CLINICAL SIGNIFICANCE

OF C-FACTOR IN
DENTISTRY

O. K. PREETHI
 CONTENTS

1. HISTORY
2. C-FACTOR IN OPERATIVE DENTISTRY
• What is C-factor?
• Why C-factor is clinically significant?
• Methods to reduce C-factor
3. C-FACTOR IN ENDODONTICS
• Relationship between C-factor and length of the root canal
• Relationship between C-factor and file sizes
• Relationship between C-factor and sealer thickness

4. CONCLUSION
5. REFERENCES
 HISTORY

In 1980s when composites were less highly filled and bonding systems were not
as reliable or strong, shrinkage stresses from composite curing could dislocate the
newly bonded surfaces and created marginal openings.

The consequences of this process were first analysed by Feilzer et al in 1987

and described in terms of the ratio of surface area of fixed walls bounding a tooth
preparation versus unbounded walls – Configuration factor or C- factor

STURDEVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY-5th EDITION

 C-FACTOR
(CONFIGURATION
FACTOR)

C-factor is a tridimensional configuration of a prepared cavity and is derived by

the ratio of the bonded to the unbonded/free surface areas

C-factor = Bonded surface area / Unbonded (free) surface area

MATERIALS USED IN DENTISTRY- Dr S. MAHALAXMI

 C-FACTOR FOR
CLASSⅠRESTORATIONS

C-factor = 5/1 = 5.0

STURDEVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY-5th EDITION

 C-FACTOR FOR
CLASSⅡRESTORATIONS

C-factor = 4/2 = 2.0

STURDEVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY-5th EDITION

 C-FACTOR FOR
CLASS Ⅲ RESTORATIONS

C-factor = 3/3 = 1.0

STURDEVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY-5th EDITION

 C-FACTOR FOR
CLASS Ⅳ RESTORATIONS

C-factor = 2/4 = 0.5

STURDEVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY-5th EDITION

 C-FACTOR FOR
CLASS Ⅴ RESTORATIONS

CERVICAL
PREPARED
ABRASIVE
CLASSⅤ
CLASS Ⅴ
CAVITY
LESIONS

C-factor = 5/1 = 5.0 C-factor = 1/5 = 0.2

STURDEVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY-5th EDITION

 WHY IS C-FACTOR CLINICALLY SIGNIFICANT ?

Most compositions can be practically cured only to levels of 55% to 65% degree of
conversion of the reactive monomer sites.

During conversion of monomer to polymer, a composite undergoes polymerization

shrinkage.

In the early stages of conversion, there are only a few polymer chains and they are
not well connected (cross – linked).

STURDEVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY-5th EDITION

In the range of approximately 20% conversion, the polymer network is sufficient to
create a gel.

At this point the system changes from behaving like a liquid that can flow to a solid
that has increasingly stronger mechanical properties.

During the first 20% of chemical reaction, the accompanying polymerization

shrinkage is accommodated by fluid changes in the dimension of the system.

After the gel point, polymerization shrinkage produces internal stresses within the
network and stresses along all the surfaces of the system.

STURDEVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY-5th EDITION

Bounded surfaces of enamel and dentin may undergo some local stress, which could
reduce the strength of the recently formed bonding layer.

Unbounded surfaces distort, when possible, to accommodate the stress.

When there is a smaller ratio of bonded to free surface area, the flow of the
composite resin undergoing polymerization occurs easily over the free area
minimizing the stress caused during polymerization shrinkage.

When there is less free surface, little flow occurs resulting in greater interfacial
stress

STURDEVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY-5th EDITION

METHODS TO REDUCE C-FACTOR
 INCREMENTAL PLACEMENT

THREE INCREMENT HORIZONTAL

DESIGN LAYERING DESIGN

TEXTBOOK OF OPERATIVE DENTISTRY – VIMAL.K.SIKRI – 4TH EDITION

 INCREMENTAL PLACEMENT

OBLIQUE LAYERING U-SHAPED

DESIGN LAYERING DESIGN

TEXTBOOK OF OPERATIVE DENTISTRY – VIMAL.K.SIKRI – 4TH EDITION

 INCREMENTAL PLACEMENT

VERTICAL
LAYERING DESIGN

TEXTBOOK OF OPERATIVE DENTISTRY – VIMAL.K.SIKRI – 4TH EDITION

 MATERIAL RELATED
FACTORS
• Polycarbonate dimethacrylates

• Dimethacrylate with a bulky, space - filling central group

• High molecular weight phase separating dicarbamate with hydrophobic side

chains

• Silorane ring opening tetrafunctional epoxy siloxane

• Ormocer
 MODES OF CURING

1. SOFT START : Pre-polymerization

using low intensity followed by
final exposure at high intensity of
photoactivation
2. PULSE DELAY : Short durations of
light energy applied with no curing
in between
3. RAMPED CURE : A combination
of both the pulse delay and soft start
polymerization
Reduce the rate of curing Reduce the speed of shrinkage

MATERIALS USED IN DENTISTRY- Dr S. MAHALAXMI

C-FACTOR IN ENDODONTICS
Franklin R. Tay et al, Geometric Factors Affecting Dentin Bonding in Root Canals:
A Theoretical Modeling Approach, JOE 2005
C-factors in bonded root canals exhibit a negative correlation with sealer
thickness.

