Dental composites and advances

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2. DENTAL COMPOSITES
PRESENTED BY : GUIDED BY :
V. Sindhu Dr. P. Venkata karteek varma
1st yr PG Reader
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COMPOSITES
MIND MAP
HISTORY
INTRODUCTION
COMPOSITION
PROPERTIES
CLASSIFICATION
FUNDAMENTALS
IN COMPOSITE
PREPARATION
CLINICAL TIPS
TYPES OF
COMPOSITES
ADVANCES
-Resin
-Filler
-Coupling agent
-Acti/inhibitor
-Optical
modifiers
-uv stabilisers
-Co thermal expansion
-wear
-poly shrinkage
-water sorption
-degree of conversion
-colour stability
-radioopacity
-biocompatibility
-optical properties
-longivity
Based on filler size
Based on matrix
composition
Based on viscosity
Based on poly method
Based on particle size
-macrofilled
-small particle
-microfill
-hybrid
-nanocomposite
-PRIMM
-Indirect composite resins
-ormocer
-Giomer
-Compomer
-masking composites
-self healing
-smart
-Antibacterial composites
- Bioactive composites
CONCLUSION
REFERENCES

4. INTRODUCTION
• Dental composite resins (better referred to as ‘resin based composites’ or
simply ‘filled resins’) are types of synthetic resins that are used in dentistry as
restorative material or adhesives.
• Micro-mechanical retention property makes composite more effective for
filling small cavities, where amalgam fillings are not as effective and retentive.
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5. COMPOSITE
• Composite material may be defined as a compound of two or more distinctly
different materials with properties that are superior or intermediate to those of the
individual constituents.
DENTAL COMPOSITE
• 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.
Philips Science of dental materials 11 th edition – K J Anusavise
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6. HISTORY
SILICATE CEMENTS = Phosphoric acid + Acid soluble glass
UNFILLED ACRYLIC RESINS = Polymethylmethacrylate
COMPOSITES
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7. 24-09-2023 7
Cangül, Suzan & Adıgüzel, Özkan. (2017). The Latest Developments Related to Composite Resins. International Dental
Research. 7. 32-41. 10.5577/intdentres.2017.vol7.no2.3.

8. COMPOSITION
• RESIN MATIX
• FILLERS
• COUPLING AGENT
• ACTIVATOR-INITIATOR
• INHIBITOR
• OPTICAL MODIFIERS
• UV STABILISERS
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9. RESIN MATRIX
• Active component
• Undergoes polymerization to convert c=c into c-c
• Aromatic or aliphatic diacrylates
• BIS-GMA
UDMA
TEGDMA
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10. BIS-GMA
• Bisphenol A + Glycidyl dimethacrylate
• Bowen in 1962
• Less polymerization shrinkage
• Dimethacylate improves cross linking
and enhances resistance to
degradation by solvents
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UDMA
• Introduced by Foster and Walker in
1974
• Difunctional resin
Contains one or more urethane
groups and two methacrylate end
groups
 These bis-GMA and UDMA are highly viscous and difficult to
manipulate.

11. TEGDMA
• Resin of lower molecular weight
• Reduces viscosity
• Enable filler loading
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• To overcome these issues, a low molecular weight, highly fluid monomers such as
Triethylene glycol dimethacrylate (TEGDMA) to blend and dilute the viscous
consistency.

12. FILLERS
• Inorganic composition
• Improves the properties of the composite
• Quartz, borosilicate or lithium aluminium silicate glasses, barium, strontium, zinc
glasses
• 30 to 70% by volume
• 50 to 80 % by weight
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13. FUNCTIONS OF FILLERS:
• Improves mechanical properties such as compressive
strength, modulus of elasticity and hardness
• Reduces water sorption and coefficient of thermal
expansion
• Contributes to aesthetics - glass is able to reflect the
color of the surrounding tooth material
• Reduces the polymerization shrinkage
• Give radio-opacity if barium or strontium glasses are
incorporated
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16. COUPLING AGENT
• Produces a bond between filler particles and resin matrix
• γ-methacryloxypropyl trimethoxy silane –Organosilane
most commonly used
• Zirconates and Titanates
ACTIONS:
• Improves physical and mechanical properties
• Prevents gradual loss of filler particles from composite surface
• Provides hydrolytic stability by preventing water from
penetrating the filler resin interface .
• Allows transfer of stresses from more flexible polymer to
stiffer filler particles.
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18. ACTIVATOR-INITIATOR SYSTEM
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19. INHIBITORS
• Prevents spontaneous start of polymerization of monomers
• Extends shelf life- Storage
• 0.01 wt%
• Butylated Hydroxytoluene
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20. UV- STABILIZERS
• To prevent discoloration with age of composites
• Compounds are incorporated which absorb electromagnetic radiation
• Improves color stability
• 2-hyroxy-4 methoxy benzophenone
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21. COLOR MODIFIERS
• To achieve various shades of dentin and enamel dental composites have visual
coloration and translucency that can simulate the tooth structure.
• Pigments such as various metal oxides in minute quantities
• OPACIFIERS: TiO2
Al2O3
COLOR PIGMENTS: Cadmium/ gold- Yellow
Nickel- Grey
Ferric- Red
Copper- Green
Tin- Brown
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22. PROPERTIES OF
COMPOSITES
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23. WORKING AND SETTING TIME
• Chemically activated composites, ADA specification no. 27
• Working time no less than 90 seconds. Since polymerization is an exothermic
reaction ,the setting time ranges from 3 - 5 minutes.
• Light-cured composites - Polymerization initiated when composite is first exposed to
light.
• Although the composite appears hard and fully cured after recommended exposure
time of curing light source, curing reaction continues for a period of 24 hours.
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24. COEFFICIENT OF THERMAL EXPANSION
• To prevent development of stresses, the CTE of composite should be as close to that
of the tooth structure as possible.
• Incorporation of filler particles results in lowering of CTE of composite resins, but it is
still higher than that of the tooth structure.
• Linear CTE of composites - 25–38 × 10−6/°C and 55–68 × 10−6/°C
• Microfilled resins contain a high amount of resin in the form of resin matrix and pre
polymerized resin filler particals - tend to have a higher CTE as compared to fine
partical composites.
• Filler loading is the only way to lower the CTE of composite resins.
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25. 24-09-2023 25
Eighteen-month clinical performance of preheated nanoceramic resin-based
composites in Class I occlusal cavities: A randomized clinical trial Neha Taufin at al
• This study (split-mouth design, RCT) aimed to evaluate effect of preheated
nanoceramic resin-based composite (RBC) (Ceram-X-Mono) placed in Class I occlusal
cavities over a period of 18 months.
• Preheating of nanoceramic RBC to 60°C for 10 min was performed before insertion
of the material into 30 prepared cavities, whereas 30 restorations in the
nonpreheated group were placed according to the manufacturer's instructions.
• Kappa index, Friedman and Wilcoxon matched pair test, and Kruskal-Wallis and
Mann-Whitney tests were used for statistical analysis.
• Preheated nanoceramic RBC restorations showed better clinical performance
compared to nonpreheated group.

