in detail about various advances in composite restoration to make it more compatible

1. RECENT ADVANCES IN
COMPOSITES
By sathwik

2. CONTENTS
• Introduction
• Briefly on composites
• Research on advances in composites
• Direct composites
• Packable
• Flow able
• Compomers
• Giomers
• Ormocers

3. Smart composites
Siloranes
Glass inserts
Anti bacterial composites
Chitosan composites
Bio active composites
Flouride releasing composites
Compo bonds
Nano-composites

4. • Indirect composites
• Art glass
• Bell glass HP
• sinfony
• Ceromer
• Fiber-reinforced substructure
• Other important advances
• Future advances

5. INTRODUCTION
• This highly competitive market continues to evolve, with the major emphasis in the past being to produce
materials with adequate strength, and high wear resistance and polishability, retention.
• The more recent research and development efforts have addressed the issue of polymerization shrinkage
and its accompanying stress, which may have a deleterious effect on the composite/tooth interfacial bond.
• Current efforts are focused on the delivery of materials with potentially therapeutic benefits and self-
adhesive properties, the latter leading to truly simplified placement in the mouth.

6. DEFINITION
According to Anusavice
• It may be defined as a compound of two or more distinctly different materials with properties that are
superior or intermediate to those of the individual constituents

7. HISTORY
• 1955: Buonocore – acid etch technique
• 1956: Dr.Bowen formulated Bis GMA
• 1962: Silane coupling agents
• 1970: First photo cured composites using UV light
• 1972: Visible light curing unit was introduced
• 1976: Micro filled composites

8. HISTORY
• Early 1980’s : hybrid composite
• Mid 1980’s: First generation indirect composites
• Early 1990’s: Second generation indirect composites
• 1996: Flowable composites & Ceromer indirect composites
was introduced
• 1997: Packable composites
• 1998: Ormocers was developed
• 2003: Nano filled composites resins
• 2009: self adhesive composites

9. COMPOSITE RESINS
3 structural components – matrix, fillers & coupling agent
Matrix - BIS-GMA, TEGDMA, UDMA
TEGDMA- Diluent monomer , cross- linking
Fillers - ↑ comp strength, tensile strength, stiffness, abrasion resistance, hardness ↓ wear, poly shrinkage,
thermal exp & contr, water sorption
Quartz or glasses, amorphous silica {0.1 – 100 µm},30- 70 vol % or 50 –85% wt
Refractive index:
BIS-GMA – 1.5, TEGDMA – 1.46, Quartz – 1.55

10. • Coupling agent :
• Organosilanes (-methacryloxypropyltrimethoxy silane) It contains Silanol group and methacrylate group
Activator – initiator system:
• Chemically activated resins- Benzoyl peroxide + Tertiary amine
• Visible light activated resins – camphoroquinone(0.2wt%) +DMAEMA(0.15 wt%)(N ,N -dimethylaminoethyl
methacrylate)
Inhibitor – Butylated hydroxytoluene(0.01 wt%)
Optical modifiers – TiO 2, Al 2O3 (0.001 – 0.007 wt %)

11. •shrinkage
•flouride
•Bio compatability
•polishability
•strength
Why

12. POLYMERIZATION INDUCED SHRINKAGE
• Failure in composite restoration
• Several generalized approaches have been attempted
• (i) manipulating the curing protocol and timing to allow for relaxation and flow of the network prior to
gelation
• (ii) altering the amount of shrinkage that occurs through changes in the monomer or functional group
density
• (iii) changing the polymerization mechanism from conventional radical chain-growth polymerization of
methacrylates to alter the network structural evolution.

13. ADVANCES IN CURING PROTOCOL
1. photoinitiation
In this visible-light-activated initiator system, camphorquinone (CQ) absorbs a photon to generate a short-
lived excited-state species that complexes with the tertiary amine to promote a sequential electron and
proton transfer that creates the active α-aminoalkyl-initiating radical.
ethyl-4-dimethylaminobenzoate (EDMAB), including N,N-dimethylaminobenzyl alcohol, 4-
(N,Ndimethylamino)phenethyl alcohol (DMPOH), and N,N-3,5-tetramethylaniline (TMA)
(Schroeder et al., 2007a, b,2008; Schroeder and Vallo, 2007)

14. • naturally occurring 1,3-benzodioxole and its derivatives were evaluated as potential replacements for
conventional amine co-initiators and were found to be effective co-initiators, resulting in kinetics and
polymer properties similar to those of equivalent systems initiated by CQ/EDMAB (Liu et al., 2007; Shi
and Nie, 2007; Shi et al., 2007).

