COMPOSITE

Presented by Sobia salam 738

DIRECT PLACEMENT RESTORATIVE MATERIALS

Esthetic materials are those materials that are tooth colored.

Direct placement materials, are placed directly by the clinician in prepared teeth without the need for extra-oral construction of the restoration

DIRECT RESTORATIVE MATERIALS

Composite Glass ionomer cements (GIC) Resin modified-GIC Compomers

COMPOSITE
Composite: mixture of two or more components. Major components:
Organic resin matrix Inorganic fillers

Coupling agents (silane), join filler and matrix

Pigments

COMPONENTS
Resin matrix: chemically active component. Fluid monomer then converts to a rigid polymer by a radical addition polymerization reaction.
Monomers used:
bis-GMA (bisphenol A-glycidyl methacrylate). Bowens resin UDMA (Urethane dimethacrylate) These resins are made of oligomers (organic molecules) and low molecular weight monomers (such as MMA, EDMA, TEGMA)

In addition an inhibitor is added (hydroquinone)

Resin matrix also contains initiators, activators

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 Fillers: silica, quartz, more recently silica based glasses some containing barium, strontium etc. Properties affected by fillers:
Strength Radiopacity (barium, strontium) Esthetics such as color, translucency Polymerization shrinkage

Varity of filler size, A, Macrofilled. B, Microfilled. C, Hybrid

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Coupling agents: what happens if bond between resin and filler is weak: The material would be weak and susceptible to creep and fracture and

The interface between filler and resin will be a source of fracture, stress will not be distributed properly.
Silane coupling agents: has a hydrophobic end (methacrylate group) to bind the resin and a hydrophilic end (OH - group) to bind glass fillers

POLYMERIZATION
Monomers join polymers
Initiators and activators cause the reaction to begin. Side chains on polymers cross-link to form stronger material

POLYMERIZATION TECHNIQUES
1. Chemical cure (self-cure): 2-paste system: Base: composite and benzoyl peroxide as initiator Catalyst: composite and tertiary amine activator Require manual mixing which may lead to air bubbles incorporation.

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2. Light cure:

started with UV light to create free radicals. UV was abandoned due to UV causing burns and eye damage. Blue light (400-500 nm) is used instead. Components that start to react once subjected to the light:
1. 2. Diketone (Camphoquinone source of free radicals) Organic amines

Protection is needed for eyes

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POLYMERIZATION
3. Dual cure: 2-paste system containing both types of initiators and activators. Advantage: light starts the polymerization rxn and the chemical reaction continues in areas were light cant reach them.

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Oxygen inhibited surface layer: sticky, should be removed by a cotton pellet or prevented by a matrix strip. Depth of cure: much better with blue light (3-4 mm) compared to UV light units (2mm maximum).

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POLYMERIZATION SHRINKAGE
Composites shrink away from cavity walls

May lead to breaking marginal seal leading to sensitivity and recurrent cries
May pull at tooth structure and lead to cracks and sensitivity Depends on type of resin and amount of resin Bond between composite and dentine is weaker than between enamel and composite

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HOW TO OVERCOME THESE PROBLEMS?

Incremental placement of composite (increment no more than 2 mm)
Slow curing or soft start curing method to allow relaxation of stresses Using highly filled composites when possible Developing improved dentine bonding systems Using low modulus liners to at as stress absorbers
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CLASSIFICATION OF COMPOSITES
1. 2. 3. 4. 5. 6. 7. 8. 9. Macrofilled (traditional) Microfilled Small-particle composite Hybrid Flowable Pit and fissure sealant Packable composite Smart composite Core build up composite

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MACROFILLED COMPOSITES
First generation

Filler particle size 10-50 m

Difficult to polish Stronger than composites with smaller particles

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MICROFILLED COMPOSITES
Filler particle size 0.01-0.05 m in diameter
Volume of filler is 35-50% (smaller compared to other Lower physical properties, better polishability
composites due to the larger volume of several small particles as opposed to one large particle of the same weight)

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HYBRID COMPOSITE
Mixture of macro and microfillers (75-80% by weight)
Hybrid composite: contains 2 particle sizes, large 15-20 m and microfine fillers (colloidal silica) 0.01-0.05 m

Small particle hybrid: 0.1-6 m

Hybrids have high polishability and strength so they can be used for anterior and posterior restorations.

