Water absorption. Linear coefficient of thermal expansion. Wear resistance. 2. Surface texture.PROPERTIES 1. 4. 6.

Although the restoration can be finished with abrasives and is functional after 10 minutes. polymerization is inhibited. The curing reaction continues for a period of 24 hours. the number of unreacted carbon double bonds may be as high as 75% in the tacky surface layer. studies report that about 25% remain unreacted in the bulk of the restorations.   PHYSICAL PROPERTIES Working and Setting times For light cured composites. about 75% of the polymerization takes place during the first 10 minutes. If the surface of the restoration is not protected from air by a transparent matrix. initiation of polymerization is related specifically to the application of the light beam to the material. Not all of the available unsaturated carbon double bonds react. . the optimum physical properties are not reached until about 24 hours after the reaction is initiated.

These short setting times have been accomplished by controlling the concentration of initiator and accelerator. and further work with the material becomes difficult. The setting times for chemically activated composites range from 3 to 5 minutes. the surface of the composite may lose its capability to flow readily against tooth structure. time period after dispensing of the paste onto a paper pad during which fresh composite flows against tooth structure at an optimum level. there is a critical properties are not reached until about 24 hours after the reaction is initiated.   For most composites that are initiated by visible light. Florescent lights labeled ³gold´ can be substituted to provide unlimited working time for light cured composites. Within 60 to 90 seconds after exposure to ambient light. .

 

Polymerization shrinkage Free volumetric polymerization shrinkage is a direct function of the amount of oligomer and diluent, and thus micro hybrid composites shrink only 0.6% to 1.4%, compared with shrinkage of microfilled composites of 2% to 3%. This shrinkage creates polymerization stresses as high as 13 MPa between the composite and tooth structure. These stresses severely strain the interfacial bond between the composite and the tooth, leading to a very small gap that can allow marginal leakage of saliva. This stress can exceed strength of enamel



and result in stress cracking and enamel fractures along the interfaces. The potential for this type of failure is even greater with microfilled composites, in which there is a much higher volume percent of polymer present, and polymerization shrinkage is greater. The net effect of polymerization shrinkage can be reduced by incrementally adding a light cured composite and polymerizing each increment independently, which allows for some contraction within each increment before successive additions

  

Thermal Properties The thermal expansion coefficient of composites ranges from 25 to 38 X 10-6/oC for composites with fine particles to 55 to 68 x 10-6/o C for composites with microfine particles. Thermal stresses place an additional strain on the bond to tooth structure, which further compounds the detrimental effect of the polymerization shrinkage. Thermal changes are also cyclic in nature, and although the entire restoration may never reach thermal equilibrium during the application of either hot or cold stimuli, the cyclic effect can lead to material fatigue and early bond failure. If a gap were formed, the difference between the thermal coefficient of expansion of composites and teeth could allow for the percolation of oral fluids.

 

Water sorption The water sorption of composites with fine particles (0.3 to 0.6 mg/cm2) is greater than that of composites with micro fine particles (1.2 to 2.2 mg/cm2), because of the lower volume fraction of polymer in the composite with fine particles. The quality and stability of the silane coupling agent are important in minimizing the deterioration of the bond between the filler and polymer and the amount of water sorption. It has been postulated that the corresponding expansion associated with the uptake of water from oral fluids could relieve polymerization stresses.

01 to 0. Inadequately polymerized resin has greater water sorption and solubility. Adequate exposure to the light source is critical in light cured composites. Inadequate polymerization can readily occur at a depth from the surface if insufficient light penetrates.  Solubility The water solubility of composites varies from 0. possibility manifested clinically with early color instability .06 mg/cm2.

cranberry/grape juice. Color stability of current composites has been studied by artificial aging in a weathering chamber (exposure to UV light and elevated temperature of 70oC) and by immersion in various stains (coffee/tea. Composites are resistant to color changes caused by oxidation but are susceptible to staining.Colour and stability    Color and Color stability Change of color and loss of shade match with surrounding tooth structure are reasons for replacing restorations. . Stress cracks within the polymer matrix and partial debonding of the filler to the resin as a result of hydrolysis tend to increase opacity and alter appearance. Discoloration can also occur by oxidation and result from water exchange within the polymer matrix and its interaction with unreacted polymer sites and unused initiator or accelerator. red wine. sesame oil).

factor. .Polymerization Shrinkage    Composites exhibit shrinkage while hardening. Most imp regarding the effects of polymerization shrinkage is C. More common when the restoration has extended onto root surface results in gap formation.

