INTRODUCTION TO COMPOSITE RESTORATIONS

Edited By: Ahmad Fawzi Ali

CONTENTS-:
1.INTRODUCTION 2.CLASSIFICATION 3.TOOTH PREPARATION. 4.RESTORATIVE TECHNIQUE 5.NEWER ADVANCEMENTS.

 INTRODUCTION-

A composite is a physical mixture of materials.The parts of mixture are chosen with the purpose of averaging the properties to achieve intermediate propertis. Dental composite indicates a mixture of silicate glass particles in an acrylic monomer that is polymerised during an application

COMPOSITION-:

Composite consists of-:

1.Resin Matrix-A plastic resin material that forms a continuous phase and binds the filler particles. 2.Filler particles-reinforcing particles and\or fibres that are dispersed in the matrix. 3.Coupling agents-bonding agents that promote adhesion between filler and resin matrix.

CLASSIFICATION-:

Based on the size of filler particles:

1.Traditional -particle size 8-12 micrometer. 2.Small particle filled-1-5 micrometer. 3.Microfilled composite-0.04-0.4 micrometer. 4.Hybrid composite-0.6-1 micrometer.

INDICATIONS-:
1. Class I,II,III,IV,V,VI restorations 2. Foundation or core buildup. 3. Esthetic enhancement procedures Partial veneers and Full veneers. Tooth contour modifications. Diastema closure. 4. For temporary restorations. 5. For periodontal splinting.

CONTRAINDICATIONS-:

1.Teeth with heavy occlusal stress. 2.If operating site cannot be isolated. 3.Patient allergic or sensitive to composite.

ADVANTAGES-:

1.Esthetic. 2.Conservation of tooth structure. 3.Insulative. 4.Bonded to tooth structure. 5.Repairable.

DISADVANTAGES-:

1. May have gap formation.

2. More difficult,time consuming,and costlier. 3. More technique sensitive. 4. May exhibit greater occlusal wear in areas of high occlusal stress. 5. Higher linear coefficient of thermal expansion resulting in marginal percolation.

TOOTH PREPARATION-:

Basically this includes1. Removing the fault,defect,old restorative material or friable tooth structure. 2. Creating prepared enamel margins of 90 degree or greater. 3. Creating 90 degree cavosurface margins on root surface. 4. Roughning the prepared tooth structure.

TYPES OF COMPOSITE TOOTH PREPARATION

1.ConventionalIndications-1.Preparation located on root surface-utilizes butt joint marginal configuration and retention groove in dentin. 2.Moderate to large classI or II restorations-there may be increased need for resistance which is provided by conventional amalgam like preparation.

2.BEVELED CONVENTIONAL

This design is indicated when a composite restoration is being used to replace an existing restoration exhibiting a conventional tooth preparation design with enamel margins or to restore a large area. This design is most typical more classIII,IV & V restorations.

Advantage of enamel bevel-ends of enamel rods are more effectively etched producing deeper microundercuts than when only the sides of enamel rods are etched.

3.MODIFIED Indicated for initial restoration of smaller, cavitated, carious lesions usually surrounded by enamel. For correcting enamel defects. For larger restoration as well(wider bevel or flares &retention grooves ,coves or locks can be given) Less tooth structure removed compared to beveled preparation.

4.BOX ONLY PREPARATION

Indicated when only the proximal surface is faulty with no lesion present on the occlusal surface

Prepared with either an inverted cone or diamond stone held parallel to the long axis of tooth crown. Initial proximal axial depth - 0.2mm inside DEJ. Neither bevel nor secondary retention required.

5.FACIAL OR LINGUAL SLOT

For restoring proximal lesions on posterior teeth. Entry is made with a diamond stone at a correct occlusogingival height as close as possible to adjacent tooth. Occlusal,facial and gingival cavosurface margin is 90 degree or greater.

RESTORATIVE TECHNIQUE
Treating the prepared tooth for bonding requires 1.Etching and then application of an adhesive-if only enamel is involved. 2.Primer and adhesive if both enamel and dentin are involved. STEPS1.L.A.

2.Preparation of operative site.

3.Shade selection- done under natural light.

shade guide used

4.Isolation-rubber dam and cotton rolls used. .polyester strip applied before etching to protect adjacent tooth from inadvertent Etching.

5.ETCHING

30-40% conc. Of phosphoric used(ideally 37%) For enamel-30 sec & for dentin 15 sec and then rinsed off. Available as liquid and gel.

Syringe for dispensing gel etchant

Applicator tip for liquid etchant

ETCHING ENAMEL affects both prism core and prism periphery. transforms smooth enamel into very irregular surface When fluid resin is applied to etched surface

Resin penetrates etched surface

Forms resin tags

Basis for adhesion of resin to enamel

ETCHING DENTIN

Affects intertubular and peritubular dentin. Removes the smear layer and exposes collagen network to achieve optimal adhesion to the dentinal surface. After rinsing the surface is kept slightly moistened when dentin is also involved because it allows the primer and adhesive material to more effectively penetrate the collagen fibre to form a hybrid layer which is the basis for mechanical bond to dentin.

6. PRIMER Applied to both the surfaces(enamel and dentin)

It contains hydrophillic monomers dissolved in a solvent that evaporates easily and removes water without need for excessive drying.

Thus,it promotes penetration of adhesive resin in to the exposed collagen network.

7.ADHESIVE RESIN .Applied to etched and primed surface and cured.

When resin is applied the resin becomes interlocked into the dense collagen forming hybrid layer which is the basis for micromechanical retention.

8.COMPOSITE PLACED.

9.CURING

Two types-1.Self curing. 2.Light curing.

SELF CURINGnot used extensively . Disadvantages-1.Mixing of two pastes required and it is almost impossible to avoid incorporation of air bubbles. Air bubble contain oxyge4n that causes oxygen inhibition during polymerisation. 2.No control of working time.

LIGHT CURING Material inserted in tooth preparation in 1-2mm thickness.This allows the light to properly polymerise the composite and may render the effect of polymerisation shrinkage appear along the gingival floor. ADVANTAGES1.Sufficient working time. 2.Not sensitive to oxygen inhibition. 3.Easy placement. LIMITATION 1.Time consuming 2.Shrink towards the light source.

9.CONTOURINGCan be initiated immediately after light cured composite have been placed or 3 minutes after the initial hardning of self cured material.
10.POLISHINGDone with fine polishing discs,fine rubber points or cups.

RECENT ADVANCES1.Flowable compositesa.New standard for convenience in anterior and posterior restorations. b.Offers smart handling. c.Flows under pressure but holds its shape in place prior to light cure. d.No oozing,slumping or running. e.Ideal viscocity and flow suitable for small classI,III,IV and shallow classV restoration and as pit and fissure sealant.

2.Packable compositespromoted as amalgam alternative or conventional universal composite. Distinguishing featurea.Less stickiness or stiffer viscosity than conventional composite which allows them to be placed in a manner that somewhat resembles amalgam placement b.Likely to offer better clinical performance than non packable composite. But it is not reccomended in deep cavities. Polymerisation shrinkage similar or higher than non packable composite.