26. WATER SORPTION
• Occurs mainly as a direct absorption of water by the composite resin.
Filler particles adsorb water onto its surface when the quality of the
silane bond between the resin matrix and the fillers is compromised.
• Bis-GMA molecules - high values of sorption -1%–2%.
• Results in expansion of restoration which hampers longevity of
restoration
• Microfilled composites owing to higher resin content have higher water
sorption value (26–30 mm g/mm3) as compared to hybrid composites
(5–17 mm g/mm3).
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Philips Science of dental materials 11 th edition – K J Anusavise

27. High water sorption values of composite resins may be attributed to many factors
1.The material may have a high solubility rate, which dissolves and leaves a space into
which water can enter.
2. The resin may contain air voids introduced during mixing or placement, into which
water can be adsorbed
3. Hydrolytic breakdown of the bond between the fillers and the resin can occur
allowing adsorption of water onto the surface of the filler particals
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28. SOLUBILITY
• Self-disintegration of the material.
• Inadequate light intensity and duration, particularly in the deeper areas of the
restoration, result in incomplete polymerization and an increased solubility rate of this
unpolymerized resin matrix.
• Higher values of water sorption and solubility lead to reduced wear and abrasion
resistance as well as color instability
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29. RADIO OPACITY
• The resin needs to be radiopaque as detection of caries is virtually
impossible under radiolucent restorations.
• The radiopacity is provided by - Ba, Sr, and Zr.
• ADA specification no. 27 requires that composite resins have radiopacity
equivalent to 1 mm of aluminum, which is approximately equal to that
of dentin.
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30. COLOR STABILITY
• Aesthetics being the major factor in the use of the composite resins ,the longevity of
the restoration depends on the material retaining its color and polish.
• Discoloration can be seen in either of the three ways—marginal, surface, and bulk
discoloration.
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31. COLOR STABILITY
.
• Marginal discoloration - due to improper adaptation of the material to the margins
of the cavity.
• Surface discoloration - due to surface roughness of composite. Composite resins
containing larger particle size fillers lead to entrapment of debris in the spaces
between protruding filler particles.
• Bulk or deep discoloration - common with chemically activated composites. Occurs
due to chemical degradation of components in the resin matrix and absorption of
fluids from oral environment.
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32. POLYMERIZATION SHRINKAGE
• Curing shrinkage arises as the monomer is converted to polymer and the free space
it occupies reduces (approximately 20% less than that among unreacted monomers)
• Decreases with increase in filler content
• Leads to cracks in enamel margin
• Causes Marginal gaps, Marginal staining, recurrent caries
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33. CONTROL OF SHRINKAGE
• C-factor = Number of bonded surfaces/
Number of unbonded surfaces, should
be low.
• Use of flowable or low viscosity bases
• Incremental layering Size, shape and
positions of the increments
• Different types of resin curing
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34. CONFIGURATION FACTOR
• Ratio of surface area of fixed walls bounding a tooth
preparation versus unbounded walls
• When there is a smaller ratio of bonded to free
surface area, flow of composite resin undergoing
polymerization occurs easily minimizing the stress
caused during polymerization shrinkage.
• with a C-factor >1, adhesion could not be maintained.
• In such cases: 1. Use of adhesive linings
2. Layering techniques
3. Different curing methods is needed
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Soft-Start” (SS) polymerization. This concept proposes to
increase pregelation time, so that a slower rate of conversion
will allow for better flow of resin with a decrease in contraction
stress.
 SS polymerization may be divided into three separate
techniques: stepped, ramped or pulse-delay.
 A stepped program emits a low irradiance for 10 seconds,
then increases immediately to a maximum value for the
duration of the exposure.
In a ramped program, the irradiance gradually increases from
a low value to maximum intensity over a short period, after
which it remains constant for the duration of the exposure.
Pulse-delay uses a short, low-level burst, a delay for polishing
and finally a long exposure at full intensity.

37. WEAR
• Wear is a complex phenomenon that depends on several intrinsic and extrinsic
factors.
• Composites have low wear resistance owing to the softer resin matrix wearing at a
faster rate than the fillers, leaving them exposed to be plucked out from the matrix
during further abrasion.
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38. DEGREE OF CONVERSION
• Degree of conversion (DC) reflects percentage of consumed methacrylate monomer
double bonds
• The DC for bis-GMA based composites - 50% to 60%
• The number of double bonds of carbon converted to single bonds during the
polymerization reaction.
• The DC depends on various factors:
1.resin composition and volume
2.amount of activator-initiator present
3.depth of transmission of light through the material
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Philips Science of dental materials 11 th edition – K J Anusavise

39. OXYGEN INHIBITION
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• Dental composites get cured by free-radical-
induced polymerization reaction which is strongly
inhibited by free-radical scavengers such as oxygen in
the air. This free oxygen in contact with composite
resin diffuses and inhibits polymerization reaction
forming peroxide radicals that have low reactivity
toward monomers.This free monomer layer
remaining on the surface after curing is known as the
oxygen-inhibited layer.
• It Is about 19um thick various among different
composites
Panchal, Aarti C, and Geeta Asthana. “Oxygen inhibition layer: A dilemma to be solved.” Journal of
conservative dentistry : JCD vol. 23,3 (2020): 254-258. doi:10.4103/JCD.JCD_325_19

