Composite Restorations

General Considerations
 Indications
■ Classes I, II, III, IV, V and VI
restorations
■ Foundations or core build-up
■ Esthetic enhancement procedures
■ Partial veneers
■ Full veneers
■ Tooth contour modifications
■ Diastema closure
■ Cements for indirect restoration
■ Temporary restorations
■ Periodontal splinting
 Isolation Factor
■ For a composite restoration to be
successful, it must be appropriately
bonded to the tooth structure
■ Bonding requires an environment isolated
from contamination by oral fluids or other
contaminants, because such
contamination prohibits bond
development
 Occlusal Factor
■ Composites exhibit less wear resistance
than amalgam
■ Factors that affect wear resistance of
composite include:
■ Tooth location
■ Width of tooth prep
■ Type of contact from opponent tooth on the
composite surface
Operator ability and Commitment
Factor
■ Tooth prep for composite is relatively easy and
less complex than for amalgam
■ However, tooth isolation, placement of
etchant, primer and adhesive on tooth
structure, insertion, finishing and polishing of
composite are more difficult than for amalgam
■ The operator must pay greater attention to
detail to successfully accomplish a composite
restoration
■ This requires both technical ability and
knowledge of the material’s use and
limitations.
 Contraindications
1. Areas which cannot be isolated
2. Areas subjected to heavy occlusal
forces
3. Root surface restorations
4. Operator ability
 Advantages
1. Esthetics
2. Conservative of tooth structure
3. Less complex preparation
4. Insulative, having low thermal conductivity
5. Used almost universally
6. Bonded to tooth structure resulting in good
retention, low microleakage, minimal
interface staining and increased strength of
remaining tooth structure
7. Repairable
 Disadvantages
1. May have gap formation usually on the root
2. More difficult, time-consuming, and costly
because:
■ Tooth treatment usually requires more step
■ Insertion is more difficult
■ Difficult to establish proximal contacts, axial
contour, embrasure and occlusal contacts
■ Finishing and polishing procedures are more
difficult
3.More technique sensitive because the
operating area needs to be isolated and
placement of etchant, primer and adhesive on
the tooth is very demanding of proper
technique
4. May exhibit greater occlusal wear in areas of
high occlusal stress
5. Have a higher linear of coefficient of thermal
expansion resulting in marginal percolation
Composition of Composite Resin
 General Composition
Composed of:
■ Dispersed phase or Filler phase

■ Silica, glass, quartz

■ Lithium, aluminum ions (for easier crushing
to generate small particles)
■ Barium, zinc, boron, zirconium and yttrium
(for radiopacity)
■ Matrix phase
■ BisGMA, UDMA, TEGDMA
■ Silorane

■ Silane coupling agent

 Classification
According to:
■ Filler particles – components, amount and

properties
■ Matrix phases- composition

■ Polymerization method– UV-light curing,

visible-light curing, dual-curing or staged-

curing
■ Handling properties
 Filler particles

■ Macrofillers – 10 to 100 um- 75% to

80% filler by weight. Exhibits rough
surface texture-more susceptible to
discoloration
 Filler particles

■ Microfillers- 0.01 to 0.04 um fine

finishing- 35%-60% filler by wt.
inferior physical property but smooth
surface finish.
 Filler particles
■ Hybrid-0.4-1 um-75%-85% filler by
weight. Combines favorable physical
and mechanical properties macrofill
and smooth surface property of
microfill
 Filler particles
■ Nanofillers- 0.005 to 0.01 um very
fine finishing, good physical
properties
■ Nanohybrids
■ Midifillers- 1- to 10 um fine
■ Minifillers- 0.1 to 1um very fine
 Other types of Composites

■ Packable composites - have increased

viscosity for:
■ Easier restoration of proximal contact

■ Similar to handling property of amalgam

 Other types of Composites

■ Flowable Composites- have lower filler

content, lower wear resistance and lower
strength. Exhibits higher polymerization
shrinkage.
■ Used for pfs, small class I or as base

under filled composites

 Types of Polymer Matrix
■ Bis-GMA- bisphenol-A glycidyl
dimethacrylate and
■ UDMA- urethane dimethacrylate most
commonly used polymer matrix
■ Silorane- newer type, less shrinkage
 Polymerization method
■ Self-cured, chemically cured, or two-
component system
■ Amine accelerators
■ Ultra-violet- light cured
■ Visible-light cured
■ Camphorquinone photoinitiator
■ Dual-cured
■ Staged-curing –(filtered light)
 Types of light curing units
■ Quartz-tunsten-halogen (QTH)
■ Plasma arc
■ Laser
■ Light-emitting diode (LED)
 Variables associated with VLC
Curing equipment factor
■ Degradation of:

■ Bulb (frosting)
■ Light reflector
■ Optical filter
■ Fiberoptic bundle breakage
■ Light-guide fracture
 Variables associated with VLC

■ Tip contaminated by resin build-up

■ Line voltage inconsistencies
■ Sterilization problems
■ Infection control barriers
 Variables associated with VLC
Procedural Factors
■ Light tip direction (light-focusing tip for

prox surface, light-transmitting wedge)

■ Access to restoration

■ Distance from surface (1-2 mm of the

composite)
■ Size of tip (3mm diameter)

■ Tip movement

■ Time of exposure (20s)

 Variables associated with VLC

Restoration factors
■ Restoration thickness (1-2 mm thick)

■ Cavity design

■ Filler amount and size

■ Restoration shade (darker shades, place at

least 1mm)
■ Monomer ratios
Note: degree of conversion- or degree of
cure is related to the intensity of light
and the duration of the exposure. It
decreases considerably with depth into a
composite.
 Clinical Considerations
Polymerization Shrinkage- the composite pulls
away from the preparation walls as it
polymerize
Configuration factor- or C-factor- this refers
to the ratio of bonded surfaces to the
unbonded or free surfaces. The higher the C-
factor, the greater is the potential for bond
disruption from polymerization effects.
 Clinical Considerations
To counteract the effect of a high-C-factor:
■ Use soft start polymerization
■ Incremental addition of composite
■ Use a stress-breaking liner (flowable or
RMGI)
■ Use composite with different polymer
(e.g.silorane) instead of BisGMA or UDMA
 Clinical Considerations
■ Color matching
■ Dry teeth appear lighter and whiter
■ Chemical change in matrix

■ Dentin darkens with age

■ Bleaching

Note: beveling blends color on margins

■ Interfacial Staining
■ Proper etching and bonding
■ Secondary caries
■ Degree of technical excellence during
composite placement
■ Wear
■ small- to medium-width restoration
■ can be repaired by rebonding a new surface
onto old composite
■ Marginal integrity
■ Butt-joint margins
■ Postoperative Sensitivity
■ Marginal diffusion of species that induce
fluid flow within dentin
■ Dimensional changes of restoration
■ Biocompatibility
■ Unpolymerized materials are potentially
cytotoxic