Done By : Vayan Khalid

Edited By : Vayan Khalid

Lect. Date : 5-11-2017

Doctor : Hanan Al-Zraikat

Period : final

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#2.1 30
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 Restorative Composite Resins
(tooth colored restorative material )

Resin composite :
- Very popular mainly due to their excellent esthetic appearance.
- Resin composite is a product which consist of at least 2 distinct phases or components ,
they are blending together so that they have a structure much better and stronger with
better properties than each component on its own.
- We combine different materials when we want to establish a new material , the mixture
has better properties than each component alone .

Components of composite:

Main component :
-resin matrix that make the material easier to manipulate and shape .
-inorganic filler particle that add :
-strength
-hardness
-lower CTE : decrease polymerization & shrinkage
-rigidity
So they improve mechanical & chemical properties of material .

- Silane coupling agent (difunctional > mean they have 2 side chain one of them connect
to the resin matrix & the other one connected to the filler so they are all acting as one
component , this help to maintain good shape & color , distribute any stress or force on
the material rather than the force that concentrated on a certain component , so the
function of this chemical component is to bind filler to the resin matrix .

uses of composite :

-This is an example for the use of

composite .
-A fractured angle of upper incisor
that has been restored with an
appropriate shades of resin composite
material.
-before composite was placed , the
tooth surface was itched first then a
bonding agent with primer was
applied then the composite was
added .

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 1-Composite used as Replacement to
amalgam > one of the main reason is
esthetic reason because of the shades and
color , another reason related to a more
conservative preparation associated with
composite , so we don’t need to establish
occlusal convergent of the wall & we don’t
need to overcut .

2-Composite used to re-shaped & re-

contouring teeth for esthetic purposes
such as this peg shaped lateral that re-
contoured by composite for esthetic
demand .

3- maybe used for cosmetic demand

4- but the mean reason for uses of

composite is out of necessity
Do you have carious lesion ? this carious
lesion need to be cleaned up & restore
the lost tooth structure with a restorative
material which is composite , like this
picture we have class 5 cavity , cervical
carious lesion that have been restored by
composite

Main component of composite (major )

1- Resin monomers (oligomers )

There are many types of resin incorporated into composite , we don’t have only single
type , the material will become less viscosity and easy to manipulate

- Bisphenol a glycidyl methacrylate (Bis – GMA )>> major resin

Not use on its own because its highly viscous & difficult to manipulate when mixed to the
filler so they need to diluent , that’s why they added another component to make it more
fluaible which is TEGMA.

-urethane dimethacrylate (UEDMA)

has good fluability so it can be used on its own

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2-Resin matrix diluent
-Monomer of lower MW added to reduce the overall viscosity of oligomers (BIS-GMA ) so
the mixture will be more fluaible & easily to manipulate & the filler can be incorporated
easily.

-Example is TEGMA (triethylene glycol dimethacylate )

BIS-GMA monomers
-extremely viscous (large benzene rings)
-viscosity lowered by adding TEGDMA because its :
Freely movable ( so it can lower the viscosity of BIS-GMA )
Increase and enhance the polymerization process
Increase cross linking to enhance strength and improve mechanical properties
Increase shrinkage (disadvantage ) because when the polymer is straightened as
polymerization is going on , these straight side chain are going to contract so the whole
resin matrix also contract & shrink a little bit .
*when they try to improve or minimize shrinkage they might try to use a different product
compared to TEGMA

This picture represent marginal gap

formation occur due to polymerization
shrinkage of composite

Curing methods and polymerization

(free radicals polymerization reaction )

-When polymerization start it called addition polymerization reaction , so monomer will be

broken down , the side chain broken down and they connected together to result in long
polymer rigid chain .
-there are many ways for setting or polymerization , the main polymerization reaction is
addition polymerization through the formation of very reactive component which are the
free radicals that released once the reaction start & they are highly reactive & start
breaking the chain of polymer & reconstructing new chain to form a long polymer that’s
why they called it free radicals addition polymerization , the reaction continue until all
monomer have been converted to polymer or free radicals are finished that’s how the
reaction stop >>
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-This can happen in many ways either by 2 component the base and catalyst that need to
be mixed in this case the reaction is called Chemical or self-cure setting reaction or by
light activation.

A)Chemical or self-cure setting reaction

Base : composite and benzoyl peroxide as initiator of reaction ( when the reaction start ,
benzoyl peroxide break down and release free radical that start polymerizing the
monomer )
Catalyst : composite and tertiary amide activator that activate benzoyl peroxide > start
braking it > releasing free radicals >> start polymerization process .
These type of composite available as :
-paste paste
-powder liquid
-capsulated as amalgam (base on one end & catalyst on the other )

One problem in using this 2 phase system that they need to be mix which may lead
to air bubble incorporation

B) Light activation ( commonly used type )

-it’s a single component material (one paste ) , it is got benzoyl peroxide within that phase
but the activation doesn’t occur by tertiary amide compound , light activate the initiator
and reaction .
-we have get a special type of light at a certain wavelength from a special source ( device
called light curing unit ) , when composite subjected to that light it is going to activate the
setting reaction & release free radicals & start polymerization reaction .

