Recent advances in composite dentistry

Dr. A. YOGHA PADHMA
1ST YEAR POSTGRADUATE
DEPT OF CONSERVATIVE DENTISTRY

The aim of the esthetic
and restorative dentistry is to
replace the lost or damaged
structures with artificial
materials that possess
biological, physical and
functional properties similar
to natural teeth.
(Chu and Ahmed, 2003)

Composite resins occupy a
paramount position because they offer
excellent esthetic potential and
acceptable longevity without the need
for extensive sound structure
preparation.
(Dietschi et al., 2006)

DIRECT COMPOSITE RESIN
MATERIALS

INDIRECT COMPOSITE RESIN
MATERIALS

• Amalgam margin repair.
• Class I, II, III, IV and V
• Composite repairs.
• Core build up.
• Crown margin repair.
• Enamel defect repair.
• Incisal edge repair.
• Liners in class I & II
• Preventive resin restorations
• Pit and fissure.
• Porcelain repairs.
I
N
D
I
C
A
T
I
O
N
S

NANO-FILLED FLOWABLE COMPOSITES

 Developed in late 1990 – Posterior
teeth
 Introduced as amalgam derivatives
 Stiff consistency – Packable /
Condensable like amalgam

 Class I restorations
 Class II restorations
INDICATIONS

 Applied in thickness upto 4mm thickness

Filtek Bulfill
Contains two novel methacrylate monomers that in combination
act to lower polymerization stress.
FILTEK
BULKFILL

Cervical area,
including composite
restorations in
gingival colours
V-shaped defects
Exposed cervical
areas
Aesthetic
corrections of the
gingival area,
Primary splinting,
and the correction of
red/white aesthetics
Ability to mask
exposed crown
margins to improve
aesthetics and
patient satisfaction.

 Nanotechnology consists of reducing components of a
material to the nanometric scale for use in a new material to
improve the final characteristics.
 To establish polish of a microfill but the strength and wear
resistance of hybrid composites
 Particles of size  1-100 nm
Swift, J Esth Rest Dent, 2005

 Was introduced to overcome the
limitations and concerns of traditional and
new packable restorative material
 Dr. Herbert Wolters from Fraunhofer
Institute for Silicate Research introduced
this in 1994
Cunha et al., 2003

ORGANICALLY
MODIFIED
CERAMICS
Inorganic-organic co-polymers with
inorganic silanated fillers.
Described as 3-dimensionally cross-linked
copolymers with multi-polymerization with no
residual unreacted monomer
Manufactured by a Sol-Gel Process from Multifunctional Urethane and
thioether(meth)acrylate alkoxy silanes.

• Introduced in 1994.
• An acronym of the words compo site and glass
ionomer.
 Polyacid modified resin composite
 Primarily composite resin-like materials that
contain one or more basic GIC components.

To have a kind of modified composite having the
main advantages of glass ionomer cement.
Compositional modifications
 Certain liquid monomer (HEMA) is modified by polyacrylic acid grafts
 Filler particles similar to the powder of glass ionomer cement
(calcium- fluoro-alumino-silicate- glass)
Drawbacks:
 Using bonding systems still mandatory
 Lower wear resistant < regular composites
 Insignificant release of fluoride

Indications
Sealing
occlusal pits
and fissures Restorations
of primary
teeth
Minimal
cavity
preparations
Lining and
Core build-
up
Repair of
defective
margins in
restorations
Class III,
Class V,
Erosion
lesion -
Restorations
Sealing of
root surface
Potential
root canal
sealers
Retrograde
filing
materials
INDICATIONS

To overcome some drawbacks of compomers
The filler particles are a kind of
pre-polymerized glass ionomer
agglomerates

Restoration of Class I.
II. III. IV, & V
Restoration of cervical
erosion and root caries
Laminate veneers and
core build-up
Ideal for pedodontic
restorations
Other dental
applications  repair of
fractured porcelain and
composite restoration
INDICATIONS

 Smart Composites are 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
49

 Ivoclair introduced a material named Ariston
pHC (pH control).
 Releases Fluoride & Ca Hydroxide when the pH in
restoration in the material is less than 5.5

 Ariston is an ion releasing composite
material, which releases fluoride, hydroxyl
and calcium ions as the pH drops in the
areas immediately adjacent to the restorative
material. This is said to neutralize the acid
and counteract the decalcification of enamel /
dentin.

BIOACTIVE FORMULATIONS
 -ACP (amorphous calcium phosphate)-2000
 -ACP + BIS-GMA /TEGDMA/HEMA with Zirconyl
methacrylate
 Fluorinated Bis-GMA analogues
 Liquid crystalline monomers

Methacryloyl fluoride –
Methyl methacrylate
copolymer in pit and fissure
sealant where fluoride
delivery lasted for 2 years
Diethylaminoethyl
methacrylate into dental resin
system - Fluoride is released
by hydrolysis at a rate of 2-
5µg/cm2/day for 1 year.

