// //

Objectives
Historical back ground Ideal requirements of restorative materials Indications, contraindications and Uses of Composites [ applications] Composition Classification based on the fillers particle size Classification based on the mode of curing Light curing units Properties of composites Acid etch technique

Restorative Composite Resins

Dr Amal Ezz El Din Fahmy Assis Prof. Dental Biomaterials Department Faculty of Dentistry Alexandria University

// //

Restorative Materials for Anterior teeth

1. Silicate cements (not used anymore) 2. Glass Ionomer Cements 3. Polymeric Restorative Materials
a) Type I (Acrylic Unfilled Resin): b) Type II (Composite Resin, Filled Resin)

IDEAL REQUIREMENTS OF RESTORAIVE MATERIALS

Excellent physical and mechanical properties High gloss ,polish ability ,color stability Biocompatibility to pulp, gingival tissues Radio opacity Good adhesion to enamel and dentine Minimal dimensional changes upon setting Good abrasion &fracture resistance No mismatch in Coefficient of thermal expansion between the filling and tooth . No water sorption or solubility

// //

UNFILLED SELF CURING ACRYLIC RESINS

Disadvantages: Monomer penetrates DT causing pulpal irritation. Poor mechanical properties Staining Higher TEC than tooth causing Marginal Percolation Phenomenon High polymerization shrinkage causing marginal gap, Microleakage and recurrent caries..

History
1871 silicates
alumina-silica glass & phosphoric acid very soluble poor mechanical properties

POWDER PMMA + INITIATOR (BENZOYL PEROXIDE) LIQUID MMA + ACTIVATOR (TERTIARY AMINE)

1948 - acrylic resins

polymethylmethacrylate high polymerization shrinkage

N.B: NO FILLERS

Rueggeberg J Prosthet Dent 2002

// //

MICROLEAKAGE PROBLEMS

// //

History
(cont.)
1962 Bis-GMA
stronger resin

1969 filled composite resin

Indications Contraindications and Uses of Composite Resins

improved mechanical properties less shrinkage paste/paste system

1970s acid etching and microfills 1980s light curing and hybrids 1990s flowables and packables 2000s nanofills
Rueggeberg J Prosthet Dent 2002

// //

Contraindications
Large posterior restorations Bruxism Poor isolation Patients with bad oral hygiene (composite not anticariostatic)

Indications
Anterior restorations Posterior restorations
preventive resin conservative class 1 or 2

// //

BLACKS CLASSIFICATIONS OF CAVITY PREPARATIONS

Class II

Class I

Class III

Class IV

Class V

// //

Uses of Composites

Uses of Composites
Class III

Peg lateral

// //

Uses of Composites
Diastema closure

Uses of Composites

Veneers

// //

Uses of Composites
Fissure sealant

Uses of Composites

Core buildup

Bonding of orthodontic brackets and bands

// //

Composite Restorative Resins

By definition, a composite is a combination of two chemically different materials with a distinct interface between them, and having properties which could not be achieved by any of the components alone. alone. Dental composites are highly cross-linked crosspolymeric materials reinforced by a dispersion of glass, crystalline, or resin filler particles and/or short fibers bound to the matrix by silane coupling agents. agents.

Sealants

2. Apply sealant

1. Etch enamel 3. Light cure

Courtesy of 3M Dental Products

21 5/16/2012

// //

COMPOSITE RESINS
Developed 1960s composed of two or 1960s more distinct phases Combination of inorganic filler particles bonded to a soft dimethacrylate polymer Advantages: Advantages: improved mechanical properties easy to use esthetics Used in class III, IV and V as well as a in III, conservative posterior restoration

Composition of composite resins

// //

Filled Composite Resin: Composition

Resin Matrix
(Organic Phase)

Composition
Organic polymer phase (resin matrix) Inorganic phase (dispersed phase/ fillers) Interfacial phase (coupling agent) Initiators and activators Pigments Inhibitors

Fillers
(Inorganic Phase)

Coupling agent
(Interfacial Phase)