15. 2.ALTERNATIVES TO CAMPHORQUINONE/AMINE SYSTEMS
• Phosphine oxide initiators
• benzoylgermanium derivatives have been synthesized and demonstrated to be efficient visible light
photoinitiators.
• Some commercial formulations have included other photoinitiators, such as PPD (1-phenyl-1,2-propanedione),
Lucirin TPO (monoacylphosphine oxide), and Irgacure 819 (bisacylphosphine oxide), which are less yellow than
CQ and thus potentially more color stable.
• Additional photoinitiators, such as OPPI (p-octyloxyphenyl-phenyl iodonium hexafluoroantimonate) have been
proposed based on encouraging experimental results.
• (Guo et al., 2008
• (Ganster et al., 2008a,b; Moszner et al., 2008b, 2009)
• (Ogunyinka et al., 2007; Schroeder et al., 2007a, b, 2008; Felipe et al., 2008; Schneider et al., 2009

16. 3.SOFT-START CURING
• The soft-start curing method originated with work by (Unterbrink and Muessner, 1994, 1995) (Braga et
al., 2005; Ferracane, 2005)
• Reduced irradiation intensity during the early stages of polymerization is hypothesized to allow stress
relaxation to occur prior to vitrification
• Extensive research has gone into and will continue to be devoted toward evaluating curing conditions and
the subsequent effects on conversion, mechanical properties, and shrinkage stress.

17. ADVANCES IN MONOMER FORMULATIONS
• The resin phase is composed primarily of dimethacrylate monomers typically selected from BisGMA,
BisEMA, and/or UDMA.
• monomers such as these generally result in low methacrylate conversion, which leads to significant
amounts of unreacted monomer that may be leached from the restoration over time, resulting in concerns
regarding long-term biocompatibility.

18. 1.MULTI METHACRYLATES
• Bile acids were utilized as starting materials to form multimethacrylate monomers (Gauthier et al., 2009)
• Polyhedral oligomeric silsesquioxane methacrylates (POSS-MA) were evaluated as alternatives to
BisGMA (Fong et al., 2005), and it was found that small amounts of POSS-MA (2-10 wt%) did indeed
improve the mechanical properties of these resins
• Methacrylated beta-cyclodextrin derivatives have also been evaluated as alternatives to BisGMA and
were found to exhibit flexural strength and volume shrinkage comparable with those of
BisGMA/TEGDMA (Hussain et al., 2005).

19. 2.ULTRARAPID MONOMETHACRYLATES
• Inclusion of monovinyl monomers into dental resins was changed with the development by Decker of a
novel class of monovinyl (meth)acrylate monomers that exhibited greatly enhanced polymerization
kinetics and significantly improved mechanical properties.
• These materials showed great promise when utilized as diluents, and several monomethacrylates were
evaluated as alternatives to TEGDMA (Lu et al., 2005; Kilambi et al., 2009)

20. 3.ACIDIC MONOMERS
• Incorporating acidic monomers in relatively small mole fractions into methacrylate resins may enable a
separate adhesive layer to be eliminated and result in improved overall performance.
• Current acidic resins do not exhibit the necessary mechanical properties to function as resin-based
composites, and hence research has focused on developing acidic monomers with improved mechanical
properties.
• (López-Suevos and Dickens, 2008).

21. NOVEL POLYMERIZATION MECHANISMS
1.POLYMERIZATION-INDUCED PHASE SEPARATION
• In one creative approach, specific methacrylate monomers, chosen to be miscible as liquids but phase-
separated at higher conversions, were incorporated into conventional methacrylate resins and
composites.
• When phase separation occurs, the volume expands, eliminating a portion of the volume shrinkage that
arises from the methacrylate polymerization.
• In particular, the use of dimer-acid-derived dimethacrylate (DADMA) monomers in novel dental resin
formulations is examined as a potential means to address the combined aims of high conversion and low
shrinkage and shrinkage stress.

22. 2.THIOL-ENE PHOTOPOLYMERIZATION
• The thiol-ene polymerization reaction proceed via a step-growth polymerization mechanism in which
propagation and chain transfer alternate (Cramer and Bowman, 2001; Hoyle et al., 2004, 2010; Lu et al.,
2005; Hoyle and Bowman, 2010).
• The step-growth nature of the polymerization results in uniform polymer networks with narrow glass
transition regions and reduced brittleness.
• Also, the gelpoint conversion is significantly higher in thiol-ene networks as compared with methacrylate
networks. and
• hence thiol-ene systems exhibit significant reductions in polymerization shrinkage stress (Carioscia et al.,
2005; Lu et al., 2005; Cramer et al., 2010).