-this light has blue color (400-500 nm ) and used to harden the composite , there is no
mixing required , you have got more working time cause the material wont set until
subjected to blue light , the normal light in dental unit or day light will affect the composite

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because blue light is part of spectrum , it won’t set but it will become more viscous & hard
to manipulate , so we take a little bit of composite out of tube & cover it then take a little
bit each time I want to fill the cavity to protect it from the outside light source .

This is an example of curing unit , when turn on the blue

light come out ,
-if you directly look at light it will cause damage & irritation
to the eyes so that’s why there is orange shield adapted to
the unit or there is a shield available that can be held or
glasses .

-orange > because they filter the light and prevent it from
damaging the eyes

-the composite is subjected to blue light & hold it as close as possible to the composite
filling to make sure that we have got a good light intensity that reach the composite &
cause it to cure or set , I wanted to go through the full thickness of the composite within
the cavity to cure it from the top to the bottom .

Factor affect the distance that the light travel :

1-shades & color and thickness of the composite:

Lighter shades will allow the light to go through easily but darker shades will absorb most of
the light as it go through & prevent it from reaching the bottom layer , when we have to fill
a cavity with a darker shades we need to use small amount of composite ( thinner layer ) to
make sure that the light is going to travel all the way from the top to the bottom & cure the
whole layer .

2-location of the composite:

How far the composite is from the curing tip of the device .

3-Intensity of the light :

That’s why in a regular bases this light curing unit need to be check with special device to
make sure that the light intensity is still good .

4- distance between light source & restoration :

Put the curing tip of device close as possible to the cavity preparation so light intensity will
be high enough to cause setting of the composite otherwise the composite will be weak if
not cure properly .

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-This picture shows you the light spectrum > we take part of wavelength between 460-
480nm ( most composite require 470nm) because there is component in composite
sensitive to this light as soon as the composite is subjected to photo initiator this
component called camphorquinone , other type of composite that doesn't have
camphoriquinone won't be sensitive to this light .

-So when you get a composite product you need to check the manufacture instruction that
state the curing time , light intensity , type pf light curing device that is necessary for the
composite .

-Photo initiator activate reaction > release of free radicals > start polymerization

Type of curing device

QTH > one of the first generation of

light curing device LED > we use it for many
reason

C) Dual cure:
-Dual cure supplied as 2 paste system containing both types of initiator & activator .
-Light start the polymerization reaction & the chemical reactions continue in areas were
light can't reach them .
-they can both chemically & light cure , if I had deep class 2 , deep subgingival cavity &
placed first layer of composite on gingival floor(subgingival) & try to subjected to a light but
I'm not 100% sure that the light is going to fully reach this very low layer , this is one of the
application of dual cure , because even the light not activate the setting reaction , after few
minutes it will set on its own cause ii has the capability of chemical reaction ( setting ) , in
situation to ensure proper setting & ensure that the light is enough you can use dual cure
composite.
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Fillers:
-Many types based on silica , quartz , glasses composed of barium , strontium
-Why filler added ?
resin

- Reduce polymerization shrinkage by reducing amount of fillers

(because resin matrix is weak & its responsible for polymerization shrinkage so when
specific amount of filler is added it will reduce the amount of resin present in the
mixture )
- add strength & rigidity to the matrix
- Increase wear resistance
-There are range of sizes of filler & based on sizes there is many types of composite
-Ratio between filler & matrix is different > increase filler but specific amount to have a
mixture easily manipulated or mixed .

Coupling agent:
-Connect resin to filler & act as one unit
-Chemical bond inside coupling agent , it has side chain that can bond to BIS-GMA (resin
polymer ) & other side chain bond to the filler so it bonds these 2 phases together so its bi
or di functional molecule
-It transfer stresses so it will not concentrated on one phase rather than other

-Organosilane (bifunctional molecule) > siloxane end bonds to hydroxyl groups on filler
methacrylate end polymerizes with resin

Inhibitors :
-Prolong shelf life because they prevent spontaneous polymerization from starting by its
own ( …)
- heat
- light

pigments :
-Metal oxide >> provide radiopacity cause I want to be able to see composite on x-ray to
evaluate it & provide different shades to be able to accommodate different shades on
people & choose the suitable one for optimal esthetic appearance .

classification of composite according to the size of fillers

1-macrofilled composites : (not used anymore )

-first generation

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-Size of filler between 10-15 µm & maybe to 17
-Stronger than composite with smaller particles so they use mainly in the post part of the
mouth , they try to enhance the esthetic appearance of this composite by reducing the size
of filler
-Not esthetic cause operator can’t finish & polish them to a smooth surface so color &
shape of it will change due to plaque & stain accumulation.

