COMPOSITES IN DENTISTRYINDIAN DENTAL ACADEMYLeader in Continuing Dental Education      www.indiandentalacademy.com
Contents Introduction Evolution  of Composites Definition and Composition Classification Indications and Contraindica...
 Properties of Composites Advantages and Disadvantages Clinical and restorative techniques in  composite resin restorat...
Introduction        www.indiandentalacademy.com
Evolution Of Composites   1955:M.Buonocore introduced the acid-etch    technique   1956:Dr.Raphael Brown formulated a re...
   1970:Introduction of photo-cured composite resin    using U-V light.   1972:First visible light curing system was int...
Mid 1980s:Hybrid composites were developed.The first  generation of Indirect lab processed microfil  composite resin syste...
 1996:Flowable    composites developed. 1997-1998:Packable posterior composites  were introduced based on PRIMM-Polymer ...
 1998:Introduction of packable resin material  based on Ormocer technology- organically  modified ceramics. 1998:Introdu...
Definition Dental composites are highly cross-linked  polymeric materials reinforced by a dispersion  of glass,crystallin...
Composition The basic structural components of a dental resin based composite are:     -Resin matrix     -Filler     -Cou...
www.indiandentalacademy.com
Resin matrix It is the continuous phase to which the other  ingredients are incorporated. It is a plastic resin which bi...
 Toreduce the viscosity of BISGMA,diluent monomers such as TEGDMA are added.They are mixed in the ratio of 75:25        w...
Filler These   are reinforcing particles or fibers that  are dispersed in the matrix. Filler particles are most commonly...
Functions of a Filler Reinforcement  of the matrix resin,resulting in  increased hardness,strength and decreased  wear. ...
Coupling agent These  bind the filler particles to the resin matrix  and allows the more flexible resin matrix to  transf...
-Provide hydrolytic stability In the presence of water,the methoxy groups  are hydrolysed to silanol grops that can bond ...
Initiator-activator system Composite   resins polymerize by an addition  polymerization mechanism that is brought  about ...
Chemically curedThey are supplied as two pastes,one of which  contains benzoyl peroxide initiator and other a  tertiary am...
Light cured The   first light cured composites were  polymerised by exposure to UV light.The  initiator was benzoin methy...
Inhibitors Inhibitors prevent or minimize spontaneous or  accidental polymerization of monomers The commonly used inhibi...
Optical modifiers   Opacifiers are added to make the translucency of the    filler particle similar to the tooth structur...
CLASSIFICATION   www.indiandentalacademy.com
1.BASED ON PARTICLE SIZE AND DISTRIBUTION    Based on primary particle size-By Sturdevanta.   Mega fill:very large indivi...
    Based on mean particle size of major filler-     By Skinnera.   Traditional composites:8-12micronsb.   Small particle...
a.   Homogenous composites:Composite     consists of filler and uncured matrix materialsb.   Heterogenous composites:Compo...
2.BASED ON HANDLINGPROPERTIES Flowable composites:The filler content is reduced by 20-25% compared to traditional hybrid ...
3.BASED ON POLMERIZATIONPROCESS U-V  light cured composites Visible light cured composites:  Blue light in range of 470n...
4.BASED ON USE Anteriorcomposite Posterior composite Core-build up composite Luting composite             www.indiande...
5.BASED ON CHRONOLOGICALDEVELOPMENT FirstGeneration composite resins:  They consist of macro ceramic reinforcing  phases ...
 Third  Generation composite resins:They are  hybrid composites in which there is a  combination of macro and micro ceram...
 Fifth Generation composite resins:  They are hybrids in which the resin matrix is  reinforced with micro ceramics(colloi...
 SixthGeneration composite resins: These are hybrid composites in which continuous phase is reinforced with a combination...
SKINNER’S Classification1.Traditional composites:  -Developed in 1970  -Also known as Conventional or Microfilled  composi...
 Which include:  -Surface texture is rough.  -They are more susceptible to discolouration from extrinsic stains.  -Resin ...
2.Small particle filled composites They  contain fillers of size 0.5-3microns. The physical and mechanical properties li...
3.Microfilled composites These   composites contain colloidal silica  particles of 0.01-0.04microns as inorganic filler....
4.Hybrid composites They  contain two types of fillers:colloidal silica  and particles of glass upto 75-80 wt%. The aver...
 Based    on the filler particle size,hybrid  composites are further divided as: Large filler:for high stress areas requ...
INDICATIONS FOR COMPOSITERESIN RESTORATIONS     www.indiandentalacademy.com
    Restoration of Class I,II,III,IV,V and VI     cavities.    Foundations or Core build ups    Pit and fissure sealant...
 As luting cements(for indirect restorations) Temporary restorations Periodontal splinting,fixing orthodontic  brackets...
CONTRAINDICATIONS www.indiandentalacademy.com
 Grossly destructed tooth High caries incidence and poor oral hygiene Heavy and abnormal occlusion Areas difficult to ...
CURING SYSTEMSwww.indiandentalacademy.com
Self cured Composite resins Polymerization   is initiated by mixing two  pastes. During mixing,there is incorporation of...
Light cured composite resins Two   types:U-V light cured and Visible light  cured. Curing lamps:These are hand held devi...
Light emitting diodes-LED lamps                          They emit radiation only                           in the blue p...
Quartz-Tungsten-Halogen(QTH)Lamps                         Most widely used light                          source.        ...
Conventional QTH curing unit      www.indiandentalacademy.com
Plasma arc curing light-PAC lamps                          They use ionized xenon                           gas to produc...
ARGON LASER LAMPS They  have the highest intensity and emit a  single wavelength at 490nm. DEPTH OF CURE Usually 20-60 ...
Degree of Conversion Itis the percentage of carbon-carbon double  bonds that have been converted to single  bonds to for...
Factors affecting curing   Procedural factors:     -Access to the restorations     -Light tip direction     -Distance fro...
   Restoration factors:     -Cavity design     -Restoration thickness:ideally 1.5-2mm,for    optimal cure     -Filler amo...
Self cure v/s Light curedcomposites   Polymerization is central      Polymerization is                                  ...
Disadvantages of Light curedcomposites Limited curing depth Relative poor accessibility Variable exposure time Sensiti...
PROPERTIES OF COMPOSITES     www.indiandentalacademy.com
 Composite  resins possess the highest tensile  and compressive strengths. The modulus of elasticity is high. COTE is t...