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C= BONDED WALLS UNBONDED WALLS . The ratio of the restoration¶s bonded to unbonded (free) surfaces.C-FACTOR The C-factor is the ratio of bonded (flow-inactive) to unbonded or free (flow-active) surfaces.

2 .One walled cavity 1 C= 5 Bonded Unbonded C-FACTOR 0.

5 .Two walled cavity 2 C= 4 Bonded Unbonded C-FACTOR 0.

Three walled cavity 3 C= 3 Bonded Unbonded C-FACTOR CAVITY CLASS 1 III .

Four walled cavity 4 C= 2 Bonded Unbonded C-FACTOR CAVITY CLASS 2 II .

Five walled cavity 5 C= 1 Bonded Unbonded C-FACTOR CAVITY CLASS 5 V&I .

greater is the potential for bond disruption from polymerization effects. Class IV with C-factor 0. .2 is at low risk compared to class I with C-factor 5 is at high risk.  Higher the C-factor .

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Low C factor restoration less shrinkage .

High C-Factor Resin shrinkage Before Polymerization .

No Translation (Compensation from Free Surface) .High C-Factor Resin Shrinkage Pre-gel Phase No Stress.

Post-gel Phase Possibility No. 1 Distortion If bond strength exceeds stress (and something can move) .

2 Gap Formation If stress exceeds bond strength .Post-gel Phase Possibility No.

Soft start polymerization. 2.Stress bearing liner. 3.Incremental additions. It can be overcome by 1. such as a filled dental adhesive or RMGI. .

two paste system .UV activated composite one paste system .POLYMERIZATION    Initiation Propagation Termination Earlier .

  Visible light  400-700 nm Most composites sensitive  400-520 nm (blue) .

4.Self curing. 2.Dual curing.Staged curing. 3. .Light curing.Curing Systems 1.

 .SELF CURING It requires 2 components. 3. 2.  Base and catalyst.Air inclusion ± greater internal porosity.  Direction of shrinkage is towards center ± helps to prevent micro leakage. Disadvantages: 1.Color stability is less.Setting time more.

. 2. Less internal porosity. 3. Disadvantages .  1.5-2 mm. Greater color stability. Requires curing light units or generators.LIGHT CURING   1. Inadequate curing ± thickness exceeds 1. Advantages : Less finishing time.

Purpose : Lengthen the pregelation phase by lowering the polymerization rate thus providing more time for composite to flow and also result in an improved adaptation of composite. .Soft start polymerization   Include initial low irradiance followed by stepped or ramped increase to higher irradiance.

. Effects : Reduces gap formation. Reduces polymerization contraction stress at tooth restoration interface. 2. 3. 1. Improved marginal adaptability due to lower shrinkage stress.

Self curing rate is slow and is designed to cure only those portions not adequately cured. .DUAL CURING   Combining self curing and light curing.

partially cured material that can be easily finished. . Afterwards . By filtering light from the curing unit during an initial cure ± possible to produce soft .STAGED CURING    In some cases composite finishing is difficult in hard fully cured material. filter is removed and the composite curing is completed with full spectrum visible light.

Curing Techniques .

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CURING LAMPS .

2.  Parts: 1.Halogen ± protect filament  .Quartz-tungsten-halogen (QTH) Most common dental curing light. 3.Tungesten filament.Quatrz bulb.

Plasma-Arc (PAC)   Uses xenon gas ± ionized to produce a plasma. High intensity white light is filtered to remove heat and to allow blue light to be emitted .

Current available emit 490 nm. Very expensive.Argon Laser      Highest intensity. . Emit single wave length. Warning signs required.

Emit radiation ± in blue light No filters Typically cordless Duke Compendium 2001 . Generate no heat.LED Curing Lights      Long lasting light source.

LED Curing Lights  First generation   high cost low irradiance   < 300 mW/cm2 increase exposure time Mills et al BDJ 2002 .

  lower cost higher irradiance   > 600 mW/cm2 similar to halogen  High heat production Price J Can Dent Assoc 2003 Soh Oper Dent 2004 .LED Curing Lights  Second generation.

1 or more low-powered chips that emit a second frequency - .LED Curing Lights  - Third Generation blue chip as the second generation and.