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Borges MG, Silva GR, Neves FT, Soares CJ, Faria-e-Silva AL, Carvalho RF, Menezes MS. Oxygen inhibition of
surface composites and its correlation with degree of conversion and color stability. Brazilian Dental Journal. 2021
Apr 2;32:91-7.
 The degree of conversion of the
composite resins surface can be
improved by using glycerin to reduce
the oxygen presence and the surface
staining can be reduced if this previous
procedure is associated with immediate
finishing and polishing procedures

41. LONGEVITY OF COMPOSITES
• The most commonly cited reasons for failure of composites in clinical studies are
secondary caries, fractures, marginal deficiencies and wear.
• Nonetheless, properly placed composite can last many years even in posterior
regions, where the wear and bite forces are great.
• Opdam and colleagues published a retrospective study in which they have concluded
with survival rate of composite resin of 91.7% at 5 years and 82.2% at 10 years.
• The survival rate overall for composite in permanent teeth after 7 years was 67%
compared with 94% for amalgam restorations according to the study done by
chadwick et al.
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42. OPTICAL PROPERTIES
• TRANSLUCENCY
• REFLECTIVENESS
• HUE, VALUE , CHROMA
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43. TRANSLUCENCY
 Composite resin with less translucency should be used for
dentin, whereas with more translucency should be used for
enamel (Villarroel M et al., 2011).
• Mostly depends on the type and nature of the unreacted
particles.
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Translucency is the property of a substance that permits
the passage of light but disperses the light so that objects
cannot be seen through the material

44. REFLECTIVENESS
• Smoother the surface, more rays are reflected
• Major modifying factor for any shade
• Saliva will impart certain reflectiveness on the surface of the tooth and material
• While choosing a shade the tooth should be covered by saliva
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45. HUE, VALUE, CHROMA
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•Hue is the color tone (ie, red, blue, yellow,
etc). The term “hue” is synonymous with the
term “color,” and is used to describe the
color of a tooth or dental restoration.
•Chroma is the intensity or saturation of the
color tone (hue), ie, light blue or dark blue.
For instance, chroma is used to describe the
orange or yellow hue of a tooth or a
restoration.
•Value is the relative lightness (brightness)
or darkness of the hue.

46. RESPONSE OF GINGIVAL TISSUES
• Respond less favourable when compared to GIC
• Incompletely cured resin might be a tissue irritant
• Roughness and porosities might lead to accumulation of plaque
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47. BIOCOMPATABILITY
• Limited problems of biocompatibility with composite
• Unpolymerized materials are cytotoxic or even carcinogenic
• Adequately polymerized composites are biocompatible
• Inadequately cured composites serve as reservoir of diffusible components at the
floor of the cavity
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48. IDEAL REQUIREMENTS OF COMPOSITE
• Coefficient of thermal expansion should be equal to that of tooth
• Should not absorb water
• Low Polymerization shrinkage
• High Wear resistance
• Smooth surface texture
• Radiopaque
• Higher Modulus of elasticity
• Less soluble in oral fluids
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49. INDICATIONS
• Sealants and preventive resin restorations
• Class I, II, III, IV, V, VI restorations
• Aesthetic enhancement procedures
• Composite inlays
• Cementation of indirect restorations
• Temporary restorations
• Non caries lesions like abrasion, erosion
• Repair of old composite restoration
• Foundations or core buildups
• For splinting
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50. CONTRA-INDICTIONS
• When proper isolation is not possible
• When occlusion is on composite restoration
• When preparing cavity extending on to root surface or subgingival area
• Poor oral hygiene
• High caries index
• Patient’s with abnormal habits (bruxism)
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51. ADVANTAGES
• Aesthetics
• Conservation of tooth structure
• Less complex when preparing the tooth
• Insulative having low thermal conductivity
• Bonds to tooth structure (good retention)
• Repairable
• Non corrosive
• Strengthens the tooth structure
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52. DISADVANTAGES
• Technique sensitive
• Increased C.O.T.E. than tooth structure
• Polymerization shrinkage
• More difficult, time consuming
• Increased occlusal wear
• Low modulus of elasticity
• Staining
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53. CLASSIFICATION OF COMPOSITES
• Based on the Filler Particle size:
i.Homogenous composites
Mega-fill – 0.5-2 μm
Macro-fill – 10-100 μm
Midi-fill – 1-10 μm
Mini-fill – 0.1-1 μm
Micro-fill – 0.01-0.1 μm
Nano-fill – 0.005-0.01 μm
ii.Heterogenous composites
Hetero-midi-fill
Hetero-mini-fill
Hetero-micro-fill
iii .Hybrid composites
Midi-micro hybrid
Mini-micro hybrid
Mini-nano hybrid
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54. • Based on matrix composition:
Bis-GMA
UDMA
• Based on polymerization method:
Self/ chemically curing system
Light curing system
• Based on viscosity
Packable composites
Flowable composites
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55. Based On Partical Size:
• Traditional
• Small-particle Filled (Spf) Composite
• Micro-filled Composite
• Hybrid Composite
• Nano-filled Composite
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57. TRADITIONAL (MACROFILLED)
• Developed in 1970‘s
• Finely ground amorphous silica or glass
• Average size 8-12µm
• Filler loading- 70-80 wt% or 60-70 Vol%
• Improvement in the compressive strength from unfilled resin
• Roughening of the surface due to abrasive wear
Examples: Adaptic, Concise
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58. SMALL PARTICAL
• Mean particle diameters between 0.1 and 10 µm
• Higher filler loading 77-88% than macrofilled
• Higher degree of hardness and strength than macrofilled
• Surface smoothness that is closest to the microfills
• Greater wear resistance and some decrease in the polymerization
shrinkage
• Excellent balance among polishability, appearance, and durability make
this category suitable for general anterior use.
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59. MICROFILL
• Particle size- 0.01-0.1µm
• Smoother surface
• Surface roughness and low translucency
eliminated
• Final filler content- 50 wt%
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Colloidal silica (0.01 -0.1um)