 Water   sorption:It swells the polymer portions  of the dental composite and promotes diffusion  and desorption of any u...
 Hardness:Composite     resins show greater  Knoop Hardness Number(KNH)of 30-100 as  compared to 300 of enamel. Surface ...
 Microleakage:The    unfilled resins and 2nd  generation composites show greatest  microleakage.However,the use of acid e...
 Wear:The    wear rate of posterior composite  resins is 0.1-0.2mm/year,more than enamel.                Occlusal wear is...
 When tooth preparation extends onto the root surface,a ‘V’ shaped gap occurs.This is because the force of polymerization...
 Configuration   factor or C-factor:It is the ratio  of bonded surfaces to the unbonded or free  surfaces in a tooth prep...
ADVANTAGES OF COMPOSITERESIN Esthetic Conservation   of tooth structure can be  achieved. Insulative,has low thermal co...
DISADVANTAGES OFCOMPOSITE RESIN Polymerization     shrinkage Expensive and time consuming Technique sensitive Greater ...
CLINICAL TECHNIQUES FORCOMPOSITE RESINRESTORATIONS     www.indiandentalacademy.com
Preliminary Steps1)   Local Anaesthesia2)   Oral Prophylaxis3)   Shade selection:Selecting the appropriate     shade of th...
Composite shade guide      www.indiandentalacademy.com
General concepts for cavitypreparations   Minimal extension   Pulpal floor and/or axial walls need not be flat    and ca...
Designs for composite resinrestorations Conventional Beveled       conventional Modified Box    only Slot            ...
Conventional cavity preparations These   are the typical amalgam cavity designs. Which include:uniform depth,flat floors...
Conventional Class I design       www.indiandentalacademy.com
Conventional Class II design       www.indiandentalacademy.com
Conventional Class III design       www.indiandentalacademy.com
Conventional Class IV design       www.indiandentalacademy.com
Conventional Class V design       www.indiandentalacademy.com
Beveled conventional cavitypreparations Similar to the conventional design but some  enamel margins are beveled. The bev...
Beveled Conventional Class IIIdesign       www.indiandentalacademy.com
Beveled conventional Class IVdesign       www.indiandentalacademy.com
Beveled conventional Class Vdesign       www.indiandentalacademy.com
Bevel on enamel margin      www.indiandentalacademy.com
Modified cavity preparations Here,the  cavity preparation appears “scooped-  out” without definite internal line angles....
Modified Class I design       www.indiandentalacademy.com
Modified Class II design       www.indiandentalacademy.com
Modified Class III design      www.indiandentalacademy.com
Modified Class IV design      www.indiandentalacademy.com
Modified Class V design      www.indiandentalacademy.com
Box-only cavity preparations This   design is employed for proximal caries in  posterior teeth(Class II) with no lesions ...
Box-only preparation      www.indiandentalacademy.com
Slot cavity preparations Indicated  for proximal carious lesions that can  be directly approached from the facial or  lin...
Slot cavity preparation                           Done using a round                            diamond point bur and    ...
   A cross-sectional view                     showing an intact                     marginal ridge.www.indiandentalacadem...
RESTORATIVE TECHNIQUESFOR COMPOSITE RESINS     www.indiandentalacademy.com
Replacement of a discoloured anteriorrestoration with composite resin       www.indiandentalacademy.com
   First and foremost the                     area is isolated with a                     rubber dam.                   ...
   Dual lights are utilized to                     accelerate the                     polymerization process.www.indiande...
Sequence of Steps Acid etching Application of bonding agent and curing Matrix placement Incremental insertion of compo...
ACID ETCHINGwww.indiandentalacademy.com
   Done with 37%                     phosphoric acid liquid or                     gel.                    It should be ...
  Acid etching is done for                    15-30secs.                   Following this it has to                    b...
BONDING AND CURING  www.indiandentalacademy.com
 The bonding agent is                    applied using a                    microbrush.                   The manufactur...
   It penetrates the                     irregularities on enamel                     and bonds                     micro...
MATRIX PLACEMENT   www.indiandentalacademy.com
 It is better to place the matrix before etching  and bonding as it provides good isolation for  proper adhesion and help...
 Several    matrix systems are available for Class    II composite restorations:   Tofflemire matrix retainer with ultra...
Sectional matrix       www.indiandentalacademy.com
Tofflemire matrix retainer andband      www.indiandentalacademy.com
INSERTION OF COMPOSITERESIN     www.indiandentalacademy.com
 The composite resin is                    built incrementally using                    special hand instruments         ...
   An alternative to hand                     instruments is the                     injectable syringe.www.indiandentala...
   The material is                     contoured before light                     curing.                    The cavity ...
Curing                            Polymerization for                             60secs is carried out                   ...
   A carbide bur is used to                     gently remove the                     excess composite at the            ...
CONTOURING THE COMPOSITE     www.indiandentalacademy.com
 Contouring the                    composite restoration                    requires skill and                    knowled...
   As a final                     step,appropriate occlusal                     relationship must be                     ...
   Occlusal adjustments                     are made.www.indiandentalacademy.com
FINISHING AND POLISHING     www.indiandentalacademy.com
   Finishing refers to the                     shaping,contouring and                     smoothening of the             ...
 The best finish and polish is provided by allowing the composite resin to polymerize against a clear plastic matrix stri...
   Post-operative view                     revealing invisible                     margins and blending of               ...
Systems available for finishing andpolishing of composite restorations   12,16 and 30 fluted carbide finishing burs.   F...
Finishing instruments       www.indiandentalacademy.com
Composite polishing kit       www.indiandentalacademy.com
Guidelines Avoid absolute dry finishing and polishing as it  can generate heat which disturbs the marginal  seal of compo...
ILLUSTRATIONS    www.indiandentalacademy.com
Case-1                             FRACTURED INCISAL                              EDGE IN 21         www.indiandentalacad...
   ISOLATION AND                     ACID ETCHING IS                     DONE.www.indiandentalacademy.com
   BONDING AGENT IS                     APPLIEDwww.indiandentalacademy.com
   COMPLETED                     COMPOSITE RESIN                     BUILD-UPwww.indiandentalacademy.com
Case-2                             SEVERE CERVICAL                              EROSION IN 21 22 23         www.indianden...
   A LABIAL BEVEL IS                     PLACED WITH A                     DIAMOND BUR                    WHICH ALSO    ...
