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Restorative Composite Resins

Dec 29, 2015





  • Restorative Composite ResinsCol Kraig S. VandewalleUSAF Dental Evaluation & Consultation Service

  • Official DisclaimerThe opinions expressed in this presentation are those of the author and do not necessarily reflect the official position of the US Air Force or the Department of Defense (DOD)Devices or materials appearing in this presentation are used as examples of currently available products/technologies and do not imply an endorsement by the author and/or the USAF/DOD

  • OverviewDirect restorativescompositionclassificationperformance factorsFlowablePackables

    Click here for briefing on composite resins (PDF)

  • CompositeMaterial with two or more distinct substancesmetals, ceramics or polymers Dental resin compositesoft organic-resin matrixpolymerhard, inorganic-filler particlesceramic Most frequently used esthetic-restorative material

    Leinfelder 1993

  • History1871 silicatesalumina-silica glass & phosphoric acidvery solublepoor mechanical properties1948 - acrylic resins polymethylmethacrylatehigh polymerization shrinkage

    Rueggeberg J Prosthet Dent 2002

  • History(cont.)1962 Bis-GMAstronger resin1969 filled composite resinimproved mechanical propertiesless shrinkagepaste/paste system1970s acid etching and microfills1980s light curing and hybrids1990s flowables and packables2000s nanofills

    Rueggeberg J Prosthet Dent 2002

  • IndicationsAnterior restorationsPosterior restorationspreventive resinconservative class 1 or 2

  • ContraindicationsLarge posterior restorationsBruxismPoor isolation

  • AdvantagesEstheticsConservation of tooth structureAdhesion to tooth structureLow thermal conductivityAlternative to amalgam

  • DisadvantagesTechnique sensitivity Polymerization shrinkage marginal leakagesecondary cariespostoperative sensitivityDecreased wear resistance

  • CompositionResin matrixmonomerinitiatorinhibitorspigmentsInorganic fillerglassquartzcolloidal silicaCoupling AgentBis-GMAPhillips Science of Dental Materials 2003

  • MonomersBinds filler particles togetherProvides workabilityTypical monomersBisphenol A glycidyl methacrylate (Bis-GMA) Urethane dimethacrylate (UEDMA) Triethylene glycol dimethacrylate (TEGMA)

  • MonomersBis-GMAextremely viscouslarge benzene ringslowered by adding TEGDMAfreely movableincreases polymer conversionincreases crosslinkingincreases shrinkage

  • MonomersShrinkage2 7 %marginal gap formation

  • Filler ParticlesCrystalline quartzlarger particlesnot polishableSilica glassbariumstrontiumlithiumpyrolyticsub-micron

    Phillips Science of Dental Materials 2003

  • Filler ParticlesIncrease fillers, increase mechanical propertiesstrengthabrasion resistanceestheticshandling50 to 86 % by weight35 to 71% by volume00.511.52Fracture Toughness02837485362% Filler VolumeFerracane J Dent Res 1995

  • Coupling AgentChemical bondfiller particle - resin matrixtransfers stressesOrganosilane (bifunctional molecule)siloxane end bonds to hydroxyl groups on fillermethacrylate end polymerizes with resin

    Phillips Science of Dental Materials 2003

  • InhibitorsPrevents spontaneous polymer formationheatlightExtends shelf lifeButylated Hydroxytoluene Phillips Science of Dental Materials 2003

  • Pigments and UV AbsorbersPigmentsmetal oxidesprovide shading and opacitytitanium and aluminum oxidesUV absorbersprevent discolorationacts like a sunscreenBenzophenone

    Phillips Science of Dental Materials 2003

  • Visible-Light ActivationCamphorquinonemost common photoinitiatorabsorbs blue light400 - 500 nm rangeInitiator reacts with amine activatorForms free radicalsInitiates addition polymerization


  • PolymerizationInitiationproduction of reactive free radicalstypically with light for restorative materialsPropagationhundreds of monomer unitspolymer network50 60% degree of conversionTerminationCraig Restorative Dental Materials 2002

  • Classification SystemHistorical ChronologicalBased on particle sizetraditionalmicrofilledsmall particle hybridPhillips Science of Dental Materials 2003

  • Traditional (Macrofilled)Developed in the 1970sCrystalline quartzproduced by grinding or millinglarge - 8 to 12 micronsDifficult to polishlarge particles prone to pluckPoor wear resistanceFracture resistantExamples: Adaptic, ConciseSuitable for Class 3, 4 and 5

    Phillips Science of Dental Materials 2003

  • MicrofillsBetter esthetics and polishabilityTiny particles0.04 micron colloidal silicaincreases viscosityTo increase filler loadingfiller added to resinheat curedground to large particlesremixed with more resin and filler

    Phillips Science of Dental Materials 2003

  • MicrofillsLower filler contentinferior propertiesincreased fracture potentiallacks coupling agentlacks radiopacityLinear clinical wear patternSuitable for Class 3, 5exceptions with reinforced microfillsClass 1 or 2