23. 3.HYBRID POLYMERIZATION REACTIONS
• Hybrid polymers are formed from co-monomers with different reactive groups that polymerize via
different curing mechanisms and are often utilized to synergistically achieve desired properties.
• The order of the reactions can be controlled by the selective addition of inhibitors of each polymerization
type or through manipulation of the initiating wavelength-initiator combination.

24. 4.RING-OPENING POLYMERIZATION
• unique shrinkage behavior observed in these polymerizations.
• ring-opening reaction relies on the opening of a cyclic structure to facilitate intermonomer bonding and
crosslinking.
• A recent exciting development in ring-opening polymerization is the commercial release of the
cationically photopolymerizable silorane material (Filtek LS) by 3M/ESPE (Weinmann et al., 2005).

25. FILLER AND FILLER MODIFICATION
• A study on the influence of mono-,bi-, and tri-modal distributions of fillers on the wear properties of
composites showed that filler size and shape significantly influence wear resistance, with the inclusion of
nano-sized filler a critical feature, often leading to enhanced properties (Turssi et al., 2005).
• A method was developed to prepare single-walled carbon nanotubes (SWCNT) with suitable compatibility
and polymerizability such that they could be introduced into dental composites as a secondary filler.
• A good dispersion of the SWCNT in the composite was demonstrated, along with a significant increase in
flexural strength compared with that of the unaltered composite material (Zhang et al., 2008).

26. SILANE TREATMENT OF INORGANIC FILLERS
• Surface modification of most fillers used in dental composites is necessary:
• (a) to reduce the filler surface energy such that composite paste consistency and hydrophilicity are
reduced while filler dispersion within the resin is enhanced; and
• (b) to provide a functional interface that permits covalent attachment between the polymer matrix and
the reinforcing higher-modulus filler.
• methacryloxypropyltrimethoxysilane (MPS) remains the most widely used surface treatment for the
inorganic fillers used in dental composites

28. Packable
• Introduced as amalgam alternatives.
• Supplied:
• Unit-dose, compules or in syringes.
• Higher filler loading:
• Fibers
• Porous filler particles
• Irregular filler particles
• Viscosity modifiers.

29. • Non sticky
• Easily transferable and packable.
• Moisture tolerant
• High critical shear bond strength
• Has excellent visible light depth of cure
• Cures rapidly to final hardness but with minimal residual stress
• Little shrinkage on curing
• Easily carved, burnished (smoothened).

30. Polymeric rigid inorganic
matrix material
• Inorganic phase:
• Continuous network or scaffold of ceramic fibers-
Alumina and silica dioxide fibers.
• Fiber diameter is 2.0 um or smaller.
• Cross-sectional dimension of scaffolding
150-200 um.
• Silanation is completed with addition of
BIS-GMA OR UDMA resin.

31. Advantages :
Produce acceptable class II restorations.
• High depth of cure possible.
Reduced polymerization shrinkage.
As low as 2%.
• Filler loading: > 80% by weight.
• Medium to high strength.
• High stiffness.
• Low wear rate: 3.5 um per year.
• Modulus of elasticity: similar to amalgam
31

32. Disadvantages
• 1. Less polishable.
• 2. Limited shades.
• 3. Increased post- op sensitivity.
• 4.  Sensitivity to ambient light.
32
Recommended uses:
• 1. Class I restorations.
• 2. Class II restorations (2-3
surfaces).

33. PRODUCT MANUFACTURER
Solitaire Heraeus Kulzer
ALERT Jeneric-Pentron
SureFil Dentspl y/Ca u I k
Prodigy Condensable KerdSybron
Filtek P60 3M Dental Products
Pyramid Bisco, Inc.
Glacier Southern Dental Industries
Synergy Compact Coltene-Whaledent
Definite Degussa

34. Solitaire
67% filler volume
Releases fluoride.
34
• 70% filler volume.
• Very good for
proximal Contacts.
80% filler vol Easy to finish and polish
Insensitive to ambient light

35. BulkFill composites
Reduced polymerization
shrinkage-Changes in
filler composition-
shrinkage stress relievers
or polymerization
modulators
Increased depth of
cure-Novel photo
initiators,polymerizati
on boosters or by
increasing
translucency
Ease of flow&
adaptability
Higher strength
& Better wear
resistance
Good esthetic
properties

38. Flowable composites
• Introduced in late 1996
• Similar to resin cements &pit and fissure sealants with filler loading + particles
size less than hybrid composites resulting in a material of low viscosity.
• Filler content less than 50% by vol polymerization shrinkage will be greater
than for more heavily filled materials.
38