   ACID ETCHING IS                     DONE AND BONDING                     AGENT                     APPLIED,FOLLOWED   ...
   BULK OF THE BODY                     CONTOUR IS CARVED                     WITH A SPECIALLY                     DESIGN...
   FINAL POLISHING IS                     DONE WITH A                     SERIES OF ABRASIVE                     POLISHIN...
   FINAL RESULT                     SHOWS A GENTLE                     BLENDING OF                     COLOUR,FORM AND   ...
RECENT ADVANCES     www.indiandentalacademy.com
PACKABLE COMPOSITES Developed    in 1980s They were available as PRIMM,fused glass  fiber powder with conventional compo...
Characteristics Moisture tolerant Non sticky,easily transferable and packable High shear strength Cures rapidly to fin...
COMPOMERS They  are resin-ionomer hybrid restorative  materials marketed as multipurpose resin that  may release fluoride...
Properties Greater wear than amalgam Less fluoride release than GIC 3% polymerization shrinkage Good radio-opacity Us...
INDIRECT COMPOSITES   Morman and Touati pioneered the use of    composites for fabrication of indirect inlays and    onla...
   Contraindications:     -Bruxism     -Opposing porcelain restoration     -Long span FPDs     -High caries rate     -Dif...
CEROMERS Itstands for Ceramic Optimized Polymers Composed of specially developed and  conditioned fine particle ceramic ...
Characteristics Durable  esthetics High abrasion resistance High stability Ease of final adjustment Effective bond wi...
Uses For veneers,inlay/onlay without a metal  framework Can be used with Fiber reinforced composite  framework for inlay...
FIBER-REINFORCEDCOMPOSITES These   are resin based restorations containing  fiber for enhancing the physical properties....
USES Splinting Restoration  of endodontically treated teeth 3 unit bridge work Metal free crowns   Examples:CONNECT,D...
FLOWABLE COMPOSITES Introduced   in late 1996 Here,the filler particle size is less thus resulting  in low viscosity. F...
USES Fillingmaterial in low stress areas Rebuilding worn composite contact areas In areas of difficult access or areas ...
 Restoration   of Class V lesions Porcelain defects,enamel defects,incisal edge  repair in anteriors. Class III lesions...
ORMOCERS The  acronym of Organically Modified  Ceramic,is a brand new material for filling  indications in the anterior a...
 The matrix consists of ceramic polysiloxane.Silicon oxide serves as the basic ingredient.         www.indiandentalacadem...
Characteristics Biocompatible Reduced   polymerization shrinkage High abrasive resistance Lasting esthetics Anticario...
GIOMERS These   are newly introduced hybrid esthetic  restorative materials for dental restorative  therapy. Giomers emp...
Indications Restoration of root caries Non-carious cervical lesions Class V cavities Deciduous tooth caries          w...
Limitations Giomers   are not as beneficial as GICs in  patients who are at high risk for recurrent  caries. The hardnes...
Advantages Fluoride  release Fluoride recharging Biocompatible Clinical stability and durability Excellent esthetics...
NANOCOMPOSITES New   composites are being developed with  nanofillers that range in size 0.005-0.01micron  which is below...
Advantages Superior  translucency and esthetic appeal. Excellent colour,high polish and polish  retention. Superior har...
CONCLUSION   Composite resins satisfy almost all the    requirements of an ideal restorative    material.Their use has ri...
References Sturdevant’s Philip’s Goldstein Albers Ramya      Raghu             www.indiandentalacademy.com
THANK      YOUwww.indiandentalacademy.com
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Composites in dentistry /certified fixed orthodontic courses by Indian dental academy

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Composites in dentistry /certified fixed orthodontic courses by Indian dental academy

  1. 1. COMPOSITES IN DENTISTRYINDIAN DENTAL ACADEMYLeader in Continuing Dental Education www.indiandentalacademy.com
  2. 2. Contents Introduction Evolution of Composites Definition and Composition Classification Indications and Contraindications Curing Systems www.indiandentalacademy.com
  3. 3.  Properties of Composites Advantages and Disadvantages Clinical and restorative techniques in composite resin restoration Recent advances in composites Conclusion References www.indiandentalacademy.com
  4. 4. Introduction www.indiandentalacademy.com
  5. 5. Evolution Of Composites 1955:M.Buonocore introduced the acid-etch technique 1956:Dr.Raphael Brown formulated a resin molecule- BISGMA 1960:Fibre filler particle was added in experimental combinations to formulate the first composite resin 1962:Dr.Ray L Bowen of the ADA research unit developed a new type of composite resin material. www.indiandentalacademy.com
  6. 6.  1970:Introduction of photo-cured composite resin using U-V light. 1972:First visible light curing system was introduced. 1976:Microfilled composites were developed which were highly polishable. Early 1980s:Microfil resin properties were altered and posterior composites introduced www.indiandentalacademy.com
  7. 7. Mid 1980s:Hybrid composites were developed.The first generation of Indirect lab processed microfil composite resin system was introduced. 1987:Second generation of Lab processed resin was developed. 1991:Mega filled composites with glass ceramic inserts coated with silane were introduced. 1992:Introduction of fiber-reinforced composites which were composed of woven glass or polythene fibers. www.indiandentalacademy.com
  8. 8.  1996:Flowable composites developed. 1997-1998:Packable posterior composites were introduced based on PRIMM-Polymer rigid inorganic matrix material. 1998:Introduction of Compomer,which combined the properties of Glass ionomer and Composites. www.indiandentalacademy.com
  9. 9.  1998:Introduction of packable resin material based on Ormocer technology- organically modified ceramics. 1998:Introduction of ion-releasing composite material 1999:Single crystal-modified composites. www.indiandentalacademy.com
  10. 10. Definition Dental composites are highly cross-linked polymeric materials reinforced by a dispersion of glass,crystalline or resin filler particles and/or short fibers bound to matrix by silane coupling agent. www.indiandentalacademy.com
  11. 11. Composition The basic structural components of a dental resin based composite are: -Resin matrix -Filler -Coupling agent -Initiator accelerator system -Inhibitors -Optical modifiers www.indiandentalacademy.com
  12. 12. www.indiandentalacademy.com