Schaan. BURTSCHER. Liechtenstein . and V. Lindemuth 2003 Photo Initiators & Absorption Spectrum Violet Blue Green 370 400 430 450 470 500 Argon Laser Halogen Plasma Arc LED Camphoroquinone PPD AADR Abstract 0042 Efficiency of Various Light Initiators after Curing with ifferent Light-curing nits P.J. Ivoclar Vivadent. RHEINBERGER.

these materials conserve the tooth structure better because they are retained by adhesive methods rather than depending on cavity design .conclusion Composites have unquestionably acquired a prominent place among the filling materials employed in direct techniques Also.

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Type of Composite    Microfills scatter light Darker shades impede energy transmission Glass fillers transmit light better  hybrids > flowables Kawaguchi JDR 1994 .

COMPOSITES .

. References. Conclusion. Recent advances. Common failures.Contents      Technique of placement.

. usually results is a marketed reduction in salivation.  Profound anaesthesia contributes to a more pleasant and uninterrupted procedure .Clinical Technique : Initial Clinical Procedures : A thorough examination. Local Anaesthesia :  May be required for many operative procedures. prognosis and treatment plan be finalized before the patient is scheduled for operative treatment.

. plaque. pellicle etc. A slurry of pumice is recommended for this procedure.  Prophylaxis paste containing flavoring agents.Preparation of Operating Site :  Cleaning the operating site to remove calculus. glycerin or fluorides are avoided to prevent conflict with acid etch technique.

.Select Shade Shade matching is much more complicated task than it may look like.

yellow. or orange tints.  Teeth are usually white with varying degrees of grey . Color also varies with the translucency . thickness . . and distribution of enamel and dentin and age of the patient.

e.e. µ w¶ (mostly enamel) is lighter and more translucent than cervical third i. whereas the middle 3rd i.Like at incisal third i. µ x¶ is a blend of incisal and cervical colors.e. . µ y ¶(mostly dentin).

 Other factors like fluorosis. It is also noted that most manufacturers also cross reference their shades with those of Vita shade guides which is a universally adopted shade guide. tetracycline staining and endodontic treatment also effect the tooth color.  . Most of the manufactures provide shade guides for their specific materials which are not interchangeable with other manufacturers.

 Good lighting. either natural or artificial is necessary when color selection is made. Dental operating light should never be used.  However if additional shades are needed they may be obtained by mixing of two or more of the available shades together by adding color modifiers. Most of composites are available in enamel and dentin shades as well as translucent and opaque shades. .

..When we combine a full selection of shades..

with a comprehensive selection of opacities.. ..

.we can recreate nature««.

Isolation of the Operating Site : Isolation for tooth colored restoration can be accomplished with 1) Rubber dam 2) Cotton rolls and retraction cords .

For Class V with facial approach ± necessary to apply a No.For anterior restoration for lingual approach ± it is better to isolate all the anterior teeth and include the premolars to provide the lingual access. .212 retainer which may stabilized with impression compound.

Etching ‡  Increases retention by phosphoric acid (~ 37%) Enamel  Produce micro-porosities  Increases contact areas  Dentin  Removal of smear layer / open up dentinal tubules Min. 15 sec. Max 15 sec. Start at Enamel Extend to Dentin .

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Do not Drying dessicate ‡Use oil-free air ‡Avoid desiccation of dentin ‡Etched surface must be ³Dried´ & enamel surface should appear chalky white .Rinsing ‡To remove all acid remnants & tooth debris for successful bonding Remove Gel and excess water 15 sec.

  Mechanical bond to tooth surface with adhesive system and surface roughness Bonding to Tooth structure  Enamel: Etching to create surface roughness increased surface  Dentin: Etching to remove smear layer open dentinal tubules Adhesive systems bonding flow into DT to form resin tags .

Bonding   Use low viscosity resin which will flow into etched enamel pores & dentinal tubules to form resin tags Act as intermediary between tooth and composite Apply ample amounts. Remove solvent with airair-syringe . leave undisturbed 20 .30 sec.

It is applied to tooth before the insertion of the composite restoration. .Matrix Placement : Matrix : Device which is applied to the prepared tooth in order to create / simulate a missing wall to restore the tooth.

.ring with sectional matrices ± Class II Translucent / Polyester strip Class III and IV restoration in anterior teeth.Numerous matrix systems are available Tofflemire matrix ± for Class II G .

