COMPOSITE : A Restorative Material

Presented By:
Dr. Shubham Srivastav ( PG-I )
Dept. Of Pediatric & Preventive Dentistry
Karnavti School Of Dentistry
  Introduction
 Definition
 History
 Classification
 Composition
 Types of composites
 Properties
CONTENTS  Indications & Contraindication
 Selection of Composites
 Advantages & Disdvantages
 Clinical techniques
 Composites in Pediatric Dentistry
 Composites over GIC
 Recent advances
  A broad definition of composite is: Two or more
chemically distinct materials which when combined have
improved properties over the individual materials.
Composites could be natural or synthetic.
 In dentistry, the term “resin composite” generally refers
Introduction to a reinforced polymer system used for restoring hard
tissues, such as enamel and dentin.
 Resin composites are used to replace missing tooth
structure and modify tooth color and contour, thus
enhancing esthetics.
  Composite – in material science, a solid formed from
two or more distinct phases (e.g. particles in a metal
phase) that have been combined to produce properties
superior to or intermediate to those of the individual
constituents.
- Annusavice

DEFINITIONS  A composite is a physical mixture of the materials the

parts of the mixture generally is chosen with the purpose
of averaging the properties of the parts to achieve
intermediate properties.
- Sturdevant
  Dental composite is defined as a highly cross-linked
polymeric material reinforced by a dispersion of
amorphous silica, glass, crystalline, or organic resin filler
particles and/or short fibers bonded to the matrix by a
coupling agent.
DEFINITIONS - Anusavice
  Early attempts at tooth-colored filling materials gave rise
to the silicate cements introduced in the 1870s, which
basically consisted of mixing phosphoric acid to acid-
soluble glass particles to form a silica gel matrix with
residual glass particles.
 Composite resins were first manufactured in the early
1970s (Adaptic, Johnson & Johnson, USA), which was
followed shortly by Concise, a composite material by 3M
ESPE, USA. These gained popularity as anterior
HISTORY restorative materials.
 The resin matrix of Bowen's formulation was BiSGMA
(Bisphenol Glycidyl methacrylate which is a reaction
product of Bisphenol A and Glycidyl methacrylate).
Bowen also gave the concept of coupling agents, which
help the filler particles to bind with the resin matrix. The
composites at this time were chemically cured, a reaction
similar to monomer polymer reaction along with
activators and inhibitors.
HISTORY
 1. Based on the resin matrix used
 A. Bis-GMA based
 B. UDMA based
 C. Silorane based
2. Based on the filler particle size (Lutz and Phillip, 1983)
 A. Conventional
 B. Microfilled
 C. Small particle
CLASSIFICATION  D. Hybrid
3. Based on area of application
 Anterior
 Posterior composites
4. Based on consistency
 Light body – Flowable composite
 Medium body– Homogeneous microfills,
macrofills and midifills
 Heavy body – Packable hybrid minifills
 5. Based on type of curing
 A. Chemical cure
 B. UV light cured
 C. Visible light cured (VLC)
 D. Dual cure
 E. Tri cure
 F. Heat and pressure cured
6. Based on range of filler particle size
 Megafill- large size
CLASSIFICATION  Macrofill – 10- 50 m
 Midifill – 1-10 m
 Minifill – 0.1-1 m
 Microfill – 0.01-0.1 m
 Nanofill – 0.005-0.01 m
  7.Classification of Resin-Based Composites and Indications
for Use

CLASSIFICATION
CLASSIFICATION
 8. Based on ISO specification for composite materials
 A. Class 1: Self-curing materials whose setting is
activated by mixing an initiator and an activator
 B. Class 2: Materials whose setting is activated by the
application of energy from an external source such as
blue light or heat.
 Class 2 Group 1: Materials whose use requires the
energy to be applied intraorally.
CLASSIFICATION  2. Class 2 Group 2: Materials whose use requires
energy to be applied extra-orally; this group
comprises indirect composite materials for
fabrication of inlays and onlays.
 Class 3: Materials with dual cure mechanism that have
a self-curing component and can also be cured by
application of external energy
 9. Based on morphological and mechanical
characteristics (Willems’ Classification, 1993)
 A. Densified composites
 1. Midway filled (<60% volume filler particles)
 a. Ultrafine (particle size <3 mm)
 b. Fine (particle size >3 mm)
 2. Compact filled (>60% volume filler particles)
CLASSIFICATION  a. Ultrafine (particle size <3 mm)
 b. Fine (particle size >3 mm)

 B. Microfine composites (average particle size of 0.04

mm):
 Homogenous and heterogenous, with splintered,
agglomerated, and spherical prepolymerized fillers
  C. Miscellaneous composites: Blends of densified an
microfi ne composites with splintered, agglomerated, and
spherical prepolymerized fillers
 D. Traditional composites: Similar to the conventional
composites
 E. Fiber-reinforced composites
10. Based on the mode of curing
CLASSIFICATION A. Instant cure
B. Soft cure
1. Ramped cure
2. Stepped cure
3. Oscillating cure
4. Delayed cure
 11. According to generations:
 1st -Macro ceramics reinforcing phase
 2nd -Colloidal silica
 3rd -Hybrid :macro and micro colloidal
ceramics- 75:25
 4th –Hybrid : heat cured irregularly shaped
macro as reinforced and micro reinforcing
CLASSIFICATION
 5th -Hybrid : heat cured spherical reinforced
which have improved wettability and bonding.
 6th -Hybrid : agglomerates of sintered micro
ceramics reinforced ,which have best
mechanical properties.
  Dental composites are highly cross-linked polymeric
materials reinforced by a dispersion of glass, crystalline
or resin filler particles and/or short fibres bound to
matrix by silane coupling agent, the basic structural
components of a dental resin based composite are:
 a) Organic Matrix or Organic Phase,
COMPOSITION  b) Filler or Disperse Phase,
 c) Coupling Agent
 d) Activator – Initiator System
 e) Inhibitors
 f) Optical Modifiers
  Blend of aromatic and/or aliphatic dimethacrylate
monomers such as bis-GMA and urethane
dimethacrylate to form highly cross-linked, strong, rigid,
and durable polymer structures.
 This matrix forms a continuous phase in which the
reinforcing filler is dispersed.
 However, UDMA and bis-GMA are highly viscous and
are difficult to blend and manipulate, so other matrix
1. Matrix were tried having lower viscosity.
 Triethylene glycol dimethacrylate(TEGDMA) is added
to control the viscosity.
  Most important properties of the resin is determined by
its filler content.
 Fillers are classified by material, shape and size.
 Broadly classified into 3 groups- Macro, Micro and
Nano. And mixture of different particle sized is referred
to as hybrid.

2. Fillers
  Improves Strength
 Reduces shrinkage
 Reduces Wear

Functions of  Surface smoothness and esthetics

 Reduces water sorption
Fillers  Reduces thermal expansion and contraction
 Improves clinical handling
 Imparts radiopacity
  Ground Quartz
 Glasses or ceramic containing heavy metals
 Boron silicates
Types of Fillers  Lithium aluminium silicates
 Ytterbium trifluoride
 Colloidal Silica
 These agents bond the filler particles to the resin matrix.
Functions:
 They improve the properties of the resin through transfer
of stresses from the more plastic resin to the stiffer filler
particles.
 They prevent water from penetrating the filler-resin
interface.
 They bond the fillers to the resin matrix thereby reducing
3. Coupling Agent the wear.
Most commonly used is organosilanes ( 3-
methacryloxypropyl-trimethoxysilane ). Zirconates and
Titanates can also be used.
  In the presence of water, the methoxy groups (–OCH3)
are hydrolyzed to silanol (–Si–OH) groups, which can
bond with other silanols on the filler surfaces by forming
siloxane bonds (–Si–O–Si–).
 The organosilane methacrylate groups form covalent
bonds with the resin when it is polymerized, thereby
completing the coupling process.
Mechanism
  Both monomethacrylate and dimethacrylate monomers
polymerize by the addition polymerization mechanism
initiated by free radicals.
4. Activator -  Free radicals can be generated by chemical activation or
Initiator system by external energy activation.

Chemically Light
Dual cure
activated activated
  Two paste system
 Benzoyl peroxide initiator (universal paste)
Chemically  Aromatic tertiary amine activator (N,N, dimethyl-p-
toluidine)
Activated (Self-
 When both pastes are mixed, addition polymerization is
Cure) Resins initiated.

Benzoyl Free
Amine
peroxide radicals
 Advantages Disadvantages

Convenience and simplicity. Mixing causes air entrapment,

leading to porosity that
Long-term storage stability weakens the material and
Manipulation of working/ increases susceptibility to
setting time by varying staining. This has been reduced
proportions by the use of mixing syringes
Adv. & Disadv. of
Chemically Degree of cure equal Aromatic amine accelerators
throughout material if oxidize and turn yellow with
Activated (Self- mixed properly time—i.e., color instability
Cure) Resins
Marginal stress buildup Difficult to mix evenly, causing
during curing is much lower unequal degree of cure and
than for photocured resins consequent poor mechanical
owing to relatively slower properties
rates of cross-link formation
  Initial light-activated systems used ultraviolet (UV) light
to initiate polymerization.
 The potential hazards of the UV light prompted its
replacement with visible light activating systems in the
blue spectrum of the wavelength (470 nm).
Photochemically  Available as a single paste containing the
photosensitizer camphoroquinone (0.2 wt%) and an
Activated (Light- amine activator
Cure) Resins  exposure to the blue light of a correct wavelength
produces an excited state of the camphoroquinone which
then interacts with the amine to form free radicals that
initiate polymerization.
  U V LIGHT CURED COMPOSITE(360-400nm)

• Benzoin methyl ether

Initiator

Photochemicall Activator
• Tertiary amine

y Activated
(Light-Cure)  Visible light cured composite(400-480nm)
Resins • Camphoroquinone.
Initiator

• Dimethyl amino ethyl

Activator
methacrylate
 Advantages Disadvantages
• materials can be easily • possible eye damage
manipulated
• maximum depth of light
• longer and still have a shorter penetration 3 mm
Adv. & Disadv. of curing time (20–40 seconds
Photochemically or less vs. minutes for • heat generation that could
autocured composites) harm the pulp
Activated (Light-
Cure) Resins • earlier finishing • high purchase and
maintenance
• better color stability.
  Consists of two light curable pastes, one containing
benzoyl peroxide and the other paste containing the
aromatic tertiary amine.
 When these two pastes are mixed and then exposed to
light, light curing is promoted by the amine/CQ
combination and the chemical curing is promoted by the
amine/BP interaction.
 Indication
Dual-cure resins Cementation of bulky ceramic inlays.
 Disadvantages:
Air inhibition of polymerisation and porosity.
  To prevent a spontaneous start of polymerization of
monomers, a very small number of inhibitors are added
to the resin.
 These inhibitors have a strong reactivity potential with
free radicals
 In situations where the composite is exposed to ambient
light briefl y when the material is dispensed, free radicals
5. Inhibitors may be formed. The inhibitor present in the composite
resin reacts with these free radicals, thus inhibiting the
ability of the radicals to initiate the polymerization
process.
 Butylated hydroxytoluene in concentrations of
0.01%.
  To achieve the various shades of dentin and enamel, dental
composites must have visual coloration and translucency
that can simulate the tooth structure.
 Titanium dioxide and aluminum oxide are added in
minute amounts (0.001–0.007 wt%) as effective opacifiers.
 All color modifiers and opacifiers affect the light
transmitting ability of the composite resin.
6. Optical modifiers  Darker shades of composites transmit less light than lighter
shades, suggesting that different shades and opacities of
composites have different depth of cure when cured with
light.
 Conventional/traditional

Small particle filled

Types of
Composites Microfilled

Hybrid
  Developed during the 1970s
 filler used - finely ground amorphous
silica and quartz.
 The average particle size is 8 - 12µm,
 Filler loading generally is 70 – 80 wt%
or 60 – 70 vol%
Traditional/  Knoop’s hardness value is 55
conventional  Exibits rough surface texture

composites  Compresive strength is 300 to 500

percent as compared to unfilled resin.
 Clinical consideration
 used in class II and class IV
 Can be used for stress bearing areas

Advantages Disadvantages
Traditional/ Compressive, tensile strength Polishability
conventional Stiffness Surface roughness
composites Hardness Staining, plaque
Polymerization shrinkage Occlusal wear
Water sorption, thermal Poor esthetics
expansion
  Introduced to overcome the disadvantages of traditional
composite.
 Inorganic fillers are ground to a size range of
approximately 0.5 to 3µm, but with a fairly broad size
range distribution.
 Contain more inorganic filler (80 wt% to 90 wt% and 65 to
77 vol%) than traditional composites.
Small (fine)  Use amorphous silica as filler, but most incorporate
glasses that contain heavy metals for radiopacity
particle composite Colloidal silica added in amounts of approximately 5 wt
% to adjust the viscosity of paste.