 Class I and II posterior restorations (stress
bearing areas)
 Class III and IV anterior restorations
 Class V restorations cervical caries, root erosion,
abfraction, wedge-shaped defects
 Inlays/onlays with extraoral post-tempering
INDICATIONS

 Guggenburger and Weinmann (2000)
 Siloxane + oxiranes
 Siloxane backbone – hydrophobic nature
 Ring opening monomers, cationic cure

As silorane-based
composite polymerizes,
“ring-opening”
monomers connect by
opening, flattening and
extending toward each
other.
As methacrylate-based
composites cure, the
molecules of these
“linear monomers”
connect by actually
SHIFTING closer
together in a linear
response.

The development of minimal-shrink composites
was based on ….
1. INCREASING THE FILLER LOAD
 Using prepolymerized composite fillers
 Using nano-sized fillers (Tetric
Evoceram, Ivoclar-Vivadent)
2. USING ORGANIC MATRICES WITH
LOWER POLYMERIZATION SHRINKAGE
 Spiro-orthocarbonate, can produce
composites with no setting contraction,
 Oxy bis-methacrylates (bifunctional
monomer) shows also a reduced rate of
the polymerization contraction
 Oxirane and silorane-based monomers
(Feltick LS, 3M-ESPE)

 Chitosan and chitosan derivatives appear to be good
candidates for the elastomeric matrix
 These natural biopolymers – Biocompatible,
Biodegradable and Osteoconductive.
 CPC–chitosan composites - Stable in a wet environment
 Have sufficient physical strength

One material – Showed similarities to resin based dental material
If a crack occurs in the epoxy resin material, some of the
microcapsules are destroyed near the the crack & release the resin.
The resin fills the crack & reacts with Grubbs catalyst dispersed in the
epoxy composite resulting in polymerization of resin & repair of crack
P. Benly et al., 2016

Trade name :- vertise flow
First compo bond introduced in
2009 by (Kerr Corp., USA)
Self adhering flowable
combining a resin-based
composite and a SE bonding
agent based on the 7th
generation DBA, OptiBond®All-
in-One
It is a light-cured composite with similar properties to
conventional flowables but with the added advantage of
eliminating the bonding stage.
Self-etching/self-bonding restorative composites

Rationale
 To get restorations with higher mechanical properties
 To reduce the subsequent effect of the polymerization shrinkage
(i.e. weak bonding, microleakage, improper contact)

Chair-side
Start with Light or
chemical-curing inside
the mouth.
Then apply post-curing
heat or light treatment
CAD-CAM
composites
Laboratory
Cured with
heat & pressure
or light & pressure
on a cast
Fiber-reinforced
composites

FIRST GENERATION
Introduced in 1980s as an attempt to decrease the
rate of the polymerization shrinkage and Improve the wear
resistance of the restoration.
MANUFACTURERPRODUCT COMMERCIAL NAME
3M-ESPE1. Visio-gem
Kulzer2. Denta Color
Ivoclar-Vivadent3. Concept
Ivoclar-Vivadent4. Isoset

SECOND GENERATION
Appeared in 1990s and named ceromers, most of
these materials are light-cured over a cast for 60 seconds and
then followed with heat treatment.
MANUFACTURERPRODUCT COMMERCIAL NAME
Heraeus-Kulzer1. Artglass
Kerr2. BelleGlass
Ivoclar-Vivadent3. Targis
3M-ESPE4. Simphony

 Launched in 1995 by Heraeus-kulzer
MATRIX FILLER
Organic resin matrix
[BisGMA / UDMA]
Barium silicate glass
0.7µ

ADVANTAGES
 Wear resistant
 Better marginal adaptation
 Better esthetics
 Superior proximal contact

 Introduced by Belle de St. Claire in 1996
 Resin matrix – BisGMA & fillers
 Belleglass
Polymerized
Esthetically appealing & wear resistant
Pressure – 29psi Reduces the
vaporization potential
of monomers
Temperature – 138ºC Increases the
polymerization rate
Nitrogen – Inert gas Increase in wear
resistance

 Polycarbonate based composite resin
ADVANTAGES
Excellent polishability & esthetics
Long term luster retention
Extremely lower wear less than 1.5µm/year

 Introduced by 3M ESPE
MATRIX FILLER
Polyfunctional
metharylate
polymer
Pyrogenic silica
0.05µ
Visco alpha
halogen lamp source
10sec
Visco beta
Fluorecent lamp
source
15min

MATRIX FILLER
BisGMA TRIMODAL
1. Barium glass – 1µm
2. Spheroidal silica –
0.25µm
3. Colloidal silica –
0.015 to 0.050µm TARGIS gel
TARGIS power
curing unit
Light emmision 10
min+ temp. 95ºC
Cooling 5min
• Also called ceromer (ceramic optimized polymer)
• Contains approximately 77wt% of filler and 23wt% of organic resin.