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Despite having lower filler fraction, will not shrink as much as expected
Bond between composite particle and clinically cured matrix is relatively weak,
facilitating wear by chipping mechanism
Resins of choice for restoring teeth with carious lesions in smooth surfaces (classes
III and V) but not in stress-bearing situations( II and IV)

63. HYBRID
• Popular as “all-purpose”
• Types: conventional hybrid, Microhybrid and Nanohybrid.
• Consists of mixture of microfiller and small filler particals that result in a considerably smaller
average partical size of 0.4-1µm
• Filler loading- 75%-85% by weight
• Superior because of particulate reinforcement
• Increase stress bearing capacity
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64. PROPERTIES:
• Physical and mechanical properties range between traditional and small
particle
• Superior to those of Microfilled composites
• Radiopacity sufficient
• Anterior restorations including class 4
• Can also be used as posterior restorations- stress bearing areas
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65. NANOFILLED/NANOHYBRID/NANOCOMPOSITES
• 0.005-0.01µm particle size
• Pyrolytic precipitation process used for colloidal silica
• The particle size is similar to that in microfilled composites, but
the difference is that the particles in microfilled composites are in
three-dimensional agglomerates that increase viscosity, whereas
those in nanofilled composites are mostly discrete and have a
minimal effect on viscosity.
• Thus, these composites have optical properties and superior
polishability like those of microfilled
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68. PACKABLE COMPOSITES
• Developed for use in class I and II restorations, with the concept of condensation similar to
that of amalgam.
• Composed of dimethacrylate resins, and a filler content of 66%–70% by volume.
• ADVANTAGES:
1. Greater depth of cure
2. Lower polymerization shrinkage, radiopacity, and lower wear rate (3.5 mm/ year)
3. Ease of achieving good contact area.
• DISADVANTAGES:
1. Difficulty in handling due to its high viscosity
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69. FLOWABLE COMPOSITES
• Flowable composites are low viscosity, light-cured
composites
• Filler loading of 42%–53% by volume.
• Used as a liner over the hybrid layer in class I and
II restorations and composite build-up is done.
• They are also used in cervical class V and in
minimal occlusal restorations.
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70. • DISADVANTAGE:
Due to its lower filler loading, it exhibits high curing
shrinkage and lower mechanical properties
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ADVANTAGES:
1. Forms a thin layer of composite over the hybrid layer.
2. Owing to its high flexibility, it acts as a stress reliever in high stress
concentration areas such as cervical areas.
3.It is also claimed that it increases marginal adaptation in a class II
restoration, thereby reducing microleakage.

71. BULKFILL COMPOSITE
• Reduced polymerization shrinkage
• Increased depth of cure - Novel photo initiators, polymerization boosters or by
increasing translucency.
• Incremental pattern can be avoided.
• Ease of flow& adaptability.
• Higher strength & Better wear resistance.
• Good esthetic properties.
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78. • Comparison of polymerization shrinkage of a new bulk‐fill flowable composite
with other composites: An in vitro study Somayeh Khoramian Tusi at al
• Assess the polymerization shrinkage of a new bulk‐fill flowable composite (G‐aenial
bulk injectable [GBI]) and compare it to other bulk‐fill and conventional composites.
• G‐aenial bulk injectable and G‐aenial universal flo showed significantly higher
polymerization shrinkage than other composites at 30, 60, and 1800 s after light
irradiation, while X‐tra fil and Filtek Z250 showed the lowest polymerization
shrinkage at the aforementioned time points.
• According to the results, the new composite had polymerization shrinkage similar
to the conventional one. Bulk‐fill composites reported similar or lower shrinkage to
conventional composites.
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FUNDAMENTALS IN
COMPOSITE
RESTORATIVE
TECHNIQUE

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CLINICAL TECHNIQUE:
1. Cleanse the tooth with pumice
. 2. Evaluate the shade of the tooth before isolation (from
the middle third of tooth).
3. Use articulating paper to determine the location of
occlusal contacts so that they can be avoided, if possible,
during preparation.
CLINICAL TIP: If the occlusal surface is intact,
fabricate a registration of the occlusal surface with a clear
polyvinyl siloxane bite registration material (e.g.,
Memosil, Heraeus Kulzer, Inc.; Sharp Parkell, Inc.) or a
thermoplastic button (Advantage Dental Products). (This
step decreases the need for subsequent carving and
occlusal adjustment.)
FUNDAMENTALS IN COMPOSITE RESTORATIVE TECHNIQUE

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4. Administer local anesthetic if necessary.
5. Isolate the area with a rubber dam
7. Etch the enamel for 15 seconds and the dentin for 10 seconds.
8. Wash with water and/or water/air spray for a minimum of 10 seconds for gel or
liquid etchants.
. 9. Air dry the enamel and blot the dentin, leaving it slightly moist. The cavity
preparation can be disinfected with a cavity disinfectant and the excess blown off and
blotted with a cotton pellet. However, in some systems the smear layer is not removed
but only modified, and bond strengths may decrease as a result of disinfection.

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10. Repeat the procedure if the enamel does not have a frosted white appearance
after air drying. If the dentin is dry, moisten the dentin again with a cotton pellet
moistened with water.
11. Place the dentin-enamel bonding agent according to the manufacturer’s
instructions.
12. With a syringe, place an increment of a dentin shade posterior composite
resin against the pulpal floor and against one of the buccal cusps. Light polymerize
for 40 seconds through the cusp. Build up the other buccal cusp and subsequently
the lingual cusps in a similar manner. This creates appropriate fissure position and
depth.
TEXTBOOK OF ESTHETICS AND RESTORATIVE DENTISTRY

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Place tints and opaques to achieve a natural appearance. Place brown and ochre tints
into pits and fissure and white or colored opaques at the crest of triangular ridges (e.g.,
Kolor1, Kerr Corp.; Creative Color, Cosmedent, Inc.).
14. Place a layer of an enamel/incisal composite resin to build up the definitive contour.
This anatomic layering technique reduces stress within the adhesive interface.
15. Place glycerin to reduce the air-inhibited layer. Light polymerize for 40 seconds.
CLINICAL TIP : The previously fabricated occlusal registration can be used at this time. It
is pressed back into position, and the resin is light polymerized for 60 seconds from the
occlusal direction. Occlusal adjustments are minimal when this technique is used.