    Click here for table of microfills

  • Small Particle1 - 5 micron heavy-metal glassesFracture resistantPolishable to semi-glossSuitable for Class 1 to 5Example: Prisma-FilPhillips Science of Dental Materials 2003

  • HybridsPopular as all-purposeAKA universal hybrid, microhybrids, microfilled hybrids0.6 to 1 micron average particle sizedistribution of particle sizesmaximizes filler loadingmicrofills added improve handlingreduce stickiness

    Phillips Science of Dental Materials 2003

  • HybridsStrongGood estheticspolishableSuitableClass 1 to 5Multiple availableClick here for table of hybrids

  • Table of PropertiesPhillips Science of Dental Materials 2003

  • Newer Classification SystemBased on particle sizemegafill0.5 - 2 millimetersmacrofill10 - 100 micronsmidifill1 - 10 micronsminifill0.1 - 1 micronsmicrofill0.01 - 0.1 micronsnanofill0.005-0.01 micronsMost new systemsminifillersNewest trend nanofillerstrimodal loadingprepolymerizedBayne JADA 1994

  • Relative Particle Sizes (not to scale)

  • Nanofill vs. NanohybridNanofillsnanometer-sized particles throughout matrixNanohybridsnanometer-sized particles combined with more conventional filler technologySwift J Esthet Restor Dent 2005

  • Nanofilled CompositeFiltek Supreme (3M ESPE)Filler particlesfilled: 78% wgtnanomers0.02 0.07 micronsnanoclusteract as single unit0.6 1.4 microns

    Click here for technical profile Click here for DECS evaluation

  • Performance FactorsMaterial factorsbiocompatibilitypolymerization shrinkagewear resistancepolish mechanismsplacement types mechanical & physical properties

  • BiocompatibilityTolerated by pulpwith good sealRare allergic reactionsHEMACytotoxicityshort livednot a chronic sourceDegree of cure importantdecrease free monomerPhillips Science of Dental Materials 2003

  • SystemicEstrogenic effects seen in cell culturesimpurities in Bis-GMA-based resinsBis-phenol A in sealantsOlea EHP 1996click here for abstracthowever, insignificant short-term riskliterature reviewSoderholm JADA 1999click here for abstract

  • Polymerization ShrinkageSignificant role in restoration failuregap formationsecondary caries formationmarginal leakagepost-operative sensitivityCounteractlower shrinkage compositesincremental placement

  • Composite WearLess wear small particle sizeless abrasionheavier filledless attritionnon-contact areas3 - 5 times lessless surface areaanterior locationpremolars vs. molarsHilton Oper Dentistry: A Contemporary Approach 2001

  • Composite WearReduced wear with smaller particlesless plucking leaving voidsHigher filler loads for enhanced propertiescorrelations between wear and fracture toughness and flexure strengthHigher cure of resin matrix to resist scratching and gouging by abrasivesHilton Oper Dentistry: A Contemporary Approach 2001

  • Polish MechanismsAcquired polishclinician inducedInherent polishultimate surfaceMicrofillshigh acquired, high inherentsimilar resin matrix and fillers wear more evenlyHybridshigh acquired, acceptable inherent

    Adept Report 1992

  • Polish MechanismsSmall Particle HybridMicrofilled CompositeTimeAcquired PolishInherent PolishAdept Report 1992Linear wear pattern

  • Shaded vs. Anatomic PlacementShadedshade selected from middle third of toothshade guide gives recipe for multiple shadesAnatomichighly chromatic dentin matched to existing dentincolorless enamel replaces existing enamel

    Click here for details

  • Shaded AnatomicTrans EnamelA3/A4 DentinEnamel ValueEnamel ValueA1 DentinA1 EnamelDentistsCeramistsMatch ShadeCreate ShadeTrans Enamel

  • Placement TypesComposite BrandsShaded4 Seasons (Ivoclar Vivadent)Esthet-X (Dentsply)Filtek Supreme (3M ESPE)Point 4 (Kerr)Venus (Heraeus Kulzer)Renamel (Cosmedent)Gradia Direct (GC)Anatomic4 Seasons (Ivoclar Vivadent)Vitalescence (Ultradent)Miris (Coltene/Whaledent)Jackson PPAD 2003

  • Composite SelectionAnterior/stress (Class 4)hybridmini- or midi-fillhybrid/microfill veneer comboAnterior/non-stress (Class 3 or 5)hybridmini-fillmicrofill

  • Composite SelectionPosteriorhybridmini- or midi-fillreinforced microfill

  • Selecting a BrandContents of kitshadesbonding agentunit-dose compules vs syringesIndicationsanterior, posterior, both?Cost of kitrefillsClick here for synopsis of restorative composite resins

  • Government Price($/gm of refill resin)Prices current as of Jan 05

  • Selecting a BrandResults of lab and clinical studiesCompositional characteristics% filler contentaverage filler particle sizeClick here for synopsis of restorative composite resins

  • Radiopacity(mm of aluminum)Source: USAF