 Initially used for anterior composite
veneers
 Light vacuum cured composite
 Initial curing – Direct – Visio alpha units
 Final cure & vaccum chamber – Visio
beta units

SINGLE
CRYSTAL
MODIFIED
COMPOSITES

 An experimental indirect composite system has
been recently developed which uses silicon
carbide single crystals as filler component.
 These are silanized and incorporated into the
resin matrix.
 Have symmetric shapes like long plates and
behave like fibers.

• Novel filler technology, using 3 different fillers--prepolymerized
filler, patented Point 4 filler, and 0.02 micron filler.
• Excellent polishability, durability, and strength

 4 part filler system
Unique restorative material with extraordinary handling
properties, cosmetics and long-term performance

 Light-cured submicron filled resin composite
containing 82 wt% , 71 vol% of filler.
 Every inorganic filler – Spherical submicron filler
 Size range: 0.1 um-0.3um
 Outstanding mechanical strength,
Superior esthetics
Strength - Posterior restorations.
 18 different shades available.

Reduced curing time
Excellent stability to ambient light
Maintaining the superior esthetic and physical properties
ESTELITE® SIGMA QUICK
utilizes Tokuyama's patented innovative initiator system

 Composites of the 2nd generation reinforced with fiber substructure
 Good alternative to all and metal-ceramic restorations
- Braid
- Unidirectional- Mesh
- Weave

• Major components: resin matrix and fibers
• Fibers- Ceramic
Glass
Carbon
Alumina
Silicon nitride
- Polymer
KEVLAR (unidirectional)
HDLPE
• Due to translucent appearance of these materials no masking
materials are needed, which allows a thin layer(0.5mm) of
composite to be placed , which is esthetic .

Triaxial Woven Spectra Fibers
Ultra-high Molecular Weight Polyethylene
(Spectra)
RIBBOND
EVER STIK

Journal of Pharmaceutical Sciences & Research
Vol 8 (8), 2016, 881 - 883
International Journal of Recent Advances in Multidisciplinary Research
Vol 03, Issue 06, pp1528-1530, June 2016

NJDSR Volume 1, Number 4, 2016
International journal of Scientific Study
December 2015 Vol 3 Issue 9

CONCLUSION:
There is much room for the improvement and further development
of resin – based dental materials.
New quality of composites can be created if nanotechnology is
used & new developments in material science and biomaterials are
considered in composites in future.
Arrals & Essences of dentistry
Volume 2 Issue 3 July – Sept 2010

“The world hates change, yet it is the only thing
that has brought progress.”
-Charles Kettering

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441.
 Vimal K Sikri; 2009. : (In) Text book of Operative Dentistry. 2nded.
Composites, CBS publications, India 387-426
 Gayathri R menon et al. Recent advancement in Restorative
composite materials. Int J of Recent Advances and Multidisciplinary
research 2016; 03 (06):1528-1530.
 P.Benly. Recent advances in composite-A review. J of
Pharmaceutical Sciences and research 2016;8(8); 881-883.
 Purva. S et al. Smart composite: A review article. NJDSR 2016; 1(4)
: 57-63.
 N.B. Cramer et al . Recent Advances and Developments in
composite Dental Restorative Materials. J Dent Research 2015;
90(4); 402-416
 Robert A.Lowe et al. Advances in Composite Resin Materials.
Inside Dentistry 2015; 2(12)

 Prachi Singh et al. Overwiew and recent advances in composite
resin – A review. Int J of Scientific Study 2015; 3(9); 169-172.
 Zohaib Khurshid et al. Advances in Nanotechnology for
Restorative Dentistry. Materials 2015; 8: 717-731.
 Yousef A. Aljehani et al. Current Trends in Aesthetic Dentistry.
Journal of health 2014;6: 1941-1949.
 Smart materials in dentistry. Journal of Pediatric dentistry 2014
 Robert A.Lowe. Advances in Direct Composite
Restorations.Inside Dentistry 2012; 8(9)
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Review. Arrals and Essences of Dentistry 2010; 2(3): 134-136.
 Yeli M et al. Recent advances in composites resins – A review. J
Oral Res Rev 2010;2: 8-14.
 Leinfelder KF. New developments in resin rstorative systems. J
Am Dent Ass0c 1997; 128: 573-581.

Recent advances in composite dentistry

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