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18. Sealant and postcuring procedures
16. Finish the restoration.
17. Polish the restoration.
finishing after 10-15 minutes is advised. Approximately 75% of the
polymerization of photo-polymerized composite resins takes place during
the first 10 minutes
 Microcracks resulting from trauma due to finishing procedures particularly at the
cavosurface margins can propagate over time . Liquid polishers/surface sealants are
low-viscosity resins with little or no filler that provide a gloss over composite
restorations improving the final appearance of the restoration. Sealants fill irregularities
and reduce microleakage at composite margins . Thus, sealant application may prevent
surface wear, thereby improving the longevity of composite restorations . If needed,
sealant can be reapplied biannually. This is a simple but efficient method to improve
surface quality but an additional step for the dentist to complete the procedure.
Vishwanath, Sankar et al. “Finishing and Polishing of Composite Restoration: Assessment of Knowledge, Attitude
and Practice Among Various Dental Professionals in India.” Cureus vol. 14,1 e20887. 3 Jan. 2022

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a. Rinse off polishing debris with water; air dry.
b.Etch for 15 seconds
c. Rinse with water for a minimum of 10 seconds.
d. Air dry the surface. (If the surface is not enamel, leave it moist.)
e. Apply sealant (e.g., Fortify, Bisco, Inc., Optiguard, Kerr Corp.,
PermSeal, Ultradent Products, Inc.)
f. Air thin.
g. Light polymerize for 40 seconds.
18. Sealant and postcuring procedures are the following:
TEXTBOOK OF ESTHETICS AND RESTORATIVE DENTISTRY

86. CLINICAL TIPS
FOR
COMPOSITE FILLINGS
24-09-2023 86

87. 24-09-2023 87
 Beveling provides a gradual transition between the composite resin restoration
and the tooth. Bevels of 45 degrees and 1 to 2 mm wide are used in facial areas,
whereas a smaller (0.5-mm) bevel is used in other areas. (A wider bevel is placed
on the facial surface to achieve better blending in the esthetic zone.) Bevels (on
the occlusal surface) should be avoided in Class I and Class II restorations because
thin composite resin margins are subject to fracturing. Widening the preparation to
allow a bevel may extend the restoration into areas of occlusal function
 Adequate contouring of a restoration before polymerization is essential for
minimizing finishing time and reducing damage to the composite resin. (Finishing
procedures can cause microcracks.) Damage to the composite resin results in a
higher wear rate, an increased fracture rate, and a greater tendency for opening of
margins.
TEXTBOOK OF ESTHETICS AND RESTORATIVE DENTISTRY

88. 24-09-2023 88
 Surface-penetrating sealants (e.g., Fortify, Bisco, Inc.; Optiguard,
Kerr Corp.) can be used to repair surface defects created during finishing,
which improves the wear of posterior composite resins and decreases
microleakage around Class V composite resins. In addition, the composite
resin that is closest to the light is often the most polymerized and therefore
the hardest part of the restoration. Because this layer is removed with
occlusal adjustment and polishing, placement of the sealant and postcuring
are necessary.
Vishwanath, Sankar et al. “Finishing and Polishing of Composite Restoration: Assessment of Knowledge, Attitude
and Practice Among Various Dental Professionals in India.” Cureus vol. 14,1 e20887. 3 Jan. 2022

89. 24-09-2023 89
Placing a sectional matrix decreases sensitivity because an
overly tightened circumferential matrix can pull the cusps
together (i.e., Contact Matrix System, Danville Materials, and
Composi-Tight 3D, Garrison Dental Solutions; V3 Ring [Narrow
and Universal], Triodent Ltd.).
Sectional matrixes influence on post-op sensitivity
TEXTBOOK OF ESTHETICS AND RESTORATIVE DENTISTRY

90. 24-09-2023 90
Luciwedges™ Classic (kerr dental)
Reduced marginal gaps by effective curing
light reflection in combination with transparent
matrices
 more effective in producing better
polymerization than clear wedges

91. 24-09-2023 91
Contact forming devices
Trimax contact forming instrument . The light from the curing unit is transmitted
through the adjustible light conducting tip into the composite resin. (Courtesy AdDent,
Inc., Danbury, CT.
TEXTBOOK OF ESTHETICS AND RESTORATIVE DENTISTRY

92. 24-09-2023 92
CERVICAL MATRICES
TEXTBOOK OF ESTHETICS AND RESTORATIVE DENTISTRY

93. 24-09-2023 93
Anterior Matrix Systems for Composite Restorations: A Review

94. DISTANCE BETWEEN LIGHT AND RESIN
• Ideal distance -1mm
• Intensity drops off rapidly as the distance from the light to the composite increases
• BASED ON FILLER:
Microfilled composites are more difficult to cure than Macro-filled composites
Heavily loaded large inorganic fillers- more easily cured.
• SHADE OF RESIN:
Darker shades cure more slowly and less deeply than lighter shades
When aesthetics is not critical lighter shades should be used
24-09-2023 94

95. ANGLE AND PATH OF LIGHT
• 90 degrees
• As the angle diverge, light energy is reflected and penetration is
reduced
• In molars, the marginal ridge of the adjacent tooth blocks light
when placed at an angle
24-09-2023 95

96. FAILURES
• A composite restoration is said to have failed when any one or more
of the following features are seen clinically:
1.Discoloration
2.Marginal ditching
3.Fracture of the restoration
4.Abnormal wear
5. Secondary caries under or around the restoration etc.
24-09-2023 96

