COMPOSITES

S.VARSHA VARDHINI, C.R.I

DEFINITION
COMPOSITE RESIN IS A THREE DIMENSIONAL COMBINATION OF TWO OR MORE CHEMICALLY DIFFERENT MATERIALS WITH A DISTINCT INTERPHASE BETWEEN THEM. IN COMBINATION, THE PROPERTIES ARE SUPERIOR TO THOSE OF INDIVIDUAL COMPONENTS.

COMPOSITE CHEMISTRY
Dental composite is composed of a resin matrix and filler materials. Coupling agents are used to improve adherence of resin to filler surfaces. Activation systems including heat, chemical and photochemical initiate polymerization. Plasticizers are solvents that contain catalysts for mixture into resin. Monomer, a single molecule, is joined together to form a polymer, a long chain of monomers.

COMPOSITION
The basic components of composite resins include the following 1.Resin matrix. 2.Fillers. 3.Coupling agent. 4.Activator-initiator system. 5.Inhibitors. 6.Optimal modifiers/ coloring agents.

RESIN MATRIX
The resin matrix is the continuous phase to which the other ingredients are incorporated, resin matrix composed of monomers which are aromatic or aliphatic diacrylates. COMPOSITE RESINS CONTAINS -BisGMA Bisphenol-A-glycidyl methacrylate. -UDMA urethane dimethacrylate. -combination of BisGMA and UDMA. Both these chemicals have reactive carbon double bond at each end that can under go addition polymerization

FILLERS
Fillers in the composite resins are usually a type of glass such as quartz,silica, borosilicate glass,barium,strontium,zinc,zirconium They are added to improve the physical,mechanical and optical properties of the resin. The filler contain in the composite resin ranges from 30% to 70%.

COUPLING AGENTS
Coupling agents are used to improve adherence of resin to filler surfaces. Coupling agents chemically coat filler surfaces and increase strength. Silanes have been used to coat fillers for over fifty years in industrial plastics and later in dental fillers. Today, they are still state of the art. Silanes have disadvantages. They age quickly in a bottle and become ineffective. Silanes are sensitive to water so the silane filler bond breaks down with moisture. Water absorbed into composites results in hydrolysis of the silane bond and eventual filler loss. Common silane agents are: vinyl triethoxysilane methacryloxypropyltrimethoxysilane

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silane molecule hydrolysis silonol group bonds with the filler particles. methacrylate group covalent bond resin

ACTIVATOR-INITIATOR SYSTEMS
Type of composites Chemically cured composites Activator N.N.dimethyl-ptoluidine Initiator Benzoyl peroxide

Light-cured composites 1.Ultrviolet light

Tertiary amine Dimethyl amino

Benzoin methyl ether

Chemically cured composites Polymerization is towards the centre Bulk placement is possible Rapid setting occurs Reduce working time so insertion and contouring should be quickly done Voids can be incorperated during

Light;-cured composites Polymerization is towards the light source Incremental placement is recommended Command setting occurs which is under the operators control Adequate working time is possible due to command set. No voids as there is no mixing so

ULTRAVIOLET LIGHT Wavelength is360-400nm Harmful to the dentist and patient Intensity of the light fails with time Limited depth of curing

VISIBLE LIGHT

Wavelength is 450-480nm Not injurious Intensity of the light remains the same Greater depth of curing is

INHIBITORS
These are added to prevent spontaneous poly merization of the monomers by inhibiting the free radical. butylated hydroxytoluene 0.01% is added as inhibitor in composite resin.

Optical modifiers/colouring agents

Metal oxides in minute ammounts are added to the composite resins to produce different shades of composites. Aluminium oxide and titaniumoxide in small amounts provide opacity to composite resin.

CLASSIFICATION
BASED ON THE MEAN PARTICLE SIZE OF THE MAJOR FILLER 1.Traditional composites,8-12m. 2.small particle composites 1-5m. 3.Microfilled composites 0.04-0.4m. 4.Hybrid composites 0.6-1 m.

 BASED ON THE FILLER PARTICLE SIZE AND DISTRIBUTION.

1.Megafilled composites very large fillers 2.macrofilled composites 10-100m 3.midifilled composites 1-10m 4.minifilled composites 0.1-1m 5.microfilled composites 0.01-0.1m 6.nanofilled composites 0.005-0.01m

 BASED ON THE METHOD OF POLYMERIZATION:

Light-cured composites 1.ultraviolet light-cured composite 2.visible light-cured composite Dual-Self cured, auto-cured or chemically cured composites . cured composites-both self curing and light curing mechanisms Staged-curing composites initial soft-start polymerization followed by complete polymerization.

 BASED ON MODE OF PRESENTATION:

Two paste system Single paste system Powder liquid system.

 BASED ON USE
Anterior composite. Posterior composite. Core buildup composite. Luting composite.

 BASED ON CONSISTENCY:
Light body composite- flowable composite Medium body composite- medium viscosity composites like microfilled, hybrid,microhybrid composites. Heavy body composites- packable composites.

