Resin composite

Theory exam change in the syllabus

Instead of a first and second exam tests there will be a Midterm exam

Date:

13/11/2008 Time: 8.30-9.30 Location: 10H 2,3,4 labs.

Lecture title
Amalgam 25/9/2008 Composites 9/10/2008 Glass ionomer 16/10/2008

Areas of interest

13/11/2008

Midterm exam 8.30-9.30 am Location: 10H 2,3,4

Direct restoratives Indirect restoratives Liners Fissure sealants Fillings Cements

Metals and investments part 2 20/11/2008

Ceramics 27/11/2008

Porcelains Cerams Others

Adhesive systems Surface preparations oAcid etchants 23/10/2008 oPrimers oAdhesives Cements 30/10/2008
Varnishes Liners Cements Fillings

Endodontic and bleaching Irrigants and lubricants Intra-canal medicaments materials Obturation materials 4/12/2008

Implant materials 18/12/2008

Metals and Metals: investments part 1 Wrought Cast 6/11/2008 Welding metals and fluxes Investment: Refractory materials Binder
oGypsum bonded oPhosphate bonded oSilica bonded

Auxiliary and provisional Finishing and polishing restorative materials Temporary materials 8/1/2009

Final Exam date assigned after this week

Direct placement restorative materials

Esthetic materials are those materials that are tooth colored. Direct placement materials, are placed directly by the clinician in prepared teeth without the need for extra-oral construction of the restoration

Direct restorative materials

Composite Glass

ionomer cements (GIC) Resin modified-GIC Compomers

Composite resin

Composite: mixture of two or more components. Major components:

Organic

resin matrix Inorganic fillers Coupling agents (silane), join filler and matrix Pigments

Components

Resin matrix: chemically active component. Fluid monomer then converts to a rigid polymer by a radical addition polymerization reaction. Monomers used:
bis-GMA

resin UDMA (Urethane dimethacrylate) These resins are made of oligomers (organic molecules) and low molecular weight monomers (such as MMA, EDMA, TEGMA)

(bisphenol A-glycidyl methacrylate). Bowens

In addition an inhibitor is added (hydroquinone) Resin matrix also contains initiators, activators
7

Fillers: silica, quartz, more recently silica based glasses some containing barium, strontium etc. Properties affected by fillers:

Strength Radiopacity (barium, strontium) Esthetics such as color, translucency CET Polymerization shrinkage

Size

of filler? Affects wear resistance and polishability Ratio or weight of filler to resin matrix?

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

9

Coupling agents: what happens if bond between resin and filler is weak:
The

material would be weak and susceptible to creep and fracture and The interface between filler and resin will be a source of fracture, stress will not be distributed properly.

Silane coupling agents: has a hydrophobic end (methacrylate group) to bind the resin and a hydrophilic end (OH- group) to bind glass fillers
10

11

Polymerization

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

12

Polymerization techniques
1.

Chemical cure (self-cure): 2-paste system:

Base: composite and benzoyl peroxide as initiator Catalyst: composite and tertiary amine activator Require manual mixing which may lead to air bubbles incorporation.

13

Continue,
2.

Light cure: started with UV light to create

free radicals. UV was abandoned due to UV causing burns and eye damage. Blue light (400-500 nm) is used instead. Components that start to react once subjected to the light:
1.

2.

Diketone (Camphoquinone source of free radicals) Organic amines

Protection is needed for eyes

14

Polymerization
3.

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

15

16

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

17

18

Depth of cure continue, : affected by:

Type

of composite e.g. shade of composite Position and depth Power and quality of light source (maximum output at 460-480 nm) Curing time: follow instruction Method used in curing

19

Light curing units

Halogen light bulbs are used as a light source. Light delivery probe or tip is glass or glass encased in metal or plastic casing. Should be covered in a disposable cover
Cordless

curing units Plugged into an electric outlet

High intensity light units: curing time

Plasma

arc curing units (PAC) Argon laser units Blue light emitting diode (LED)
20

Plasma arc lamps: use a xenon bulb.

Require efficient cooling system due to high energy output. Produce high intensity light so shorter curing times and better curing depth. Filters are needed to remove wavelengths <400 & >500nm. Disadvantages:

Specific wavelength so some composites may not be sensitive to it Rapid curing so no stress relaxation and more shrinkage

21

Laser: Argon laser: emit a blue light. Advantages:

Radiation is absorbed in a narrow wavelength distribution which increases efficiency Can emit a collimated beam so it can travel long distance without dispersion Heat production is minimized Disadvantages: more expensive than plasma arc, rapid curing prevent proper stress relaxation. Solved by using pulsed not continuous laser

22

Continue
3.