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FLOWABLE COMPOSITES
Low-viscosity, light cured
Can be lightly filled (40%), or more heavily filled (70%)

Pit and fissure sealing

Liners (cushion

Particle size 0.07-1 m

Delivered into cavity using a syringe
Weaker and wear more compared to hybrids

stress caused by polymerization shrinkage of overlying composite)

Class V

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PIT AND FISSURE SEALANTS

Range from no filler to more heavily filled composites similar to flowable composites

Low viscosity
Preventive material

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PACKABLE COMPOSITES
Highly viscous which is achieved by:
Higher filler loading Increasing filler particle size range Modifying particle shape (make them interlock) Modifying resin matrix to create stronger intermolecular attraction so higher viscosity

Drawback: they appear opaque, not stronger than hybrid composites, air maybe trapped when composite is packed into cavity Suited for posterior restorations
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SMART COMPOSITES
Combat caries by having the ability to release fluoride, calcium, hydroxyl ions when acidity increases Effectiveness has not yet been proven

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CORE BUILDUP COMPOSITES

Heavily filled

Replace lost tooth structure in teeth needing crowns

Colored to distinguish then from natural tooth structure

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PROPERTIES
Biocompatibility: potentially harmful components, however once set, its well tolerated.

Leaching out of some components may cause cytotoxicity and delayed hypersensitivity
Water sorpion and solubility

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PROPERTIES

Greater than tooth structure, causes debonding & leakage. Higher filler content reduces CTE
Coefficient of thermal expansion:

Radiopacity: helps to detect caries around and underneath composite fillings. Should be as radiopaque as enamel

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PROPERTIES
Color matching: causes of discoloration
1. 2. 3. Marginal discoloration Surface discoloration Bulk discoloration: due to chemical breakdown of components and fluid absorption

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MECHANICAL PROPERTIES
Compressive strength: Composites usually fail under tension

Diametral tensile strength: its an alternative method to measure tensile strength and used with brittle material

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 Hardness: indicates wear resistance, improved by filler addition Wear: lower filler content increases wear
Abrasive wear Fatigue wear: lead to cracks forming below the surface Corrosive wear : due to chemical attack and erosion

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CLINICAL HANDLING OF COMPOSITES

Composite is used for all sorts of restorative procedures from class I to class IV. Selection criteria:

Esthetic demands: Microfills and microhybrids are suited

Strength demands: in posterior teeth and stress bearing areas, hybrids are more suited

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SUGGESTED CONTRAINDICATIONS FOR USING COMPOSITE

1. Large restorations: usually in molars
1. 2. 3. Greater polymerization shrinkage, so, difficult to achieve good marginal seal Possibility of bond breakdown with dentine leading to gap formation and pain Higher load, so more wear

2.

Deep gingival preparations:

1. 2. Marginal seal Good adaptation

3.
4.

Depth of cure
Dentine cavity margin

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CONTRAINDICATIONS
3. Lack of peripheral enamel: bond to dentine is unreliable. Cavities due to erosion and abrasion may still be successfully restored with composite even if enamel is lacking since these areas will not be subjected to high stress
onlays of load bearing cusps

4.

5.
6.

Poor moisture control

Habitual bruxism/chewing
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 Shade guide: Some practitioners apply a portion of composite on tooth surface

and cure it to observe the appropriate shade.

Shelf life: follow manufacturer instructions but as a general rule, avoid heat and light. Average shelf life 2-3 years.