97. FACTORS FOR FAILURE
• Some of the factors for the failure are:
1. Choice of material for the particular clinical situation
2. Isolation of the operating field
3. Etching and bonding technique
4. Composite layering techniques
5. Adaptation of the composite to the cavosurface margins
6. Curing light intensity and wavelength
7. Distance from the curing tip to the composite
8. Curing time
9. Care during finishing and polishing procedures
A well-bonded and adapted , contoured composite resin restoration which has been
finished and polished to perfection is considered to last for a long time.
24-09-2023 97

98. RECENT
ADVANCES
24-09-2023 98

99. Condensable composites or packable composites or
polymer rigid Inorganic matrix material (PRIMM)
24-09-2023 99
This system is composed of a resin matrix and an inorganic ceramic component. Unlike
in conventional composites; in this system, the resin is incorporated into the fibrous
ceramic filler network rather than including the filler particles into the composite resin
matrix.
The filler mainly consists of Aluminium oxide, Silicon oxide glass particles or barium
aluminium silicate or strontium glasses. Further, colloidal silica ultrafine particles are also
incorporated to control the handling characteristics such as viscosity, resistance to flow,
condensability and reduced stickiness
. The physical and mechanical behaviour of these materials is better than that of
hybrid-composites and similar to that of silver amalgam .
However, the clinical performance of these materials is identical to that of the hybrid
composites
. Condensable composites are indicated in class II cavities
Rao DB, Chandrappa V. Recent Advances in Dental Composites: An Overview.

100. INDIRECT COMPOSITE RESINS
• Because of major clinical problems with direct posterior composite resins, the
indirect composite inlay/on lay system was introduced.
• ADVANTAGES:
1. Has superior adaptation.
2. Contour and proximal contact
3. Wear resistance
4. Good aesthetics
5. Control over polymerization technique
24-09-2023 100

101. SECOND GENERATION INDIRECT COMPOSITES
These new materials included
Artglass (Heraeus-Kulzer),
BelleGlass HP (Kerr),
Targis (Ivoclar),
 Colombus (Cendres et Métaux) and
 Sinfony (ESPE)
Sculpture/FibreKor
Gradia
Herculite XR & XRV (Kerr)
Indirect composites: restorative material systems Dr G. Vasudeva and Dr R. Kaur

102. 24-09-2023 102
Art glass is a nonconventional dental polymer marketed since 1999. It is widely
used in making indirect restorations such as inlays, onlays, and crowns.
 These materials exhibit improved wear resistance and other physical and
mechanical properties due to the greater level of crosslinking.
 A special light curing unit such as Xenon stroboscopic light-curing device with the
emission ranges from 300-500 nm is used for curing of these resins
. The advantages of these materials include high wear resistance compared to
traditional composites, good marginal adaptation and superior proximal contac
ART GLASS
Rao DB, Chandrappa V. Recent Advances in Dental Composites: An Overview.

103. BELLGLASS HP (Kerr) (Dentron)
24-09-2023 103
 These materials have increased polymerization rate as they are cured under pressure
(29 PSI) at an elevated temperature of 1380C and in the presence of nitrogen gas
 Wear resistance of the Bellglass HP is increased due to curing in the presence of
nitrogen gas.
Rao DB, Chandrappa V. Recent Advances in Dental Composites: An Overview
GRADIA (GC LAB TECHNOLOGIES)
The unique chemistry of Gradia couples a micro-fine ceramic/pre-polymer filler
with a urethane dimethacrylate matrix to produce a superior ceramic composite
with exceptionally high strength, wear resistance and superior polishability.

104. 24-09-2023 104
Objective
The study aimed to evaluate survival and failure behavior of Direct Composite Restorations
(DRC) and Indirect Composite Restorations (ICR) on molars and anterior teeth, in a
Randomized Controlled Trial (RCT).
Methods
Patients with generalized severe tooth wear were included, and randomly assigned to one of 2
protocols: (1) DCR: All teeth were restored with directly applied micro-hybrid composite
restorations (Clearfil AP-X, Kuraray) for load bearing areas and nano-hybrid composite
restorations (IPS Empress Direct, Ivoclar Vivadent) for buccal veneers; (2) ICR: First molars
were restored with indirect composite ‘tabletop’ restorations and maxillary anterior teeth
were restored with indirect palatal veneer restorations (Clearfil Estenia C&B, cemented with
Panavia F, Kuraray). Remaining teeth were restored directly. Restorations were evaluated after
3 years, focusing on clinical acceptability. Statistical analysis was performed using Kaplan Meier
curves, Annual Failure Rates (AFRs), and univariate Cox regression analyses (p < 0.05).
Crins LAMJ, Opdam NJM, Kreulen CM, et al. Randomized controlled trial on the
performance of direct and indirect composite restorations in patients with severe tooth
wear. Dent Mater. 2021;37(11):1645-1654. doi:10.1016/j.dental.2021.08.018

105. Conclusion
• This randomized controlled trial showed that for molar restorations, the applied
indirect composite is not suitable for use in severe tooth wear patients. Indirect
composite restorations in anterior teeth and direct composite restorations for
anterior and posterior teeth showed a satisfying performance after a 3-year
observation period.
24-09-2023 105

106. ORMOCER
• Organically Modified Ceramic contains inorganic organic co-polymers in addition to
the inorganic silanated filler particles such as urethane and thioether methacrylate
alkoxysilanes.
• Synthesized through a sol-gel process. Described as 3-dimensionally cross-linked co-
polymers.
• Indications:
1. For classes I to V cavities
2. Fractured anteriors
3. Veneering
4. Core buildups
5.Orthodontic bonding adhesives
24-09-2023 106

107. 24-09-2023 107
Comparison of microleakage of Conventional Microfilled Composite resin restorations,
Nano composite resin and ORMOCER- An in vitro study
The objective of the current study was to determine and compare the microleakage of
restorations made with newer materials ORMOCER and Nanocomposite resin with that
of Conventional microfilled composites
Methodology:
30 premolars were used and prepared with Class II cavities. They were randomly divided
into three groups of 10 teeth each, based on the restorative material used. Group I was
filled with a Conventional Microfilled Composite (Filtek Z250 Universal restorative+ DX.
Bond, which is a total etch light cure adhesive System) Group II with Nanocomposite
(Filtek Supreme XT by 3M ESPE, St Paul, MN, USA + Scotchbond Multipurpose, 3M ESPE)
and Group III with ORMOCER (Admira Fusion Voco + Admira Bond). The microleakage
was assessed by sectioning the teeth and examining them under a stereomicroscope.
Conclusion:
Compared to Nanocomposite and Conventional microfilled composites, ORMOCER
materials demonstrated the least microleakage.

