Composites in dentistry /certified fixed orthodontic courses by Indian dental academy

COMPOSITES IN DENTISTRY

INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education

www.indiandentalacademy.com

Contents

 Introduction
 Evolution of Composites
 Definition and Composition
 Classification
 Indications and Contraindications
 Curing Systems


 Properties of Composites
 Advantages and Disadvantages
 Clinical and restorative techniques in
composite resin restoration
 Recent advances in composites
 Conclusion
 References


Introduction


Evolution Of Composites

 1955:M.Buonocore introduced the acid-etch
technique
 1956:Dr.Raphael Brown formulated a resin molecule-
BISGMA
 1960:Fibre filler particle was added in experimental
combinations to formulate the first composite resin
 1962:Dr.Ray L Bowen of the ADA research unit
developed a new type of composite resin material.


 1970:Introduction of photo-cured composite resin
using U-V light.
 1972:First visible light curing system was introduced.
 1976:Microfilled composites were developed which
were highly polishable.
 Early 1980s:Microfil resin properties were altered and
posterior composites introduced


Mid 1980s:Hybrid composites were developed.The first
generation of Indirect lab processed microfil
composite resin system was introduced.
 1987:Second generation of Lab processed resin was
developed.
 1991:Mega filled composites with glass ceramic inserts
coated with silane were introduced.
 1992:Introduction of fiber-reinforced composites
which were composed of woven glass or polythene
fibers.

 1996:Flowable composites developed.
 1997-1998:Packable posterior composites
were introduced based on PRIMM-Polymer
rigid inorganic matrix material.
 1998:Introduction of Compomer,which
combined the properties of Glass ionomer and
Composites.


 1998:Introduction of packable resin material
based on Ormocer technology- organically
modified ceramics.
 1998:Introduction of ion-releasing composite
material
 1999:Single crystal-modified composites.


Definition

 Dental composites are highly cross-linked
polymeric materials reinforced by a dispersion
of glass,crystalline or resin filler particles
and/or short fibers bound to matrix by silane
coupling agent.


Composition

 The basic structural components of a dental
resin based composite are:
-Resin matrix
-Filler
-Coupling agent
-Initiator accelerator system
-Inhibitors
-Optical modifiers

Resin matrix
 It is the continuous phase to which the other
ingredients are incorporated.
 It is a plastic resin which binds the filler
particles.
 Most composite resins are a blend of aromatic
and aliphatic dimethacrylate monomers like:
BISGMA,TEGDMA & UDMA


 Toreduce the viscosity of BISGMA,diluent
monomers such as TEGDMA are added.They
are mixed in the ratio of 75:25


Filler

 These are reinforcing particles or fibers that
are dispersed in the matrix.
 Filler particles are most commonly produced by
grinding or milling quartz or glass to produce
particles of varying sizes.
 Various fillers used are:Colloidal silica,Glass
fibers,lithium aluminium silicates,crystalline
quartz,barium glass,microfine silica,sintered
silica. www.indiandentalacademy.com

Functions of a Filler
 Reinforcement of the matrix resin,resulting in
increased hardness,strength and decreased
wear.
 Reducing polymerization shrinkage.
 Reduction in thermal expansion and
contraction
 Improved workability by increasing viscosity.
 Reduction in water sorption,softening,staining.
 Improve translucency.

Coupling agent

 These bind the filler particles to the resin matrix
and allows the more flexible resin matrix to
transfer stresses to the stiffer filler particles.
 Most commonly used
are:Titanates,Zirconates,organosilanes such
as gamma-methacryloxypropyl silane.
 Function-Improves the physical and the
mechanical properties.

-Provide hydrolytic stability
 In the presence of water,the methoxy groups
are hydrolysed to silanol grops that can bond
with other silanols on the filler surfaces by
formation of a siloxane bond(-Si-O-Si-)
 The organosilane methacrylate groups form
covalent bonds with the resin when it is
polymerised,thereby completing the coupling.

Initiator-activator system

 Composite resins polymerize by an addition
polymerization mechanism that is brought
about by the release of free radicals.
 There are two types of resin systems:
 Chemically cured
 Light cured


Chemically cured

They are supplied as two pastes,one of which
contains benzoyl peroxide initiator and other a
tertiary amine activator(N,N-dimethyl P-
toludine)
 On mixing,they react with each other to form
free radicals which start the addition
polymerization reaction.