Silane-coated
silica or glass
(1-5 u)

Polymer
matrix
 Clinical application –
 Indicated for application in which large stresses and
where abrasion might be encountered
 Attains a reasonably smooth surface for anterior
application but not as good as hybrid or microfilled
composites.

Small (fine) Advantages Disadvantages

particle composite
• Good mechanical • Prone to wear and
properties deterioration
• Less polymerization
Shrinkage
• Radiopacity
  Introduced in 1970s- also called as polishable
composites.
 Individual particles are approximately 0.04 µm (40nm)
in size - Colloidal silica particles
 Inorganic filler content - 35 to 60% by wt.
 Filler is made by a pyrolytic precipitationn process
Microfilled where a silicon compound is burned in an
oxygen/hydrogen atmosphere to form amorphous
composites silica.
 The bond between the composite particles and the
clinically cured matrix is relatively weak, facilitating
wear by a chipping mechanism.
Ground
polymer
with
colloidal
silica (50 u)
Polymer
matrix
with
colloidal
silica
 Clinical application -
 Esthetic anterior restoration
 Carious lesion on smooth surface (Class V) due to its
low modulus of elasticity which allows the composite to
flex.

Microfilled •
•
Advantages
Best surface finish
• Disadvantages
• Low Tensile strength
composites • Excellent wear resistance • Water sorption and
• Fracture resistance coefficient of thermal
expansion
• Polymerization
shrinkage
  Developed to combine properties of conventional and
microfilled composites.
 Contain two kinds of filler particles - colloidal silica
and ground particles of glasses containing heavy
metals.
 Contains filler loading of approximately 75 to 80 wt%.
Hybrid  Average particle size of about 0.4 to 1.0 µm.
 Colloidal silica represents 10 – 20 wt% of total filler
composites content.

Silane-coated
silica or glass

Polymer
matrix with
colloidal
silica
 Clinical considerations –
 Used in anteriors including Class IV
 Provides a smooth surface texture in finished restoration.
 Currently are the predominant direct esthetic restorative
material used.
 Have almost universal clinical applicability.
Hybrid
composites Advantages Disadvantages
• Good physical properties • Increased surface
• Improve wear resistance roughness with time
• Superior surface
morphology
• Good esthetics
Type of Restoration Recommended Resin Composite

Class 1 Multipurpose, nanocomposite, bulk filled, microfilled (posterior), compomer

(posterior)
Class 2 Multipurpose, nanocomposite, bulk filled, laboratory, microfilled (posterior),
compomer (posterior)
Class 3 Multipurpose, nanocomposite, microfilled, compomer

Class 4 Multipurpose, nanocomposite

Class 5 Multipurpose, nanocomposite, microfilled, resin-modified glass ionomer, compomer

Class 6 (MOD) Bulk filled, nanocomposite

Cervical lesions Flowable, resin-modified glass ionomer, compomer

Pediatric Restorations Flowable, resin-modified glass ionomer, compomer

3-unit bridge or Crown Laboratory (with fiber reinforcement)

Alloy substructure Laboratory (bonded)

Core build-up Core
Temporary restoration Provisional
High caries-risk patients Glass ionomers, resin-modified glass ionomer
 Properties
A. Physical
1. Working, setting time
2. Polymerization shrinkage
C. Clinical
3. Thermal properties
1) Wear
4. Water sorption
2) Depth of cure
5. Solubility
PROPERTIES 6. Colour stability
3) Radiopacity
4) Biocompatibility
B. Mechanical
5) Marginal integrity
7. Compressive strenght
6) Post op sensitivity
8. Flexural strenght
9. Knoop hardness
10. Modulus of elasticity
  Physical properties vary between the three basic types of
composites i.e. conventional or macrofilled, microfilled and
hybrid.

PROPERTIES
  For chemically activated composites:
Working time- 90 secs
Setting time- 3-4 mins
Working and  For light-cured composites,
setting time  Curing is considered to be “on demand.”
Polymerization is initiated when the composite is
first exposed to light, the curing reaction continues
for a period of 24 hours
  This occurs when carbon double bonds in the monomers
are converted to single bonds during curing.
 This conversion results in a decrease in the distance
between the molecules from vander Waal’s gap to the
distance of a covalent bond.
 When a tooth preparation has extended onto the root
surface, polymerization shrinkage can cause a gap
formation at the junction of the composite and root
Polymerization surface.

shrinkage  The V-shaped gap occurs because

 force of polymerization of the composite > initial bond
strength of the composite to the dentin of the root.
Polymerization
shrinkage
 Factors affecting curing shrinkage –
1. Filler content: Shrinkage is a direct function of the
volume fraction of polymer matrix in the composite.
Therefore, the presence of high filler levels is
fundamental to reduce shrinkage of the composite
Polymerization during polymerization.
2. Elastic modulus: Most rigid material show highest
shrinkage stress
3. Water sorption: They show hygroscopic expansion
4. C-factor
5. Self curing or light-curing composite
  C-factor is the ratio of bonded surface area in a cavity to
the unbonded surface area.
 When there is a smaller ratio of bonded to free surface
area, the flow of the composite resin undergoing
polymerization occurs easily over the free area
minimizing the stress caused during polymerization
shrinkage.
 On the other hand, when there is less free surface, little
CONFIGURATION - flow occurs resulting in greater interfacial stress.
FACTOR
  A prepared class V cavity with five defined internal
surfaces also has a higher C-factor.
 Cervical abrasive class V lesions, on the other hand, have
a saucer-shaped cavity design that will lower the C-factor
significantly since this saucer shape can be visualized as
a single surface.
CONFIGURATION -  C-factor >1, adhesion could not be maintained with
conventional adhesives alone. In such cases, use of
FACTOR adhesive linings, different formulations of resins and
their layering techniques, and curing methods is
recommended.
 There is a relationship between C-factor values and
occlusal surface areas; the larger the occlusal surface
area of the restoration (i.e., the broader the cavity), the
smaller the C-factor.
CONFIGURATION -
FACTOR
A cavity with four walls and a floor has a C-factor of 5 (A).
To reduce this C-factor, one of the clinical methods is to
use a flowable composite liner over the bonded surface.
The regular composite resin is then built up incrementally
over this liner as shown in the figure, curing each
increment before placing the next (B). Care should be
taken to place each increment on not more than two
adjacent walls
CONFIGURATION -
FACTOR
  Shrinkage during polymerization induces stresses within
the material since the material is constrained on one/two
sides by its adhesion to the cavity wall of the tooth
surface.
 These stresses can be suffcient to cause a breakdown of
the interfacial bond causing a marginal gap that leads to
microleakage.

Shrinkage  The low molecular weight diluent monomers added to

the composites to decrease their viscosity increase the
Stresses time before gelation of the matrix occurs; hence, they
compensate for the stresses induced during
polymerization.
  (1) “soft-start” polymerization instead of high-intensity
light curing
 (2) incremental additions to reduce the effects of
polymerization shrinkage
Compensation  (3) a stress-breaking liner, such as a filled dentinal
Of adhesive, flowable composite, or RMGI.
 (4) Application of thick adhesive layers
Polymerization  (5) use of materials with higher filler loading and smaller
Stress particle size.
 (6) Modified cavity design, placement of bevels, reduced
depths and rounded internal line angles are very effective
in providing good marginal adaptation.
  The rate of dimensional change of a material per unit
Linear change in temperature.
Coefficient Of  Closer the LCTE of material to the LCTE of tooth
Thermal structure, lesser are the chances of it creatiing voids or
gap junctions during temperature changes.
Expansion
Enamel dentin Traditional Hybrid Hybrid microfille
(small) (all purpose) d
particle
11.8 8 25-35 19-26 30-40 50-60
  Most composites contain radiopaque fillers, such as
barium glass, to make the material radiopaque.
Radiopacity  Composite resins have radiopacity equivalent to 1 mm of
aluminum, which is approximately equal to that of
dentin.
  The amount of water that a material absorbs over time
per unit of surface area or volume.
 Materials with high filler contents exhibit lower water
absorption values.
Water sorption
Traditional Hybrid (small) Hybrid (all microfilled
particle purpose)
0.5-0,7 0.5-0.6 0.5-0.7 1.4-1.7
  Solubility is the loss in weight per unit surface area or volume
secondary to dissolution or disintegration of a material in oral
fluids, over time, at a given temperature. Composite materials do
not show any clinically relevant solubility.
 The water solubility of composites varies from 0.25 to 2.5
mg/mm3
 During the storage of microhybrid composites in water, the
leaching of inorganic ions can be detected; such ions are
Solubility associated with a breakdown in interfacial bonding.
 Silicon leaches in the greatest quantity (15 to 17 μg/mL) during
the first 30 days of storage in water and decreases with time of
exposure.
 Boron, barium, and strontium, which are present in glass fillers,
are leached to various degrees (6 to 19 μg/mL) from the various
resin-filler systems.
 Breakdown and leakage can be a contributing factor to the
reduced resistance to wear and abrasion of composites.
  Stress cracks within the polymer matrix and partial
debonding of the filler to the resin as a result of
hydrolysis tend to increase opacity and alter appearance.
3 types: marginal, surface, and bulk discoloration
 Marginal discolouration: due to improper adaptation of
the material to the margins of the cavity or breakage of
Colour Stability the interfacial bonds between the resin and the cavity
wall due to shrinkage stresses
 Leads to marginal gap formation which accumulates
debris leading to marginal staining.
 Elimination of the marginal gap will completely avoid
this type of staining.
  Surface discolouration: related to the surface roughness
of the composite, in other words the polishability.
 more likely to occur with composite resins containing
larger particle size fillers. Debris gets entrapped in the
spaces between the protruding filler particles
 graded finishing and polishing procedures can avoid
Colour Stability this.
 Bulk discolouration: is common with chemically
activated composites.
 This occurs due to the chemical degradation of the
components in the resin matrix and the absorption of
fluids from the oral environment.
 The color of the restoration changes slowly over a
long period of time, giving a yellowish appearance
  The compressive strength of most composites is similar,
ranging from 200 MPa to 300 MPa.
 The flexural and compressive moduli of microfilled and
Strength and flowable composites are about 50% lower than values for