39. Advantages
 Low viscosity
 Easy to use
 Improved marginal adaptation
 High wettability
 High depth of cure
 Penetration
 High flexibility
39
Disadvantages
 wear
 poor mechanical properties
More polymerization shrinkage
Sticks to the instrument

40. Artiste® nano-hybrid Flowable composite
40
Exceptional polish ability
Reduce shrinkage
Increase wear resistance

41. ENA HRi flow
No bubbles formulation
• HRi features breakthrough technology - a light refractive index (1.62) that is
identical to natural enamel, with optical properties that can't be found in any other
composite.
• The ENA HRi Flow formulation eliminates air bubbles, resulting in superior physical
properties.
41

42. • An aesthetic gingiva-shaded light-cured composite resin recently
introduced, providing practitioners with the option of correcting
gingival recession with a minimally invasive and less costly
procedure.
• Pink-colored composite  available in one translucent gingival
color and 3 pink flowable opaquers  mixed together to better
match an individual's gingival shade
Gingival masking composites

43. 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.

44. Esthet x flow
• Pseudo plastic handling - flows on command
• Superb strength and wear resistance
• Highly radiopaque
• Low shrinkage & porosity
• 8 VITA shades plus 1 opaque and 1 bleach
shade
• Excellent polish & Fluoride release
44

45. • Low stress applications but not in class I and II in premolars and molars.
• Resurfacing composite or GIC restorations or for rebuilding worn composite
contact areas.
• 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 liner or base in class II proximal box.
• Cementing porcelain veneers.
• Restoration of air abrasion preparation, class v lesions, porcelain repairs, enamel
defects, incisal edge repair in anteriors, class III lesions.
Uses
45

46. • Contains the major ingredients of both composites (resin component) and glass
Ionomer cements (Polyalkenoate acid and glass fillers component) except for water
• Resin component  bulky macro-monomers, such (bisGMA) or UDMA with
viscosity-reducing diluents, such as Triethylene glycol dimethacrylate (TEGDMA).
• Fillers  fluoride containing glasses
Compomers
46

47. Strength and Wear Performance:
GIC – 140 MPa,
composite- 300 MPa,
compomer 200 – 250 Mpa
• Dyract has 3 times the wear rate of a hybrid composite.
47
Fluoride Release :
Dyract shows fluoride release for more that 12 months and maintains the same rate
of diffusion.
It is shown that more fluoride is released in acidic solution

48. Indications
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

49. Advantages:
• Superior working characteristics to RMGIC
• Ease of use
• Easily adapts to the tooth
• Good esthetics
EX: DYRACT Ap, Compo glass F, Compo glass flow, F2000, Hytac

50. • GIOMER is basically a modified GLASS IONOMER.
• It is a true hybrid of two compounds, Glass
Ionomer and Composite
• The properties of GIOMER is fluoride release and fluoride recharging of
glass ionomer and esthetics, easy of polishing, and strength of composite.
Giomers
50

51. COMPOSITION of GIOMER :
• Bisphenol A glycidyl
dimethacrylate&TEGDMA
• Inorganic glass filler-Aluminuoxide, silica
• Pre-reacted glass ionomer filler
• DL-Camphorquinone
51

52. • Reactmer bond is the glass ionomer based, tricurable, all -in-one, filled
adhesive based on PRG technology
52

53. Indications:
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

54. Limitations:
• Giomers are not as beneficial as GIC’s in
patients who are at risk for recurrent
caries
• Long term fluoride release is questionable
• Auj Yap etal (2002) hardness value (VHN)
for Giomer was less than composite
54
Advantages:
• Fluoride release
• Biocompatibility
• Clinical Stability and Durability
• Excellent aesthetics
• Smooth Surface Finish
• Excellent Bonding

56. • Dr. Herbert Wolters from Fraunhofer Institute for Silicate Research introduced
this class of material in 1994
• acronym of Organically Modified Ceramic
• described as 3-dimensionally cross-linked copolymers.
Composition:
Ormocer
56
Silicon oxide, a filler--basic substance
It is modified originally by adding polymerisable side chains in the form of
methacrylate group
Filler 1-1.5 µm in size
material contains 77% filler by weight and 61 % by vol
essential difference between ORMOCER and the previously available
composites is found in the matrix
The matrix, consisting of ceramic polysiloxane (siliconoxygen-chains)
Ormocer was formulated in an attempt to overcome the problems created
by the polymerization shrinkage of conventional composites because the
coefficient of thermal expansion is very similar to natural tooth structure.