Light transmitting wedge To stabilize the matrix band.Wedges Triangular wooden wedges ± mostly used  Round tooth pick . To gain separation of teeth To prevent overhang at gingival margin .

Syringes  These are used for flowable and other viscous composites . clean and without any scratches.Insertion of Composite : Instruments used for Insertion : Usually Teflon coated instrument used Instruments ± whichever used should be dry.

Curing is preferred from labial aspect if lingual approach was used and vice versa in labial approach. ‡Each increment is cured for 20 seconds and final increment for 40 seconds to 1 minute. ‡First increment which is placed should be 1. .5 mm thick. But finally cured from all surfaces.00 mm thick and the subsequent increments 1. Care should be taken to completely visualize the gingival cavosurface area (can use retraction cords etc).RESTORING THE ANTERIOR TEETH CLASS III AND IV Here whether the approach is lingual / labial first increment is placed on the gingival wall.

. Darker ± cervical  Less dark ± Middle 3rd Lighter . closure of composite would be from dark to light and translucent.Here blending of shades is more important.Incisal Translucent ± Incisal edge Similarly restoring fracture incisal edges / horizontal fracture of tooth care to be taken to blend the colour following the basic principles. Labial involvement From cervical Incisal area. It depends on Extent of lesion.

creating a gap. So this leaves a small contraction gap at the gingival margin.RESTORING THE POSTERIOR TEETH : Chemical cured composite shrink toward the geometric centre of mass. . This in turn pulls the softer composite resin from the gingival margin. Photo cured / light cured composite resins shrink toward the light sources because compression resin closest to light hardens first.

fibre optic extension can minimize gap formation. To overcome this . . 2) Incremental technique reduce the gingival contraction gap and stresses . 1) A plastic wedge .

.Placement Techniques   Bulk technique Incremental placement technique Three incremental design Horizontal layering design Oblique layering design U shaped layering design Vertical layering design Successive cusp build up technique Stratified layering technique split incremental technique.

Bulk technique .

Successive Cusp Build up Technique    The first composite increment is applied to a single dentin surface without contacting the opposing cavity walls Each cusp then is built up separately by placing a series of wedge-shaped composite increments Minimize the C-factor in 3-D cavity preparations .

Dentin shades of higher chroma are placed in the middle of the preparation and of lower chroma close to the cusp walls.Stratified Layering Technique - - Designed to produce the various degrees of chroma present within a tooth. .

 The use of opaque and warm shades at the bottom to translucent and lighter shades at the top result in more natural appearing restorations. .

5 mm thick composite resin increments were used to restore cervical carious lesions. . two diagonal cuts were made in each increment in order to split it into four triangular-shaped flat portions.Split incremental technique  Technique: Two flat 1. Prior to light-curing.

unbounded areas created by the two diagonal cuts. Clinical Significance: This technique results in the reduction of the C-factor and the generated shrinkage stresses by directing the shrinking composite resin during curing towards the free. .

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removal of gross excess with finishing burs.creation of smooth and shining surface with polishing discs/paste. Essential in promoting longevity of filling and prevent discoloration .Finishing & Polishing Finishing . diamonds or stones Polishing .

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Especially At Margins 2) Marginal Fracture 3) Recurrent Caries 4) Post Operative Sensitivity 5) Cross Fracture Of Restoration 6) Lack Of Maintaining Contact 7) Accumulation Of Plaque Around The Restoration . during and after manipulation.Composite restorations are very technique sensitive ² so utmost care is necessary before. The Visible Modes Of Failures 1) Discoloration.

RECENT ADVANCES

Flowable Composite   



Introduced in 1996. Characterized by presence of filler particles that have particle size similar to that of the traditional hybrid composites. but content of filler is reduced which results in decrease in viscosity. FEATURES : Filler content is 20-25% less than that of traditional hybrid composites. Depth of cure is approximately 6mm.

  

Stickiness to instrument , makes it difficult to smoothen the material. Mechanical properties of material are generally about 60-90% of those of conventional composites. hence should be avoided in high stress areas. Flow increased and the material flows immediately on dispensing from syringe.

Types
1)With Lower Filler Content intended for use such as pit and fissure sealants or small anterior restorations. 2) With Higher Filler Content 
For use in Class I, II, III, IV and V restorations

Mechanical properties 
Inferior to those of standard hybrid composites.