Bis-GMA (Bowens resin) UDMA TEGDMA DEGDMA

Silica(quartz) Glass Fibers Lithium Barium Strontium

Silane

Gamma methacryloxy propyl silane

// //

Organic Polymer Phase

Difunctional dimethacrylate monomer BIS-GMA or UDMA BIS Diluents as DEGDMA or TEGDMA 75% BISGMA + 25% Diluent 75% 25% Function of organic matrix: matrix:
Protect the dispersed phase to retain its strength Cement the fillers into bundles Transfer externally applied load to the fillers

// //

Most common dental resins

Bisphenol A glycidyl dimethacrylate

Organic polymer phase

Bis-GMA : extremely viscous
large benzene rings

lowered by adding TEGDMA

freely movable increases polymer conversion increases cross linking increases in diluents increase shrinkage
O

CH3 -CCH3

O OCH2CHCH2O-C-C=CH2 OH CH3

CH2=C-C-O-CH2CH-CH2O =CCH30

triethylene glycol dimethacrylate

5/16/2012

CH3

OH

// //

Composition & Structure

:Resin matrix

Organic Polymer Phase

Lower polymerization shrinkage Lower coefficient of thermal expansion Harder and stronger cross linked polymer Less water sorption UDMA IS LESS VISCOUSVISCOUS-LESS WATER SORPTION High viscosity which require thinning by diluent monomers High water sorption Air inhibition of polymerization
AIR Second increment First increment 1.5

Oligomers (2Monomers)
Monomer:Methylmethacrylate (MMA)
Dimethacrylate(Bis-GMA) Urethane dimethacrylate(UDMA)

// //

Filled Composite Resin: Composition (contd)

Filled Composite Resin: Composition

Role of each constituent

Initiators
Chemically Activated

Activators
Chemically Activated (Tertiary amine)

Inhibitors
Hydroquinone

Resin Matrix
(Organic Phase)
1. Protect Fillers 2. Cushion transferring loads to strong fibers 3. Hold fillers together

Fillers
(Inorganic Phase)
1. Strength 2. Hardness 3. Abrasion resistance

Coupling agent
(Interfacial Phase)

(benzoyl peroxide)
Light Activated (Diketone) (Camphor Quinone)

Bond matrix to fillers

Light Activated (Light)

Hydroquinone BHT

Responsible for: Physical Properties

Responsible for: Mechanical properties

Responsible for: Filler to matrix bond

// //

Inorganic phase ( dispersed fillers)

Shape: spherical OR splintered OR colloidal Size: macrofillers -microfillers -hybrid -fine

Inorganic phase ( dispersed fillers)

Improve the mechanical properties i.e compressive strength. Modulus of strength. elasticity and hardness and wear resistance. resistance. Reduce polymerization shrinkage Reduce the coefficient of thermal expansion Improves the abrasion resistance Improves optical properties

// //

Types of fillers
Quartz: advantages translucent, hard irregularly Quartz: shaped particles, inert disadvantage Very difficult to finish and polish high thermal diffusivity Pyrogenic silica (aerosil): prepared from silicon (aerosil): compounds have very large surface area Barium/ strontium aluminosilicate glasses Radiopaque, Radiopaque, softer than quartz, more easily polished develop basic surface in water which compromise resin filler bond. bond. Beta eucryptite ytterbium tri flouride Zirconium

// //

Type of composite resin

:By filler size
macrofilled back Hybrid

Types of Fillers according to particle size

MACROFILLERS: quartz, lithium, alumino silicate glass, barium or strontium Particle size= 0.1 100 microns average 8-12 12 70-80 % by weight 70 MICROFILLERS Hydrolyzed silica (pyrogenic silica) Average particle size 0.04-0.4 35-67%wt. 0435-67%wt. Prepolym microfiller. microfiller. Complexes HYBRID (BLENDED FILLERS) average Fine fillers 0.4-1 + 0.04 - 60% wt. + 60% microfillers 0.04 m. 15% wt 75-80% by 15% 75-80% weight FINE (SMALL PARTICLE) Particle size reduced to 0.5-3 (1-6 ) 80-90% by wt. 80-90%

microfilled

SP filled

// //

Micro fillers
Pyrogenic silica
Homogenous

Pre polymerized Heterogeneous particles not purely inorganic

// //

Current pattern microfill composite

// //

Classification Based on Filler Particle Size

CLASS of composite
Traditional ( macro filled) Microfilled A) Homogenous B) Heterogenous