modulus multipurpose hybrids and packable composites, which

reflects the lower volume percent of fillers in these
material.
  The hardness of composites is directly related to the
volume fraction of inorganic fillers present.
 Hence, microhardness of hybrid composites is somewhat
greater than that of microfilled composites.
 Microhardness measurement may not be dependable for
Knoops composites with a traditional particle size since the
values depend on whether the microindentation is made
hardness on the organic or on the inorganic phase.
 Microhardness is also dependent on the degree of
polymerization. In laboratory studies, composites that
were cured with secondary heat treatment showed higher
Knoop hardness values than composites that were only
light cured.
 ENAMEL AND DENTIN
 The bond strength of composites to etched enamel and
primed dentin is typically between 20 and 30 MPa.
Bond Strength  Bonding is principally a result of micromechanical
to Dental retention of the bonding agent into the etched surfaces of
enamel and primed dentin.
Substrates  In dentin, a hybrid layer of bonding resin and collagen is
often formed, and the bonding adhesive penetrates the
dentinal tubules.
  Composite can be bonded to existing composite
restorations, ceramics, and alloys when the substrate is
roughened and appropriately primed
 In general, the surface to be bonded is sandblasted
Bond Strength (microetched) with 50-μm alumina and then treated with
 a resin-silane primer for composite,
to other  a silane primer for silica-based ceramics,
Substrates  an acidic phosphate monomer for zirconia, a
special alloy primer.
 Bond strengths to treated surfaces are typically greater
than 20 MPa.
  Modulus of elasticity is the stiffness of a material. A
material having a higher modulus is more rigid.
 A microfill composite material with greater flexibility
may perform better in certain Class V restorations than a
more rigid hybrid composite.
 Particularly true for Class V restorations in teeth
experiencing heavy occlusal forces, where stress
Modulus of concentrations exist in the cervical area. Such stress can
cause tooth flexure that can disrupt the bonding
Elasticity interface.
 Using a more flexible material, such as a microfill
composite, allows the restorations to bend with the tooth,
better protecting the bonding interface.
 Stress-breaking liners that possess a lower elastic
modulus also can be used to protect the bonding
interface better.
 Compressive Tensile Modulus Knoops
strength strength of hardness
(Mpa) elasticity
Traditional 250-300 50-65 8-15 55

Hybrid (small) 350-400 75-90 15-20 50-60

particle
Hybrid (all 300-350 40-50 11-15 50-60
purpose)
MECHANICAL Microfilled 250-350 30-50 3-6 25-35
PROPERTIES Flowable 4-8

Packable 40-45 3-13

Enamel 384 10 84 350-430

Dentin 297 52 18 68

Vimal Sikri : Textbook of operative dentistry

  Measure of the percentage of carbon-carbon double
bonds that have been converted to single bonds to form a
polymeric resin
 A conversion of 50% to 60%, of highly cross-linked bis-
GMA–based composites, implies that 50% to 60% of the
Degree of methacrylate groups have polymerized.
conversion  depends on several factors, such as resin composition,
the transmission of light through the material, and the
concentrations of sensitizer, initiator, and inhibitor.
 Conversion values of 50% to 70% are achieved at room
temperature for both curing systems.

Vimal Sikri : Textbook of operative dentistry

  Wear resistance refers to a material’s ability to resist
surface loss as a result of abrasive contact with opposing
tooth structure, restorative material, food boli, and such
items as toothbrush bristles and toothpicks.
 Wear rate differences of 10 to 20 μm/ year, this wear
rate still amounts to 0.1 to 0.2 mm more than enamel
over 10 years.

Wear resistance First mode is two-body wear,

Second mode is three body
wear, which simulates loss of
based on direct contact of the material in noncontacting
restoration with an opposing areas, owing to contact with
cusp or with adjacent proximal food as it is forced across the
surfaces to mimic the high occlusal surfaces. This type of
stresses developed in the small wear is affected in a complex
area of contact way by a number of
composite properties

Vimal Sikri : Textbook of operative dentistry

 Fillers:
Wear resistance~
 Directly proportional filler loading
 Indirectly to particle size
Softer filler particles are more capable of absorbing the forces
generated during occlusion and transmit less of stress to the
matrix.
Wear Resistance
 Porosity: Air entrapment during mixing or placement of the
Depends On Various composites results in concentration of stresses within the
Factors Such As matrix.
 Tooth position: posterior > anterior.
 Degree of polymerization: directly proportional to wear
resistance.
 Finishing and polishing : Use of carbides and diamonds
results in formation of microcracks and heat generation in the
resins, leading to degradation and more wear.
Vimal Sikri : Textbook of operative dentistry
 Factors contributing to microleakage –
 Polymerization shrinkage
 Difference in Coefficient of thermal expansion between
tooth and composite
 Modulus of elasticity.
Marginal defects related to occlusal loading - Four types
 Surface fracture of excess composite resin material
 Crevice formation – ditching, marginal fracture
Marginal  Voids or porosities – incorporation of air between restoration
leakage/margin and tooth during placement.
al integrity  Wear – progressive exposure of the axially directed cavity wall.

Vimal Sikri : Textbook of operative dentistry

 Direct biological risk
 Post-placement tooth sensitivity
 Local immunological effects
 Apoptotic reactions
 Long-term pulpal inflammation
Biocompatibility  Systemic estrogenic effects
 May elicit allergic reactions, or may possibly even act as
carcinogens
Indirect biological risk –
 Post-operative sensitivity, pulpitis, and secondary caries
resulting from microleakage/nanoleakage.

Vimal Sikri : Textbook of operative dentistry

  Since the DC is never 100%, the uncured monomers can
leach out of the restoration, transgressing through the
dentin, and cause a moderate degree of cytotoxicity, even
in lower concentrations.
Biocompatibility  A dentin barrier reduces the ability of these monomers to
reach the pulp; hence, care should be taken to protect the
pulp in cavities where the remaining dentin thickness is
less than 1 mm.

Vimal Sikri : Textbook of operative dentistry

  Bisphenol A and bisphenol-based monomers in
composite resins have shown the capability of inducing
changes in estrogen-sensitive organs and cells. In other
words, these components can act as xenoestrogens.
 This is termed estrogenicity.
Estrogenecity  low molecular weight monomers, such as TEGDMA,
also leach out and cause the symptoms rather than the
high molecular weight monomers such as bis-GMA.
 estrogenicity from cured composite resins has not been
demonstrated

Vimal Sikri : Textbook of operative dentistry

  Caused due to :
1. Marginal diffusion of species that induce dentinal
fluid flow.
2. Dimensional changes within the restoration itself.
 The methods to reduce or eliminate postoperative
sensitivity include:
Post operative  1. Use of the incremental layering technique during
placement ensuring the adaptation
sensitivity  2. Use of self-etch adhesives, which show lesser
postoperative sensitivity than etch and rinse
adhesives
 3. For deeper cavities, the use of a glass ionomer
liner or flowable composite lining has shown to
reduce postoperative sensitivity.

Vimal Sikri : Textbook of operative dentistry

 Isolation factors
 Bonding to tooth structure requires an environment isolated
from contamination by oral fluids or other contaminants; such
contamination prohibits bond development.
 The ability to isolate the operating area is a major factor in
selecting a composite material for a restoration.
GENERAL Occlusal Factors
CONSIDERATIONS  Composite materials exhibit less wear resistance than
FOR COMPOSITE amalgam
RESTORATIONS
 For patients with heavy occlusion, bruxism, or restorations
that provide all of a tooth’s occlusal contacts, amalgam, rather
than composite, is usually the material of choice.
 Nevertheless, for most teeth experiencing normal occlusal
loading and having occlusal contacts that are at least shared
with tooth structure, composite restorations perform well.

Vimal Sikri : Textbook of operative dentistry

 Class 1 restorations Class II restoration

INDICATIONS  Small and moderate restorations, preferably with enamel

margins
 A restoration that does not have heavy occlusal contacts
 Some restorations that may serve as foundations for crowns
 Some large restorations that are used to strengthen
remaining weakened tooth structure (for economic or
interim use reasons)
 Traditional, hybrid ( large partcle0 or packable composites
are used in high stress areas.

Vimal Sikri : Textbook of operative dentistry

 Microfilled composites are
recommended for low stress
areas like class 3 and 5
restorations, in which a high Class III restoration Class IV restoration
polish and esthetics are
important.
 Hybrid composites are suitable
for high stress areas where
esthetic is required like class 4
restorations

ClassV restoration
Vimal Sikri : Textbook of operative dentistry
 Core composites are available
as selfcured, light-cured, and
dual-cured products.
 Core composites are usually
tinted (blue, white, or opaque)
to provide a contrasting color Class VI restorations
with the tooth structure
 Composite with higher tensile
strength should be chosen
 Retention of the final
restoration should not rely on
the composite structure alone
because adhesion of the
composite core to remaining
dentin alone is insufficient to
resist rotation and
dislodgement of the crown. Sealants and preventive resins Core build-up

Vimal Sikri : Textbook of operative dentistry

  INDIRECT RESTORATION
 Considered for restoration of
large Class I and II defects or
replacement of large
compromised existing
restorations, especially those
that are wide faciolingually and
require cusp coverage
 The contours of large
restorations are easily
developed
 more durable than direct
composites when placed in
large occlusal posterior
restorations,
 Provides better wear resistance

Vimal Sikri : Textbook of operative dentistry

 Aesthetic enhancement

Partial veeners Full veeners

Enamel hypoplasia Diastema closure

Vimal Sikri : Textbook of operative dentistry
 Provisional inlays, crowns, Periodontal splinting
and fixed partial dentures are
usually fabricated from acrylic
resins or composites.
 Provisional restorations
fabricated from composites are
generally harder, stiffer, and
more color stable than those
made from acrylics.

Temporaray restorations

Vimal Sikri : Textbook of operative dentistry

 CONTRAINDICATIONS
Subgingival area/root Operator ability and
Isolation Occlusion surface commitment factors

• If the operating site • If all of the occlusion is • Composite restoration • Operator should have
cannot be isolated from on the restorative extensions on the root Technical ability and
contamination by oral material, patients with surface may exhibit knowledge of the
fluids, composite (or any heavy occlusion, gap formation at the material’s use and
other bonded material) bruxism junction of the limitations are
should not be used composite and root due required.
to polymerization
shrinkage
• the use of a RMGI
liner beneath the
composite in the root-
surface area may
reduce the potential
microleakage, gap
formation, and
recurrent caries

Vimal Sikri : Textbook of operative dentistry

  Phillips’ Science of dental materials
 Vimal Sikri : Textbook of operative dentistry
 Craig: Dental marterials
 S. Mahalaxmi: Materials used in Dentistry

References  Sturdevant : Art and science of operative dentistry

 Marzouk : Operative dentistry - modern theory and
practice
 John J. Manappalli - Basic Dental Materials.
 1. Esthetics
2. Conservative of tooth structure removal
3. Less complex when preparing the tooth
4. Insulative, having low thermal conductivity
ADVANTAGES 5. Bonded to tooth structure resulting in low
microleakage, minimal interfacial staining

6. No corrosion
7. Repairable
 1. May have a gap formation, usually occurring on root surfaces
as a result of the forces of polymerization shrinkage
2. Are more difficult, time-consuming, and costly
Bonding has multiple steps
Difficulty in insertion, establishing proximal contacts and
contours, finishing polishing etc
DISADVANTAGES
3. Are more technique sensitive because the operating site must
be appropriately isolated,
4. May exhibit greater occlusal wear in areas of high occlusal
stress
5. Have a highercoefficient of thermal expansion, resulting in
potential marginal percolation if an bonding is inadequate.
  Most curing lamps are handheld devices
 that contain the light source and are equipped with a
relatively short, rigid light guide made up of fused
CURING LAMPS optical fibers.
 A few lamps have the power unit connected to the dental
handpiece by a long flexible liquid-filled light guide.