Applications 

Pit and fissure sealants



Preventive resin restorations (minimal invasive occlusal class I)



Inner layer of class II posterior composite resin placement in sealing the gingival margin to avoid deficiencies

     

Enamel defect repair. Repair of crown margins. Repair of composite resin margins. Small class V abfraction lesions. luting porcelain and composite resins. Small class III restorations.

Diameter .Packable/ condensable composites:     Based on PRIMM (polymer rigid inorganic matrix material). Fillers instead of being incorporated into composites as glass particles are present as a continuous/scaffold of ceramic particles. Consist of resin and ceramic component.< 2 µm. .

PLACEMENT:  Consistency is similar to that of freshly triturated mass of silver amalgam. . Excess is removed with cleoid-discoid or Hollenbeck carver and the restoration light cured for 30sec. It is placed into cavity by carrying and ejecting from a carrier whose nozzle is preferably made from /coated with wear resistant Teflon polymer.then polished. Each ejected increment is then condensed similar to silver amalgam restorations. Preparation is filled to a point beyond the cavosurface margin.

Increased wear resistance. Non stickiness. Higher depth of cure. Solitaire . Decreased polymerization shrinkage. surefil .Properties      Improved flexural modulus. filtek. .

After silanating the fibers.May 1997)  Introduced the concept of PRIMM(polymeric Rigid Inorganic Matrix Material) for fabricatig packable composites. dia 2 micrometer.vol 128. In this.inorganic phase consists of scaffold of ceramic fillers.Karl Leiflander(JADA.the space within the fibrous network is filled with BisGMA/UDMA  .

 Advantages:  Decreased curing shrinkage.less wear rate  Material condensable like Amalgam  Depth of curing is more(6mm)-due to light conducting properties of individual ceramic fibers.  Curing time-30 sec. .

   SOLTAIRE ALERT SUREFILL .Range of Packable composites.

  . Porasity &geometry of fillers allows packability of composites Greater the forces applied during condensation better is packing ability. SOLTAIRE: (1997) First comercially  i available packable composite material contains barium aluminio silicate glass particles fused at elevated temp creating large particles with coarse texture.

ALERT(Amalgam Like Esthetic Restorative Treatment)    Highly filled polyceramic material. Low wear rate& polymerization shrikage. high strength. combination of conventional fillers & chopped glass fillers.(crushed barium alumino silicate glass & collidal silica.good proximal contacts dia &20 mm length) in addition to hybrid composite filler.) .

Good clinical wear Tight proximal contacts Curing depth -5mm .SUREFILL      Contain Urethane modified BisGMA High packing density by incorporation of 3 types of fillers-midfiller.minifiller& microfiller.

INDICATIONS-1.decreased wear 3. .INDIRECT COMPOSITE RESINS      Mormann &Touti ±pioneered the indirect inlays &onlays Touti &Pissis.metal free dentistry &esthetics 2.conservative tooth preparation.gave the concept of metal composite inlays &onlays after silinating tech.

Bruxism 2.long span bridges.io       CONTRAINDICATIONS: 1.opposing porcelain 3. .high caries rate 5.difficult moisture controll. 4.

Filler(trimodal)-Ba glass. .spheroidal silica filler. Resin matrix-BisGMA & UDMA. Optimized chemical composition. effective bonding to luting cement. onlays. Consists of 77%filler. combine advantages of both composites and ceramics.Ceromers(Ceramic optimized polymer)           Developed by TARGIS. collidal silica. Advantages:Durable esthetics High abrasion resistance Conservation of tooth structure Ease of final adjustment. polishability. 23% organic matrix. Uses:Inlays. veneers.

Also known as PRG (pre reacted glass ionomer) composites. Low moisture sensitivity.but certain amount of acid-base reaction has already occurred when supplied by manufacturer. Differ from compomers-as they light cures and variable amount of dehydrate polyalkeonic acid is incorporated into resin matrix and the acid does not mix with glass until water uptake occurs into restoration.Giomers      Hybrids of GIC and Composites. Fluro aluminosilicate glass in these materials react with polyalkeonic acid in water prior to inclusion to silica filled urethane resin. .

Class V restorations. require bonding system for adhesion and light polymerization. deci tooth caries. Indications: . 4AET-Phenyl-p bonding system. non carious cervical lesions. filled adhesive (self etch primer) based on PRG technology. assist in close adaptation of restoration without gap formation.single application bonding system. Etch pattern are shallow.   root caries.giomers come in 1 paste system.   Reactor bond is glass ionomer based. trcerableall in one.