Particle size

Filler Clinical use content W%

70-80 High stress area Low stress & sub gingival area requiring high luster and polish Moderate stress area class III,IV High stress area class I,II,III, IV

1-50m Glass ,quartz

Small Particle filled SPF HYBRID

0.04m pyrogenic 35-45 silica 45-79 0.04 m pyrogenic silica& prepolymerized resin containing silica 1-6 m glass& 0.04 m 80-90 silica 0.4-1 m glass and +0.04 m silica 75-80

// //

Interfacial Phase (Coupling Agent)

Provides a chemical bond between the filler particles and the resin matrix Silanes are used e.g. triethoxy vinyl silane More recently gamma methacryloxy propyl silane is used. used. Lack of adequate bond--- dislodgment of fillers, bond--and penetration of water along the filler-matrix fillerinterface. interface.

Surface Roughness Before and After Finishing

// //

Inhibitors
Prevents spontaneous polymer formation
heat light

CHEMISTRY OF COMPOSITES
Interfacial Coupling Agents

Extends shelf life Butylated Hydroxytoluene

Phillips Science of Dental Materials 2003

// //

Classification:
According to the curing mode:
Chemically activated composite resin. Light activated composite resin

Pigments and UV Absorbers

Pigments
metal oxides
provide shading and opacity titanium and aluminum oxides

According to the size of fillers:

Macrofilled composite resin. Microfilled composite resin. Hybrid composite resin.

UV absorbers
prevent discoloration acts like a sunscreen
Benzophenone
Phillips Science of Dental Materials 2003

// //

Chemical activated resin

Two pastes Initiator :Benzoyl peroxid Activator :Tertiary amine I-

Classification according to Polymerization Techniques

CHEMICALLY ACTIVATED (two paste system) Initiators benzoyl peroxide Activator tertiary amine (dihydroxyl ethyl p-toluidine) toluidine) II LIGHT ACTIVATED (single paste systems) II a) ultra violet light b) visible light III- DUAL CURED COMPOSITE IIIChemically and light together. together.

// //

Mode of Supply
Two paste systems Two jars a base paste +a catalyst paste Single paste systems Disposable syringes Compules with color coded tips N.B: a composite kit may also be supplied with an acid etchant and a bonding agent

// //

Manipulation
1. Etching: 37% phosphoric acid 2 .Washing and drying
Micro-irregularities

2 Bottles bond

2 Jars of composite pastes

Acid Etchant

3.Bonding: Mix drops from 2 bottles of bonding agent mixed

and applied to tooth surface with brush then air dried. 4.Application of composite resin: Use Plastic spatula Bulk or pressure pack tech. Celluloid strip

// //

Disadvantages of chemically Activated composite:

Short working time Polymerization is inhibited by air. Voids: Due to bulk technique High polymerization shrinkage One Shade

// //

Light Activated Composite Resin:

Supplied in the form of:
Single paste system or Compules

LIGHT ACTIVATED COMPOSITES

A) ULTRA VIOLET RADIATION PHOTO INITIATOR= BENZOIN METHYL ETHER DISADVANTEGES Limited depth of cure Hazards-skin (cancer) Hazardseye (retinal damage) Intensity fades with time B) VISIBLE LIGHT (BLUE LIGHT 468nm) 468nm) PHOTO INITIATOR= DIKETONE (E.G CAMPHOR QUINONE) DEAEMA (activator) ADVANTAGES Greater depth of cure The intensity of the light bulb remains constant until it fail

// //

Manipulation:
Same as chemical cured composite except for:
Single component for each step Bonding agent is light cured Composite resin is applied incrementally, each increment is max. 2mm thick. Each increment is light cured separately with blue light. This decreases the polymerization shrinkage of the composite.

A Shade guide is supplied to determine the shade of the tooth, hence the composite.

// //

Advantages of light cured composite resin Vs Chemical cured one.