Physical Characteristics
FOLLOWING ARE THE IMP PHYSICAL PROPERTIES:-

1) Linear coefficient of thermal expansion (LCTE) 2) Water Absorption 3) Wear resistance 4) Surface texture 5) Radiopacity 6) Modulus of elasticity 7) Solubility

INDICATIONS
1) Class-I, II, III, IV, V & VI restorations. 2) Foundations or core buildups. 3) Sealant & Preventive resin restorations. 4) Esthetic enhancement procedures. 5) Luting 6) Temporary restorations 7) Periodontal splinting.

CONTRAINDICATIONS
1) Inability to isolate the site. 2) Excessive masticatory forces. 3) Restorations extending to the root surfaces. 4) Other operator errors.

ADVANTAGES
1) Esthetics 2) Conservative tooth preparation. 3) Insulative. 4) Bonded to the tooth structure. 5) repairable.

DISADVANTAGES
1) May result in gap formation when restoration extends to the root surface. 2) Technique sensitive. 3) Expensive 4) May exhibit more occlusal wear in areas of higher stresses. 5) Higher linear coefficient of thermal expansion.

STEPS IN COMPOSITE RESTORATION

1) Local anaesthesia. 2) Preparation of the operating site. 3) Shade selection 4) Isolation of the operating site. 5) Tooth preparation. 6) preliminary steps of enamel and dentin bonding. 7) Matrix placement. 8) Inserting the composite. 9) Contouring the composite. 10) polishing the composite.

1. Smile Design 2. Color and Color Analysis 3. Tooth Color 4. Tooth Shape 5. Tooth Position 6. Esthetic Goals 7. Composite Selection 8. Tooth Preparation 9. Bonding Techniques 10. Composite Placement 11. Composite Sculpture and 12. Composite Polishing to properly restore anterior teeth with composite:

PRINCIPLES OF ANTERIOR COMPOSITE RESTORATION

1. SMILE DESIGN
A dentist must understand proper smile design so composite restoration can achieve a beautiful smile. This is true for extensive veneering and small restorations. Factors which are considered in smile design include:A. Smile Form which includes size in relation to the face, size of one tooth to another, gingival contours to the upper lip line, incisal edges overall to the lower lip line, arch position, teeth shape and size, perspective, and midline. B. Teeth Form which includes understanding long axis, incisal edge, surface contours, line angles, contact areas, embrasure form, height of contour, surface texture, characterization, and tissue contours within an overall smile design. C. Tooth Color of gingival, middle, incisal, and interproximal areas and the intricacies of characterization within an overall smile design.

2. COLOUR AND COLOUR ANALYSIS

Colour is a study in and of itself. In dentistry, the effect of enamel rods, surface contours, surface textures, dentinal light absorption, etc. on light transmission and reflection is difficult to understand and even more difficult replicate. The intricacies of understanding matching and replicating hue, chroma, value, translucency, florescence; light transmission, reflection and refraction to that of a natural tooth under various light sources is essential but far beyond the scope of this article.

3. TOOTH COLOUR
Analysis of colour variation within teeth is improved by an understanding of how teeth produce color variation. Enamel is prismatic and translucent which results in a blue gray color on the incisal edge, interproximal areas and areas of increased thickness at the junction of lobe formations. The gingival third of a tooth appears darker as enamel thins and dentin shows through. Color deviation, such as craze lines or hypocalcifications, within dentin or enamel can cause further color variation. Aging has a profound effect on color caused by internal or external staining, enamel wear and cracking, caries, acute trauma and dentistry.

4. TOOTH SHAPE
Understanding tooth shape requires studying dental anatomy. Studying anatomy of teeth requires recognition of general form, detail anatomy and internal anatomy. It is important to know ideal anatomy and anatomy as a result of aging, disease, trauma and wear. Knowledge of anatomy allows a dentist to reproduce natural teeth. For example, a craze line is not a straight line as often is produced by a dentist, but is a more irregular form guided by enamel rods.

5. TOOTH POSITION
Knowledge of normal position and axial tilt of teeth within a head, lips, and arches allows reproduction of natural beautiful smiles. Understanding the goals of an ideal smile and compromises from limitations of treatment allows realistic expectations of a dentist and patient. Often, learning about tooth position is easily done through denture esthetics. Ideal and normal variations of tooth position is emphasized in removable prosthetics so a denture look does not occur.

6. ESTHETIC GOALS
The results of esthetic dentistry are limited by limitations of ideals and limitations of treatment. Ideals of the golden proportion have been replaced by preconceived perceptions. Limitations of ideals are based on physical, environmental and psychological factors.

 Esthetic dentistry is an art form. There are different levels of appreciation so individual dentists evaluate results of esthetic dentistry differently. Artistically dentists select composites based on their level of appreciation, artistic ability and knowledge of specific materials. Factors which influence composite selection include A- Restoration Strength, B- Wear C- Restoration Color D- Placement characteristics. E- Ability to use and combine opaquers and tints. F- Ease of shaping. G- Polishing characteristics. H- Polish and colour stability

7. COMPOSITE SELECTION

8. TOOTH PREPARATION
Tooth preparation often defines restoration strength. Small tooth defects which receive minimal force require minimal tooth preparation because only bond strength is required to provide retention and resistance. In larger tooth defects where maximum forces are applied, mechanical retention and resistance with increased bond area can be required to provide adequate strength.