. prevent secondary caries.Advantages:       Flouride release. Bio compatible Reduced moisture sensitivity Good esthetics Smooth surface finish Excellent bonding.

 Silica glass particles are fused onto high strength 5 sized ceramic crstalline whisker at high temperature.Single crystal modified composite A novel ceramic whisker filler system developed for reninforcement of dental composites. Allows for bimodal distribution of filler particals.  .  These crystals(0.4micro meter) are silanated and incorporated into resin matrix.

Eg. . Resinous photopolymerization. DYRACT AP. DYRACT. Contains both polyalkenoic acid and glass fillers exceot water.Compomers     Composite resin-glass ionomer hybrid restorative material.

Fiber Reinforced composites . Limiting factor: Fibers only may be used with dimensions greater than 1 Qm .diameters 5 to 10 Qm . . Main Advantages : Excellent strength. effective lengths of 20-40 Q.

. Composition of FRC: Reinforcing component. Surrounding matrix.

Composite Inserts : Available in different shapes ± L. Round. cylindrical. conical. T. Minimize marginal contraction gaps in composite fillings Reduces polymerization shrinkage by up to 75% increased stiffness of the filling .

. Reduces secondary caries formation at the margin of a restoration .Smart Composites Ion releasing composite material fluoride hydroxyl and calcium ions as the pH drops in the area immediately adjacent to the restorative materials R educed demineralization.

Core Composites : Types Self Cured Composites Light Cured  Dual Cured Products Core composites are usually tinted (blue. white or opaque) to provide a contrasting color with tooth structure. .

Advantages :      Can be finished immediately Easy to contour Have high rigidity Have good color under ceramic restorations Bond to dentin. .

Conservative preparations. 2. . Patients experiencing Para functional habits.Minimize thermal condition (amalgam is metallic conduct had rapidly). In caries active mouth 3.Esthetics is the primary concern 2. 3. cuspal coverage or large restorations exceeding 1/3rd buccolingual width of tooth ± inferior physical properties.Indications : 1. Contraindications : 1.

Attempts to incorporate antibacterial propertiesantibacterial composites.Antibacterial Composites Greater amount of bacteria & plaque accumulate on the surface of resin composites than on other restorative surfaces. .Chlorhexidine was tried ± not successful since  Release was not uniform. First.  Toxic effects  Population shifts of microorganisms  Antibacterial activity short lived  Deterioration of physical & mechanical properties.

Neisseria.MDPB Imazato et al (1994) ± non releasing newly synthesized monomer . .MDPB (methacryloxy decyl pyridinium bromide) It copolymerizes with methacrylate monomers and hence chemically bound to matrix resin on curing Had good antibacterial properties even after immersion in water No adverse effect on mechanical properties Effective against Streptococci & other plaque forming organisms like Actinomyces. & Vellionella.

Silver Silver added for antibacterial properties. . Supported into silica gel & coated over the surface of composites. Silver ions are added by one of the following ways: Incorporated into organic oxides like SiO2 Hydrothermally crystal lattice network space of filler particles.

optical properties & does not disrupt the polymer network or impair polymerization composite monomers. Does not impair mechanical.  Silver has Oligodynamic action ± silver ions catalyses into silver & hydroxyl radicals which cause damage to bacterial structure. .

Used preferably with epoxy resins. Epoxy resins contract approximately 3.EXPANDING MATRIX RESINS FOR COMPOSITES     It was first studied by THOMPSON in 1979.6% therefore combining these two will achieve a net polymerization expansion. . Spiro ortho carbonates (SOCs) are the expanding matrix used.4% and SOCs expand approximately 3.

 Features: Decreases polymerization shrinkage. Increases toughness. Decreases water permeation. that is 2 covalent bonds break to form one new bond and thus expansion is evident.  SOCs consists of 4 rings. . the double ring of Spiro molecule opens. and on polymerization. 2 on each side of Spiro carbon.

moderate amount of colloidal silica enhance handling characteristics. it provides the opportunity for double bond conversion. particle size 0. .Art Glass:    In addition to conventional bifunctional molecules. It aid in improving the wear resistance & physical & mechanical properties. art glass contain molecules with 4-6 functional groups. Filler ± radio opaque barium glass.7 µm.

emission range is 320. emits 4.550nm.5watts. Curing photo cured in special unit xenostroboscopic light. .