Utilizing Light Cure Units: A Concise Narrative Review (Fatin A. Hasanain and Hani M. Nassar)
 CURING LAMPS

QTH curing lamp Plasma Arc

Argon laser curing unit LED curing light

Utilizing Light Cure Units: A Concise Narrative Review (Fatin A. Hasanain and Hani M. Nassar)
  The first visible LCUs introduced for use in dental
clinics were quartz–tungsten halogen (QTH) devices.
 These units had a bulb which consisted of a tungsten
filament encircled in a quartz case.
 The case was filled with a halogen-based gas.
Quartz–Tungsten  . They also incorporate removable light guides which are
hard and non-flexible.
Halogen
 These guides allowed a wide range of coverage patterns
and improved the ability to reach particular locations
within the dental arch.
 30–60 s of exposure was required to adequately
polymerize a 2 mm increment of dental resin composite.

Utilizing Light Cure Units: A Concise Narrative Review (Fatin A. Hasanain and Hani M. Nassar)
 Advantages Disadvantages
• Easy to install •Cure time (about 40 to 60
• Relatively inexpensive seconds).
Advantages & • The units are large and
cumbersome.
Disadvantages of • The lights (bulbs) decrease in
Quartz–Tungsten output with time and thus need
frequent replacement.
Halogen • They have low-energy
performance and generate high
temperatures.
• They require a filter and
ventilating fan.

Utilizing Light Cure Units: A Concise Narrative Review (Fatin A. Hasanain and Hani M. Nassar)
  Light-emitting diode (LED) LCUs were developed in the late
1990s.
 LED diodes should last thousands of hours, while QTH bulbs last
approximately 30–50 h.
 Three generations of LEDs have been developed so far.
 The first generation of LEDs contained several low-power LEDs.
 First-generation LED LCUs did not cure dental resin composites as
LED Curing well as QTH could.
Lamps  Second-generation LEDs used a single high-power LED which
provided a higher light output than the first generation.
 However, the spectral output was still narrower than that of QTH,
similar to that of the first-generation LEDs.
 Both first- and second-generation LED LCUs are also known as
single peak (monowave) LEDs, because they only emit a single
color of light (blue) with a wavelength above 420 nm.

Utilizing Light Cure Units: A Concise Narrative Review (Fatin A. Hasanain and Hani M. Nassar)
  Lastly, third-generation LEDs have a broader spectral
output because of the incorporation of a combination of
LEDs.
 This generation of LCUs is also referred to as multi-
wave (multi-peak) LEDs because they emit light of more
than one color or wavelength range.
LED Curing
Lamps
 Advantages Disadvantages
•Constant effectiveness • The batteries must be
without any drop in recharged.
intensity with time • They cost more than
Advantages & • Cooling fan is not needed
occurs during curing.
conventional halogen lights.
• The curing time is slower
Disadvantages • Depth of curing with LED
units is higher than QTH
than that of plasmaarcuring
lights and some enhanced
of LED curing devices. halogen lights
•No bulb or filter that
light require maintenance.

Utilizing Light Cure Units: A Concise Narrative Review (Fatin A. Hasanain and Hani M. Nassar)
  PAC lamps use a xenon gas that is ionized to produce a
plasma.
 The high-intensity white light is filtered to remove heat
and to allow blue light to be emitted.
 Wavelength is around 390 nm – 510 nm
 Disadvantage: Xenon bulb replacement is expensive.
Plasma Arc

Utilizing Light Cure Units: A Concise Narrative Review (Fatin A. Hasanain and Hani M. Nassar)
  Argon laser lamps have the highest intensity and emit at
a single wavelength.
 Lamps currently available emit light at wavelength of
about 490 nm.
 Disadvantages: narrow spectrum of emission not
Argon Laser portable

Curing Unit

Utilizing Light Cure Units: A Concise Narrative Review (Fatin A. Hasanain and Hani M. Nassar)
 CONTINUOUS CURING TEACHNIQUE
 Uniform Continuous Cure
 Step Cure
Modes Of  Ramp Cure
Curing  High Frequency Pulse Cure
INTERMITTENT CURING TECHNIQUE
 Pulse Delay Cure

Curing Techniques of Composite Resin: Continuous or Intermittent? : Indian

Journal of Forensic Medicine and Toxicology · November 2021
  In uniform continuous curing, a light of constant
intensity is applied to the composite resin for a specific
period of time.
 This type of continuous curing technique is currently
used. It is carried out using QTH and LED curing units.

Uniform
Continuous Cure

Curing Techniques of Composite Resin: Continuous or Intermittent? : Indian

Journal of Forensic Medicine and Toxicology · November 2021
  In the step cure technique, the composite is first cured at low
energy, then stepped up to higher intensity, each for a set period
of time.
 This is done to reduce the polymerization stress by inducing the
composite to flow in a gel state.
 This technique reduces the overall polymerization shrinkage at
the margin of the final restoration.
 The first commercially available light cure unit based on this
technique was Elipar Highlight (ESPE).

Step Cure  It uses a 10-second exposure of light at 150 mW/cm followed by

30-50 seconds at 700mW/ cm.

Curing Techniques of Composite Resin: Continuous or Intermittent? : Indian

Journal of Forensic Medicine and Toxicology · November 2021
  In the ramp cure, light is initially applied at low intensity and
gradually increased over time to high intensity levels.
 This allows the composite to cure slowly, thereby reducing the
initial stress, as the composite can flow during polymerization.
 Studies indicate that ramp curing causes polymerization with
longer chains, resulting in a more stable composite.

Ramp Cure

Curing Techniques of Composite Resin: Continuous or Intermittent? : Indian

Journal of Forensic Medicine and Toxicology · November 2021
  The high-energy pulse cure technique uses a brief (10 seconds)
pulse of extremely high energy (1000-2800 mW/cm2), which is
three to six times the normal power density.
 However, rapid application of energy might result in a weaker
resin restoration due to the formation of short polymer chains,
could reduce the diametral tensile strength and result in more
High Frequency brittle resins.

Pulse Cure

Curing Techniques of Composite Resin: Continuous or Intermittent? : Indian

Journal of Forensic Medicine and Toxicology · November 2021
  In this technique, a single pulse of light is applied to a restoration,
followed by a short pause, and then by a second pulse of light
which has greater intensity and duration of exposure than the first
one.
 This technique is believed to be an interrupted step increase.
 The lower intensity light slows the rate of polymerisation, thus
allowing shrinkage to occur until the composite becomes rigid.
Thus the margins do not show much discrepancy.
Pulse Delay  The second pulse of greater intensity brings the composite to the
final stage of polymerisation.
Cure

Curing Techniques of Composite Resin: Continuous or Intermittent? : Indian

Journal of Forensic Medicine and Toxicology · November 2021
  Most common photo-initiator systems used in dental RCs
is Camphorquinone/tertiary amine (CQ/TA). Its
maximum light absorption occurs at a wavelength of 468
nm and nearly all LCUs can activate it.
 Disadvantages: CQ is yellow, and once it has been
activated, it has an effect on the final color of the
restoration, giving it a yellowish tinge. A second
disadvantage of using CQ as a photo-initiator is the
shorter working time.
Photoinitiators  (2,4,6-trimethylbenzoyl) phosphine oxide (TPO) and
phenyl-propanedione (PPD) has been shown to result in
a higher degree of conversion as well as improved color
stability.
 Ivocerin is a new photo-initiator which was developed
with the aim of providing a wider spectrum of short-
wave absorption. It is a patented germanium derivative
and is currently only used in certain Vivadent products.

Utilizing Light Cure Units: A Concise Narrative Review (Fatin A. Hasanain and Hani M. Nassar)
  Radiant Exitance and Irradiance Value
 Active Tip Diameter
Factors Affecting  Visible Light Curing and Ophthalmological Hazards
Light Cure  Light Beam Uniformity
Irradiance  Effect of Light Cure Tip to Resin Distance
 Effect of Infection Control Barrier

Utilizing Light Cure Units: A Concise Narrative Review (Fatin A. Hasanain and Hani M. Nassar)
  For maximum curing, a radiant energy influx of
approximately 16,000 millijoules/cm2 (16 J/cm2) is required
for a 2-mm-thick layer of resin. This can be delivered by a 40-
second exposure to a lamp emitting 400 mW/cm2
 The same result can be produced by a 20-second exposure at
800 mW/cm2, or an exposure of about 13 seconds with a
Depth Of Cure 1200-mW/cm2 lamp.

And Exposure  Recently QTH, PAC, laser, and LED lamps have been
introduced with substantially increased intensities (greater
Time than 1000 mW/cm2),
 light absorption and scattering in resin composites reduces the
power density and degree of conversion (DC) exponentially
with depth of penetration
 Thus, the surface must be irradiated for a longer time to
deliver sufficient power density well below the surface.

Utilizing Light Cure Units: A Concise Narrative Review (Fatin A. Hasanain and Hani M. Nassar)
  A curing lamp with a wavelength range overlapping the
absorbance range of the resin photoinitiation system must
be selected.
 Intensity of light decreases with distance; therefore, the
lamp tip must be placed and held at the minimal
distance possible throughout the exposure interval (20
seconds or more).

Techniques  Curing angle is critical, since maximal intensity is

delivered perpendicular (90°) to the resin surface
therefore, the lamp tip must be placed and held as close
as possible to 90° throughout the exposure interval.
 Lamp intensity should be evaluated frequently and
adjustments made to ensure sufficient radiant energy
influx (about 16 J/cm2) for adequate curing.
 Training is required to develop the best practice
techniques for optimal intraoral curing.

Utilizing Light Cure Units: A Concise Narrative Review (Fatin A. Hasanain and Hani M. Nassar)
Parameters Ensure Avoid

a) Inspection:
clean tip with
adequate
irradiance
checked with a
radiometer

b) Plastic
sleeve barriers
should always
be used to
prevent
crosscontamination

C) Amber eye
protection
should always
be used with
LCUs
Parameters Ensure Avoid

d) Distance
from curing tip
should be as
minimal as
Possible

e) Tip should
be flat on the
tooth rather
than titled to
avoid areas of
missed curing
f) Ensure that
the curing tip
covers the
whole cavity
or use
overlapping
curing runs
  A clinician must consider a number of factors in
selecting a composite resin restorative material.
 A resin’s composition in terms of filler loading and
particle size determines its ability to provide any of three
functions: support, form and contour, and surface finish.
 The heavy filled hybrids, because of high loading and
strength, are best for support.
 The minifills and small-particle composites are best for
COMPOSITE form.

