Recent adv composite/prosthodontic courses

RECENTRECENT
ADVANCES INADVANCES IN
COMPOSITESCOMPOSITES
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

CLASSIFICATONCLASSIFICATON
Monomers for reduced shrinkage/stress
Monomers for enhanced cure& properties
Hydrophobic monomers
Anticariogenic monomers
Bioactive materials
Surface coatings
Direct posterior composites
Indirect posterior composites
Fiber reinforced composites
Nano fillers

MONOMERS FOR REDUCED SHRINKAGEMONOMERS FOR REDUCED SHRINKAGE
Spiro-ortho-carbonates.(1970)
Polyol with oxirane.
Vinylcyclopropanes(VCP)(1997)
Polybutadiene rubber
polymer(1999)
Methacrylated styrene allyl
alchol(mssa)1997

MONOMERS FOR ENCHANCED CURE &MONOMERS FOR ENCHANCED CURE &
PROPERTIESPROPERTIES
30wt%PEG600 DMA.
BPA-mixed with TEGDMA-1999
Benzyl methacrylate and laurayl
methacrylate added to Bis-
Gma/TEGDMA.
Chain transfer agent propanol and
diacetyl added to Bis-GMA/UDMA.
ormocers

HYDROPHOBIC MONOMERSHYDROPHOBIC MONOMERS
Addition of fluorine and phenyl to
central carbon
10 methacryl oxidecyl trimethoxysilane
Phenoxymethyl groups in UDMA

ANTIBACTERIAL MATERIALSANTIBACTERIAL MATERIALS
MDPB
1wt%halo(active against S.mutans and
action viscous for 10 wks).

BIOACTIVE FORMULATIONSBIOACTIVE FORMULATIONS
ACP -(amorphous calcium phosaphate)-
2000
SURFACE COATING
Copolymer of acrylic acid,
alcylmethacrylate and polysiloxane
resist demineralization ,decreases plaque
retention, resist tooth brush abrasion

SPIRO- ORTHOCABONATES(SOC}SPIRO- ORTHOCABONATES(SOC}
expanding monomers
Early soc– not compatible with BisGma
incomplete polymerization
Soc with lower melting point & structural
variation- compatible with
BisGma/TEGMA- less shrinkage
Expansion---3.6%
Soc + epoxy resins react at room temp
by uv light

Prolong curing--- addition of polyol to epoxy
resin , ratio 50: 50/or40:60
(Eick et al 1990)
ADVANTAGESADVANTAGES
Dec polymerization shrinkage
Inc toughness,
Dec water penetration
Bulk placement
Dec post operative sensitivity

(( bb) POLYOL WITH OXIRANE) POLYOL WITH OXIRANE
Cyracure(2002)
Prototype composite of (polyol)& oxirane
monomers (epoxy) with zr silicate fillers
Light cured& cationic initiated
Shrinkage-1% at 60 min
-1.6% at 24 hrs
Contraction stress-1.0mpa,conventional
composite 10mpa
Low shrinkage-expansion of oxirane ring,
opens during polymerization
Higher strength.

Low stress- slower curing rates which
allows stress relaxation.
(c) VINYL CYLOPROPANES(VCPVINYL CYLOPROPANES(VCP)
1997
VCP monomers have been
formulated
Replaces Bis-gma /UDMA resin
Shrinkage is 2/3 of Bis-gma /UDMA
resin.

(D) POLYBUTADIENE RUBBER(D) POLYBUTADIENE RUBBER
POLYMERPOLYMER
1999
20um polymer is absorbed into fumed
silica and added Bis-gma / TEGDMA
Reduces shrinkage by 25%

(f)(f) Methacrylated Styrene Allyl AlcoholMethacrylated Styrene Allyl Alcohol
(MSSA)(MSSA)
1997
It replaced 20% Bis-gma/ TEGDMA with
62 vol% filler.
Reduces shrinkage– by 20%