 Stroboscopic light system: Emits light intensity for 20 null seconds followed by 80 milli sec of darkness. .

Elevated temperature 138ºc increases polymerization rate.polymerized under pressure at elevated temperature & in presence of Nitrogen an inert gas. . Curing . Elevated atmospheric pressure decreases vaporization potential of the monomer at elevated temperature.Belle glass:     Resin matrix ± similar to that of BISGMA.

  Nitrogen gas produces an oxygen free environment which results in higher level of polymerization. . Nitrogen gas increases the wear resistance.

on light activation only 60-70% of free monomers are converted. The polysiloxane is biocompatible & exhibit low shrinkage. contains low mol wt monomer BisGMA.77%wt.filler partical size 1-1. Introduced by HERBERT WOLTERS The Ormocer matrix consists of ceramic polysiloxane (silicon-oxygen chains). .Ormocer : (organically modified ceramics) Ormocer is the acronym for ³originally modified ceramics´ can be used as a restorative material for both anterior and posterior teeth and can virtually replace amalgam and composites. it contains 20-25% of matrix and the rest is fillers & coloring agents.5mm.

Esthetically pleasing.Advantages : Biocompatible Reduced polymerization shrinkage High abrasion resistance. can be used in stress bearing areas. available in different shades Anticaries properties due to fluoride release Safe handling and easy manipulation Cost effective .

Nanomers are discreate non-agglomerated and non-aggregated particals of 20-75 nm in size. Nanotubes have remarkable tensile strength. Improved physical properties Superior translucency and retained surface finish. Reduces internal spacing of filler particles. increased filler loading.4 microns.0.Nano composites         Contain nano-sized filler particals. Nanoclusters are loosely bound agglomerates of nono-sized particles. . Most shades contain nonomers and aggregated zirconia/nanocluster filler.6-1.

these materials conserve the tooth structure better because they are retained by adhesive methods rather than depending on cavity design .conclusion Composites have unquestionably acquired a prominent place among the filling materials employed in direct techniques Also.

it should not be forgotten that they are highly technique-sensitive. .Nonetheless. hence the need to control certain aspects: correct indication. use of a good procedure for bonding to the dental tissues and proper curing are essential if satisfactory clinical results are to be achieved. good isolation. choice of the right composite for each situation.

Satoshi Imazato. 16 (2000) 41 ± 47 . Yuichiro Noiri . R C Peterson. F C Eichmiller . 17 (2001) 485 ± 491 2. Noboru Ebi . Dental mat. S Deb . A Lopz . J M Antonucci . Macipe . G B Blackwell . 19 (2003) 517 ± 522 4 Continuous fiber reinforcement of dental resin composite restorations . M Toledano . Mechanical properties of visible light cured resins reinforced with hydroxyapetite for dental restorations . R W Milles .Inhibitory effects of resin composite containing bactericide ± immobilized on plaque accumulation. A comparative studies of the properties of the dental resin composites polymerized with plasma and halogen light. E Osorio . 19 (2003) 5. Depth of cure and compressive strength of dental composites cured with blue light emitting diodes. K D Jantt . G E Schumacher . H J MuvllerDental mat. R Rodriguez ± Clemente . Shigeeyuki Ebisu . S H Ashworth .Referances       1. J Murtra . H H Xu . R W Arcis . M A Fanovich . C D Pascual Dental mat. Dental mat. H Shemi Denatl mat. 18 (2002) 49-57 3.

1 . K D Lange . 431. Felix Lutz and R W PhilipsJ Prosthet. Dent. G Wieczkowski Jr. Clinical evaluation of two posterior composite resins retained with bonding agents. Dent 62 . W H Dougles . 4. R L Sakaguchi J Dent. Clinical significance of polymerization shrinkage of composite resins . Naoki Satou . Jumko Satou. 50 . Dent 57 . A J DeGeee J Prosthet.435 (1987) 10. Philips Science of dental mater . J R Boaush . Classification and evaluation of composite resin systems .      6.Hideaki Shintani . Effects of composites resin restorations on resistance to cuspal fracture in posterior teeth. 627 ± 632 (1989) 12. Does an incremental filling technique reduce polymerization shrinkage stress? A Versluis . 75 . 871 ± 878 7. 4 . 480-488 (1983) 8 . J Prosthet. E L Davis J Prosthet. Dent 48 . A Peters . M Cross . R Klockwski . (1992) 11. Res. C L Davidson . R B Joynt .