Light cured
 The first light cured composites were
polymerised by exposure to UV light.The
initiator was benzoin methyl ether.
 The initiator in the visible light activated
systems is camphoroquinone present at 0.12%
by wt or less.
 The light curable dental composites are
supplied as single paste contained in a syringe
containing photo initiator&amine activator.

Inhibitors

 Inhibitors prevent or minimize spontaneous or
accidental polymerization of monomers
 The commonly used inhibitor is Butylated
hydroxy toluene in a conc.of 0.01% by wt.
 Inhibitors extend the storage lifetime and thus
ensure sufficient working time.


Optical modifiers
 Opacifiers are added to make the translucency of the
filler particle similar to the tooth structure.
 They affect light transmission through the composite
resin.
 They include metal oxides in minute quantities (0.001-
0.007% by wt)
 Aluminium oxide
 Titanum dioxide


CLASSIFICATION


1.BASED ON PARTICLE SIZE
AND DISTRIBUTION

 Based on primary particle size-By Sturdevant
a. Mega fill:very large individual particles or inserts
for posterior composites
b. Macro fill:10-100microns
c. Midi fill:1-10microns
d. Mini fill:0.1-1microns
e. Micro fill:0.01-0.1microns
f. www.indiandentalacademy.com
Nano fill:0.005-0.01microns

 Based on mean particle size of major filler-
By Skinner
a. Traditional composites:8-12microns
b. Small particle filled composites:1-5microns
c. Micro filled composites:0.04-0.4microns
d. Hybrid composites:0.6-1microns


a. Homogenous composites:Composite
consists of filler and uncured matrix materials
b. Heterogenous composites:Composites
consists of precured composite fillers
c. Modified composites:Composites consists
of modified fillers in addition to conventional
fillers


2.BASED ON HANDLING
PROPERTIES

 Flowable composites:The filler content is
reduced by 20-25% compared to traditional
hybrid composites.

 Packable/Condensable composites:The filler
is present as continuous network/scaffold of
ceramic fibers composed of alumina and
silicon dioxide.

3.BASED ON POLMERIZATION
PROCESS

 U-V light cured composites
 Visible light cured composites:
Blue light in range of 470nm wavelength is
used.
 Dual cured composite:
They combine self curing and light curing.
 Chemically cured composites.


4.BASED ON USE

 Anteriorcomposite
 Posterior composite
 Core-build up composite
 Luting composite


5.BASED ON CHRONOLOGICAL
DEVELOPMENT
 FirstGeneration composite resins:
They consist of macro ceramic reinforcing
phases in the resin matrix.They have the
highest mechanical properties and highest
surface roughness.
 Second Generation composite resins:
They consist of colloidal and micro ceramic
phases in a continuous resin phase.Best
surface texture and better wear resistance.

 Third Generation composite resins:They are
hybrid composites in which there is a
combination of macro and micro ceramics as
reinforcers in the ratio of 75:25.The properties
are intermediate to those of the 1st and 2nd gen.
 Fourth Generation composite resins:They
are also hybrid types that contain heat cured
irregularly shaped,highly reinforced composite
macro particles with micro ceramics.

 Fifth Generation composite resins:
They are hybrids in which the resin matrix is
reinforced with micro ceramics(colloidal) and
macro spherical,highly reinforced heat cured
composite particles.They have improved
wettability and consequently improved bonding
to continuous phase.


 SixthGeneration composite resins:
These are hybrid composites in which
continuous phase is reinforced with a
combination of micro ceramics and
agglomerates of sintered micro ceramics.
They have the best mechanical
properties.They exhibit the least shrinkage and
the wear and surface texture is similar to 4th
generation composite resins.

SKINNER’S Classification

1.Traditional composites:
-Developed in 1970
-Also known as Conventional or Microfilled
composites.
-The average size of filler particles(amorphous
silica and quartz)is 8-12microns
-However,they had a few disadvantages.

 Which include:
-Surface texture is rough.
-They are more susceptible to discolouration
from extrinsic stains.
-Resin matrix wears at a faster rate.
-Higher amount of initial wear at occlusal
contacts.