Light Cured
Easy application

Chemical Cured
Needs mixing Single shade. Bulk Technique application Higher Polymerization shrinkage (Bulk tech) More voids, hence lower strength. Difficult application Short working time. Less color stability due to discoloration caused By NN,P toluidine

No MixingCommand cure
Different shades. Incremental application Less Polymerization shrinkage (Incremental application) Less voids, hence higher strength. Long working time. Higher color stability.

// //

Polymerization
C=C C=C C=C C=C
Monomer

Polymerization Reaction
C=C C=C

C=C

C=C

C=C

C=C C=C C=C C=C C=C polymerization C=C C=C C=C C=C C=C C=C
Ferracane

C=C C=C

C=C

C=C

C=C C=C C=C

Dimethacrylate + Initiator (peroxide OR diketone + blue light) + Accelerator (amine) + silane treated particles Dental composite Polymerization is incomplete (degree of conversion is 60 -75% 75%

C=C C=C
Polymer

C=C

// //

Degree of Conversion ( DC)

The percentage of carboncarbon carbon double bonds that have been converted to single bonds to form a polymeric resin. resin. Higher DC= Higher strength . DC depend on: on: Resin composition. composition. Concentration of initiator and inhibitor. inhibitor. Transmission of light. light.

Factors Affecting Depth of Cure

Light intensity is inversely proportional to the distance from the light source Exposure time (not less than 40 secs) Shade and opacity of the composite Thickness 2-2.5mm Filler particle size; the smaller particles size; cause dispersion of lighttherefore light needs longer exposure time as in microfilled composites

// //

Degree of Conversion ( DC)

Transmission of light .

Dental Curing Lights

// //

TYPES OF LIGHT SOURCES

Quartz halogen Tungstun halogen lamp produces blue light radiation at468 nm. After filtering both IR and UV . Irradiation is transmitted through a fiber optic tip Light emitting diodes (LED) Junctions of doped semi conductors (p-n) junctions are used for generation of light instead of a hot filament.the spectral output is within the absorption of CQ

New Types of Light Sources

Traditional Halogen light Argon beam laser Plasma arc Light emitting Diode (LED)

// //

LED Developed to overcome problems of QTH They are light in weight Cable free (Cordless) NO bulb fails Higher efficiency than QTH No need for filters to filter unwanted UV and infra red radiation No noisy fan and less heat generated Ergonomic design

Argon Laser and Plasma Arc More specific to the absorption of CQ Shorter exposure times Higher intensities ( 1000 mW )and shorter curing times 1-3 seconds Disadv: early termination of polymerization reaction lead to less chain length is less average mol w

INTENSITY

Advantages and Disadvantages of Other Light Sources

INTRAPULPAL HEAT, GINGIVAL IRRITATION

UV bandband-pass filter

UV

Visible

CQ

IR bandband-pass filter

IR

WAVELENGTH (nm)

Power Supply Cycle Timer (Circuit Board) Bulb / Reflector Filter Fan FiberFiber-Optic Train

// //

Mechanism of Acid Etching

Removes surface debris Selective dissolution of enamel prismsprisms--rough porous surface --rough Increases the surface energy of enamel and helps wetting by the adhesive Increases the surface area of enamel Enamel bonding agent (diluted BISBISGMA) can flow and fill the produced irregularities bond by mechanical interlocking Resin Tags

Acid Etch Technique

Bunocore 1955 Aim: to overcome the problem of micro Aim: leakage.. leakage.. To provide a good bond between the resin and tooth, improves marginal seal, reduce marginal staining Mechanism: 37% phosphoric acid liquid Mechanism: 37% or gel gives opaque white chalky enamel Etch (30secs for enamel 15 for dentine)30secs dentine) wash (45secs)-dry (15secs) apply 45secs)15secs)

// //

ETCH

Wash & dry Apply

// //

Properties of Composites
Mechanical properties Polymerization shrinkage Water sorption Thermal properties # coefficient # conductivity Color stability Radio opacity Compressive strength Tensile strength Modulus of elasticity Hardness

How does composite resin bond to tooth enamel and dentin?