Light emitting diode: produce blue light over a narrow wavelength band. Advantages:

Uses a low current so portable re-chargeable designs is possible No heat production Consistent output Quiet, there are no cooling fans

Disadvantages for laser and LED is that some initiators in composite maybe insensitive to them due to their specific wavelength output
23

Polymerization shrinkage

Composites shrink away from cavity walls May lead to breaking marginal seal leading to sensitivity and recurrent cries May pull at tooth structure and lead to cracks and sensitivity Depends on type of resin and amount of resin Bond between composite and dentine is weaker than between enamel and composite
24

25

How to overcome these problems?

Incremental placement of composite (increment no more than 2 mm) Slow curing or soft start curing method to allow relaxation of stresses Using highly filled composites when possible Developing improved dentine bonding systems Using low modulus liners to at as stress absorbers
26

27

Classification of composites
1. 2. 3. 4. 5. 6. 7. 8. 9.

Macrofilled (traditional) Microfilled Small-particle composite Hybrid Flowable Pit and fissure sealant Packable composite Smart composite Core build up composite

28

Macrofilled composites
First generation Filler particle size 10-50 m Difficult to polish Stronger than composites with smaller particles

29

Microfilled composites

Filler particle size 0.01-0.05 m in diameter Volume of filler is 35-50% (smaller compared to

other composites due to the larger volume of several small particles as opposed to one large particle of the same weight)

Lower physical properties, better polishability Methods to increase the number of fillers:
Clumping

microfillers together by heating or condensing Ground pre-polymerized resin and microfillers to size 10-40 microns
30

Hybrid composite

Mixture of macro and microfillers (75-80% by weight) Hybrid composite: contains 2 particle sizes, large 15-20 m and microfine fillers (colloidal silica) 0.01-0.05 m Small particle hybrid: 0.1-6 m Hybrids have high polishability and strength so they can be used for anterior and posterior restorations.
31

Flowable composites

Low-viscosity, light cured Can be lightly filled (40%), or more heavily filled (70%) Particle size 0.07-1 m Delivered into cavity using a syringe

Used for PRR Pit and fissure sealing Liners (cushion stress
caused by polymerization shrinkage of overlying composite)

Weaker and wear more compared to hybrids

Class V

32

Pit and fissure sealants

Range from no filler to more heavily filled composites similar to flowable composites Low viscosity Preventive material

33

Packable composites

Highly viscous which is achieved by:

Higher

filler loading Increasing filler particle size range Modifying particle shape (make them interlock) Modifying resin matrix to create stronger intermolecular attraction so higher viscosity Adding dispersants which lower viscosity and allow more filler loading

Drawback: they appear opaque, not stronger than hybrid composites, air maybe trapped when composite is packed into cavity Suited for posterior restorations
34

Smart composites
Combat caries by having the ability to release fluoride, calcium, hydroxyl ions when acidity increases Effectiveness has not yet been proven

35

Core buildup composites

Heavily filled Replace lost tooth structure in teeth needing crowns Colored to distinguish then from natural tooth structure

36

Properties
Biocompatibility: potentially harmful components, however once set, its well tolerated. Leaching out of some components may cause cytotoxicity and delayed hypersensitivity

37

Properties

Water sorption and solubility: Sorption depends on:

Resin

content Bond between resin and filler

Factors

which may lead to high water sorption: Introduction of voids during placement High solubility leading to voids Bond failure between filler and resin
38

Properties

Coefficient of thermal expansion: Greater

than tooth structure, causes debonding & leakage. Higher filler content reduces CTE

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

39

Properties

Color matching: causes of discoloration

1. 2. 3.

Marginal discoloration Surface discoloration Bulk discoloration: due to chemical breakdown of components and fluid absorption

40

Mechanical properties
Compressive strength: Composites usually fail under tension Diametral tensile strength: its an alternative method to measure tensile strength and used with brittle material

41

 Hardness:

indicates wear resistance, improved by filler addition Wear: lower filler content increases wear
Abrasive

wear Fatigue wear: lead to cracks forming below the surface Corrosive wear : due to chemical attack and erosion

42

Indirect esthetic materials

Inlays Onlays Veneers PFM All-ceramic Crowns with composite resin facing Indirect composites

43

Dental laboratory composites

Indirect composite veneers, inlays, onlays: Multiple placement of composites may be problematic:

Time

consuming Difficulty to ensure good tooth to tooth contact Problems of marginal adaptation due to shrinkage Risk f incomplete curing due to limited depth of cure
44

Indirect composite restorations

Veneers: can be porcelain or composite. Veneers are used to treat staining, close diastemas, lighten teeth color, reshape crooked teeth.