2.Small particle filled composites
 They contain fillers of size 0.5-3microns.
 The physical and mechanical properties like
compressive strength is higher than traditional
composites.
 Polymerization shrinkage is less and wear
resistance is improved.
 They are indicated for high stress and abrasion
prone areas.

3.Microfilled composites
 These composites contain colloidal silica
particles of 0.01-0.04microns as inorganic filler.
 The restorative surface produced is smooth.
 They are wear resistant.
 However,have inferior physical and mechanical
properties.
 Indicated for Class III and Class V cavity
restorations.

4.Hybrid composites
 They contain two types of fillers:colloidal silica
and particles of glass upto 75-80 wt%.
 The average particle size is 0.4-1microns.
 Their physical and mechanical are intermediate
to those of traditional and small particle filled
composites.
 They produce a smooth surface and have good
strength.

 Based on the filler particle size,hybrid
composites are further divided as:
 Large filler:for high stress areas requiring
improved polishability.
Class I,II,III,IV
 Mid filler:for Class III and IV
 Mini filler:for moderate stress areas requiring
optimal polishability

INDICATIONS FOR COMPOSITE
RESIN RESTORATIONS


 Restoration of Class I,II,III,IV,V and VI
cavities.
 Foundations or Core build ups
 Pit and fissure sealants
 Esthetic considerations such as:
a) Full and partial veneers
b) Closure of diastema
c) Tooth contour modifications

 As luting cements(for indirect restorations)
 Temporary restorations
 Periodontal splinting,fixing orthodontic
brackets,repair of fractured ceramic crowns..


CONTRAINDICATIONS


 Grossly destructed tooth
 High caries incidence and poor oral hygiene
 Heavy and abnormal occlusion
 Areas difficult to isolate
 Sub-gingival extensions
 Limited operator skill and knowledge as
composite resins are highly technique sensitive

CURING SYSTEMS


Self cured Composite resins

 Polymerization is initiated by mixing two
pastes.
 During mixing,there is incorporation of
air.Leading to inclusion of pores and
weakening of the structure.
 Which in turn traps oxygen and inhibits
polymerization.
 However,there is no control over the working
time. www.indiandentalacademy.com

Light cured composite resins

 Two types:U-V light cured and Visible light
cured.
 Curing lamps:These are hand held devices that
contain light source and are equipped with a
rigid light guide made of fused optical fibers.
 The various types of light devices used are:


Light emitting diodes-LED lamps
 They emit radiation only
in the blue part of visible
light between 440-
480nm.
 They do not require
filters.
 They can be battery
operated and do no
produce heat.

Quartz-Tungsten-Halogen
(QTH)Lamps
 Most widely used light
source.
 Contains quartz bulb
with tungsten filament in
halogen environment.
 It produces U-V and
white light.Hence,it
requires a filter to
remove heat and
unwanted wavelengths
to produce violet-blue
light in 400-500nm
range.

Conventional QTH curing unit


Plasma arc curing light-PAC lamps
 They use ionized xenon
gas to produce plasma.
 They require filters to
remove high intensity
white light and allow blue
light in the range of 400-
500nm to be emitted.


ARGON LASER LAMPS

 They have the highest intensity and emit a
single wavelength at 490nm.
 DEPTH OF CURE
 Usually 20-60 seconds under optimal
conditions for 2mm increments.
 Post-curing for 20-60 secs may slightly
improve the surface layer.


Degree of Conversion

 Itis the percentage of carbon-carbon double
bonds that have been converted to single
bonds to form a polymeric resin.
 A 65% conversion is considered to be good.
 The higher the degree of conversion,the better
will be the strength and wear resistance.


Factors affecting curing

 Procedural factors:
-Access to the restorations
-Light tip direction
-Distance from the surface:ideally 2mm
-Size of the tip:ranges from 3-11mm
-Tip movement
-Time of exposure

 Restoration factors:
-Cavity design
-Restoration thickness:ideally 1.5-2mm,for
optimal cure
-Filler amount size
-Restoration shade
-Monomer ratios

Self cure v/s Light cured
composites
 Polymerization is central  Polymerization is
peripheral.
 Curing in one phase
 Curing in increments
 Self cured composites
 Command
set within 45secs polymerization
 Working time is limited
 It is increased and
adequate
 Less wastage
 More wastage  Good surface finish
 Surface finish is not
adequate

Disadvantages of Light cured
composites

 Limited curing depth
 Relative poor accessibility
 Variable exposure time
 Sensitivity to room illumination


PROPERTIES OF COMPOSITES


 Composite resins possess the highest tensile
and compressive strengths.
 The modulus of elasticity is high.
 COTE is three times more than that of tooth
structure.
 They show less resistance to abrasion.
 The modulus of resilience is very low.