  13. 13. Resin matrix It is the continuous phase to which the other ingredients are incorporated. It is a plastic resin which binds the filler particles. Most composite resins are a blend of aromatic and aliphatic dimethacrylate monomers like: BISGMA,TEGDMA & UDMA www.indiandentalacademy.com
  14. 14.  Toreduce the viscosity of BISGMA,diluent monomers such as TEGDMA are added.They are mixed in the ratio of 75:25 www.indiandentalacademy.com
  15. 15. Filler These are reinforcing particles or fibers that are dispersed in the matrix. Filler particles are most commonly produced by grinding or milling quartz or glass to produce particles of varying sizes. Various fillers used are:Colloidal silica,Glass fibers,lithium aluminium silicates,crystalline quartz,barium glass,microfine silica,sintered silica. www.indiandentalacademy.com
  16. 16. Functions of a Filler Reinforcement of the matrix resin,resulting in increased hardness,strength and decreased wear. Reducing polymerization shrinkage. Reduction in thermal expansion and contraction Improved workability by increasing viscosity. Reduction in water sorption,softening,staining. Improve translucency. www.indiandentalacademy.com
  17. 17. Coupling agent These bind the filler particles to the resin matrix and allows the more flexible resin matrix to transfer stresses to the stiffer filler particles. Most commonly used are:Titanates,Zirconates,organosilanes such as gamma-methacryloxypropyl silane. Function-Improves the physical and the mechanical properties. www.indiandentalacademy.com
  18. 18. -Provide hydrolytic stability In the presence of water,the methoxy groups are hydrolysed to silanol grops that can bond with other silanols on the filler surfaces by formation of a siloxane bond(-Si-O-Si-) The organosilane methacrylate groups form covalent bonds with the resin when it is polymerised,thereby completing the coupling. www.indiandentalacademy.com
  19. 19. Initiator-activator system Composite resins polymerize by an addition polymerization mechanism that is brought about by the release of free radicals. There are two types of resin systems: Chemically cured Light cured www.indiandentalacademy.com
  20. 20. Chemically curedThey are supplied as two pastes,one of which contains benzoyl peroxide initiator and other a tertiary amine activator(N,N-dimethyl P- toludine) On mixing,they react with each other to form free radicals which start the addition polymerization reaction. www.indiandentalacademy.com
  21. 21. Light cured The first light cured composites were polymerised by exposure to UV light.The initiator was benzoin methyl ether. The initiator in the visible light activated systems is camphoroquinone present at 0.12% by wt or less. The light curable dental composites are supplied as single paste contained in a syringe containing photo initiator&amine activator. www.indiandentalacademy.com
  22. 22. Inhibitors Inhibitors prevent or minimize spontaneous or accidental polymerization of monomers The commonly used inhibitor is Butylated hydroxy toluene in a conc.of 0.01% by wt. Inhibitors extend the storage lifetime and thus ensure sufficient working time. www.indiandentalacademy.com
  23. 23. Optical modifiers Opacifiers are added to make the translucency of the filler particle similar to the tooth structure. They affect light transmission through the composite resin. They include metal oxides in minute quantities (0.001- 0.007% by wt) Aluminium oxide Titanum dioxide www.indiandentalacademy.com
  24. 24. CLASSIFICATION www.indiandentalacademy.com
  25. 25. 1.BASED ON PARTICLE SIZE AND DISTRIBUTION Based on primary particle size-By Sturdevanta. Mega fill:very large individual particles or inserts for posterior compositesb. Macro fill:10-100micronsc. Midi fill:1-10micronsd. Mini fill:0.1-1micronse. Micro fill:0.01-0.1micronsf. www.indiandentalacademy.com Nano fill:0.005-0.01microns
  26. 26.  Based on mean particle size of major filler- By Skinnera. Traditional composites:8-12micronsb. Small particle filled composites:1-5micronsc. Micro filled composites:0.04-0.4micronsd. Hybrid composites:0.6-1microns www.indiandentalacademy.com
  27. 27. a. Homogenous composites:Composite consists of filler and uncured matrix materialsb. Heterogenous composites:Composites consists of precured composite fillersc. Modified composites:Composites consists of modified fillers in addition to conventional fillers www.indiandentalacademy.com
  28. 28. 2.BASED ON HANDLINGPROPERTIES Flowable composites:The filler content is reduced by 20-25% compared to traditional hybrid composites. Packable/Condensable composites:The filler is present as continuous network/scaffold of ceramic fibers composed of alumina and silicon dioxide. www.indiandentalacademy.com
  29. 29. 3.BASED ON POLMERIZATIONPROCESS U-V light cured composites Visible light cured composites: Blue light in range of 470nm wavelength is used. Dual cured composite: They combine self curing and light curing. Chemically cured composites. www.indiandentalacademy.com
  30. 30. 4.BASED ON USE Anteriorcomposite Posterior composite Core-build up composite Luting composite www.indiandentalacademy.com
  31. 31. 5.BASED ON CHRONOLOGICALDEVELOPMENT FirstGeneration composite resins: They consist of macro ceramic reinforcing phases in the resin matrix.They have the highest mechanical properties and highest surface roughness. Second Generation composite resins: They consist of colloidal and micro ceramic phases in a continuous resin phase.Best surface texture and better wear resistance. www.indiandentalacademy.com
  32. 32.  Third Generation composite resins:They are hybrid composites in which there is a combination of macro and micro ceramics as reinforcers in the ratio of 75:25.The properties are intermediate to those of the 1st and 2nd gen. Fourth Generation composite resins:They are also hybrid types that contain heat cured irregularly shaped,highly reinforced composite macro particles with micro ceramics. www.indiandentalacademy.com
  33. 33.  Fifth Generation composite resins: They are hybrids in which the resin matrix is reinforced with micro ceramics(colloidal) and macro spherical,highly reinforced heat cured composite particles.They have improved wettability and consequently improved bonding to continuous phase. www.indiandentalacademy.com
  34. 34.  SixthGeneration composite resins: These are hybrid composites in which continuous phase is reinforced with a combination of micro ceramics and agglomerates of sintered micro ceramics. They have the best mechanical properties.They exhibit the least shrinkage and the wear and surface texture is similar to 4th generation composite resins. www.indiandentalacademy.com