SELECTION  The various types of microfills are best at providing a

lasting, smooth finish.
 In large restorations, a heavy filled composite is used for
stiffness and strength, followed by a microfilled
composite for a smooth finish.
 The submicron hybrid and radiopaque microfilled
composites are clinically acceptable for both contour and
finish in small to moderate-sized restorations in areas
bearing minimal stress.
TOOTH-COLORED RESTORATIVES : PRINCIPLES AND TECHNIQUES (Ninth Edition); Harry F. Albers
TOOTH-COLORED RESTORATIVES : PRINCIPLES AND TECHNIQUES (Ninth Edition); Harry F. Albers
 Selecting an  No one material can suffice for all anterior restorations.
anterior  If it is necessary to choose a single restorative for all
uses, the best choice is a minifill with particles under 1
composite μm.

restorative

TOOTH-COLORED RESTORATIVES : PRINCIPLES AND TECHNIQUES (Ninth Edition); Harry F. Albers

  Submicron composites are recommended for small
preparations because they
(1) are radiopaque,
(2) have a good finish,
Class III (3) are durable to occlusal forces, and

restorations (4) have a favorable thermal coefficient of expansion that

helps maintain a good marginal seal.
 Agglomerated and condensed microfills can also work
well in small areas.

TOOTH-COLORED RESTORATIVES : PRINCIPLES AND TECHNIQUES (Ninth Edition); Harry F. Albers

  In small restorations involving dentin, and for patients
highly susceptible to caries, a modified resin glass-
ionomer restorative is a good choice.
 In large restorations, a submicron composite is
recommended.
Class V  If the patient smokes or drinks a lot of coffee, placing a
restorations flowable microfill veneer over a submicron composite
reduces surface staining.
 In small non–stress-bearing restorations entirely in
enamel, traditional microfills (eg, Durafill) have proven
successful.

TOOTH-COLORED RESTORATIVES : PRINCIPLES AND TECHNIQUES (Ninth Edition); Harry F. Albers

  Small Class IV carious lesions are best treated with a micron or
submicron hybrid.
 Large restorations involving an occlusal contact point are best
treated with a heavy filled material.
 To improve esthetics, these can be coated with a micron or
submicron hybrid.
 Where esthetics is a primary concern, coating the surface with a
thin microfilled veneer is advisable.
Class IV
restorations

Placement of layers of different composite types in large restorations: A.

TOOTH-COLORED RESTORATIVES : PRINCIPLES AND TECHNIQUES (Ninth Edition); Harry F. Albers
Anterior composite ; B. Posterior composite
  Longevity is the major concern for posterior composite
restoratives.
 The two key unresolved issues are loss of anatomic form
and bulk fracture.

Selecting A  In addition, technique sensitivity and marginal integrity

present major obstacles for most clinicians in achieving
Posterior consistent clinical success.

Composite The ideal composite for a posterior restoration is a

 submicron,
Restorative
 radiopaque light-cured composite with
 high filler volume and
 high viscosity.

TOOTH-COLORED RESTORATIVES : PRINCIPLES AND TECHNIQUES (Ninth Edition); Harry F. Albers

  Smaller filler particles make a composite more wear-
resistant, because lost particles leave smaller voids on the
resin surface.
 In addition, smaller particles generally pack together,
Small filler leaving smaller interparticle distances.

particle size  As this distance decreases, the resin is protected by filler

particles, which further reduces resin matrix wear and
filler loss rate.
 The ideal average filler size is less than 2 μm.

TOOTH-COLORED RESTORATIVES : PRINCIPLES AND TECHNIQUES (Ninth Edition); Harry F. Albers

  To allow detection of overhangs and recurrent decay,
Radiopacity radiopacity is desirable in a posterior material.

TOOTH-COLORED RESTORATIVES : PRINCIPLES AND TECHNIQUES (Ninth Edition); Harry F. Albers

  Light-cured materials are denser than their autoset
counterparts.
 Air incorporated during mixing of autoset systems
weakens these restorations.

Light-cured  Some researchers and clinicians believe that an

autocured resin is better suited for large posterior

materials composites, since shrinkage might be better directed to

the tooth by warmth and an active polymerizing bonding
agent.
 This technique, although common in buildups, is
controversial for direct composite restorations.

TOOTH-COLORED RESTORATIVES : PRINCIPLES AND TECHNIQUES (Ninth Edition); Harry F. Albers

  Composites with more hard filler have less exposed soft
resin matrix.
 Over 70% filler by volume (82 to 87% by weight) is
High filler desirable.

volume  Increasing the filler to these levels ensures more particle-

to-particle contact, which reduces the stress on the resin
matrix during function.

TOOTH-COLORED RESTORATIVES : PRINCIPLES AND TECHNIQUES (Ninth Edition); Harry F. Albers

  A high viscosity is desirable for higher filler loading.
 Some clinicians prefer to tightly pack puttylike composites to help
improve marginal adaptation and to secure tighter proximal contacts.
 Owing to their lower filler volume, most microfilled composites are
contraindicated for occlusal stress-bearing posterior restorations.
 Microfills in posterior areas may appear to be successful in the short
Putty-like term, by wearing exceptionally well for 3 to 5 years.
 However, studies on early autoset microfills show that by the fourth
composite year up to 20% of these restorations can fracture and fail in high–
stress-bearing areas.
 A few condensed and macrofill reinforced microfills have been
successful for 3 or more years in small conservative restorations.
 Some newer condensed light-cured microfills (eg,Heliomolar RO)
have had better 5-year clinical results (Setcos J. Personal
communication).
 Clinical  INITIAL CLINICAL PROCEDURE
techniques for  TOOTH PREPARATIONS
composite  RESTORATIVE TECHNIQUE
restorations
Initial Clinical Anaesthesia Prophylaxis
Shade
selection
Isolation
Occlusal
factors

Procedures
 Anaesthesia acts in two ways:
(i) it eliminates the apprehensions of the patient
(ii) it also help in isolation procedure. Anaesthesia also
reduces salivation, thereby keeping the operator
and the patient at ease.

Anaesthesia
  It may be necessary to clean the operating site with a
slurry of pumice to remove plaque, pellicle, and
superficial stains

Prophylaxis  Prophylactic pastes containing flavoring agents,

glycerine, or fluorides act as contaminants and should be
avoided to prevent a possible conflict with the acid-etch
technique
  The selection of shade/color should preferably be carried out
in day light. In case, the day light is not available, the light
source should be kept at a distance of six feet.
 Ask the patient to rinse or sip water before shade selection (as
dry tooth appear lighter)
 One selects and holds a specific shade tab beside the area of
the tooth to be restored. The shade tab should be partially
covered with the patient’s lip or operator’s thumb to create the
natural effect of shadows
Shade Selection  Examine the shade for 30 seconds only. If more time is
needed, the eyes should be rested by looking at a blue or violet
object for few seconds
 For final checking the shade, place a small amount of selected
composite on the adjacent tooth and cure.
Shade Selection
Commercially available shade guides
 Ceramic Based
 Polymer Resin Based
 Other Materials (Plastics/Acrylics)
  Contamination of etched enamel or dentin by saliva
results in a decreased bond, contamination of the
composite material during insertion results in
degradation of physical properties.

Direct methods Indirect methods

Isolation
1. Rubber dam 1. Local
2. Cotton rolls and cotton anaesthesia
roll holder 2. Drugs
3. Gauze pieces
4. Absorbent wafers
5. Suction devices
6. Gingival retraction cord
  When restoring posterior occlusal surfaces, a
preoperative assessment of the occlusion should be
made.

Other  Knowing the preoperative location of occlusal contacts is

important in planning the restoration outline form (so as
preoperative to prevent an area of occlusal contact directly at a
cavosurface/restoration interface) and establishing the
considerations proper occlusal contact on the restoration.
 Remembering where the contacts are located on adjacent
teeth provides guidance in knowing when the restoration
contacts are correctly adjusted.
 The tooth preparation for a composite restoration
includes:
 1. Removing the fault, defect, old material, or friable
Tooth tooth structure

preparations  2. Creating prepared enamel margins of 90 degrees or

greater (>90 degrees usually preferable)
 3. Creating 90-degree (or butt joint) cavosurface margins
on root surfaces

Operative dentistry: Modern Theory & Practices; M.A.Marzouk, A.L.Simonton, R.D.Gross

  Outline form: The periphery to sound tooth structure while
maintaining a specific initial depth, in the most conservative manner
possible.

 Resistance form: is primarily accomplished by the strength of the

micromechanical bond, but may be increased, by usual resistance form
features, such as flat preparation floors, boxlike forms, and floors prepared
perpendicular to the occlusal forces.
The basic principles
of tooth preparation  Retention form: This primarily results from the micromechanical
bonding of the composite to the roughened, etched, and primed enamel and
must be followed for dentin. In some instances, a dentinal retention groove or enamel bevel may
composite be prepared to enhance the retention form.

restorations  Pulp protection: composite material is insulative, hence there is no

need for any bases under composite restorations. A calcium hydroxide liner
is still be indicated in cases of a pulpal exposure (or possible pulpal
exposure) . In such cases, a RMGI base should be used to cover the calcium
hydroxide liner, sealing the area and preventing the etchant from dissolving
the liner. RMGIC can also be used as liner.

Operative dentistry: Modern Theory & Practices; M.A.Marzouk, A.L.Simonton, R.D.Gross

 (1) Conventional

(2) Beveled Conventional

Types of cavity (3) Modified

design
(4) Box-only

(5) Slot Preparation.

  This design is very similar to conventional amalgam.
Outline form is the necessary extension of external walls
at an initial, uniform dentinal depth, resulting in the
formation of the walls in a butt joint junction (90
degrees) with the restorative material.
 Indications:
• Preparations located on root surfaces (non-enamel
areas).
Conventional • Moderate to large class I or II restorations.
design

Marzouk : Operative dentistry - modern theory and practice

 An inverted cone diamond stone or carbide bur is used to
prepare the tooth, resulting in a preparation design
similar to that for amalgam, but usually smaller in width
and extensions.
 The cavosurface angle in areas on the preparation
periphery can be more flared (obtuse) than 90 degrees.
The occlusal cavosurface angle is obtuse, yet provides
for occlusally converging walls.
 Although the use of a diamond stone leaves a roughened
surface, increasing the surface area and potentially
increasing retention, the diamond instrument creates a
thicker smear layer which affects bonding.

Marzouk : Operative dentistry - modern theory and practice

 Preparation design for a Class III restoration
that extends onto root surface.
 The root-surface portion is a conventional
preparation design, using butt joint marginal
configuration and retention groove in dentin.
The coronal portion is a beveled conventional
design preparation (RMGI liner could be
placed in the root-surface portion before
insertion of the composite.).