MONOMERS FOR ENHANCED CUREMONOMERS FOR ENHANCED CURE
AND PROPERTIESAND PROPERTIES
(a) 30wt% PEG 600 DMA-30wt% PEG 600 DMA- copolymer of
poly (ethylene glycol 600) dimethacrylate
with diethyelene glycol dimethacrylate.
Dc-95-100% (better strength& wear
resistance)
(b) BPA-mixed with TEGDMA—BPA-mixed with TEGDMA—
19991999
Poly (isopropyl diphenol)
E.g.-- solitaire

ADVATAGESADVATAGES
Shrinkage reduction– 10-15%
Increase compressive strength
Low water sorption
Decrease wear rate.

(c) Benzyl methacrylate& laurylBenzyl methacrylate& lauryl
methacrylate added to Bis-gma/methacrylate added to Bis-gma/
TEGDMATEGDMA
high degree of cure due to decreased
viscosity
(D) CHAIN TRANSFER AGENTSCHAIN TRANSFER AGENTS
PROPANALOL AND DIACETYL ADDEDPROPANALOL AND DIACETYL ADDED
TO BIS-GMA/ TEGDMATO BIS-GMA/ TEGDMA
((E) ORMOCERS—EX DEFINITE) ORMOCERS—EX DEFINITE

HYDROPHOBIC MONOMERSHYDROPHOBIC MONOMERS
ADDITION OF FLUORINE AND PHENYLADDITION OF FLUORINE AND PHENYL
TO CENTRAL CARBONTO CENTRAL CARBON
Adv– decreases water sorption due to 10%
Bis-gma
((B) PHENOXYMETHYL GR IN UDMA) PHENOXYMETHYL GR IN UDMA
10- 30% reduction in water sorption

FLOWABLE COMPOSITESFLOWABLE COMPOSITES
Modification of hybrid & SPF
Reduce filler content
Consistency, good flow
Spread uniformly
Intimately adapted to cavity

DISADVANTAGESDISADVANTAGES
Low elastic modulii ,more polymerization
shrinkage-inc filler content
More susceptible to wear
Difficult to manipulate- stickiness.
INDICATIONINDICATION
aa To repair old composites, amalgam, crown margins
b)b) Class 2 ,access difficult
c) Cl-1 gingival areas
d) Fissure sealants
e) Class v lesions
F) Porcelain repairs
G) Resurfacing worn composites

DIRECT POSTERIOR COMPOSITESDIRECT POSTERIOR COMPOSITES
PACK ABLE COMPOSITES(1990)
Elongated fibers, fibrous filler particles
Size-100um in length, textured surface
interlock and resist flow.
Uncured resin is stiff and resistant to
slumping ,yet moldable under forces of
amalgam condensing instruments
Similar to amalgam ,placement tech.

PRIMMPRIMM
Dr .lars Ehrnford ,sweeden
Polymer Rigid Inorganic Matrix Material
Consist of resin& ceramic
Filler-continuous network of ceramic
Fibers-Al2o3,sio2
Diameter->2.0 um
Crossection—15.0- 20.0 um
Silanization— BisGma/ UDMA
Colloidal silica ultrafine particles were in
corporated to control handling chracterstics
Viscosity, resistance to flow, condensibility, reduce
stickness. www.indiandentalacademy.com

PROPERTIESPROPERTIES
increased flexure strength. greater
incorporation of ceramic fibers
Increased resistance to wear high conc
of ceramic fibers, wear more than
enamel(5um)
Higher depth of cure- 6mm, QTH
Reduced polymerization shrinkage —
greater ceramic fibers, Silanization of
ceramic surfaces so the resin does not pull
away from surface of fibers
Non-sticky

Better marginal adaptation
Lower potential for incorporation of micro
porosities
Lesser polymerization shrinkage (localized
within ceramic chamber)
Optimum mechanical characteristics,
flexure strength, modulus of elasticity,coff-
thermal expansion
Greater wear resistance.