45

Indirect composite

Inlays: constructed by a technician depending on an impression taken by the dentist. Advantages:

Better

tooth to tooth contact Optimal cure is assured

Shrinkage problems are not totally eliminated because of luting cement. Also bond between luting cement and composite maybe compromised

46

Indirect composites:
inlays, onlays, veneers. Preparation is done in the clinic, followed by an impression and construction of the restoration on a die, then cementation in the preparation. With resin cements and bonding agent.

47

Laboratory processed composites

Procedure:
Preparation

is performed by dentist Impression and bite registration Restoration construction Cementation

Shrinkage occurs outside the cavity, therefore less stress is created as opposed to direct restorations
48

Restorative materials used:

Conventional

composite Fiber reinforced composite. Fiber source is carbon Kevlar, glass fiber, polyethylene ( to improve strength). Particle-reinforced composite: heavily filled (70-80% by weight) with ceramic particles to improve wear resistance.

Fiber reinforced composites improve flexural strength, toughness, stiffness. Uses: splints, crowns, bridges removable dentures but clinical experience is limited

49

Clinical handling of composites

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

Esthetic

demands: Microfills and microhybrids are suited Strength demands: in posterior teeth and stress bearing areas, hybrids are more suited
50

Suggested contraindications for using composite

1.

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

1.

Deep gingival preparations:

1. 2. 3. 4.

Marginal seal Good adaptation Depth of cure Dentine cavity margin

51

Contraindications
3.

4. 5. 6.

Lack of peripheral enamel: bond to dentine is unreliable. Cavities due to erosion and abrasion may still be successfully restored with composite even if enamel is lacking since these areas will not be subjected to high stress onlays of load bearing cusps Poor moisture control Habitual bruxism/chewing
52

 Shade

guide: Some practitioners apply a

portion of composite on tooth surface and cure it to observe the appropriate shade.

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

53

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

54

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

Self-cure 2 paste composite, and bonding agent bottle

55

Matrix strips/ bands: Mylar strip is used in class III, IV.

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

Incremental placement: 2 mm thick is recommended:

To

minimize polymerization shrinkage Allow curing light to properly penetrate and cure

56

Etching and bonding:

Fourth and fifth generation bonding agents:
Etching

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

Sixth and seventh generation bonding agents:

Etching

and priming is done in one application, and no rinsing is required.

57

 Contaminants: After etching and

bonding. Re-etching? Eugenol containing cements should be avoided.

Light-curing:
Should

be held as closely as possible to composite 20-40 seconds for thin layers Thicker layers, darker shades, deeper locations require more time
58

Finishing and polishing: sandpaper discs, fine, ultra-fine diamonds. For gingival or interproximal areas, scalpel knife, abrasive strips and needle-shaped diamond burs are used. Polishing pasts can also be used. Surface sealers: unfilled resin maybe added to reseal margins opened by polymerization shrinkage, or surface porosities.

59

Precautions for light curing

1.

Inadequate light output: monthly check on light

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

2. 3. 4.

Premature set of composites Eye protection Heat generation

60

Light curing unit, protective glasses and shield

61

Compomers

Composites modified with polyacid (polyacidmodified resin). The resin contains MMA and polycarboxylic acid. Light activation chemicals are included and also fluoride containing glasses. Fluoride release? Setting rxn occurs in 2 stages Same as light-cured composite Acid-base rxn Bonding to tooth structure occurs as in composites
62

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

63

Compomers clinical applications

Low stress bearing areas such as abrasion lesions, proximal surfaces In primary teeth Long term temporary in permanent teeth Disadvantage due to hygroscopic expansion, fracture of crowns when compomers are use as luting agents

64

Shade taking

1. Hue 2. Chroma 3. value Dentist

Patient

Assistant

65

Vita shade guide and shade selection

66

Guidelines for taking the shade:

Group

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

67

Continue,
A

neutral background should be used (e.g. blue apron) Female patients should be asked to remove lipstick, and colorful clothes should be covered Several tabs are held close to patients teeth and kept moist. Separate shades for cervical part of the tooth might be necessary.
68

Characterizing the shade

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

69

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

70

Reference
Introduction to dental materials. Chapter 2.2 Dental materials, clinical applications for dental assistants and dental hygienists. Chapter 6

71