Marzouk : Operative dentistry - modern theory and practice

  Beveled conventional tooth preparations are similar to
conventional preparations in that the outline form has
external boxlike walls, but with some beveled enamel
margins
 Indications
 when a composite restoration is being used to
replace an existing restoration (usually amalgam)
exhibiting a conventional tooth preparation design
Beveled with enamel margins or to restore a large area.

conventional  This design is most typical for Classes III, IV, and V
restorations

Marzouk : Operative dentistry - modern theory and practice

  To facilitate better marginal sealing and bonding, some
accessible enamel margins may be beveled and acid etched.
 Advantage of an enamel bevel:
 The ends of the enamel rods (exposed by beveling) are
more effectively etched the sides of the enamel rods
exposed to the acid etchant
 Also, the increase in etched surface area results in a
stronger enamel-to-resin bond, which increases
retention of the restoration and reduces marginal
leakage and marginal discoloration.
 Contraindications of bevels
 Occlusal surfaces of posterior teeth or other areas of
potential heavy contact because a conventional
preparation design already produces end-on etching of
Ends of enamel rods (A) are more effectively the enamel rods by virtue of the enamel rod direction
etched, producing deeper microundercuts than on occlusal surfaces
when only the sides of enamel rods are etched
 Proximal margins if such beveling results in excessive
(B).
extension of theMarzouk
cavosurface
: Operativemargins.
dentistry - modern theory and practice
  Modified tooth preparations for composite restorations
have neither specified wall configurations nor specified
pulpal or axial depths; preferably, they have enamel
margins.
 The extension of the margins and the depth of a modified
Modified tooth preparation are dictated solely by the extent
(laterally) and the depth of the carious lesion or other
preparation defects
 The objectives of this preparation design are to remove
the fault as conservatively as possible and to rely on the
micromechanical adhesion of composite to surrounding
enamel and dentin to retain the restoration in the tooth.

Marzouk : Operative dentistry - modern theory and practice

 Round burs or diamond stones may be used for
this type of preparation, resulting in a marginal
design similar to a beveled preparation. Often, the
preparation appears to have been “scooped
out”rather than having the distinct internal line
angles
 Indications:
 initial restoration of smaller, cavitated,
carious lesions usually surrounded by enamel
and for correcting enamel defects.

Marzouk : Operative dentistry - modern theory and practice

  Indications:
 when only the proximal surface is faulty, with no
lesions present on the occlusal surface.
 A proximal box is prepared with an inverted cone or
round diamond stone or bur held parallel to the long axis
of the tooth crown.

Box only  The instrument is extended through the marginal ridge in

a gingival direction.
preparations  The initial proximal axial depth is prepared 0.2 mm inside
the dentinoenamel junction.
 The facial, lingual, and gingival extensions are dictated
by the fault or caries.
 Caries excavation in a pulpal direction is done with a
round bur or spoon excavator

Marzouk : Operative dentistry - modern theory and practice

  In this case, a lesion is detected on the proximal surface,
but access to the lesion can be obtained from either a
facial or a lingual direction, rather than through the
marginal ridge from an occlusal direction.
 A small round bur is oriented at the correct
occlusogingival height, and the entry is made with the
Facial and instrument close to the adjacent tooth , preserving as
much of the facial or lingual surface as possible.
lingual slot  The preparation is extended occlusogingivally and
faciolingually enough to remove the lesion.
 The initial axial depth is 0.2mm inside the dentinoenamel
junction.
 The occlusal, facial, and gingival cavosurface margins
are 90 degrees or greater.

Marzouk : Operative dentistry - modern theory and practice

  Any abrupt incline between the two surface of prepared
tooth or between the cavity wall and the cavosurface
margin in the prepared cavity.
Purpose of bevels
 Reduces Microleakage
 Better marginal fit
BEVELS  Better esthetics
 Removes unsupported enamel
 Better bonding/adhesion
 Provides Retention and resistance form
 Creates cleansable and finishable areas

Bevels And Flares for Different Restorations: A Narrative Review [1]Ekta Choudhary, [2]Garima Joshi, [3]Farheen Khan
 According to shape and types of tissue involvement
 Partial bevel
 Short bevel
 Long bevel
 Full bevel
Types Of  Counter bevel
Bevels  Hollow ground bevel
According to the surface involved
 Gingival bevel
 Occlusal bevel
 Functional cusp bevel

Bevels And Flares for Different Restorations: A Narrative Review [1]Ekta Choudhary, [2]Garima Joshi, [3]Farheen Khan
Cavosurface margins for various restorations October 2022 : IP Indian Journal of Conservative and Endodontics 7(3):1-7
 Small to Moderate Class I Direct Composite Restorations

Preparation is made with a No. 1 or No. 2 bur or similar diamond.

Carious pits excavated

Initial extensions. and preparation
Pit remnants remain. roughened.

Sturdevant : Art and science of operative dentistry 6 th Edition

 Conservative Composite Restoration Preparation

Two small, faulty pits are Preparations are

often present on a accomplished with
mandibular first premolar. coarse diamond.

Sturdevant : Art and science of operative dentistry 6 th Edition

Moderate to Large Class I Direct Composite Restorations

Entry cut. Diamond or bur

held parallel to the long axis
of the crown. Initial pulpal 1.75- 2 mm

depth is 1.5 mm from the

1.5 mm
central groove. When the
central groove is removed,
facial and lingual wall
measurements usually are
greater than 1.5 mm. (The
steeper the wall, the greater
is the height.)
1.5-mm depth Approximately 1.75-
from the to 2-mm facial or
central groove. lingual wall heights.
Sturdevant : Art and science of operative dentistry 6 th Edition
2mm
1.6mm

Mesiodistal extension. Preserve dentin support of After initial entry cut at correct initial depth (1.5
marginal ridge enamel. A, Molar. B, Premolar. mm), the caries remains facially and lingually.
B, Orientation of diamond or bur must be tilted
as the instrument is extended facially or lingually
to maintain a 1.5-mm depth.

Sturdevant : Art and science of operative dentistry 6 th Edition

Groove extension. A, Cross-section through
the faciolingual groove area. B, Extension
through cusp ridge at 1.5-mm initial pulpal
depth; the facial wall depth is 0.2 mm inside
the dentinoenamel junction (DEJ). C, Facial
view.

Sturdevant : Art and science of operative dentistry 6 th Edition

 Sturdevant : Art and science of operative dentistry 6 th Edition

Final tooth preparation AND Incremental placement of composite.

Incremental placement of composite AND Rubber dam is removed and occlusion checked
Buccal view, a finishing
Polishing with brush
fluted bur is used to
and diamond paste.
selectively adjust the
occlusion.

Completed restoration.
Sturdevant : Art and science of operative dentistry 6 th Edition
 Class II direct composite tooth preparation.

Round or oval, small elongated pearl instrument used.

Pre-operative visualization of C and D, Facial, lingual, and gingival margins may need
faciolingual proximal box extensions. undermined cavosurface enamel (indicated by dotted
Arrows indicate desired extensions. lines) removed with straight-sided thin and flat-tipped
rotary instrument or hand instrument.
Sturdevant : Art and science of operative dentistry 6 th Edition
 Preserve Caries
Caries DEJ
marginal
ridge

Preparation
outline
Occlusal extension into faulty proximal surface.
A and B, Extension exposes the dentinoenamel
junction (DEJ) but does not hit the adjacent
tooth.

When only one proximal surfaces is affected, the

opposite marginal ridge should be maintained.
Sturdevant : Art and science of operative dentistry 6 th Edition
A, The proximal wall may be left in C, Faciolingual direction of axial wallpre paration follows the DEJ.
contact with the adjacent tooth. B, D, Axial wall 0.2 mm inside the DEJ.
Proximal ditch cut. The instrument is
positioned such that gingivally directed
cut creates the axial wall 0.2 mm inside
the dentinoenamel junction (DEJ).
Sturdevant : Art and science of operative dentistry 6 th Edition
Using a smaller instrument to prepare the Final Class II composite tooth preparation.
cavosurface margin areas of facial and A, Occlusal view.
lingual proximal walls. A, Facial and lingual B, Proximal view.
proximal margins undermined. B, Using a
smaller instrument.

Sturdevant : Art and science of operative dentistry 6 th Edition

Mesio-occlusal (MO) Class II Direct Composite Restoration, Which Does Not Require A Liner

Sturdevant : Art and science of operative dentistry 6 th Edition

Sectional Matrix Systems For Posterior Composites.
Sectional matrix Sectional matrix
system in place system in place
with plastic with wooden wedge
wedge and bitine and bitine ring to
ring to restore the restore the
maxillary mandibular
premolar with premolar with
direct composite. direct composite.

Sectional matrix
system in place
with plastic
wedge and bitine
ring to restore the
maxillary
premolar with
direct composite.
Sturdevant : Art and science of operative dentistry 6 th Edition
 When restoring a proximal surface for anterior teeth, two
approaches can be considered:
 Labial Approach
 Lingual Approach
Lingual approach is usually preferred as:
Class III cavity 1. The facial enamel is conserved for enhanced
esthetics.
preparation 2. Some unsupported, but not friable, enamel may be
left on the facial wall of a Class III or Class IV
preparation.
3. Color matching of the composite is not as critical as
for facial
4. Discoloration or deterioration of the restoration is
less visible

Marzouk : Operative dentistry - modern theory and practice

Small proximal caries Dotted line indicates Extension
lesion on the mesial normal outline form (convenience form)
surface of a maxillary dictated by shape of required for preparing
lateral incisor. the caries lesion. and restoring
preparation from
lingual approach when
teeth are in normal
alignment
Sturdevant : Art and science of operative dentistry 6 th Edition
Facial view of a caries lesion Obtaining access to carious dentin.
on the distal surface of the
maxillary central incisor.

Infected dentin is removed Completed caries excavation.

with round bur.
Sturdevant : Art and science of operative dentistry 6 th Edition
The bur or diamond is
held perpendicular to The correct angle
the enamel surface, and of entry is parallel
an initial to the enamel rods
opening is made close on
to the adjacent tooth at the mesiolingual
the incisogingival level angle of the tooth.
of the caries.

The same bur or

diamond is used to Incorrect entry
enlarge opening for overextends
caries removal and the lingual
convenience form outline.
while establishing the
initial axial wall depth.
Sturdevant : Art and science of operative dentistry 6 th Edition
 No effort is made to prepare the walls that are
perpendicular to the enamel surface; for small
preparations, the walls may diverge externally from the
axial depth in a scooped shape, resulting in a beveled
marginal design and conservation of internal tooth
structure.

A small, scoop-
shaped Class III
tooth preparation.

Sturdevant : Art and science of operative dentistry 6 th Edition

A B C D

E F

Preparation designs for Class III (A and B), Class IV (C and D), and
Class V (E and F) initial composite restorations (primary caries).
Sturdevant : Art and science of operative dentistry 6 th Edition
A B C D

E F

Larger preparation designs for Class III (A and B), Class IV (C and
D), and Class V (E and F) restorations.
Sturdevant : Art and science of operative dentistry 6 th Edition
 Cross-section of facial
approach Class III before

Beveling. The cavosurface bevel is prepared

with a flame-shaped or round diamond,
resulting in an angle approximately 45
degrees to the external tooth surface. Before bevel

After 45-degree
cavosurface bevel
on the facial
margin.

Completed cavosurface bevel (arrowhead). After bevel

Sturdevant : Art and science of operative dentistry 6 th Edition
Completed Class III tooth preparation (facial approach),
with the bevel marked.

Sturdevant : Art and science of operative dentistry 6 th Edition

Large proximal Isolated area of Entry and extension Caries removal Explorer point
caries with facial operation. with No. 2 bur or with spoon removes caries at
involvement. diamond excavator. the
dentinoenamel
junction (DEJ).