 Water sorption:It swells the polymer portions
of the dental composite and promotes diffusion
and desorption of any unbound monomer.This
increases the dimensions of the
restoration,thus compensating for the
polymerization shrinkage.
 Plasticity:They are viscoelastic and show
limited degree of plasticity which may lead to
change in shape under forces.

 Hardness:Composite resins show greater
Knoop Hardness Number(KNH)of 30-100 as
compared to 300 of enamel.
 Surface Roughness:Composites have the
highest and deepest scratches after all
finishing and polishing procedures.The 2 nd
generation composite exhibits the least surface
roughness.

 Microleakage:The unfilled resins and 2nd
generation composites show greatest
microleakage.However,the use of acid etch
technique has reduced the microleakage of
composites.
 Optical properties:They have almost the
same translucency as that of enamel.
 Colour stability:Composites may undergo
discolouration,either extrinsic or intrinsic.

 Wear:The wear rate of posterior composite
resins is 0.1-0.2mm/year,more than enamel.
Occlusal wear is the second most
frequent clinical problem apart from
polymerization shrinkage.
 Polymerization shrinkage:It ranges from 1.5-
5.5% by volume.Composites shrink during
hardening.

 When tooth preparation extends onto the root
surface,a ‘V’ shaped gap occurs.This is
because the force of polymerization of
composite is greater than the initial bond
strength of the composite to the dentin of the
root.


 Configuration factor or C-factor:It is the ratio
of bonded surfaces to the unbonded or free
surfaces in a tooth preparation.
 Higher the C-factor,greater is the potential for
bond disruption for polymerization effects.


ADVANTAGES OF COMPOSITE
RESIN
 Esthetic
 Conservation of tooth structure can be
achieved.
 Insulative,has low thermal conductivity.
 Bonded to tooth structure,resulting in good
retention,low microleakage,minimal interfacial
staining.
 Repairable.
 Used almost universally

DISADVANTAGES OF
COMPOSITE RESIN

 Polymerization shrinkage
 Expensive and time consuming
 Technique sensitive
 Greater occlusal wear in areas of high occlusal
stress.
 Higher linear coefficient of thermal expansion.
 Difficult to finish and polish.


CLINICAL TECHNIQUES FOR
COMPOSITE RESIN
RESTORATIONS


Preliminary Steps

1) Local Anaesthesia
2) Oral Prophylaxis
3) Shade selection:Selecting the appropriate
shade of the tooth is very critical to achieve
optimum esthetics with composites.Certain
guidelines should be followed.
4) Isolation
5) Checking the occlusal contacts

Composite shade guide


General concepts for cavity
preparations

 Minimal extension
 Pulpal floor and/or axial walls need not be flat
and can be of varying depths
 Enamel bevel
 Butt joint on root surfaces
 Tooth preparation walls must be rough


Designs for composite resin
restorations

 Conventional
 Beveled conventional
 Modified
 Box only
 Slot


Conventional cavity preparations

 These are the typical amalgam cavity designs.
 Which include:uniform depth,flat floors,butt
joint and retention grooves in dentin.
 Indicated in:

-Large Class I and Class II composite
restorations.
-Cavity preparations on root surfaces(non
enamel areas).

Conventional Class I design


Conventional Class II design


Conventional Class III design


Conventional Class IV design


Conventional Class V design


Beveled conventional cavity
preparations
 Similar to the conventional design but some
enamel margins are beveled.
 The bevel is prepared using a flame-shaped
diamond point and the width of the bevel may
vary from 0.25-0.5mm
 Indications:

-For replacing an existing old non-adhesive
restoration with composite resin.
-Class III,IV and V composite restorations

Beveled Conventional Class III
design


Beveled conventional Class IV
design


Beveled conventional Class V
design


Bevel on enamel margin


Modified cavity preparations
 Here,the cavity preparation appears “scooped-
out” without definite internal line angles.
 The outline form and axial depth is only upto
the extent of caries.The walls are divergent.
 Indications:

-Small to moderate carious defects
-Traumatic injuries resulting in incisal edge
fractures.
-Hypoplastic areas in cervical third of the
tooth.