  35. 35. SKINNER’S Classification1.Traditional composites: -Developed in 1970 -Also known as Conventional or Microfilled composites. -The average size of filler particles(amorphous silica and quartz)is 8-12microns -However,they had a few disadvantages. www.indiandentalacademy.com
  36. 36.  Which include: -Surface texture is rough. -They are more susceptible to discolouration from extrinsic stains. -Resin matrix wears at a faster rate. -Higher amount of initial wear at occlusal contacts. www.indiandentalacademy.com
  37. 37. 2.Small particle filled composites They contain fillers of size 0.5-3microns. The physical and mechanical properties like compressive strength is higher than traditional composites. Polymerization shrinkage is less and wear resistance is improved. They are indicated for high stress and abrasion prone areas. www.indiandentalacademy.com
  38. 38. 3.Microfilled composites These composites contain colloidal silica particles of 0.01-0.04microns as inorganic filler. The restorative surface produced is smooth. They are wear resistant. However,have inferior physical and mechanical properties. Indicated for Class III and Class V cavity restorations. www.indiandentalacademy.com
  39. 39. 4.Hybrid composites They contain two types of fillers:colloidal silica and particles of glass upto 75-80 wt%. The average particle size is 0.4-1microns. Their physical and mechanical are intermediate to those of traditional and small particle filled composites. They produce a smooth surface and have good strength. www.indiandentalacademy.com
  40. 40.  Based on the filler particle size,hybrid composites are further divided as: Large filler:for high stress areas requiring improved polishability. Class I,II,III,IV Mid filler:for Class III and IV Mini filler:for moderate stress areas requiring optimal polishability www.indiandentalacademy.com
  41. 41. INDICATIONS FOR COMPOSITERESIN RESTORATIONS www.indiandentalacademy.com
  42. 42.  Restoration of Class I,II,III,IV,V and VI cavities. Foundations or Core build ups Pit and fissure sealants Esthetic considerations such as:a) Full and partial veneersb) Closure of diastemac) Tooth contour modifications www.indiandentalacademy.com
  43. 43.  As luting cements(for indirect restorations) Temporary restorations Periodontal splinting,fixing orthodontic brackets,repair of fractured ceramic crowns.. www.indiandentalacademy.com
  44. 44. CONTRAINDICATIONS www.indiandentalacademy.com
  45. 45.  Grossly destructed tooth High caries incidence and poor oral hygiene Heavy and abnormal occlusion Areas difficult to isolate Sub-gingival extensions Limited operator skill and knowledge as composite resins are highly technique sensitive www.indiandentalacademy.com
  46. 46. CURING SYSTEMSwww.indiandentalacademy.com
  47. 47. Self cured Composite resins Polymerization is initiated by mixing two pastes. During mixing,there is incorporation of air.Leading to inclusion of pores and weakening of the structure. Which in turn traps oxygen and inhibits polymerization. However,there is no control over the working time. www.indiandentalacademy.com
  48. 48. Light cured composite resins Two types:U-V light cured and Visible light cured. Curing lamps:These are hand held devices that contain light source and are equipped with a rigid light guide made of fused optical fibers. The various types of light devices used are: www.indiandentalacademy.com
  49. 49. Light emitting diodes-LED lamps  They emit radiation only in the blue part of visible light between 440- 480nm.  They do not require filters.  They can be battery operated and do no produce heat. www.indiandentalacademy.com
  50. 50. Quartz-Tungsten-Halogen(QTH)Lamps  Most widely used light source.  Contains quartz bulb with tungsten filament in halogen environment.  It produces U-V and white light.Hence,it requires a filter to remove heat and unwanted wavelengths to produce violet-blue www.indiandentalacademy.com light in 400-500nm range.
  51. 51. Conventional QTH curing unit www.indiandentalacademy.com
  52. 52. Plasma arc curing light-PAC lamps  They use ionized xenon gas to produce plasma.  They require filters to remove high intensity white light and allow blue light in the range of 400- 500nm to be emitted. www.indiandentalacademy.com
  53. 53. ARGON LASER LAMPS They have the highest intensity and emit a single wavelength at 490nm. DEPTH OF CURE Usually 20-60 seconds under optimal conditions for 2mm increments. Post-curing for 20-60 secs may slightly improve the surface layer. www.indiandentalacademy.com
  54. 54. Degree of Conversion Itis the percentage of carbon-carbon double bonds that have been converted to single bonds to form a polymeric resin. A 65% conversion is considered to be good. The higher the degree of conversion,the better will be the strength and wear resistance. www.indiandentalacademy.com
  55. 55. Factors affecting curing Procedural factors: -Access to the restorations -Light tip direction -Distance from the surface:ideally 2mm -Size of the tip:ranges from 3-11mm -Tip movement -Time of exposure www.indiandentalacademy.com
  56. 56.  Restoration factors: -Cavity design -Restoration thickness:ideally 1.5-2mm,for optimal cure -Filler amount size -Restoration shade -Monomer ratios www.indiandentalacademy.com
  57. 57. Self cure v/s Light curedcomposites Polymerization is central  Polymerization is peripheral. Curing in one phase  Curing in increments Self cured composites  Command set within 45secs polymerization Working time is limited  It is increased and adequate  Less wastage More wastage  Good surface finish Surface finish is not adequate www.indiandentalacademy.com
  58. 58. Disadvantages of Light curedcomposites Limited curing depth Relative poor accessibility Variable exposure time Sensitivity to room illumination www.indiandentalacademy.com
  59. 59. PROPERTIES OF COMPOSITES www.indiandentalacademy.com
  60. 60.  Composite resins possess the highest tensile and compressive strengths. The modulus of elasticity is high. COTE is three times more than that of tooth structure. They show less resistance to abrasion. The modulus of resilience is very low. www.indiandentalacademy.com
  61. 61.  Water sorption:It swells the polymer portions of the dental composite and promotes diffusion and desorption of any unbound monomer.This increases the dimensions of the restoration,thus compensating for the polymerization shrinkage. Plasticity:They are viscoelastic and show limited degree of plasticity which may lead to change in shape under forces. www.indiandentalacademy.com