57. • 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
Smart composites
57

58. Based on a newly developed alkaline glass filler and is expected
to reduce the formation of secondary caries at the margins of the
restorations due to inhibition of bacterial growth, reduced
demineralization and buffering of acids produced by cariogenic
micro-organisms

59. • Smart composites work is based on the newly developed alkaline glass. The paste
contains Ba, Al, and F silicate glass filler (1m) with Ytterbium trifluoride, silicon
dioxide and alkaline glass (1.6 m) in dimethacrylate monomers
• Ivoclar 1998 named Ariston pHC (pH control) which was claimed to
release:Fluoride
• Hydroxyl Calciumif PH falls in the vicinity of the restoration < 5.8
• This was said to neutralize acid and counter act the decalcification of enamel and
dentine.
59

60. Smart nano composites
• In 2007,Hockin Xu used nanosized(25-100nm)Dicalcium phosphate with reinforcing
nanofillers – Load bearing, decay inhibiting ability
• Nanofillers-Small fibres fused at high temp with Nanoscale silica particles
• This material can buffer tooth against decay caused by acid producing bacteria by
“Smartly” increasing ion release in presence of acids

61. Siloranes
• Guggenburger and Weinmann (2000)
• Siloxane + oxiranes
• Siloxane backbone – hydrophobic nature
• Ring opening monomers, cationic cure

62. 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.

63. Filtek™ P90 low shrink posterior restorative
system
• Combines the lowest-shrinking
silorane-based composite with a
dedicated two-step, self-etching
bonding system.

64. Glass inserts
• An alternative to conventional composites has been developed (Bowen et al, 1991)
known as "Megafilled" composite restorations are produced by filling the bulk of
the cavity preparation with beta-quartz glass inserts.
• The inserts are surrounded by lightcured composite, which bonds to the insert via
a silane coupling agent. The inserts are produced in a variety of shapes and sizes
to fit most cavity preps.
• When fitted into the cavity, they minimize the volume of shrinking composite and
reduce curing contraction (George and Richards, 1993). The integration of inserts
reduces the polymerization shrinkage stress and lowers the overall coefficient of
thermal expansion.
64

65. 65

66. Available insert systems:
Beta quartz: glass ceramic inserts:
• Beta quartz inserts are manufactured of a cast glass ceramic based upon a lithium
aluminium silicate with the addition of iron, sulphur. The surface of inserts is
presilanized. Beta quartz silane liquid is available for the chairside resilanization
of contaminated inserts
66
SDS feldspathic inserts:
• SDS inserts ( Schumacher Dental Systems, Germany) consists of a feldspathic
ceramic with a flexural strength of upto 10-20% greater Other insert systems

67. Ceramic leucite reinforced Ceramic inserts:
• Cerafil inserts consists of a dental ceramic reinforced by leucite crystals. The
cerafil system offers conical, symmetrical ceramic inserts of various sizes with
matching preparation instruments and finishing diamonds.
Sonic Sys leucite-reinforced ceramic inserts:
• Sonic Sys inserts (Vivadent) are made of leucite reinforced glass ceramic. The
Sonic sys inserts allows the finishing preparation and restoration of a non
symmetrical proximal cavity.
Cerena glass ceramic inserts:
• Cerena inserts (Noediska Dental, Sweden) are manufactured of a translucent
glass ceramic material without any addition of color pigments. 67

68. Antibacterial composites
• Chlorhexidine has been tried in an attempt to reduce plaque accumulation on the
surface of filling materials. However, this was not successful since the release
was not uniform and lead to certain disadvantages like:
• -toxic effects of the released materials
• -population shift of microorganisms
• - short-lived antibacterial activity
• -deterioration of physical and mechanical properties of the materials.
68

69. Imazato et al (1994) attempted to make the composite antibacterial by
incorporating a non releasing newly synthesized monomer, MDPB with
antibacterial properties into the composite resin.
Metacryloyloxydodicylpyridinum bromide
MDPB was found to be effective against important species in plaque
formation like actinomyces, Neisseria and veilonella
69

70. • Silver has also been added in the composites to make it antibacterial - ‘oligodynamic
action’
• Silver can be added either:
• Silver ions are incorporated into inorganic oxides like silicon dioxide
• silver ions may be hydrothermally supported into the space between the crystal
lattice network of filler particles.
• Silver ions may be incorporated into the silica gel and the thin films are coated over
the surface of composites.
70
1wt%halo(active against S.mutans and A. viscous for 10 wks).