Sturdevant : Art and science of operative dentistry 6 th Edition

Large Class III Tooth Preparation Extending Onto Root Surface

Mesial view showing

Facial view. Lingual view gingival and
incisal retention,
which is only used
when deemed
necessary to increase
retention.
Sturdevant : Art and science of operative dentistry 6 th Edition
Inserting And Wedging Mylar Strip Matrix

Strip with concave area next Strip in position and wedge

to the preparation is inserted. The length of the
positioned between teeth. Mylar strip can be reduced,
as needed.
Sturdevant : Art and science of operative dentistry 6 th Edition
 Using A Triangular Wood Wedge To Expose
Gingival Margin Of Large Proximal Preparation

The dam is stretched facially Insertion of wedge (the dam Wedge in place.
and gingivally with the is released during
fingertip. wedge insertion).

Sturdevant : Art and science of operative dentistry 6 th Edition

 Insertion of light-activated composite.

The lingual aspect of the

Bonding adhesive is applied After insertion of the
strip is secured
and light-activated. composite, the matrix strip
with the index finger, while
is closed, and the material is
the facial portion is reflected
activated through the strip.
away for access.

Sturdevant : Art and science of operative dentistry 6 th Edition

 Finishing And Polishing.

Flame-shaped finishing bur Rubber polishing point

removing excess and
contouring.

Aluminum oxide polishing paste Completed restoration.

(C) used for final polishing. Sturdevant : Art and science of operative dentistry 6 th Edition
Finishing Composites

Abrasive disk
mounted on The round carbide
mandrel can be finishing bur is
used for finishing well suited for
when finishing lingual
access permits. surfaces.

The No. 12
surgical blade in The abrasive
Bard-Parker handle strip
can be used for should be curved
removing over the area to
interproximal excess. be finished.

Sturdevant : Art and science of operative dentistry 6 th Edition

Class IV Tooth Preparation And Restoration

Extraoral view,
minor Intraoral view.
traumatic
fracture.

Fractured The conservative

enamel is preparation is
roughened etched, while
with a flame- adjacent teeth are
shaped diamond protected with
instrument. Mylar strip.

Sturdevant : Art and science of operative dentistry 6 th Edition

Contouring and polishing the composite.

Intraoral view of Extraoral view.

the completed
restoration.

Sturdevant : Art and science of operative dentistry 6 th Edition

Class IV Tooth Preparation
Large defective
Class III Beveling
restoration with cavosurface
resulting margin.
fractured incisal
angle.

Completed Class
Gingival retention IV tooth
groove. preparation.

Sturdevant : Art and science of operative dentistry 6 th Edition

Incisal and gingival retention grooves and dovetail
extension in a large Class IV tooth preparation before
beveling.

Sturdevant : Art and science of operative dentistry 6 th Edition

 Custom Lingual Matrix

Facial preoperative view. Pre-operative shade determination.

Lingual pre-operative view The old composite material is

after placement of the removed, and a conservative
rubber dam. enamel bevel is placed.
Sturdevant : Art and science of operative dentistry 6 th
Edition
The lingual matrix obtained
The lingual composite layer The dentin buildup can be made
before tooth preparation is
determines the future directly against the lingual enamel;
positioned and guides the
contours of the restoration; the clinician can visualize the
application of the first
note the intrinsic material whole tooth shape and place dentin
lingual composite layer.
translucency. with appropriate thickness and
relation to the incisal edge.

Sturdevant : Art and science of operative dentistry 6 th Edition

Color modifier or tint blue View of the completed
material is applied between the restoration (with second Facial post-operative
dentin lobes and slightly below enamel layer placed on the
the incisal edge to simulate the buccal surface), after
blue natural opalescence. finishing.

Sturdevant : Art and science of operative dentistry 6 th Edition

 Class V Tooth Preparation For Abrasion And Erosion Lesions

Pre-operative notched lesion. Completed preparation with etched enamel.

Beveling the enamel margin and roughening the internal walls.

Sturdevant : Art and science of operative dentistry 6 th Edition
Bonding adhesive applied. Material inserted incrementally. Restorative material light-activated.

Sturdevant : Art and science of operative dentistry 6 th Edition

Completed Class V tooth Completed large Class V
preparation extending onto the preparation. A retention groove
root; the incisal margin is beveled; on the incisal aspect is rarely
the root portion has a retention required
groove for increased retention. Sturdevant : Art and science of operative dentistry 6 th Edition
 Class VI tooth preparation for composite restoration

Class VI preparation on the facial Entry with small round bur or Preparation roughened with
cusp tip of the maxillary diamond. diamond, if necessary.
premolar. Preparation roughened
with diamond, if necessary.

Sturdevant : Art and science of operative dentistry 6 th Edition

  In this method, a thin layer of flowable composite is
placed on the floor of the preparation as a liner, left
uncured, and then followed by a bulk fill placement of
composite.
Modified  The bulk fill of composite acts as a snowplow would,
Snowplow pushing the uncured flowable into all the nooks and

Technique crannies, filling any voids or deficiencies, and resulting

in a solid restoration.
 The material is then shaped. The flowable composite
and packable composite are cured simultaneously.

How To Use Composites That Stand the Test of Time for Pediatric Patients : June 2, 2022By Carla Cohn, DMD
  The flowable composite flows easily into areas that are
too small for the packable composite to reach. This
method shows effective control of microleakage and
Modified provides durable long-lasting results.

Snowplow  It is critical to have proper working conditions. A proper

dry field must be maintained.
Technique  Due to the hydrophobic nature of composite resin
materials, use of a rubber dam or isolation device is
essential.

How To Use Composites That Stand the Test of Time for Pediatric Patients : June 2, 2022By Carla Cohn, DMD
 The Decision ,Whether, To Restore The Defect Or Not Is Made Considering Following Factors

 Caries: if present, tooth should be restored, unless the lesion is incipient and very superficial.
 For the incipient root-caries lesion, minor recontouring of the area (cementoplasty) and
application of a topical fluoride or bonding adhesive

 Gingival Health. If the notched defect is determined to be causing gingival inflammation or

gingival recession, it should be restored.
 Sensitivity: application of a dentin bonding agent or desensitizing agent may reduce at least
temporarily or eliminate the sensitivity.

 Pulp Protection: If the notched area is very large and deep pulpally, the restoration of the defect
may be indicated to avoid pulpal exposure.
 Tooth strength : deep and large defect can compromise with the strength of the tooth at
cervical region. Hence it should be restored with bonded restoration
 Instruments Used
 Hand instruments: usually made up of coating with Teflon so as to
avoid sticking of composite to the instrument problem of air
trapping during insertion of composite can occur.
 Syringe: carries the low viscosity composite which can easily flow
through needle. This technique provides an easy way for placement
Placement And of composite with decreased chances of air trapping.

Insertion Of  Composite gun: Composite gun is made up of plastic. It is

commonly used with composite filled ampules
Composite
 Placing Self-cured Composite

Mix base and accelerator paste on a pad and place in the prepared tooth. Simultaneously, mix base
and catalyst paste and place into the preparation.

Use hand instrument to spread composite material and plugger to condense it.

Remove gross excess using sharp spoon excavator.

Hold matrix for approximately three minutes, until polymerization is complete. After composite
hardens, remove wedge and matrix strip.
 Placing Light-cured Composites
 Composite restoration should be placed in small increments to reduce
polymerization shrinkage.
 Place first increment of composite using a plastic instrument, pack
and cure it for 20 to 30 seconds.
 Subsequent increments are added and cured till the complete
preparation is filled.
 If composite material sticks to the instrument, bonding agent or a
gauze dampened with alcohol can be used to lubricate the instrument
so as to avoid sticking
In a class II preparation
Light transmitting wedges should be preferred for composite
restorations. First increment should be applied at gingival margin and
cured for 20 seconds. After this, build the whole of proximal box up to
the level of the pulpal floor in increments.

After removing the band and matrix, give additional curing lingually
and facially for complete polymerization
 Incremental Layering Technique

 This technique is based on polymerization of resin-based composite

layers of less than 2 mm thickness
 Helps to attain good marginal quality
 Prevents deformation of the preparation wall
 Ensures complete polymerization of the resin-based composite
 Advocated for use in medium to large posterior composite restorations
Horizontal Technique

It utilizes composite resin increments of less than 2 mm thickness each.

This technique produces the highest and the most unfavorable C-factor of
5 when light-cured

Generates very high polymerization shrinkage stresses at the adhesive

interfaces, within the composite restoration, and in the restored tooth
The first composite increment is placed horizontally to cover the entire
pulpal wall and parts of the four surrounding wall.
Oblique Technique

The Wedge-Shaped Layering Technique

It is accomplished by placing alternating buccal and lingual wedge-
shaped composite increments .

Light-curing of each increment is performed first through buccal and

lingual cavity walls, and then from the occlusal direction aiming to
direct the vectors of polymerization towards the adhesive surfaces.
 U-shaped Layering Technique
 First increment in the form of U-Shape is placed at the
base, both gingival and occlusal.
 Over that place horizontal and oblique increments to pack
the preparation.
 Then, curing is carried out from all the sides.

Vertical Layering Technique

 Place small increments in vertical pattern starting from one wall, i.e. buccal
or lingual and carried to another wall
 Start polymerization from behind the wall, i.e. if buccal increment is placed
on the lingual wall, it is cured from outside of the lingual wall
 Reduces gap at gingival wall which is formed due to
polymerization shrinkage, hence postoperative sensitivity and secondary
caries.
 Successive Cusp Build-up Technique
 It is achieved by placing the first composite increment in the center of
the pulpal wall without contacting the opposing cavity walls.
 Then, each cusp is built up separately by placing a series of oblique
composite increments.
 This technique enables the direct fabrication of excellent “esthetic”
restorations.
 The disadvantages include the need for long learning curve to build up
each cusp separately while replicating tooth color, and the increased
chair-side time consumption.
The Split-Increment Horizontal Technique

In this technique, the first horizontal This increment is split by two diagonal cuts, before
composite increment is placed to cover the light-curing, into four triangular-shaped portions,
pulpal floor completely and parts of the four with each portion connecting one cavity wall and
surrounding walls. part of the pulpal floor.
Then, one diagonal cut is filled completely
with composite and light cured. This is Using the same sequence, subsequent
followed by filling the other diagonal cut increments are each placed and light-
cured until the cavity is completely
with composite, one half at a time, and
filled.
light-curing it.
 For Restoring Proximal Surfaces
A. The Horizontal Placement Technique
 It utilizes 1.5mm thick flat composite resin increments for restoring proximal cavities.
 In this technique , the first increment was placed in the proximal box to cover the gingival wall
completely, part of the matrix band and parts of the three surrounding walls, and light cured.
 The subsequent increments were each placed and light-cured individually until the cavity was completely
filled.
 B. The 3-Sited Light Curing Technique
 The basis for this technique is that composite resin shrinks toward the
light, and can be indirectly light-cured.
 In this technique, the curing light is directed through a reflective wedge
in order to guide the polymerization vectors toward the margin of the
first layer placed horizontally on the gingival wall, thus preventing any
gingival gap formation.
 Building of the proximal wall is completed using buccal and then
lingual vertical increments. These increments are each light-cured first
through cavity walls, and then from occlusal direction
 C. The Modified Incremental Technique