  62. 62.  Hardness:Composite resins show greater Knoop Hardness Number(KNH)of 30-100 as compared to 300 of enamel. Surface Roughness:Composites have the highest and deepest scratches after all finishing and polishing procedures.The 2 nd generation composite exhibits the least surface roughness. www.indiandentalacademy.com
  63. 63.  Microleakage:The unfilled resins and 2nd generation composites show greatest microleakage.However,the use of acid etch technique has reduced the microleakage of composites. Optical properties:They have almost the same translucency as that of enamel. Colour stability:Composites may undergo discolouration,either extrinsic or intrinsic. www.indiandentalacademy.com
  64. 64.  Wear:The wear rate of posterior composite resins is 0.1-0.2mm/year,more than enamel. Occlusal wear is the second most frequent clinical problem apart from polymerization shrinkage. Polymerization shrinkage:It ranges from 1.5- 5.5% by volume.Composites shrink during hardening. www.indiandentalacademy.com
  65. 65.  When tooth preparation extends onto the root surface,a ‘V’ shaped gap occurs.This is because the force of polymerization of composite is greater than the initial bond strength of the composite to the dentin of the root. www.indiandentalacademy.com
  66. 66.  Configuration factor or C-factor:It is the ratio of bonded surfaces to the unbonded or free surfaces in a tooth preparation. Higher the C-factor,greater is the potential for bond disruption for polymerization effects. www.indiandentalacademy.com
  67. 67. ADVANTAGES OF COMPOSITERESIN Esthetic Conservation of tooth structure can be achieved. Insulative,has low thermal conductivity. Bonded to tooth structure,resulting in good retention,low microleakage,minimal interfacial staining. Repairable. Used almost universally www.indiandentalacademy.com
  68. 68. DISADVANTAGES OFCOMPOSITE RESIN Polymerization shrinkage Expensive and time consuming Technique sensitive Greater occlusal wear in areas of high occlusal stress. Higher linear coefficient of thermal expansion. Difficult to finish and polish. www.indiandentalacademy.com
  69. 69. CLINICAL TECHNIQUES FORCOMPOSITE RESINRESTORATIONS www.indiandentalacademy.com
  70. 70. Preliminary Steps1) Local Anaesthesia2) Oral Prophylaxis3) Shade selection:Selecting the appropriate shade of the tooth is very critical to achieve optimum esthetics with composites.Certain guidelines should be followed.4) Isolation5) Checking the occlusal contacts www.indiandentalacademy.com
  71. 71. Composite shade guide www.indiandentalacademy.com
  72. 72. General concepts for cavitypreparations Minimal extension Pulpal floor and/or axial walls need not be flat and can be of varying depths Enamel bevel Butt joint on root surfaces Tooth preparation walls must be rough www.indiandentalacademy.com
  73. 73. Designs for composite resinrestorations Conventional Beveled conventional Modified Box only Slot www.indiandentalacademy.com
  74. 74. Conventional cavity preparations These are the typical amalgam cavity designs. Which include:uniform depth,flat floors,butt joint and retention grooves in dentin. Indicated in: -Large Class I and Class II composite restorations. -Cavity preparations on root surfaces(non enamel areas). www.indiandentalacademy.com
  75. 75. Conventional Class I design www.indiandentalacademy.com
  76. 76. Conventional Class II design www.indiandentalacademy.com
  77. 77. Conventional Class III design www.indiandentalacademy.com
  78. 78. Conventional Class IV design www.indiandentalacademy.com
  79. 79. Conventional Class V design www.indiandentalacademy.com
  80. 80. Beveled conventional cavitypreparations Similar to the conventional design but some enamel margins are beveled. The bevel is prepared using a flame-shaped diamond point and the width of the bevel may vary from 0.25-0.5mm Indications: -For replacing an existing old non-adhesive restoration with composite resin. -Class III,IV and V composite restorations www.indiandentalacademy.com
  81. 81. Beveled Conventional Class IIIdesign www.indiandentalacademy.com
  82. 82. Beveled conventional Class IVdesign www.indiandentalacademy.com
  83. 83. Beveled conventional Class Vdesign www.indiandentalacademy.com
  84. 84. Bevel on enamel margin www.indiandentalacademy.com
  85. 85. Modified cavity preparations Here,the cavity preparation appears “scooped- out” without definite internal line angles. The outline form and axial depth is only upto the extent of caries.The walls are divergent. Indications: -Small to moderate carious defects -Traumatic injuries resulting in incisal edge fractures. -Hypoplastic areas in cervical third of the www.indiandentalacademy.com tooth.
  86. 86. Modified Class I design www.indiandentalacademy.com
  87. 87. Modified Class II design www.indiandentalacademy.com
  88. 88. Modified Class III design www.indiandentalacademy.com
  89. 89. Modified Class IV design www.indiandentalacademy.com
  90. 90. Modified Class V design www.indiandentalacademy.com
  91. 91. Box-only cavity preparations This design is employed for proximal caries in posterior teeth(Class II) with no lesions present on the occlusal surface. Preparation is started by cutting through the involved marginal ridge and extending gingivally till the caries is eliminated. The axial depth should be minimal about 0.2mm No bevels or secondary retentive features needed. www.indiandentalacademy.com
  92. 92. Box-only preparation www.indiandentalacademy.com
  93. 93. Slot cavity preparations Indicated for proximal carious lesions that can be directly approached from the facial or lingual aspect rather than the marginal ridge. The occlusal,facial,lingual and gingival cavosurface margins are at 90 degrees. No bevels are necessary. www.indiandentalacademy.com
  94. 94. Slot cavity preparation  Done using a round diamond point bur and the preparation is extended only upto the extent of caries. www.indiandentalacademy.com
  95. 95.  A cross-sectional view showing an intact marginal ridge.www.indiandentalacademy.com
  96. 96. RESTORATIVE TECHNIQUESFOR COMPOSITE RESINS www.indiandentalacademy.com
  97. 97. Replacement of a discoloured anteriorrestoration with composite resin www.indiandentalacademy.com
  98. 98.  First and foremost the area is isolated with a rubber dam.  Then the old restoration is removed,and a reverse bevel is placed followed by  insertion of Light polymerized Glass ionomer liners.www.indiandentalacademy.com
  99. 99.  Dual lights are utilized to accelerate the polymerization process.www.indiandentalacademy.com