1. Etchant 37% phosphoric acid produces microirregularities in enamel, and opens DT removing the smear layer.
Etched Dentin

Etched Enamel

// //

Modulus of Elasticity
Depends on the amount of fillers Modulus of elasticity of microfilled composite is 0r that of fine particle composite High modulus is essential in high stress bearing areas to minimize wear HARDNESS: related to the filler content HARDNESS: rather than the hardness of the fillers themselves Can be measured using microindentation tests

Compressive and tensile strengths and E.modulus

Compressive strength is higher for fine and hybrid due to higher volume fraction of fillers Low tensile strength reflects brittle behavior of composites Modulus of elasticty for microfilled Composites Is that of fine particles

// //

Polymerization Shrinkage

Polymerization Shrinkage
Chemically activated
Significant role in restoration failure
gap formation
secondary caries formation marginal leakage post-operative sensitivity

Counteract

Light activated

lower shrinkage composites incremental placement Construct composite inlay

// //

Polymerization Shrinkage
Leads to marginal micro leakage To overcome: Place composite incrementally OR Construct composite inlays either direct (chair side technique) or indirect Inlays are subjected to additional curing by Visible light Visible light and heat Heat and pressure (at 120 OC and 6 bar pressure for 10 min. min. Cementation: Cementation: dual cure resin cement

Physical properties
Polymerized shrinkage
Microhybrid : 1.5-2% Microfilled : 2-4%. Polymerized stress :high as MPa

Self cure

Light cure

// //

Thermal Conductivity & Thermal Expansion

Conductivity of resin composite s is much lower than metallic filling materials They provide good thermal insulation to the pulp Expansion :the higher the amount of organic matrix phase the higher the expansion

// //

Radio Opacity
Not all composites appear radio

Water Sorption
The organic matrix is responsible for the absorption of water which is accompanied by swelling of composite however it is not effective in counteracting the effect of polymerization shrinkage. shrinkage. This phenomenon is in part responsible for discoloration of composite by water soluble stains. stains.

opaque in dental radiographs. radiographs. It must contain heavy metal elements such as barium ,strontium, zirconium to be radio opaque in dental radiographic films. films.

// //

Factors Contributing to Wear

Porosity Filler content and filler particle size Degree of polymerization Hardness Interfacial bonding Position of tooth in the dental arch

// //

Classification

Properties

Properties of Composites
Property Microfine Hybrid 60-65 60Fine Macrofilled 60-77 6050-65 50-

Macrofilled (Traditional) Microfilled

Hard, rough surfaces over time, . abrades enamel and poor wear . resistance; difficult to polish .
. Poor mechanical properties (use in low stress areas), excellent for polishing, decreased shrinkage, increased wear resistance but debatable

Hybrid

Good mechanical properties, better polishes than macrofilled, better wear resistance than microfilled Better polish, mechanical properties similar to hybrids. Continuum filled Better polish, mechanical properties similar to hybrids Good mechanical properties, excellent polish

Micro-Hybrid

Filler 20-55 20Content Vol % Polym. Polym. 2-4 Shrink % Coefficient 50-68 50Thermal exp OCx10 OCx106 Water sorp 1.2-2.2 mg/cm2

1.5-4 1. 20-40 20-

1-1.7 119-38 19-

1-1.7 117-35 17-

0.5-0.7 0.

0.3-0.6 0.

0.3-0.7 0.

Nanofilled.

// //

Applications: (uses)
- As an anterior restorative material for class III & class IV (especially microfilled composites) - Hybrids can now be used in small class II and class I (especially radiopaque types) - As core build up materials - As laminate veneers < facial & labial surfaces of natural teeth) - For cementation of resin bonded bridges maryland & rochette types - Diastema closure - Cementation of orthodontic brackets - Pit & fissure sealants

// //

DEFINITION OF COMPOSITE
Phases and Interfaces

INTERFACE INTERFACE
Enamel Surface Unfinished Composite Surface

INTERFACE
Finished Composite Surface

INTERFACE
Etched Enamel Rods Silicate Reinforcing Filler COMPOSITE Crosslinked Resin Matrix

INTERFACE
Voids at Margins

50 v/o filler = 75 w/o filler

// //

Different Types of Composites according to Filler Particle Size

// //

FILLER PARTICLES
Schematic Examples
MEGAFILL MACROFILL MIDIFILL MINIFILL MICROFILL NANOFILL

Different Types of Composites according to Filler Particle Size

Different Filler Particle Sizes

Not Shown

Not Shown

HYBRID (MIDIFILL)

HYBRID (MINIFILL)

Mixtures Of Filler Sizes

Heterogeneous MIDIFILL

Heterogeneous MINIFILL

Heterogeneous MICROFILL

Mixtures Of Pre-Cured Pieces of Composite

HOW DO YOU MAKE FILLERS?