71. Antibacterial activity of dental composites containing zinc
oxide nanoparticles.
June 2010 in J Biomed Mater Res B appl biomater, 94(1):
22-31.
• It is demonstrated here that zinc oxide nanoparticles (ZnO-NPs) blended at 10%
(w/w) fraction into dental composites display antimicrobial activity and reduce
growth of bacterial biofilms by roughly 80% for a single-species model dental biofilm.
• ZnO-NP-containing composites (10%) qualitatively showed less biofilm after 1-
day-anaerobic growth of a three-species initial colonizer biofilm after being
compared with unmodified composites, but did not significantly reduce growth
after 3 days.

72. Chitosan composites
• Chitosan and chitosan derivatives appear to be good candidates for the
elastomeric matrix. These natural biopolymers are biocompatible ,biodegradable
and osteoconductive. They have been used in surgical interventions for the
reduction of periodontal pockets.
• Biocompatibility , biodegradable, muco adherent
• CPC–chitosan composites are stable in a wet environment and had sufficient
physical strength for many clinical applications. The strength did not decrease
with time under simulated physiological conditions.
72

73. • Bioactive formulations:
• -ACP (amorphous calcium phosphate)-2000
• -ACP + BIS-GMA /TEGDMA/HEMA with Zirconyl methacrylate
• Fluorinated Bis-GMA analogues
• Liquid crystalline monomers
Bioactive composites

74. Amorphous calcium phosphate (ACP)
• Replace missing/decayed tooth structure by remineralization-Antonucci , Skrtic
• Intermediate in hydroxyapatite formation
• Single solid phase precursor
• Biocompatible with hard & soft tissues
• Sustain Ca & PO4 release
• Effective remineralising agent – sealants, adhesives, bases, liners

75. Hydroxyapatite (HAP)
• As a reinforcing filler
• Synthetic HAP- hardness similar to tooth- Improved wear
• Intrinsic radio opacity
• Enhanced polish ability
• Less expensive
• Biocompatible
• High refractive index

76. Flouride releasing composites
• Tanaka et al used methacryloyl fluoride – methyl methacrylate copolymer in
pit and fissure sealant where fluoride delivery lasted for 2 years (MF-MMA).
• Kwan et al used Lewis acid i.e. BF3 and Lewis base i.e. diethylaminoethyl
methacrylate into dental resin system fluoride is released by hydrolysis at a
rate of 2-5µg/cm2/day for 1 year.
• Other experiments are still under progress using – morpholinoethyl
methacrylate hydrofluoride – tetrabutyl ammonium tetrafluoroborate.

77. • Compobonds exploit the benefits of SE DBAs and nanofilled resins, eliminating the
precursory bonding stage necessary to adhere a resin to tooth substrate, and are
termed Self-adhering Composites.
COMPOBONDS

78. 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

79. Preoperative view showing the existing
amalgam restorations which were in need
of replacement.
Amalgam restorations were removed
Vertise (Kerr) flowable composite was
dispensed onto a microbrush in order
to accurately place it into the
conservative preparation
The cleaned-out preparations.
A 37% phosphoric acid etchant (Kerr) was
used on the cavo-surface margin.

80. The completed self-etching, self-
bonding flowable composite
restorations.
Application of the flowable composite
into the preparation.
The restorative material was scrubbed
onto the prepared tooth and then light-
cured for 20 seconds.

81. Fusio™ liquid dentin
• It is a 4-META (4-methacryloxyethyl trimellitic acid) based flowable composite
featuring nano-sized amorphous silica and glass fillers.
81

82. Characteristics and properties of compo bonds
•Acts as a Shock Absorber beneath resin-based composite
restorations.
Incorporates the properties of the 7th generation DBA,
OptiBond®
•1) Chemical adhesion by the phosphate function group of the
GPDM& 4-META monomer uniting with the calcium ions within
the tooth
•2) Micromechanical adhesion by formation of the hybrid layer
composed of resin impregnation with the collagen fibres and the
dentine smear layer.
The bonding mechanism to dentine is two-fold.

83. • Because Compobonds function both as a dentine adhesive and a
resin restorative material, a Longer Curing Time Is Necessary to
ensure that both constituents are fully polymerised.
Light curing
reaction also
halts the etching
process of the SE
agent
Increasing its pH
from
approximately 2
to 7
So that continual
acidity does not
erode the dentine
bond.