Modified Class I design


Modified Class II design


Modified Class III design


Modified Class IV design


Modified Class V design


Box-only cavity preparations
 This design is employed for proximal caries in
posterior teeth(Class II) with no lesions present
on the occlusal surface.
 Preparation is started by cutting through the
involved marginal ridge and extending gingivally
till the caries is eliminated.
 The axial depth should be minimal about 0.2mm
 No bevels or secondary retentive features
needed.

Box-only preparation


Slot cavity preparations

 Indicated for proximal carious lesions that can
be directly approached from the facial or
lingual aspect rather than the marginal ridge.
 The occlusal,facial,lingual and gingival
cavosurface margins are at 90 degrees.
 No bevels are necessary.


Slot cavity preparation
 Done using a round
diamond point bur and
the preparation is
extended only upto the
extent of caries.


 A cross-sectional view
showing an intact
marginal ridge.


RESTORATIVE TECHNIQUES
FOR COMPOSITE RESINS


Replacement of a discoloured anterior
restoration with composite resin


 First and foremost the
area is isolated with a
rubber dam.
 Then the old restoration
is removed,and a
reverse bevel is placed
followed by
 insertion of Light
polymerized Glass
ionomer liners.


 Dual lights are utilized to
accelerate the
polymerization process.


Sequence of Steps

 Acid etching
 Application of bonding agent and curing
 Matrix placement
 Incremental insertion of composite resin
 Contouring and curing
 Finishing and polishing


ACID ETCHING


 Done with 37%
phosphoric acid liquid or
gel.
 It should be of
contrasting colour for
easy visualisation.
 The gel may be applied
using a syringe
applicator or a brush.


 Acid etching is done for
15-30secs.
 Following this it has to
be thoroughly rinsed with
a water spray for 5-
15secs.
 Later the surface should
be dried with air or
cotton pellets.
 The etched enamel
appears frosty white.

BONDING AND CURING


 The bonding agent is
applied using a
microbrush.
 The manufacturer’s
instructions are followed
regarding the no.of coats
to be applied and the
curing time.(usually
20secs labially and
lingually each)

 It penetrates the
irregularities on enamel
and bonds
micromechanically by
formation of resin tags.
 On dentin,it penetrates
the collagen network and
the dentinal tubules.


MATRIX PLACEMENT


 It is better to place the matrix before etching
and bonding as it provides good isolation for
proper adhesion and helps to assess the
soundness of gingival cavosurface margin.
 For Class III and Class IV cavities,clear
polyester strip matrix may be used.
 It is inserted atleast 1mm past the gingival and
incisal margins of the prepared cavity.
 Wedge is placed to stabilize the band.

 Several matrix systems are available for Class
II composite restorations:
 Tofflemire matrix retainer with ultra thin metal
band.
 Compound supported ultra thin metal matrix.
 Clear polyester matrix
 Sectional matrix systems-Palodent contact
matrix, Composi-tight matrix systems.

Sectional matrix


Tofflemire matrix retainer and
band


INSERTION OF COMPOSITE
RESIN


 The composite resin is
built incrementally using
special hand instruments
in 1-2mm thickness.This
allows the light to
properly polymerize the
composite and may
reduce the effects of
polymerization
shrinkage,esp.along the
gingival floor in Class II
restorations.

 An alternative to hand
instruments is the
injectable syringe.


 The material is
contoured before light
curing.
 The cavity is filled in
excess and contoured
using the matrix before
final curing as
recommended by the
manufacturer.


Curing
 Polymerization for
60secs is carried out
both labially and
lingually,as each
increment of composite
resin is applied.
 Here,a mylar matrix strip
is loosely held to ensure
separation and adequate
thickness for proper
polishing.

 A carbide bur is used to
gently remove the
excess composite at the
mesiolabial line angle.


CONTOURING THE COMPOSITE


 Contouring the
composite restoration
requires skill and
knowledge of correct
dental anatomy.
 Instruments are chosen
based on the area.
 Careful visual and tactile
assessment of
interproximal
contours,contacts,and
www.indiandentalacademy.com integrity is
marginal
necessary.

 As a final
step,appropriate occlusal
relationship must be
developed.