  100. 100. Sequence of Steps Acid etching Application of bonding agent and curing Matrix placement Incremental insertion of composite resin Contouring and curing Finishing and polishing www.indiandentalacademy.com
  101. 101. ACID ETCHINGwww.indiandentalacademy.com
  102. 102.  Done with 37% phosphoric acid liquid or gel.  It should be of contrasting colour for easy visualisation.  The gel may be applied using a syringe applicator or a brush.www.indiandentalacademy.com
  103. 103.  Acid etching is done for 15-30secs.  Following this it has to be thoroughly rinsed with a water spray for 5- 15secs.  Later the surface should be dried with air or cotton pellets.  The etched enamel appears frosty white.www.indiandentalacademy.com
  104. 104. BONDING AND CURING www.indiandentalacademy.com
  105. 105.  The bonding agent is applied using a microbrush.  The manufacturer’s instructions are followed regarding the no.of coats to be applied and the curing time.(usually 20secs labially and lingually each)www.indiandentalacademy.com
  106. 106.  It penetrates the irregularities on enamel and bonds micromechanically by formation of resin tags.  On dentin,it penetrates the collagen network and the dentinal tubules.www.indiandentalacademy.com
  107. 107. MATRIX PLACEMENT www.indiandentalacademy.com
  108. 108.  It is better to place the matrix before etching and bonding as it provides good isolation for proper adhesion and helps to assess the soundness of gingival cavosurface margin. For Class III and Class IV cavities,clear polyester strip matrix may be used. It is inserted atleast 1mm past the gingival and incisal margins of the prepared cavity. Wedge is placed to stabilize the band. www.indiandentalacademy.com
  109. 109.  Several matrix systems are available for Class II composite restorations: Tofflemire matrix retainer with ultra thin metal band. Compound supported ultra thin metal matrix. Clear polyester matrix Sectional matrix systems-Palodent contact matrix, Composi-tight matrix systems. www.indiandentalacademy.com
  110. 110. Sectional matrix www.indiandentalacademy.com
  111. 111. Tofflemire matrix retainer andband www.indiandentalacademy.com
  112. 112. INSERTION OF COMPOSITERESIN www.indiandentalacademy.com
  113. 113.  The composite resin is built incrementally using special hand instruments in 1-2mm thickness.This allows the light to properly polymerize the composite and may reduce the effects of polymerization shrinkage,esp.along the gingival floor in Class II restorations.www.indiandentalacademy.com
  114. 114.  An alternative to hand instruments is the injectable syringe.www.indiandentalacademy.com
  115. 115.  The material is contoured before light curing.  The cavity is filled in excess and contoured using the matrix before final curing as recommended by the manufacturer.www.indiandentalacademy.com
  116. 116. Curing  Polymerization for 60secs is carried out both labially and lingually,as each increment of composite resin is applied.  Here,a mylar matrix strip is loosely held to ensure separation and adequate thickness for proper polishing. www.indiandentalacademy.com
  117. 117.  A carbide bur is used to gently remove the excess composite at the mesiolabial line angle.www.indiandentalacademy.com
  118. 118. CONTOURING THE COMPOSITE www.indiandentalacademy.com
  119. 119.  Contouring the composite restoration requires skill and knowledge of correct dental anatomy.  Instruments are chosen based on the area.  Careful visual and tactile assessment of interproximal contours,contacts,andwww.indiandentalacademy.com integrity is marginal necessary.
  120. 120.  As a final step,appropriate occlusal relationship must be developed.www.indiandentalacademy.com
  121. 121.  Occlusal adjustments are made.www.indiandentalacademy.com
  122. 122. FINISHING AND POLISHING www.indiandentalacademy.com
  123. 123.  Finishing refers to the shaping,contouring and smoothening of the restoration.  Polishing is the removal of surface irregularities to make the surface of the restoration absolutely smooth,shiny and lustrous.www.indiandentalacademy.com
  124. 124.  The best finish and polish is provided by allowing the composite resin to polymerize against a clear plastic matrix strip. www.indiandentalacademy.com
  125. 125.  Post-operative view revealing invisible margins and blending of colour to match existing tooth structure.www.indiandentalacademy.com
  126. 126. Systems available for finishing andpolishing of composite restorations 12,16 and 30 fluted carbide finishing burs. Finishing diamonds in various shapes. Flexible discs coated with aluminium oxide coating. Rubber cups impregnated with abrasives. Silicon-carbide impregnated polishing brushes. Metal and plastic finishing strips for hand use. Polishing pastes containing silica,alumina or pumice www.indiandentalacademy.com
  127. 127. Finishing instruments www.indiandentalacademy.com
  128. 128. Composite polishing kit www.indiandentalacademy.com
  129. 129. Guidelines Avoid absolute dry finishing and polishing as it can generate heat which disturbs the marginal seal of composite resins. Use light pressure,slow speed and water cooling. Finish and polish approx.15mins after curing. www.indiandentalacademy.com
  130. 130. ILLUSTRATIONS www.indiandentalacademy.com
  131. 131. Case-1  FRACTURED INCISAL EDGE IN 21 www.indiandentalacademy.com
  132. 132.  ISOLATION AND ACID ETCHING IS DONE.www.indiandentalacademy.com
  133. 133.  BONDING AGENT IS APPLIEDwww.indiandentalacademy.com
  134. 134.  COMPLETED COMPOSITE RESIN BUILD-UPwww.indiandentalacademy.com
  135. 135. Case-2  SEVERE CERVICAL EROSION IN 21 22 23 www.indiandentalacademy.com
  136. 136.  A LABIAL BEVEL IS PLACED WITH A DIAMOND BUR  WHICH ALSO ROUGHENS THE TOOTH SURFACE TO BE COVEREDwww.indiandentalacademy.com
  137. 137.  ACID ETCHING IS DONE AND BONDING AGENT APPLIED,FOLLOWED BY INSERTON OF COMPOSITE AND CURING.  GINGIVAL CONTOUR IS CREATED WITH A CARBIDE BUR.www.indiandentalacademy.com
  138. 138.  BULK OF THE BODY CONTOUR IS CARVED WITH A SPECIALLY DESIGNED INSTRUMENT.www.indiandentalacademy.com
  139. 139.  FINAL POLISHING IS DONE WITH A SERIES OF ABRASIVE POLISHING DISCS,CUPS,POINTS IN SEQUENCE UNTIL THE DESIRED LUSTRE IS ACHIEVED.www.indiandentalacademy.com
  140. 140.  FINAL RESULT SHOWS A GENTLE BLENDING OF COLOUR,FORM AND TEXTURE WITHOUT DISCERNIBLE MARGIN.www.indiandentalacademy.com
  141. 141. RECENT ADVANCES www.indiandentalacademy.com
  142. 142. PACKABLE COMPOSITES Developed in 1980s They were available as PRIMM,fused glass fiber powder with conventional composites. It consists of a resin and ceramic component.The inorganic phase consists of a continuous network or scaffold of ceramic fibers.Their individual diameter being 2microns or smaller. www.indiandentalacademy.com