Eg–
Solitare (kulzer)
Alert (jeneric/ pentron)
Surefil (dentsply)
Filtek P60(3m)

ANTIBACTERIAL COMPOSITEANTIBACTERIAL COMPOSITE
Chlorhexidene was tried– no uniform
release unsuccessful.
Toxic effect on released material.Toxic effect on released material.
Population shift of microorganism.Population shift of microorganism.
Short lived antibacterial activityShort lived antibacterial activity
Deterioration of physical & mechanialDeterioration of physical & mechanial
properties of materialproperties of material

IMTIAZO ET AL(1994)IMTIAZO ET AL(1994)
Synthesized monomers
MDPB (Methacryloxydecyl pyridinium
bromide)
Quaternary ammonia compound
Chemically bound to resin matrix.
Antibacterial effect was seen after long
term immersion in water
No adverse effect mechanical properties of
BisGma
Effect on streptococci.www.indiandentalacademy.com

SILVER
Ag ions organic oxide sio2
Hydro thermally supported into space
b/w crystal lattice network of filler
particles.
Supported in silica gel and thin film
were coated over surface composites
Direct contact with bacteria.
Oligodynamic action

No adverse effect on mechanical
properties, strength.
Color stability
Good depth of cure
Do not disturb polymer network
When silica gel,as carrieer of ag ionswater
sorptionadverse effect on mechanical
properties

INDIRECT POSTERIOR COMPOSITESINDIRECT POSTERIOR COMPOSITES
Indirect composites inlays & onlays reduce
wear & leakage
Art glass
Bell glass hp
Clearfil CR inlay
Coltene inlay system
Cristobal
Sculpture
Targis
True vitality
Visio gem

ART GLASSART GLASS
Polyglass
Improved resin & filler technology
Higher levels of cross-linking
COMPOSITIONCOMPOSITION
Multifunctional methacrylates
Bifunctional monomers
filler--20% silica, Ba glass (mean particle
size-0.7mm)
Microglass filler

Emisssion range-320-500nm, xeno
stroboscopic light
Silica-reduces slumping, improve sculpt
ability
indicationindication
Metal & non metal crowns
FPD
Inlays, onlays, veeners
Repair introrally-artglass liquid& charisma
light cured composite resin

More wear resistance than conventional
light cured composites (i.e/yr 3-4um/1 yr)
Good marginal adaptation
Esthetics
Proximal contact and contour

BELL GLASS HPBELL GLASS HP
Belle de. St .clair 1996
Resin marix- bis gma& fillers
Dual cure indirect polymer ceramic
Low wear, high strength .
Physical properties-strength of porcelain
Avg wear rate-1.2-1.5 um/yr
Cure rate 98.5%,fiber optic light, heat level
140ºc, 60lb pressure in nitrogen
environment.

Elevated temp-inc polymerization rate
Inc atmospheric pressure dec
monomer vaporization
Nitrogen gas oxygen free environment-
inc polymerization-inc translucency
Why oxygen is not usedWhy oxygen is not used
1. Interferes with curing process
2. Reduce translucency
3. Entrapment in resin mass-inhibit
polymerization inhibit max curing
potential-dec wear resistance

INDICATIONSINDICATIONS
Inlays
Onlays
Anterior veneers
Implants
Full coverage crowns
Metal free partial dentures
Long term provisional restorations
splints

CLEARFIL CR INLAYCLEARFIL CR INLAY
kurary
Hybrid composite
Processed in CRC-100 curing oven
inlay bonded with CR inlay cement, dual
cured luting composite resin inlay.
Light irradiation 40s- sets cement, stabilize
inlay, chemical cure-beneath restoration
ensures save bond
Repaired intra orally- clear field posterior
light cured composite resin.

COLTENE INLAY SYSTEMCOLTENE INLAY SYSTEM
Direct & indirect application.
Fabricated directly in the tooth& placed in
special oven ,heat -120°c& light -7min and
cooled- 1min
Brilliant dentin( hybrid resin composite)
Repaired intra orally- brilliant light cure
composite resin.

