PRINCIPLES OF COMPOSIT

  RESTORATION
WRITTEN BY: DR AAKASH BARI
BDS
PRINCIPLES OF COMPOSITE RESTORATION

Composite restoration is the most demanding procedure in dentistry.

Composite restoration is used to restore defects in tooth color, shape or position caused by
developmental problems, acute or chronic trauma, or caries. Restoration can be simple or
complex. A simple restoration may involve a surface defect while a complex case may
involve complete smile design. A dentist is responsible for understanding
1. Smile Design
2. Color and Color Analysis
3. Tooth Color
4. Tooth Shape
5. Tooth Position
6. Esthetic Goals
7. Composite Selection
8. Tooth Preparation
9. Bonding Techniques
10. Composite Placement
11. Composite Sculpture and
12. Composite Polishing to properly restore anterior teeth with composite:
1. SMILE DESIGN
A dentist must understand proper smile design so composite restoration can achieve a
beautiful smile. This is true for extensive veneering and small restorations. Factors which
are considered in smile design include A. Smile Form which includes size in relation to
the face, size of one tooth to another, gingival contours to the upper lip line, incisal edges
overall to the lower lip line, arch position, teeth shape and size, perspective, and midline.
B. Teeth Form which includes understanding long axis, incisal edge, surface contours, line
angles, contact areas, embrasure form, height of contour, surface texture, characterization,
and tissue contours within an overall smile design. C. Tooth Color of gingival, middle,
incisal, and interproximal areas and the intricacies of characterization within an overall
smile design.
2. COLOR AND COLOR ANALYSIS
Color is a study in and of itself. In dentistry, the effect of enamel rods, surface contours,
surface textures, dentinal light absorption, etc. on light transmission and reflection is
difficult to understand and even more difficult replicate. The intricacies of understanding
matching and replicating hue, chroma, value, translucency, florescence; light transmission,
reflection and refraction to that of a natural tooth under various light sources is essential
but far beyond the 
3. TOOTH COLOR
Analysis of color variation within teeth is improved by an understanding of how teeth
produce color variation. Enamel is prismatic and translucent which results in a blue gray
color on the incisal edge, interproximal areas and areas of increased thickness at the junction
of lobe formations. The gingival third of a tooth appears darker as enamel thins and dentin
shows through. Color deviation, such as craze lines or hypocalcifications, within dentin or
enamel can cause further color variation. Aging has a profound effect on color caused by
internal or external staining, enamel wear and cracking, caries, acute trauma and dentistry.
4. TOOTH SHAPE
Understanding tooth shape requires studying dental anatomy. Studying anatomy of teeth
requires recognition of general form, detail anatomy and internal anatomy. It is important to
know ideal anatomy and anatomy as a result of aging, disease, trauma and wear. Knowledge
of anatomy allows a dentist to reproduce natural teeth. For example, a craze line is not a
straight line as often is produced by a dentist, but is a more irregular form guided by enamel
rods.
5. TOOTH POSITION
Knowledge of normal position and axial tilt of teeth within a head, lips,
and arches allows reproduction of natural beautiful smiles. Understanding
the goals of an ideal smile and compromises from limitations of treatment
allows realistic expectations of a dentist and patient. Often, learning about
tooth position is easily done through denture esthetics. Ideal and normal
variations of tooth position is emphasized in removable prosthetics so a
denture look does not occur.
6. ESTHETIC GOALS
The results of esthetic dentistry are limited by limitations of ideals and
limitations of treatment. Ideals of the golden proportion have been
replaced by preconceived perceptions. Limitations of ideals are based on
physical, environmental and psychological factors. Limitations of
treatment are base on physical, financial and psychological factors.
7. COMPOSITE SELECTION
Esthetic dentistry is an art form. There are different levels of appreciation so individual dentists
evaluate results of esthetic dentistry differently. Artistically dentists select composites based on
their level of appreciation, artistic ability and knowledge of specific materials. Factors which
influence composite selection include require ‑.rents for A. Restoration Strength, B. `'Fear and C.
Restoration Color.
A.   Restoration Strength is determined to be sufficient if force applied to a tooth is resisted by a
restoration. Measuring sufficient restoration strength is done by examining and comparing
direction, magnitude and frequency of applied force to resistance provided by material and
support structure. This includes analysis of occlusion and parafunctional forces.

A restoration is strongest if failure of resistance to force requires fracture of composite material,

debonding of material and fracture of support structure . Ultimate strength determination of a
restoration is often the weakest link in this chain.
B.  Wear is determined by resistance to abrasive, adhesive, chemical, and corrosive wear.
Additional forms of wear include hydrolysis of silane and fatigue. Composite chemical structure
and filler type are primary factors which affect wear.
C.   Restoration Color is determined by analysis of composite hue, chroma, value, translucency
and florescence with interaction of a tooth defect. Tooth defects are classified into two major
categories including those with tooth backing and those with no tooth backing. Tooth backing is
determined by observing teeth from a facial view.
D. Placement Characteristics defines how easy handling characteristics are to place
composite within or on tooth defects. Ideally composite should flow into small defects, not
sag when in place, be sticky to a defect surface and non ‑sticky to instruments.
E. Ability to Use and Combine Opaquers and Tints is important to change composite
color or block out defect background effects. In addition, these materials must provide ability
to produce natural characterization when desired.
F. Ease of Shaping is especially important when producing larger restorations. The
ability to mold material into position, have it stay in position and not be sensitive to ambient
light which would result in premature thickening is also important.
G. Polishing Characteristics defines how easy it is to polish a composite and the
appearance of a polished surface. It is further important to have the ability to polish different
types of surfaces such as finely contoured or highly textured.
H. Polish and Color Stability defines long term esthetic excellence. If a polished surface
fades or color changes, the results of excellent dentistry diminish as well.
8. TOOTH PREPARATION
Tooth preparation often defines restoration strength. Small tooth defects which receive
minimal force require minimal tooth preparation because only bond strength is required to
provide retention and resistance. In larger tooth defects where maximum forces are
applied, mechanical retention and resistance with increased bond area can be required to
provide adequate strength.
9. BONDING TECHNIQUES
Understanding techniques to bond composite to dentin and enamel provide strength,
elimination of sensitivity and prevention of microleakage. Enamel bonding is a well
understood science. Dentinal bonding, however, is constantly changing as more research
is being done and requires constant periodic review. Microetching combined with
composite bonding techniques to old composite, porcelain, and metal must be understood
to do anterior composite repairs.
10. COMPOSITE PLACEMENT TECHNIQUE
Understanding techniques which allow ease of placement, minimize effects of shrinkage,
eliminate air entrapment and prevent material from pulling back from tooth structure during
instrumentation determine ultimate success or failure of a restoration. It is important to
incorporate proper instrumentation to allow ease of shaping tooth anatomy and provide color
variation prior to curing composite. In addition, a dentist must understand placement of
various composite layers with varying opacities and color to replicate normal tooth structure.
11. COMPOSITE SCULPTURE
Composite sculpture of cured composite is properly done if appropriate use of polishing strips,
burs, cups, wheels and points is understood. In addition, proper use of instrumentation
maximizes esthetics and allows minimal heat or vibrational trauma to composite resulting in a
long lasting restoration.
12. COMPOSITE POLISHING
Polishing composite to allow a smooth or textured surface shiny produces realistic, natural
restorations. Proper use of polishing strips, burs, cups, wheels and points with water or polish
pastes as required minimizes heat generation and vibration trauma to composite material for a
long lasting restoration.