 Occlusal adjustments
are made.


FINISHING AND POLISHING


 Finishing refers to the
shaping,contouring and
smoothening of the
restoration.
 Polishing is the removal
of surface irregularities
to make the surface of
the restoration
absolutely smooth,shiny
and lustrous.


 The best finish and polish is provided by
allowing the composite resin to polymerize
against a clear plastic matrix strip.


 Post-operative view
revealing invisible
margins and blending of
colour to match existing
tooth structure.


Systems available for finishing and
polishing of composite restorations
 12,16 and 30 fluted carbide finishing burs.
 Finishing diamonds in various shapes.
 Flexible discs coated with aluminium oxide
coating.
 Rubber cups impregnated with abrasives.
 Silicon-carbide impregnated polishing brushes.
 Metal and plastic finishing strips for hand use.
 Polishing pastes containing silica,alumina or
pumice www.indiandentalacademy.com

Finishing instruments


Composite polishing kit


Guidelines

 Avoid absolute dry finishing and polishing as it
can generate heat which disturbs the marginal
seal of composite resins.
 Use light pressure,slow speed and water
cooling.
 Finish and polish approx.15mins after curing.


ILLUSTRATIONS


Case-1

 FRACTURED INCISAL
EDGE IN 21


 ISOLATION AND
ACID ETCHING IS
DONE.


 BONDING AGENT IS
APPLIED


 COMPLETED
COMPOSITE RESIN
BUILD-UP


Case-2

 SEVERE CERVICAL
EROSION IN 21 22 23


 A LABIAL BEVEL IS
PLACED WITH A
DIAMOND BUR
 WHICH ALSO
ROUGHENS THE
TOOTH SURFACE TO
BE COVERED


 ACID ETCHING IS
DONE AND BONDING
AGENT
APPLIED,FOLLOWED
BY INSERTON OF
COMPOSITE AND
CURING.
 GINGIVAL CONTOUR
IS CREATED WITH A
CARBIDE BUR.


 BULK OF THE BODY
CONTOUR IS CARVED
WITH A SPECIALLY
DESIGNED
INSTRUMENT.


 FINAL POLISHING IS
DONE WITH A
SERIES OF ABRASIVE
POLISHING
DISCS,CUPS,POINTS
IN SEQUENCE UNTIL
THE DESIRED LUSTRE
IS ACHIEVED.


 FINAL RESULT
SHOWS A GENTLE
BLENDING OF
COLOUR,FORM AND
TEXTURE WITHOUT
DISCERNIBLE
MARGIN.


RECENT ADVANCES


PACKABLE COMPOSITES

 Developed in 1980s
 They were available as PRIMM,fused glass
fiber powder with conventional composites.
 It consists of a resin and ceramic
component.The inorganic phase consists of a
continuous network or scaffold of ceramic
fibers.Their individual diameter being 2microns
or smaller.

Characteristics
 Moisture tolerant
 Non sticky,easily transferable and packable
 High shear strength
 Cures rapidly to final hardness but with
minimal residual stress.
 Examples:SOLITAIRE,ALERT,SUREFIL,
FILTEK PGO,PYRAMID,GLAGIER,SYNERGY
COMPACT.

COMPOMERS

 They are resin-ionomer hybrid restorative
materials marketed as multipurpose resin that
may release fluoride.
 It contains the major ingredients of both
composites(resin) and glass ionomer cements
(polyalkenoate acid and glass fillers
component) except for water.
 They have a limited dual setting mechanism

Properties

 Greater wear than amalgam
 Less fluoride release than GIC
 3% polymerization shrinkage
 Good radio-opacity
 Uses:Low stress bearing areas,Luting for
prosthesis
 Examples:DYRACT,COMPOGLASS,F-2000


INDIRECT COMPOSITES

 Morman and Touati pioneered the use of
composites for fabrication of indirect inlays and
onlays.
 Indications:
-Esthetics
-Metal free dentistry
-Decreased wear of opposing dentition
-Conservative tooth preparation

 Contraindications:
-Bruxism
-Opposing porcelain restoration
-Long span FPDs
-High caries rate
-Difficult moisture control


CEROMERS

 Itstands for Ceramic Optimized Polymers
 Composed of specially developed and
conditioned fine particle ceramic fillers of sub
micron size(0.04-1micron) which are closely
packed and embedded in an advanced
temperable organic polymer matrix.