85. • Nanotechnology consists of reducing components of a material to the nanometric
scale for use in a new material to improve the final characteristics.
• To estabilish polish of a microfill but the strength and wear resistance of hybrid
composites (Swift, J Esth Rest Dent, 2005).
Nanofilled composites

86. Nanoparticles
• Particles of size  1-100 nm in diameter exhibit unique electronic, optical,
photonic and catalytic properties.
• Display properties intermediate between quantum and bulk material because
of their intermediate size and large surface area-to-volume ratios.
• Nanoparticles of different sizes and shapes exhibit different absorbance and
fluorescence features

87. Advantages of nano fillers
Does not thicken the
resin
Size (0.4-0.8µ).
Enhance the
polishability of resin.
An extreme surface
to volume ratio gives
a high filler loading
in a workable
consistency.
Increased wear
resistance &
hardness.
50% decrease in
polymerisation
shrinkage
Reduced staining

88. • Nano hybrid composites have nanometer sized
particles combined with more conventional filler
technology.
• Nanofilled resins have approximately 60%
volume filler loading, making the Nanofilled
resins as strong as the hybrid and micro hybrid
resins.
• Nanofillers have a refractive index of 1.508.

89. Nanomer
Discrete non-agglomerated and
non-aggregated particles of 20-75
nm
Nanotubes
Nanotubes have remarkable
tensile strength
Nanocluster
Loosely bound agglomerates
of nano-sized particles

90. TRADE NAMES TYPE OF NANO COMPOSITES IMPORTANT POINTS
Tetric EvoFlow NANO-OPTIMIZED FLOWABLE Class V restorations , fissure sealing &
adhesive cementation technique
Filtek supreme XT NANOFILL COMPOSITES •Superior translucency and esthetics
•Superior hardness, flexural strength and
modulus of elasticity.
•50% reduction in polymerization shrinkage.
•Excellent handling properties.

91. TRADE NAMES TYPE OF NANO COMPOSITES IMPORTANT POINTS
Ceram·X™ duo+ Nanohybrid
Double Translucency System
•highly esthetic restorations
•Nano-Ceramic matrix in combination with
the optimized filler particle size
Ceram.X® mono+ Nano hybrid improved handling features; reduced
stickiness and improved slump resistance.
AELITE™ AESTHETIC
ENAMEL
Nano hybrid High strength
Excellent polishability
Easy manipulation and highly sculptable
Low attrition and wear
High flexural strength

92. TRADE NAMES TYPE OF NANO COMPOSITES IMPORTANT POINTS
Filtek™ Z350 Universal
Restorative
NANOHYBRID •Low polymerization shrinkage.
•High wear resistance
•Anterior and posterior restorations, core-
build-ups, splinting and indirect
restorations
Tetric EvoCeram
(Ivoclar Vivadent)
NANOHYBRID
3 types of nanoparticles - fillers,
pigments and modifier.
Anterior and posterior restorations.
Aelite Aesthetic Enamel
Bisco
NANOHYBRID
Filler
70 - 75%
High strength,excellent polish ability
Anterior and posterior restorations.

93. TRIMODAL APPROACH TO NANOTECHNOLOGY
Premise Universal

94. Indirect composite resins
• Three type of composite materials are available for use in indirect
technique,microfilled resins (sr adoro ), small particle resins and hybrid resins.
• New category of processed composite resin recently was introduced-polymer glass,
polymer ceramic and Ceromer
• All show excellent wear resistance & small particle composite resins and hybrid
resins can be etched to produce micromechanical retention
• They can all be silanated to increase bond strength
94

95.  Early 1980s, Mormann and Touati Composite resins for the fabrication of indirect
inlays and onlays
 Mid 1980Touati and Pissis developed the concept of metal composite inlays and
bridges after the silanating technique
 Disadvantages of direct composites:
 Inadequate wear resistance
 High incidence of secondary caries
 Indirect composites:
 Allow improved adaptation of the restoration to the cavity walls – better
marginal integrity, less post operative sensitivity
 Post-cure heat treatment (125° C or 275° F) increases double bond conversion-
better polymerization, better wear resistance
95

96. • Launched in 1995 by Heraeus-kulzer
COMPOSITION
Silica-reduces slumping, improve sculptability, high degree of conversion (multifunctional
monomers)
xenon stroboscopic light ( high cross linking)
Art glass
96
Matrix Filler
Organic resin
matrix
Barium silicate
glass 0.7µ

97. Bell glass HP
Bell de in 1996
The opaceous dentin material of BelleGlass HP
incorporates a specific filler size and particle
distribution that helps to achieve thermal
expansion, flexibility and stress response
characteristics similar to natural dentin.
• polymerized under pressure at elevated
temperature
138ºc rate 20 min & in presence of Nitrogen
, an inert gas. inc. polymerization &wear
resistance.
 Curing method- Light, heat and pressure
 Improved D.C
 Improved translucency
97
Matrix Filler
Base : BisGMA
Surface:
TEGDMA
Base : silanated
microhybrid
filler 0.6µ
Surface:
borosilicate