108. FIBER REINFORCED COMPOSITE
• Glass fibres, carbon fibres, polyethylene fibres, aramid fibres
• These fibres can be unidirectional, weave type, mesh type etc in the resin matrix to
improve physical and mechanical properties.
• CLINICAL APPLICATIONS:
1. Reinforced direct composite restoration
2. Single indirect restoration
3. Periodontal splinting/ Post- trauma
4. Reinforcing or repairing dentures
5. Fixed orthodontic retainers
24-09-2023 108

109. • The purpose of this study was to explore the effects of fibre-reinforced
composites and onlay restorations on the fracture resistance of the cracked
teeth. The experiments were grouped as follows: intact teeth, cracked teeth,
crown; onlay; annular ribbond + onlay, laminated ribbond + onlay and fibre post
+ onlay; annular ribbond + crown, laminated ribbond + crown and fibre post +
crown. The maximal Von Mises stress of dentin, the maximal Von Mises stress at
the crack, the fracture resistance and fracture pattern under static loading were
analysed by single-factor analysis of variance (ANOVA) and post-test by LSD. The
annular ribbond + crown had a significant difference in fracture resistance than
the crown (P < 0.05). The annular ribbond + onlay had more favourable fractures
than crown in fracture pattern, and there were significant differences (P < 0.05).
Compared with crown restoration, fibre-reinforced composites and onlay can
improve the fracture resistance of the cracked teeth.
24-09-2023 109
Shi R, Meng X, Feng R, et al. Stress Distribution and Fracture Resistance of repairing
Cracked Tooth with Fiber-reinforced Composites and Onlay. Aust Endod J.
2022;48(3):458-464. doi:10.1111/aej.12578

110. GINGIVAL MASKING COMPOSITES
• An aesthetic gingiva-shaded light-cured composite resin recently
introduced, providing practitioners with the option of correcting gingival
recession with a minimally invasive and less costly procedure.
• Pink- colored composite : available in one translucent gingival color and 3
pink flowable opaquers mixed together to better match an individual's
gingival shade
24-09-2023 110

111. COMPOMERS
• Contains the major ingredients of both composites and glass Ionomer cements
except for water
• Resin component- bulky macro-monomers, such as bisGMA or UDMA with
viscosity-reducing diluents, such as Triethylene glycol dimethacrylate
(TEGDMA).
• Fillers- fluoride containing glasses
Advantages:
Superior working characteristics to RMGIC
Ease of use
Easily adapts to the tooth
Good aesthetics'
EX: DYRACT extra, Compo glass F, Compo glass flow, F2000, Hytac, Glasiosite
24-09-2023 111

112. GIOMERS
24-09-2023 112
The Giomer concept is based on PRG technology where PRG filler are induced in to
resin matrix
 They are:
 S-PRG (Surface Pre Reacted Glass Ionomer) marketed as BEAUTIFIIL (shofu)
 F-PRG (Full Pre Reacted Glass Ionomer) marketed as REACTMER (shofu)
INDICATIONS:
Restoration of root caries
Non-carious cervical lesions
Class V cavities
Caries in deciduous teeth

113. SMART COMPOSITES/STIMULI RESPONSE
COMPOSITES
• 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 surroundings.
• These are also called as Intelligent composite
• 1) Ariston phc
• 2) self repairing/ self healing composites
• 3) smart monochromatic compositesXEX
24-09-2023
113
Smart composites – A new era in dentisitry , Archieves of dental research 2023

114. SELF –REPAIRING MATERIALS
These materials are made of epoxy system with the resin
filled microcapsules.
resin subsequently fills the crack and reacts with a Grubbs catalyst
resulting in a polymerization of the resin and repair of the crack
microcapsules are destroyed near the crack and release the resin.
If crack occurs in epoxy material

115. SILORANES
• Siloxane + oxiranes
• Siloxane backbone –hydrophobic nature
• Ring opening monomers, cationic innature
• As silorane-based composite polymerizes,“ring-opening” monomers connect
by opening, flattening and extending toward each other
24-09-2023 115

116. ANTIBACTERIAL COMPOSITES
24-09-2023 116
Various materials are incorporated such as low molecular wieght antibiotics, zinc ions,
silver ions, iodine and chlorhexidine
 Methacryloxydodecyl Pyridinium Bromide( MDPB)
By Imazo et al in 1994
Combined antibacterial agent (hydroxydodecyl pyridinium bromide) with methacryl
group.
Bio-active restorative materials with antibacterial effects: new dimension of innovation in restorative
dentistry Dental Materials Journal 2009; 28(1): 11－19
Microbes may be killed on direct contact with these materials or through leaching of
the antimicrobial materials into the oral environment.