 The rationale for this technique is to use one composite increment for building the proximal wall instead of
using horizontal increments in order to avoid creating demarcation lines on the outer proximal composite
surface.
 This technique converts Class II into Class I and is accomplished by adapting composite resin on the inner
surface of the Tofflemire matrix band and the marginal part of the gingival, buccal, and lingual walls.
 Then, building of the proximal box is completed using 2-3 horizontal increments. Each composite
increment is light cured individually
 Contouring the Composite

 Contouring can be initiated immediately after a light-

cured composite material has been polymerized or 3
minutes after the initial hardening of a self-cured material
 Minimizing contouring retains the sealed margins of the
restoration.
 It also helps minimizing microcracks which can be
formed by using abrasives on the surface of restoration Gross contouring of
 Any excess material can be trimmed with composite proximal restoration can
be done using a small and
finishing diamond bur and/or multi-bladed tungsten
thin disk rotating from 90
carbide finishing bur. Use a coolant/lubricant in gross degrees towards the facial
reduction to reduce production of heat and friction surface
Contact areas may be finished by using a series
of abrasive finishing strips threaded below the
contact point so as not to destroy the contact
point

Finishing and polishing of a

composite restoration is done
with finishing diamond
In class III restoration, to avoid any damage to Polishing is done using rubber-
contact point, the finishing strip should be used polishing points, abrasive disks
in S-shaped pattern. If strip is pulled on same or pumice-impregnated points.
side, it can lead to open contact points
The placement and finishing of various composite
materials has been completely revolutionized with the
new XTSTM product line from Hu-Friedy. With the
help of ultra-modern technology and innovative
design, Hu-Friedy has produced a high-quality line of
instruments – XTSTM, instruments which make
perfect, non-adhering application of composite
materials possible, without discolouring the filling.

Independent research has confirmed the improved

quality of our coating of aluminium- titanium nitride
(AlTiN) compared with conventional gold-colored
titanium coatings.
Studies show that aluminium-titanium nitride coatings
are considerably harder, smoother and more scratch-
resistant and thus composite materials adhere less, in
comparison with customary titanium coatings.
Coating of aluminium-titanium nitride (AlTiN)
The unique, black aluminium-titanium nitride coating improves the
contrast between the instrument, the tooth structure and the composite
material. The hard black coating will not discolour the filling material or
damage it in any way.
Corrosion-resistance
Hu-Friedy instruments are made of Immunity Steel®. The material
guarantees a long service life and can be cleaned and sterilized with all
customary processes.
Excellent handling with smooth, ergonomic design of handle.
The smooth design of the handles makes simple cleaning possible, In
addition, the low weight of the instrument results in ergonomic benefits
such as low fatigue of the hands and improved possibilities of control for
exact placement and handling of all Composite materials.
ADVANCES IN COMPOSITE
RESTORATION
  Introduced as amalgam alternative
 Stiff consistency, packable/condensable like amalgam.
• Non sticky

Packable • Easily transferable

composite • High critical shear bond strength

• Moisture tolerant
• Little shrinkage on curing
• Easily carved
  Fillers- Continuous network of elongated fibers of
alumina and silica
 Spaces within this fiberous network are infiltrated with
Bis-GMA/UDMA resin.
Polymeric  Advantages
Rigid Inorganic • High depth of cure possible
Matrix Material • Modulus of elasticity – similar to amalgam
(PRIMM) • Low wear rate
• Less polymerization shrinkage
• High stiffness
  Introduced in late 1966
 Reduced filler content resulting in lower viscosity

Flowable  Improved handling characteristics

Composite  Decreased physical properties

 More polymerization shrinkage
  It is a 4-META based flowable composite featuring nano-
sized amorphous silica and glass fillers

Fusio liquid
dentin
  Higher strength and better wear resistance
 Ease of flow and adaptability
 Reduce polymerization shrinkage
Bulk fill  Offer 4mm depth of cure
composite Commercial Brands:
 Quix-fill (Dentsply)
 Sonic-fill (Kerr)
  An aesthetic gingiva shaded light cured composite
 Used in correcting gingival recession with minimal invasion
and less cost

Gingival
masking
composite
Nanocomposites
They contain nano sized fillers.
Filler size may vary from 0.005-0.01 µm

Filtek supreme XT
Uses unique nanofiller technology; that it is
formulated with nanomer and nanocluster filler
particles
Advantage
  Showcased as polyacid-modified composite resins and
are resultant of a combination of composites and glass
ionomer cements.
 Can adhere efficiently to dental hard tissues

Compomers:  Gives fluoride articulation

 Biocompatible material
 Fluoride release and recharge of compomer was found
to be much lower than glass ionomer cement
 Lower mechanical properties than conventional
composites
  Made to overcome drawbacks of compomer.
 Filler contains Pre Reacted Glass inomer(PRG)
 The filler allows the material to release fluoride and they
Giomers: can be recharged with fluoride even on a daily basis by
means of fluoride dentrifices.
 1. Better esthetics
2. Improved handling and physical properties compared to
conventional composites
3. Increased radioopacity compared to conventional
Advantages: composites.
4. High fluoride release and recharge capability.
5. Shade stability before and after curing.
6. Low shrinkage stress
  Adhesion decalcification concept:
Acidic functional monomers favor a bonded restoration to
adhere to the tooth tissues more than their ability to decalcify
it.

Self adhering
composite
  Organically modified Ceramic
 consist of three components – organic, inorganic portions
and the polysiloxanes

Ormocer  Inorganic components are bound to the organic polymers

by multifunctional coupling agent silane molecules. After
polymerisation the organic portion of the methacrylate
groups form a three-dimensional network.
ADVANTAGES:
 Better marginal seal
 Reduced marginal shrinkage

DISADVANTAGES
 High cytotoxicity
 Less wear resistance
 Tendency to discolour
  Ceramic Optimized Polymer
 The material consists of a paste containing barium
glass, spheroidal mixed oxide, ytterbium trifluoride,

Ceromers: and silicon dioxide (57 vol%) dimethacrylate

monomers (Bis-GMA & urethane dimethacrylate)
 Introduced by Ivoclar to describe their composite
Tetric Ceram.
  Class I and II posterior restoration (stress bearing
areas)
 Class III and IV
Indication:  Class V caries, cervical caries, root erosion,
abfraction, wedge shaped defects.
 Veneer, Inlay/Onlay
  Intelligent composite
 Active dental polymers that contain bioactive amorphous
calcium phosphate (ACP) filler capable of responding to
environmental pH changes by releasing calcium and
phosphate ions and thus become adaptable to the
Smart surroundings.
Composites  Ariston pHc: ion releasing composite material
 It releases functional ions like fluoride, hydroxyl, and
calcium ions as the pH drops in the area immediately
adjacent to the restorative materials, as a result of active
plaque
  Dental resins with a bioactive ionic resin matrix, shock-
Activa absorbing rubberized resin component, and reactive

Bioactive ionomer glass fillers

 The ionic resin matrix facilitates the diffusion of
restoration calcium, phosphate and fluoride ions
  This is primarily an epoxy framework which contains
resin filled microcapsules.
 The resin in this way fills the break in the material and
responds with a Grubbs catalyst scattered in the epoxy
composite, bringing about polymerization of the resin
Self Healing thereby leading to fix of the split

Composite
  Guggenburg and Weinmann(2000)
 Siloxane + Oxyranes

Siloranes  Siloxane Backbone – Hydrophobic nature

 Oxyranes – Lessen polymerization shrinkage
 Filtek Silorane
 • Silver and Titanium were introduced to provide
antimicrobial property and upgrade biocompatibility of the
material.
• Microorganisms are subsequently executed on contact with
the materials or through leaching of the antimicrobial agents
• New dental composites incorporating quaternary ammonium
Anti-Microbial dimethacrylate (QADM)and silver nanoparticles
Composites (AgNP)have been manufactured and observed to inhibit
Streptococcus mutans (S. mutans)(Zhang et al., 2013; Cheng
et al., 2018) .
• Incorporation of a methacryloyloxydodecyl pyridinium
bromide(MDPB) monomer in composite resins that showed
no release of the incorporated monomer but still exhibited
antibacterial properties.
  Calcium phosphate nanoparticles have been incorporated
into composites in addition to QADM(quaternary
ammonium dimethacrylate)and AgNP(silver
nanoparticles)to induce regenerative properties (Cheng et
al., 2012)
Calcium phosphate
nanoparticles
incorporated  Calcium-fluoride and chlorhexidine or a new sol-gel
composites derived Ag-doped bioactive glass, are also some of the
new components in novel dental materials development
aiming to enhance remineralization, regeneration and
bactericidal properties(Cheng et al., 2012b;
Chatzistavrou et al., 2015) .
ADVANTAGE
 1. Enhanced biocompatibility
 2. Reduces formation of secondary caries near margin of
restorations due to inhibition of bacterial growth
 3. Reduced demineralization and buffering of acids
produced by cariogenic microbes.

DISADVANTAGE
 1. Deterioration of physical and mechanical properties of
the material
 2. Toxic effects of released materials
 3. Short lived antibacterial activity
  Material that shows a definitive wide-go shading
coordinating capacity, covering every old style conceal
with only one shade of composite.
 Use auxiliary shading with its 260nm round fillers
particles.
Omnichroma  Fillers of essentially specific size and shape are
anticipated to cause production of red-to-yellow shading
as encircling light goes through the composite material,
without the requirement of adding any other extra
pigment or dyes.
 Trimodal
compositers
 Novel filler technology using 3 filler system-
prepolymerized filler, patented point 4 filler and 0.04
micron nano filler.
 Posses higher compressive strength along with increased
durability, easy placement, and superior polishability.
 Ultra low shrinkage
  Reduced curing time and excellent stability to ambient
light while maintaining the superior esthetic and physical
properties
"Radical Amplified
Photopolymerizatio
n Technology"
(RAP),
 It is a universal, supra-nano filled dental
composite that utilizes 100% spherical fillers
(82% by weight/ 71% by volume)
  It has two distinct constituents; the reinforcing
component provides strength while the surrounding
matrix provides workability and protects the fibers from
mechanical damage and moisture.
 Fibers: ceramic

Fiber reinforced -glass

-Carbon
composite -Alumina
Polymer
-KEVLAR
-HDELPE
 Fiber-reinforced composites have much higher
mechanical strength and their strength to
weight ratios are even higher than most of the
alloys with more advantages such as being,
• non-corrosive,
• translucency,
• superior bonding to tooth structures and
• repair facility
  RECENT ADVANCES IN COMPOSITE RESTORATIONS. Dr. K.
Lahari(2019)
 Textbook of operative dentistry, Summit
 Textbook of operative dentistry, Sturdvent
 Recent Advances in Composite Resin Mohamed Esam(2020)
 Recent Advancement In Composites – A Review Dr. Jasmine
Marwaha1(2020)
 Advances in composite resin: A review Vrinda Vats1(2020)
References  Biosmart Materials in Dentistry: An Update 1 Kanika S Dhull,
 Durability of self-healing dental composites: A comparison of
performance under monotonic and cyclic loading
 Advanced Restorative Dental Composite Resins: Research and
Development"
 2021 Trends in Restorative Dentistry: Composites, Curing
Lights, and Matrix Bands Nathaniel C. Lawson
 A review of dental composites: Challenges, chemistry aspects, filler
influences, and future insights