Characteristics

 Durable esthetics
 High abrasion resistance
 High stability
 Ease of final adjustment
 Effective bond with luting composites
 Low degree of brittleness
 Conservation of tooth structure


Uses

 For veneers,inlay/onlay without a metal
framework
 Can be used with Fiber reinforced composite
framework for inlays/onlays,crowns and
bridges(3 unit) and for crown and bridges
including implant restorations on a metal
framework.


FIBER-REINFORCED
COMPOSITES

 These are resin based restorations containing
fiber for enhancing the physical properties.
 Also known as polyglass or polymer ceramic.
 Fibers are bonded to resin via adhesive
interface.
 Fibers improve structural properties by acting
as crack stopper.


USES

 Splinting
 Restoration of endodontically treated teeth
 3 unit bridge work
 Metal free crowns

 Examples:CONNECT,DVA,FIBERFLEX,
FIBERKOR,GLASSPAN,RIBBOND,VECTRIS

FLOWABLE COMPOSITES
 Introduced in late 1996
 Here,the filler particle size is less thus resulting
in low viscosity.
 Filler content is generally less than 50% by
volume,so polymerization shrinkage is greater.
 The modulus of elasticity is lower than for
conventional composites,thus allowing the
material to flex and flow.

USES
 Fillingmaterial in low stress areas
 Rebuilding worn composite contact areas
 In areas of difficult access or areas that require
greater penetration.Amalgam,composite or
crown margin repairs,pit and fissure sealant or
preventive resin restoration.
 As a liner or base in ClassII proximal box
 For veneers or cementing porcelain veneers.


 Restoration of Class V lesions
 Porcelain defects,enamel defects,incisal edge
repair in anteriors.
 Class III lesions

 Examples:AELITEFLOW,FLOW RESTORE


ORMOCERS

 The acronym of Organically Modified
Ceramic,is a brand new material for filling
indications in the anterior and posterior area
which serve as an optimum and up-to-date
replacement for amalgam,composite and
compomers.
 The filler particles are 1-1.5microns in size and
the material contains 77% filler by weight.

 The matrix consists of ceramic
polysiloxane.Silicon oxide serves as the basic
ingredient.


Characteristics

 Biocompatible
 Reduced polymerization shrinkage
 High abrasive resistance
 Lasting esthetics
 Anticariogenic properties
 Fast and safe handling
 Example:DEFINITE


GIOMERS

 These are newly introduced hybrid esthetic
restorative materials for dental restorative
therapy.
 Giomers employ the use of pre-reacted glass
ionomer technology to form a stable material.
 They are supplied in a one-paste form.They
are light polymerizing and require bonding
agents for adhesion to tooth structure.

Indications

 Restoration of root caries
 Non-carious cervical lesions
 Class V cavities
 Deciduous tooth caries


Limitations

 Giomers are not as beneficial as GICs in
patients who are at high risk for recurrent
caries.
 The hardness value is less than composite
 They exhibit rapid and extensive expansion
and should be avoided in tooth preparations
that involve thin unsupported enamel.


Advantages

 Fluoride release
 Fluoride recharging
 Biocompatible
 Clinical stability and durability
 Excellent esthetics
 Smooth surface finish
 Excellent bonding


NANOCOMPOSITES

 New composites are being developed with
nanofillers that range in size 0.005-0.01micron
which is below the wavelength of visible light.
 Non silicate based compositions can be used
for nanofillers because they are effectively
invisible.


Advantages
 Superior translucency and esthetic appeal.
 Excellent colour,high polish and polish
retention.
 Superior hardness,flexural strength and
modulus of elasticity.
 About 50% reduction in polymerization
shrinkage.
 Example:FILTEK SUPREME


CONCLUSION

 Composite resins satisfy almost all the
requirements of an ideal restorative
material.Their use has risen greatly in the last
two decades and have enabled dentists to
implement preventive and minimally invasive
techniques.More importantly,patients can
retain their teeth longer with a more esthetic
appearance,resulting in a healthier and self-
confident population.

References

 Sturdevant’s
 Philip’s
 Goldstein
 Albers
 Ramya Raghu


THANK
YOU

Composites in dentistry /certified fixed orthodontic courses by Indian dental academy

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