-They don’t have good abrasion resistance ( poor wear resistance ) > they become rough
very quickly with time.

-High filler loading >> increase strength , 60-80 % filler loading by weight & there is by
volume ( surface area occupied by filler ) & by volume is more relevant & accurate
representation
(60-80 % by weight >> 70% by volume so it occupy large surface area )

2-microfilled composites :-

-30-60% by volume ( occupy large surface area ) so they can’t add greater amount of it .

-Size of filler 40-50 nm> to improve esthetic appearance cause it can be finished & polished
to a very smooth surface & have good abrasion resistance , particles are very well
incorporated into the material & can’t be lost from the surface of the filling with time which
enhances their esthetic appearance
-Not strong as macrofilled so they are suitable for ant. teeth
-Lower physical properties

-Because size of fillers very small , they can't load the composite with a high percentage of
these filler , cause they occupy large surface area , one of the way to modify microfilled
composite & increase loading that they collected a few of these fillers , polymerize them ,
broke them down into slightly larger filler particle & also incorporated them , so the overall
filler component slightly higher but this doesn’t improve strength .

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3-hybrid composite ( ‫) بنستخدمه بالعيادات‬

-Filler weight 75 – 80 %
-Include micro & macro to combine strength & good esthetic appearance ( but not as
microfilled ) so we use it for ant & post teeth that why we call it "all purposes" , they try to
refine the particle even more & modify sizes so they produce small particles hybrid

- We have large particles in between small particles so the overall filler component is high >
increase strength > decrease shrinkage so distribution of particles sizes maximize filler
loading .

-Suitable for class 1 to & multiple available .

All of these types ( macrofilled , microfilled , hybrid ) is for commercial purposes just , there is
slightly difference between them , each product have properties slightly different from the other
''Increase filler loading >> increase strength >> decrease shrinkage '”

Flowable composites
-We decrease amount of filler in order to use composite that has low viscosity , so flowable
composites has low viscosity & lightly filled , it doesn’t has high filler content so I can't use it
for class 1 & 2 cavity , we use them in low stress area .
-Used as preventive material to seal pit & fissure.
-Used as liner underneath regular or conventional or hybrid composite, cause they
minimize stress that result from polymerization shrinkage from overlying composite .
-Good adaptation because its flowable .
-Used for class 5 cavity ( to restore cervical cavity ) >> low stress bearing area.
-Weaker & wear more compared to hybrids

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Packable composite
-I can be packed & condense it in the cavity in similar manner to amalgam
-highly viscous
-heavily filled
-suitable for post teeth as substitute for amalgam
-stiff & strong
-shrink less due to higher filler content

Core build up composite

-Replace lost part of the tooth that later on covered by crowns
-Heavily filled so they are strong
-Have distinct color to distinguish between restoration & teeth .

We build up the tooth then we take impression & make crown to preserve the remaining
structure of the tooth.

Prosperities of composite
1-Biocombatibility :
-Once composite is cured usually it has good biocompatibility , if the surface of composite
finished & polished properly , it will not adversely affect the surrounding soft tissue , if it
isn’t properly cured the component can cause harm especially to the surrounding soft
tissue because resin will be released and cause irritation & toxicity .

-Setting characteristic : different between light cure & cold cure when they polymerize they
release a bit heat so polymerization reaction is slightly exothermic

-Working time & setting time depend on the product , usually setting time doesn’t exceed
5 minute & working time 90 seconds ( time needed to mix & load the composite in the
cavity )

-release of heat due to exothermic reaction between 1-5 degree that’s why in deep cavity it
might be good idea to use liner to protect the pulp from the heat released during setting
reaction
-when you start to apply composite especially in ant part of the mouth you will use
cellulose strip , we apply and adapt it on the final layer of composite then light cure the
composite , this adaptation of strop will prevent the formation of sticky layer after curing is
done , this final sticky layer occur cause there is contact with oxygen (atmosphere) called
oxygen inhibited layer , not important cause it will be removed when finishing & polishing
start.

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2-Light cured composite
-They release heat due to exothermic polymerization reaction but because I force the
setting to occur within seconds the heat will be higher compare to chemical cure material ,
it could release 15 degree cause setting occur quickly .
-Working time is longer so we should protect composite from any light source.

-we call it command set >> I command the setting when I use the light cure device without
it composite wont set or polymerized .