  143. 143. Characteristics Moisture tolerant Non sticky,easily transferable and packable High shear strength Cures rapidly to final hardness but with minimal residual stress. Examples:SOLITAIRE,ALERT,SUREFIL, FILTEK PGO,PYRAMID,GLAGIER,SYNERGY COMPACT. www.indiandentalacademy.com
  144. 144. COMPOMERS They are resin-ionomer hybrid restorative materials marketed as multipurpose resin that may release fluoride. It contains the major ingredients of both composites(resin) and glass ionomer cements (polyalkenoate acid and glass fillers component) except for water. They have a limited dual setting mechanism www.indiandentalacademy.com
  145. 145. Properties Greater wear than amalgam Less fluoride release than GIC 3% polymerization shrinkage Good radio-opacity Uses:Low stress bearing areas,Luting for prosthesis Examples:DYRACT,COMPOGLASS,F-2000 www.indiandentalacademy.com
  146. 146. INDIRECT COMPOSITES Morman and Touati pioneered the use of composites for fabrication of indirect inlays and onlays. Indications: -Esthetics -Metal free dentistry -Decreased wear of opposing dentition -Conservative tooth preparation www.indiandentalacademy.com
  147. 147.  Contraindications: -Bruxism -Opposing porcelain restoration -Long span FPDs -High caries rate -Difficult moisture control www.indiandentalacademy.com
  148. 148. CEROMERS Itstands for Ceramic Optimized Polymers Composed of specially developed and conditioned fine particle ceramic fillers of sub micron size(0.04-1micron) which are closely packed and embedded in an advanced temperable organic polymer matrix. www.indiandentalacademy.com
  149. 149. Characteristics Durable esthetics High abrasion resistance High stability Ease of final adjustment Effective bond with luting composites Low degree of brittleness Conservation of tooth structure www.indiandentalacademy.com
  150. 150. Uses For veneers,inlay/onlay without a metal framework Can be used with Fiber reinforced composite framework for inlays/onlays,crowns and bridges(3 unit) and for crown and bridges including implant restorations on a metal framework. www.indiandentalacademy.com
  151. 151. FIBER-REINFORCEDCOMPOSITES These are resin based restorations containing fiber for enhancing the physical properties. Also known as polyglass or polymer ceramic. Fibers are bonded to resin via adhesive interface. Fibers improve structural properties by acting as crack stopper. www.indiandentalacademy.com
  152. 152. USES Splinting Restoration of endodontically treated teeth 3 unit bridge work Metal free crowns Examples:CONNECT,DVA,FIBERFLEX, FIBERKOR,GLASSPAN,RIBBOND,VECTRIS www.indiandentalacademy.com
  153. 153. FLOWABLE COMPOSITES Introduced in late 1996 Here,the filler particle size is less thus resulting in low viscosity. Filler content is generally less than 50% by volume,so polymerization shrinkage is greater. The modulus of elasticity is lower than for conventional composites,thus allowing the material to flex and flow. www.indiandentalacademy.com
  154. 154. USES Fillingmaterial in low stress areas Rebuilding worn composite contact areas In areas of difficult access or areas that require greater penetration.Amalgam,composite or crown margin repairs,pit and fissure sealant or preventive resin restoration. As a liner or base in ClassII proximal box For veneers or cementing porcelain veneers. www.indiandentalacademy.com
  155. 155.  Restoration of Class V lesions Porcelain defects,enamel defects,incisal edge repair in anteriors. Class III lesions Examples:AELITEFLOW,FLOW RESTORE www.indiandentalacademy.com
  156. 156. ORMOCERS The acronym of Organically Modified Ceramic,is a brand new material for filling indications in the anterior and posterior area which serve as an optimum and up-to-date replacement for amalgam,composite and compomers. The filler particles are 1-1.5microns in size and the material contains 77% filler by weight. www.indiandentalacademy.com
  157. 157.  The matrix consists of ceramic polysiloxane.Silicon oxide serves as the basic ingredient. www.indiandentalacademy.com
  158. 158. Characteristics Biocompatible Reduced polymerization shrinkage High abrasive resistance Lasting esthetics Anticariogenic properties Fast and safe handling Example:DEFINITE www.indiandentalacademy.com
  159. 159. GIOMERS These are newly introduced hybrid esthetic restorative materials for dental restorative therapy. Giomers employ the use of pre-reacted glass ionomer technology to form a stable material. They are supplied in a one-paste form.They are light polymerizing and require bonding agents for adhesion to tooth structure. www.indiandentalacademy.com
  160. 160. Indications Restoration of root caries Non-carious cervical lesions Class V cavities Deciduous tooth caries www.indiandentalacademy.com
  161. 161. Limitations Giomers are not as beneficial as GICs in patients who are at high risk for recurrent caries. The hardness value is less than composite They exhibit rapid and extensive expansion and should be avoided in tooth preparations that involve thin unsupported enamel. www.indiandentalacademy.com
  162. 162. Advantages Fluoride release Fluoride recharging Biocompatible Clinical stability and durability Excellent esthetics Smooth surface finish Excellent bonding www.indiandentalacademy.com
  163. 163. NANOCOMPOSITES New composites are being developed with nanofillers that range in size 0.005-0.01micron which is below the wavelength of visible light. Non silicate based compositions can be used for nanofillers because they are effectively invisible. www.indiandentalacademy.com
  164. 164. Advantages Superior translucency and esthetic appeal. Excellent colour,high polish and polish retention. Superior hardness,flexural strength and modulus of elasticity. About 50% reduction in polymerization shrinkage. Example:FILTEK SUPREME www.indiandentalacademy.com
  165. 165. CONCLUSION Composite resins satisfy almost all the requirements of an ideal restorative material.Their use has risen greatly in the last two decades and have enabled dentists to implement preventive and minimally invasive techniques.More importantly,patients can retain their teeth longer with a more esthetic appearance,resulting in a healthier and self- confident population. www.indiandentalacademy.com
  166. 166. References Sturdevant’s Philip’s Goldstein Albers Ramya Raghu www.indiandentalacademy.com
  167. 167. THANK YOUwww.indiandentalacademy.com

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