CRISTOBALCRISTOBAL
Patented bioglass polymer materialPatented bioglass polymer material
COMPOSITIONCOMPOSITION
Metal primer
Adhesive liquid
Intense color liquid
Opaquer liquid(12 shades)
Opaquer powder(20 shades)
Modeling liquid
Oxygen barrier
Dentin opaque core(19 shades))

Dentin core(17 shades)
Incisal core(16 shades)
Transparent core(4 shades)
Opalescent core(4 shades)
Gingival core(1 shade)
Barium glass-74.2%
Particle size-0.7um,matrix is bis Gma,
TEGDMA,UDMA
Very low polymerization shrinkage(0.12
after 24 hr)
Low wear rate(>5um/yr)
High compressive strengths.

SCULPTURESCULPTURE
Polymeric ceramic
Very low water sorption
High wear resistance
High fracture toughness
Low polymerization shrinkage
Truly challenge esthetics of porcelain, user
friendly handling, excellent marginal
integrity, polishability

Polymerization-cure-lite plus /hands free
spectralite
Surface glazed-light curing in pressure
vessel under nitrogen atmosphere
Final curing –heat curing under vacuum-
raise mechanical prop, virtually eliminate
residual monomers.

TARGISTARGIS
Ivoclar,AG
Ceromer (ceramic –optimized polymer)
Provided –base, dentin and incisal shades
Processed-heat& light oven for ideal
polymerization (targis powder)

Inlays
On lays
Veneers
Single & multiple units of metal free
restorations

TRUE VITALITYTRUE VITALITY
Den Mat inc
Hybrid composite resin
Three curing modes- heat cure, self, light
curing
Wear rate less than that of amalgam
High compressive strength, tensile, flexural
strength
3mm depth of cure, low water sorption
Radiopaque,vita lumin shades
Simple direct restoration to inlays,
onlays,FPD, laminate veneerswww.indiandentalacademy.com

VISIO- GEMVISIO- GEM
ESPE Dental AG
Light vacuum cured micro filled composite
designed for laboratory fabrication over the
metal substructures for crown & FPD
Initial curing- direct visible light source
(visio alpha units)
Final cure-light & vacuum chamber (visio
beta unit)
Vacuum completes curing of oxygen –
inhibited layer & results in greater color
stability, enhanced physical properties.

FIBER REINFORCED COMPOSITESFIBER REINFORCED COMPOSITES
Resin based restorations containing fibers,
enhancing their physical properties.
Gr is hetrogeneous, depending on nature
of fibers, geometrical arrangement of fibers
and overlying resin used.
Fibers are bonded to resin via adhesive
interface
Fibers improved structural properties,
acting as crack stopper.

CLINICAL APPLICATIONSCLINICAL APPLICATIONS
Reinforced resin based composites.
Individual restorations (inlay, onlay, full
veneer crown).
Periodontal splinting/ post trauma splint.
Immediate replacement trasitional-long
term provisional bridges.
Fixed bridges-ant & posterior,
1. Simple cantilever
2. Implant supported
Reinforcing or repairing dentures.
Fixed orthodontic retainers.

ADVATAGESADVATAGES
Single visit immediate treatment
Suitable for transitional& long term
replacement.
Suitable for young pt
Metal free restoration
Improved esthetics
Easy to make
Can be frequently used with minimal or no
tooth preparation
Less wear of opposing tooth as compared
to traditional compositeswww.indiandentalacademy.com

Suitable for transitional and long term
provisional restorations.
Readily repaired.
Potential wear of overlying veneering
composite—pt with parafunctional habits
Excellent moisture control required– for
adhesive technique
Space requirement greater in comparison
to metal occlusal surfaces to allow
sufficient room for fibers & adequate bulk
for veenerin composite onlay

May lack sufficient rigidity for long span
bridges.
Uncertain longevity in comparison to
traditional technique.