3-increment placement recommended

-light must goes through the whole layer of composite to completely polymerize the whole
thickness of the layer , that’s why there is a maximum thickness for the layer of composite ,
increment of composite shouldn’t exceed 2 mm , if cavity 4-5 mm deep I shouldn’t place
conventional composite in one bulge , I should place it in layers (max 2 mm thick layer ) , if
the shade is darker I can use 1 mm thick layer that help to allow the light to penetrate &
polymerize the whole thickness , when polymerization stare , if I have maximum 2mm thick
layer as polymerization goes on , stress is going to be relieved but if I have a thick layer
mean I have greater bulge of composite with greater chance of shrinkage .

-place the bottom layer horizontally or diagonally

polymerization reaction:

Exothermic ( consider the pulp )

-heat produced by setting from composite & from
curing device(high temperature) >> cold cured
composite ( 1-5 degree ), light cured composite (5-
15 degree )
-so protection of the pulp from extra heat in deep
cavity is essential by using liner or base .

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 Light activation units
1) QTH unit ( conventional)
- It contains halogen light bulb
- Cheap
- Needs cooling device because of filters of the light coming out of unit, they are noisy &
produce a lot of heat so they can overheat.
- Not commonly used , now we have other user friendly alternatives
- Needs filters because light coming from halogen bulb is not
concentrated in the 470nm wave length needed so we need it to
make it confined in this range(to eliminate harmful part of light
spectrum ),also presence of filters means more energy & heat
release.
- Halogen bulb need to be replaced from time to time because Light energy & intensity
deteriorates with time.

2) Other option is LED (Light Emitting Diode)

- Semiconductor (specific metal) passing through it a current
resulting in producing light
- We have many types of it:

a) Monowave : specific range of 470nm

b) Polywaves: on a wider range of wave length , needed when

composite contains photo initiator other than camphorquinone(and TPO(lucirin))
also be cured.
3) Laser(argon laser)

- The problem here is that it is dangerous because of laser so it needs specific regulations
to be able to use them.
- It produces a lot of energy & it is too hot
- Radiation is produced in a narrow wavelength

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4) Plasma arc( xenon bulb)
- Produces very high energy
- Light intensity is very high so curing time will be less, instead of 40s it will be 10s or 15s
but the problem is that it produces very high energy increasing levels of temperature so
it’s not friendly
- Light filtering is required < 400nm or > 500 nm
- Main disadvantage:
- it is still too hot and too risky

Back to LED
- It is the best one
- It has specific light spectrum output
- The design can be either portable or connected to electronic outlet so multiple user
friendly designs are available
- No light bulbs need to be changed but still light intensity should be checked by
radiometers
- Radiometer has a hole in center, on which the tip of curing devise should be placed,
once placed it is turned on then the radiometer will measure the light intensity, if it’s
less than what it should be then device must be replaced.
- Must be checked regularly
- low power consumption,
it doesn’t produce heat & no need for cooling devises which are noisy .

Properties of composite

1) Polymerization shrinkage

- Presence of fillers decrease shrinkage because we decrease amount of resin matrix

which is responsible of shrinkage

- More fillers > decreased resin > decreased shrinkage

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- The type of resin affects the amount of shrinkage, so In Some
new types they are trying to replace tig DNA??? (which is
responsible of shrinkage) with another type of monomers like
Silorane which when it polymerizes doesn’t cause linear
shrinkage so it is called “ low shrinkage composite” , but they
found that other properties like strength & physical properties
are not as good as conventional composite so they stopped making it.

- They tried to play around with light curing units to decrease shrinkage using devises
called “soft start curing units” that subjects the composite to low intensity light first to
start the polymerization reaction, because of low intensity > less shrinkage &
contraction in addition to greater chance for stress to be relieved, then after few
seconds, devise will make a gradual increase in intensity until composite is completely
polymerised.

- 1.5-3% is typical

- As consequence of shrinkage, staining, sensitivity & recurrent caries will take place
because of micro leakage.

Scanning electron microscope showing a gap formation between resin & tooth
structure.
- Factors that help to reduce shrinkage or effect of it like stress after composite sets :
1) C factor or configuration factor

Here we are talking about cavity preparation so it is concerned with configuration of the
cavity.

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- C factor is a ratio between bonded composite to cavity margin & free unbonded
composite. (The ratio of bonded : free area )

- If we have for example, class 4 cavity where we have broken angle of tooth so
composite replacing it is going to be bonded to tooth structure from one side & the
remaining 2 sides are free, so here we have a ratio between bonded & free area of
composite >> called C factor.

- The more the C factor is less (meaning number of bonded surfaces is less than free
surfaces) the lesser the stress caused by polymerization shrinkage on tooth.

- If 4 sides were boded & one is free (this one allows flow & release of stress) then C
factor will be high so more stress & lesser chance of flow & relieve of stress, then stress
will be applied on cavity walls & will cause gap formation or marginal leakage.

- As C factor is low this means that we have chance for flow & relieve of stress.

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