Not Shown Not Shown

Crushing, Grinding, Sieving Vapor Phase Condensation Sol-Gel Precipitation

// //

Packable and Flowable Composites

Flowable: Flowable: Reduced filler level to allow the material to flow readily and adapt intimately to cavity wall. More susceptible to wear Lower strength Used as liner and in class V cavities Packable : Contain elongated fibrous filler particles(100 micron in particles(100 length which may be textured to resist flow and interlock with the resin Sculpt able and non slumping similar to amalgam in placement technique Less sticky Used in large posterior restorations to establish contact areas and occlusal anatomy.

// //

Coupling agent

// //

Visible-Light Activation
single paste in an opaque syringe Photo-initiator (camphorquinone ) reacts with amine activator Forms free radicals Initiates addition polymerization
monomer
Bis-GMA

Direct viewing will damage the eye

// //

Methods of Curing
Soft start or Ramped: 1st step (initial Ramped: cure) slow irradiation at low energy e.g. at 150mW/ cm2 to reduce early stiffening 150mW/ and contraction stress build up and promote marginal integrity 2nd step (final cure) prolonged irradiation at higher energy 650 mW/cm2 to achieve mW/cm better physical and mechanical properties

TYPES OF LIGHT SOURCES

PLASMA ARC A xenon short arc lamp is used for curing DC. Discharge is passed between two electrodes in a gas which become ionized producing a combination of electrons &+ve ions ARGON LASER Beams of photons emitted in phase. The emission wave length corresponds to the absorption spectrum of CQ

// //

Visible light source Methods of Curing (cont.)

The radiation beam is transmitted to the tooth surface by a quartz rod.

Pulse delay: delay:

Initial cure at 200mW/ cm2 for 3 secs. 200mW/ cm2 secs. 3 minutes REST. REST. Final cure at 500-600mW/ cm 2 for 30 500-600mW/ secs. secs.

// //

Aim of Light Curing

1. Short irradiation time. 2. Low shrinkage stress. 3. Uniform degree of conversion of polymer throughout the whole mass of composite. 4. To overcome the problems of chemical activation, such as air incorporation in the mix leading to porosity and oxygen inhibition of polymerization and uncontrolled working time.

Photo-initiator
Camphorquinone (CQ)
most common photo-absorbing material maximum sensitivity
blue range (465 nm)

// //

Manipulation of Chemically Activated Composites

Select proper shade. shade. In deep cavities place calcium hydroxide or glass ionomer cement. cement. Never use eugenol containing cements as they inhibit polymerization of composites. composites.

Advantages of Light Cure Vs . Chemical Cure

Complete control (command cure) over working time

Avoid cross contamination spatula) avoid metal spatulas

(double-ended (double-

plastic

No mixing less voids within the mass mixing Less finishing time More colour stable and wear resistant Disadvantages extra cost of light curing unitunit-depth of cure depends on shade and opacityopacity-high intensity hazard to the eye

Two pastes system: equal volumes are mixed on paper system: pad mixing time 20-30 secs 20Working time 1.5-2 min setting =3-5 min min Avoid trapping voids; bulk pack technique voids; Contour: Contour: celluloid (mylar) strip mylar)

// //

INCREMENTAL PLACEMENT TECHNIQUES

Oblique incremental Lateral incremental Directional curing technique(light transmitting wedges and transparent matrices) Aim :minimizing adverse effect of polymerization shrinkage

Light Activated Systems Manipulation

Select proper shade. shade. In deep cavities place calcium hydroxide or glass ionomer cement. cement. Never use eugenol containing cements as they inhibit polymerization of composites. composites. Place composite in increments 2mm. mm. Each cure for 20-40 secs. 20- secs. After 2-6min. Start finishing and min. polishing. polishing.

// //