NANOFILLERSNANOFILLERS
Size-0.005-0.01um
Below wavelength of visible light(0.02-
0.2um)
Do not produce scattering or significant
absorption.
Nanosilicate bonded composite can be
used for
1. Effectively invisible.
2. Do not tend to agglomerate in chains like
silica- based fillers.

Nanofillers fit between several polymer
chains high filler loading.
Eg- filtek supreme(3M ESPE)
New RBC-nanomer, nanocluster filler
particles, strength of hybrid and polish of
micro fill.
Nanomer – discrete, non-agglomerated
nanosized particles.
Nanoclusters- loosely bound agglomerates
of particle size 20-75 um.

ORMOCERSORMOCERS
Organically modified ceramic.
Developed by fraunhofer institute for
silicate research, wurzburg, in co-operation
with partners from dental industry
Introduced in 1998
Classification
Inorganic polymer
Organic polymer
Three structural segments chracterze the
monomeric molecular perstages

1. The inorganic condensing molecule
segment is used to build inorganic
network . An inorganic si-o-si network is
derived through targeted hydrolysis and
in organic polycondensation in a sol-gel
process.
2. The organically polymerizing molecular
segment has (meth) acryl ate gr, which
form an additional cross linked network
matrix after induction of a radical based
polymerization.

3. The inorganic polycondensation with
organic polymerization result in formation
of as inorganic- organic co polymer.
SMART COMPOSITESSMART COMPOSITES
1998
releases f, OH, Ca ions as ph drops in
area immediately adjacent to the
restorative material due to plaque
increase in release functional ions.
Smart composites—alkaline glass fibers
decreases in secondary caries at margins
of restoration

Paste consist of Ba, Al and silicate glass
fillers(1um) with yttrium fluoride, calcium
silicate glass(1.6 um) in dimetharylate
monomers.
80% wt,60% vol.
Use of adhesive is not recommended.
Dentin should be sealed to decreases the
sensitivity. fluoride release from this
material is lower than conventional GIC,
but more than composites.

GIOMERSGIOMERS
Hybrid of GIC& composites.
Prop of GIC (fluoride release, flouride
recharge) resin based materials (esthetics,
strength and biocompatibility).
Pre reacted glass ionomer particles,
fluorosilicate glass react with polyacrylic
acid prior incorporation in resin.
Similar to compomer and resin –based
materials, visible light cured, require use of
bonding agent eg- beautifil(shofu),

Class v
Cervical erosion
Root caries

SILORANES(DM-2005)SILORANES(DM-2005)
Combination of siloxane+ oxiraneCombination of siloxane+ oxirane
Hydrophobic in natureHydrophobic in nature
Network – generated by cationic ringNetwork – generated by cationic ring
opening, polymerization of cyloaliphaticopening, polymerization of cyloaliphatic
oxiraneoxirane low shrinkage,declow shrinkage,dec
polymerization stress.polymerization stress.
INITIATING SYSTEM-3 componentsINITIATING SYSTEM-3 components
CamphroquinoneCamphroquinone- match emission spectra.- match emission spectra.
An iodonium salt-An iodonium salt-
An electron donor-An electron donor-

Filler-quartz—0.5 um
Silane layer– prevent attack of acidic
si-oH gr of quartz,-prevents
undesired initiation of cationic
polymerization.
Optimal balance b/w high
polymerization rn& best light intensity
Volumetric shrinkage—0.94% at 60 s
Low stress buildup

High reactivity
Higest ambient light stability

REFERENCESREFERENCES
Recent advances in restorative dental materials–
Dr .NAGESWAR RAO(PROF& H.O.D), Dr CAROL
SEQUEIRA
Jada-1997& 98
J am dent asso 132(5); 639-645,2001
Text book of operative dentistry- Vimal .k .Sikri
Dental materials(2005),21,68-74
Dental materials(2002).18,413-421
Journal of esthetic dentistry (2000)12,216-226
J Am dent asso(1990),20;177
J am dent asso 106;634, 1983
J am dent asso 20;177,1990
J am dent asso 134(12);1581-9 2003www.indiandentalacademy.com

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