9. BONDING TECHNIQUES
Understanding techniques to bond composite to dentin and enamel provide strength, elimination of sensitivity and prevention of microleakage. Enamel bonding is a well understood science. Dentinal bonding, however, is constantly changing as more research is being done and requires constant periodic review. Micro-etching combined with composite bonding techniques to old composite, porcelain, and metal must be understood to do anterior composite repairs.

10. COMPOSITE PLACEMENT TECHNIQUE

Understanding techniques which allow ease of placement, minimize effects of shrinkage, eliminate air entrapment and prevent material from pulling back from tooth structure during instrumentation determine ultimate success or failure of a restoration. It is important to incorporate proper instrumentation to allow ease of shaping tooth anatomy and provide color variation prior to curing composite. In addition, a dentist must understand placement of various composite layers with varying opacities and color to replicate normal tooth structure.

11. COMPOSITE SCULPTURE

Composite sculpture of cured composite is properly done if appropriate use of polishing strips, burs, cups, wheels and points is understood. In addition, proper use of instrumentation maximizes esthetics and allows minimal heat or vibrational trauma to composite resulting in a long lasting restoration.

12. COMPOSITE POLISHING

Polishing composite to allow a smooth or textured surface shiny produces realistic, natural restorations. Proper use of polishing strips, burs, cups, wheels and points with water or polish pastes as required minimizes heat generation and vibration trauma to composite material for a long lasting restoration.

DIRECT POSTERIOR COMPOSITES

Composites are indicated for Class 1, class 2 and class 5 defects on premolars and molars. Ideally, an isthmus width of less than one third the intercuspal distance is required. This requirement is balanced against forces created on remaining tooth structure and composite material. Forces are analyzed by direction, frequency, duration and intensity. High force occurs with low angle cases, in molar areas, with strong muscles, point contacts and parafunctional forces such as grinding and biting finger nails. Failure of a restoration occurs if composite fractures, tooth fractures, composite debonds from tooth structure or micro-leakage and subsequent caries occurs. A common area of failure is direct point contact by sharp opposing cusps. Enameloplasty that creates a three point contact in fossa or flat contacts is often indicated.

 Tooth preparation requires adequate access to remove caries, removal of caries, elimination of weak tooth structure that could fracture, beveling of enamel to maximize enamel bond strength, and extension into defective areas such as stained grooves and decalcified areas. Matrix systems are placed to contain materials within the tooth and form proper interproximal contours and contacts. Selection of a matrix system should vary depending on the situation (see web pages contacts and contours in this section). Enamel and dentin bonding is completed. Composite shrinks when cured so large areas must be layered to minimize negative forces. Generally, any area thicker than two millimeters requires layering. In addition, cavity preparation produces multiple wall defects. Composite curing when touching multiple walls creates dramatic stress and should be avoided.

 Composite built in layers replicate tooth structure by placing dentin layers first and then enamel layers. Final contouring with hand instruments is ideal to minimize the trauma of shaping with burs. Matrix systems are removed and refined shaping and occlusal adjustment done with a 245 bur and a flame shaped finishing bur. Interproximal buccal and lingual areas are trimmed of excess with a flame shaped finishing bur. Final polish is achieved with polishing cups, points, sandpaper disks, and polishing paste.

COMPOSITE WEAR
There are several mechanisms of composite wear including adhesive wear, abrasive wear, fatigue, and chemical wear. Adhesive wear is created by extremely small contacts and therefore extremely high forces, of two opposing surfaces. When small forces release, material is removed. Abrasive wear is when a rough material gouges out material on an opposing surface. A harder surface gouges a softer surface. Materials are not uniform so hard materials in a soft matrix, such as filler in resin, gouge resin and opposing surfaces. Fatigue causes wear. Constant repeated force causes substructure deterioration and eventual loss of surface material. Chemical wear occurs when environmental materials such s saliva, acids or like affect a surface.

 Dental composite is composed of a resin matrix and filler materials. The resin filler interface is important for most physical properties. There are three causes of stress on this interface including: resin shrinkage pulls on fillers, filler modulus of elasticity is higher than resin, and filler thermo coefficient of expansion allows resin to expand more with heat. When fracture occurs, a crack propagates and strikes a filler particle. Resin pulls away from filler particle surfaces during failure. This type of failure is more difficult with larger particles as surface area is greater. A macrofill composite is stronger than a microfill composite. Coupling agents are used to improve adherence of resin to filler surfaces. Modification of filler physical structure on the surface or aggregating filler particles create mechanical locking to improve interface strength. Coupling agents chemically coat filler surfaces and increase strength. Silanes have been used to coat fillers for over fifty years in industrial plastics and later in dental fillers. Today,

COMPOSITE FRACTURE

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