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Dispensing and cross-contamination: composites are usually dispensed in syringes. Disposable small containers are used to avoid cross-contamination. Once composite is dispensed, it should be covered with a light-protected container

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Single paste, light activated composite Instruments for placing composite Syringe for injecting composite

Self-cure 2 paste composite, and bonding agent bottle

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 Matrix strips/ bands: Mylar strip is used in class III, IV. Metal
matrix bands are used for class II cavities (curing is from an occlusal direction then after the band is removed, light is directed from facial and lingual aspects). Clear crown forms are used for build up restorations. A wedge is also used to seal gingivally.

Incremental placement: 2 mm thick is recommended:

To minimize polymerization shrinkage Allow curing light to properly penetrate and cure

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Etching and bonding:

Fourth and fifth generation bonding agents:

Etching is achieved using phosphoric acid (34-37%). After etching, tooth surface is washed and gently dried, etched enamel will appear frosty white. Bonding agent is applied in a thin layer and light-cured according to manufacturer instructions. (remember micromechanical retention).

Sixth and seventh generation bonding agents:

Etching and priming is done in one application, and no rinsing is required.
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 Contaminants: After etching and bonding. Re-etching? Eugenol containing

cements should be avoided.

Light-curing:
Should be held as closely as possible to composite 20-40 seconds for thin layers

Thicker layers, darker shades, deeper locations require more time

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Finishing and polishing: sandpaper discs, fine, ultra-fine diamonds. For gingival or interproximal areas, scalpel knife, abrasive strips and needle-shaped diamond burs are used. Polishing pasts can also be used.

Surface sealers: unfilled resin maybe added to reseal margins opened by polymerization shrinkage, or surface porosities.

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1.

PRECAUTIONS FOR LIGHT CURING

Premature set of composites Eye protection Heat generation

Inadequate light output : monthly check on light source, to

examine output (using radiometers), any scratches on light probes or darkening due to disinfection.

2. 3. 4.

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Light curing unit, protective glasses and shield

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COMPOMERS
Composites modified with polyacid (polyacid-modified resin). The resin contains MMA and polycarboxylic acid. Light activation chemicals are included and also fluoride containing glasses. Fluoride release? Setting rxn occurs in 2 stages
Same as light-cured composite Acid-base rxn

Bonding to tooth structure occurs as in composites

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COMPOMERS PROPERTIES

Fluoride release: lower than that of GIC or resin modified glass ionomers.
Adhesion: similar to composite but in low stress areas acid etching maybe discarded. Polymerization shrinkage: similar to composite. Rate of water uptake is faster Weaker than composites, lower wear resistance

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COMPOMERS CLINICAL APPLICATIONS

Low stress bearing areas such as abrasion lesions, proximal surfaces

In primary teeth
Long term temporary in permanent teeth Disadvantage due to hygroscopic expansion, fracture of crowns when compomers are use as luting agents

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SHADE TAKING

Patient 1. Hue 2. Chroma 3. value Dentist Assistant

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Vita shade guide and shade selection

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 Guidelines for taking the shade:

Group effort by dentist, assistant and patient Should be taken before preparation Taken before rubber dam placement Teeth should be clean, free of stains and moist Two different lights should be used (Metamerism): dental offices usually have fluorescent light (blue), or incandescent light (yellow). Natural light is a good source except in morning or late afternoon (more yellow and orange, and less green and blue)

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A neutral background should be used (e.g. blue apron) Female patients should be asked to remove lipstick, and colorful clothes should be covered

Several tabs are held close to patients teeth and kept moist. Separate shades for cervical part of the tooth might be necessary.

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CHARACTERIZING THE SHADE

Surface texture (affects light scatter from tooth) and luster (the degree to which the surface appears shiny) should be noted. These two properties affect how the tooth reflects light and scatter it. The amount of translucency (especially near the incisal edge) should also be noted.

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Any surface characteristics should be replicated if the patient demands that the restoration matches existing teeth. A photograph of the patients teeth and adjacent shade guide tab maybe helpful.

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