As the thickness of the adhesive is reduced, the volumetric shrinkage is reduced,

which results in a reduction in shrinkage stress (S-factor).

Interaction of these two geometrically related factors (C-and S-factors) predicts that
bonding of adhesive root-filling materials to root canals is highly unfavorable when
compared with indirect intracoronal restorations with a similar resin film thickness.
Shrinkage stresses are higher in low filled, lower viscosity resin cements and root
canal sealers than highly filled resin composites.

A major problem associated with endodontic bonding is the lack of relief of

shrinkage stresses created in deep, narrow canals. Stress relief by resin flow is
dependent upon cavity geometry and resin film thickness.

During polymerization, the unbonded surface can move and flow, thereby relieving
shrinkage stresses. However, as the unbonded surface area becomes small, as in a
long narrow root canal, there is insufficient stress relief by flow and a high
probability than one or more bonded areas will pull off or debond.

Franklin R. Tay et al, Geometric Factors Affecting Dentin Bonding in Root Canals:
A Theoretical Modeling Approach, JOE 2005
C-factors associated with different root canal lengths with mean sealer widths
varying from 1 to 20 micrometer for root canal lengths of 10 to 28mm.
C-factors associated with different root canal lengths with mean sealer widths
varying from 25 to 500 micrometer for root canal lengths of 10 to 28mm. It could
be seen that although the C-factor increases with increasing canal length, such an
increase is not as important as that contributed by decreasing mean sealer width or
thickness.
A negative power correlation exists for canal lengths and file sizes.

They are many times higher than that obtained when the canal is filled with sealer
only (C-factor of 32) or that of a bonded cubic intracoronal class I cavity with one
free or open surface for resin flow (C-factor of 5).

Whereas C-factors in a class I cavity may be reduced by layering techniques, such a

strategy is not possible when bonding is performed in root canals.

Franklin R. Tay et al, Geometric Factors Affecting Dentin Bonding in Root Canals:
A Theoretical Modeling Approach, JOE 2005
The increases in C-factors associated with increasing file size are modest when
compared with the changes that are associated with reducing the sealer widths.

C factors decrease with increasing file size when a root canal is filled with an
adhesive sealer without the use of a bondable root filling material.

Franklin R. Tay et al, Geometric Factors Affecting Dentin Bonding in Root Canals:
A Theoretical Modeling Approach, JOE 2005
Despite the potential reduction in C-factors with a low sealer thickness, it could be
seen from the sealer thickness that indirect bonding in long narrow root canals still
resulted in exceedingly high C-factors when compared to indirect intracoronal
restorations with similar resin film thickness.

When root canals are filled only with resin sealers, the reductions in C-factor occur
when canal fins, cul-de-sacs and anastomoses are filled only with sealers.

These bonded spaces are unlikely to provide additional avenues for stress relief if
they are filled three-dimensionally, except when voids are present for resin flow.

Franklin R. Tay et al, Geometric Factors Affecting Dentin Bonding in Root Canals:
A Theoretical Modeling Approach, JOE 2005
The generation of actual shrinkage stresses and how these stresses are ultimately
dissipated rely on critical parameters such as

- the amount of volumetric shrinkage of the resin sealer,

- the elastic moduli of the intraradicular dentin,

- contribution of air voids within the sealer,

- the rate of polymerization and gelation time of the resin sealer

Franklin R. Tay et al, Geometric Factors Affecting Dentin Bonding in Root Canals:
A Theoretical Modeling Approach, JOE 2005
 CONCLUSION

OPERATIVE DENTISTRY

In order to reduce the polymerization shrinkage stresses, incremental layering

techniques and modifications of the methods of curing and materials are
recommended.

ENDODONTICS

Because of the highly unfavourable cavity geometry within the root canal space,
which is detrimental to the relief of shrinkage stresses during the polymerization of
low viscosity resinous materials, a slow polymerizing resin sealer would improve
the chance for the relief of shrinkage stress via resin flow, because of prolonged
gelation time.
 REFERENCES

1. STURDEVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY - 5th

EDITION

2. MATERIALS USED IN DENTISTRY – DR.S.MAHALAXMI

3. TEXTBOOK OF OPERATIVE DENTISTRY – VIMAL.K.SIKRI – 4TH

EDITION

4. SUMMITT’S FUNDAMENTALS OF OPERATIVE DENTISTRY

5. FRANKLIN R. TAY ET AL, GEOMETRIC FACTORS AFFECTING DENTIN

BONDING IN ROOT CANALS: A THEORETICAL MODELING
APPROACH, JOE 2005
THANK YOU