117. The world’s first antibacterial adhesive system
(Clearfil Protect Bond), employing a self-etching
primer containing 5％ MDPB.
The experimental antibacterial dentin primer was prepared by incorporating
MDPB into the primer of a commercial self-etching system (Liner Bond 2
system, Kuraray Medical, Tokyo, Japan);

118. HRI enamels
 The HRI enamels use high refractive index Nano-Zirconium Oxide particles (12%),
together with a specially developed silanisation process.
 The HRI enamels also contain a high refractive index glass filler (68%), and have a Vickers
hardness of 700mpa, and a flexural strength of 13,500mpa.
Possess same light refractive index as that of natural tooth enamels, and
consequently they can be applied over the dentine composite as a much thinner
layer; this being virtually as thin as that of the natural tooth enamel.
Functions of this material was to balance light reflection and refraction effects.
Optident Ltd, International Development Centre
,www.optident.co.uk

119. 24-09-2023 119
Sonicfill Composite
SonicFill is a bulk fill system comprised of a specially designed handpiece
and new, bulk-filled composite material in Unidose tips. SonicFill’s
composite incorporates a highly-filled proprietary resin with special
modifiers that react to sonic energy.
Sonic energy is applied through the hand piece the modifier causes the
viscosity to drop upto 87% increasing the flowability the composite,
enabling quick placement and precise adaptation to cavity walls.
When stopped ,the composite returns to a more viscous,non slumping
state for carving and contouring.
 One can go from placement to a polished restoration in less than 3
minutes in cavities upto 5mm in depth.

120. 24-09-2023 120
ADVANTAGES:
- Better flow of material into the cavity than using hand placement + Reliable bulk fill
- Reportedly low shrinkage
- Excellent for use in core build-ups
- no voids
DISADVANTAGES:
- Possible waste of material due to overfills
- longer tips should be manfactured.
- Limited variation of shades
USAF Dental Evaluation & Consultation Service

121. 24-09-2023 121
SELF ADHESIVE COMPOSITE
Self-adhering composites are also called as compobonds
An all-in-one etchant, adhesive and restorative allowing one-step placement
for most challenging cases.
 It is the only tooth-colored restorative material balancing the speed and ease
of a glass ionomer with the longevity of a bonded composite.

122. 24-09-2023 122
Randomized clinical split-mouth study on a novel self-adhesive bulk-fill restorative vs. a
conventional bulk-fill composite for restoration of class II cavities – results after three years
Fabian Cieplik at al
• Randomized prospective split-mouth study evaluated the clinical performance of a novel,
tooth-colored, self-adhesive bulk-fill restorative (SABF, 3M) for restoration of class II cavities
as compared to a conventional bulk-fill composite (Filtek One, 3M; FOBF) over 36 months.
• self-adhesive bulk-fill restorative exhibited clinically fully acceptable results over 36 months of
clinical service similar to a conventional bulk-fill restorative used with a universal adhesive,
but with slight shortcomings in esthetic properties. Therefore, both restorative materials may
be recommended for clinical use.

123. BIOACTIVE COMPOSITES
Calcium phosphate and its modified varieties are being used as fillers.
Composite releases Ca & phosphate ions form hydroxy apatite-Ca10( po4)6 (OH)2
Enhances reminerlization but have low strength & less stable
Journal of biomedical materials research. Part B, Applied biomaterialsDental glass-reinforced
composite for caries inhibition: Calcium phosphate ion release and mechanical properties
Advantages:
Remineralizing potential
Disadvantages
Calcium- phosphate composites have flexural strengths half of that of unfilled resin
Cannot be used as bulk restoratives

124. CONCLUSION
24-09-2023 124
• Contemporary composite resin materials have improved significantly over the years, now
the materials have good wear resistance and wide variety of shades and translucencies.
They are quite polishable and provide excellent esthetics.
• Major disadvantages like technique sensitivity and polymerization shrinkage can be
avoided by placing restorations in excellent isolation in conjunction with meticulous
bonding procedures.
• Properly placed composite resin can provide a very esthetic and durable restoration and
the results are gratifying to both patients and clinicians

125. REFERENCES
 Philips Science of dental materials 11 th edition – K J Anusavise
 Sturdevants art and science of operative dentistry 4 th edition – T M
Roberson
 Restorative dental materials 11 th edition - Robert G. Craig
 Dental Materials Science- Rama Krishna Alla
 TEXTBOOK OF ESTHETICS AND RESTORATIVE DENTISTRY
 Anterior Matrix Systems for Composite Restorations: A Review
 Rao DB, Chandrappa V. Recent Advances in Dental Composites: An Overview
 Indirect composites: restorative material systems Dr G. Vasudeva and Dr R.
Kaur
 Smart composites – A new era in dentisitry , Archieves of dental research
125

126. 24-09-2023 126
Cangül, Suzan & Adıgüzel, Özkan. (2017). The Latest Developments Related to Composite
Resins. International Dental Research. 7. 32-41. 10.5577/intdentres.2017.vol7.no2.3.
Crins LAMJ, Opdam NJM, Kreulen CM, et al. Randomized controlled trial on the
performance of direct and indirect composite restorations in patients with severe tooth
wear. Dent Mater. 2021;37(11):1645-1654. doi:10.1016/j.dental.2021.08.018
Comparison of microleakage of Conventional Microfilled Composite resin restorations,
Nano composite resin and ORMOCER- An in vitro study
Shi R, Meng X, Feng R, et al. Stress Distribution and Fracture Resistance of repairing Cracked
Tooth with Fiber-reinforced Composites and Onlay. Aust Endod J. 2022;48(3):458-464.
doi:10.1111/aej.12578

127. 24-09-2023 127
 Randomized clinical split-mouth study on a novel self-adhesive bulk-fill restorative
vs. a conventional bulk-fill composite for restoration of class II cavities – results
after three years Fabian Cieplik at al
 Comparison of polymerization shrinkage of a new bulk‐fill flowable composite
with other composites: An in vitro study Somayeh Khoramian Tusi at al
 Borges MG, Silva GR, Neves FT, Soares CJ, Faria-e-Silva AL, Carvalho RF, Menezes
MS. Oxygen inhibition of surface composites and its correlation with degree of
conversion and color stability. Brazilian Dental Journal. 2021 Apr 2;32:91-7.

128. 24-09-2023 128
Bio-active restorative materials with antibacterial effects: new dimension of
innovation in restorative dentistry Dental Materials Journal 2009; 28(1): 11－19
 Vishwanath, Sankar et al. “Finishing and Polishing of Composite Restoration:
Assessment of Knowledge, Attitude and Practice Among Various Dental
Professionals in India.” Cureus vol. 14,1 e20887. 3 Jan. 2022

129. 24-09-2023 129
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