98. Sinfony
• 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

99. Ceromers:
• The term ceromer stands for Ceramic Optimized Polymer and was introduced by
Ivoclar.
• Composed of specially developed & conditioned fine particle ceramic fillers -
barium glass (< 1 µm), spheroidal mixed oxide, ytterbium trifluoride, and silicon
dioxide (57 vol%) of submicron size ( 0.04 & 1.0 μm ), which are closely packed (
75 – 85 weight %) & embedded in an advanced temperable organic polymer
matrix-dimethacrylate monomers (Bis-GMA and urethane dimethacrylate.
• Setting is by a polymerization of C=C of the methacrylate.
99
Advances in indirect composite resin systems

100. Ceromers combine the advantages of ceramics and composites
• Durable esthetics
• High abrasion resistance
• High stability
• Ease of final adjustment
• Excellent polish ability
• Effective bond with luting composite
• Low degree of brittleness
• Conservation of tooth structure

101. • Ivoclar in 1996
• Provided –base, dentin and
incisal shades
Targis
101
Matrix Filler
BisGMA Ceromer (ceramic –
optimized polymer)
TARGIS gel
TARGIS power
curing unit
Light emmision
10 min+ temp.
95ºC
Cooling 5min

102. Laboratory based, Preimpregnated fiber reinforced
systems
Targis/vectris:
• Highly filled Targis Ceromer (ceramic optimized polymer)
composition, along with Vectris, a fiber reinforcing composite
framework
Consist of 2 major components
1. Targis - forms the bulk of the restoration
2. Vectris - fiber framework.

103. Sculpture/fibrekor:
• Involves veneering a composite resin (Sculpture) to a resin
preimpregnated glass fiber network (Fibrekor)
• Fibers available in 15 cm lengths of various widths.
• Sculpture is polycarbonate based composite resin.
Ribbond:
• It is a cross-linked leno stitch weave of polyethylene fibers.
• Can be used chair side or in laboratory to fabricate composite resin
bridges .

104. Single crystal modified composites
• Have symmetric shapes like long plates and behave like fibers.
• 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.
104

105. 105
fiber reinforced composites
Properties of FRC:
• Geometrical arrangement of fibers
Wave, Braided, Unidirectional, Mesh
• Nature of the fiber
Stresses on the matrix are transmitted to fibers
• Adequate adhesion of the fibers to the polymer matrix-Covalent
bond
Proper adhesion maximizes reinforcement and transfer of stresses
Silane coupling agents – to improve adhesion

106. 106
Forms
• Short staple:
Reduces matrix volume
Improves wear resistance
• Long lengths:
Can improve strength and stiffness
• Woven material:
Also improves strength and stiffness
Assist in forming structure

107. 107
Classification
• Pre- Impregnated Lab Products ( ex: vectris)
• Pre- Impregnated chairside products ( connect – kerr)
• Impregnation required- Chairside ( glaspan)
• Preimpregnated prefabricated posts ( everstick )

108. Advantages
• 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
composites
• Suitable for transitional and long term provisional
restorations.
• Readily repaired.

109. Disadvantages:
• Potential wear of overlying veneering composite—pt with para
functional 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 veneering
composite onlay
• May lack sufficient rigidity for long span bridges.
• Uncertain longevity in comparison to traditional technique.

110. Clinical 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.

111. GC EVEREX posterior:
The short fibres used in everX
Posterior provide a fracture
toughness equal to collagen-
containing dentine and almost
double that of a conventional
composite.
composite restoration in large
preparations.*

113. 113
• They are available as:
• Light cure
• Dual cure
• Self cure
Core build up composites
• Ti-Core EDS
• Core paste Den-Mat
• Build-it J/P
• Bis-core BISCO
• Corestore Kerr
• Fluorocore Caulk
• Clearfil photocure J-Morita

114. 114
Composite splints
• Resins along with the reinforcement of
fibers can also be used as splints for
esthetic purposes.
• These fibers are strong and durable.
• These are applied with flowable or
hybrid composites.
• They are available in different:
• Thickness.
• Breadth.
• Pattern.
System
s
Ribbond Ribbond
Connect Kerr
Splint-it J/P
Glass span Glass Span

115. 115
Root posts
• Resin reinforced with carbon or quartz fibers have been
used to produce black or white root posts with stiffness similar to
that of dentin.
• Fiberglass resin posts – refracts and transmits light to
the luting resin cements even after light curing cycle.

116. Future advances
• Carbon Nanotubes- Applications of carbon nanotubes
reinforcement of composites
• Boron nitride Nanotubes
Addition of small amounts of the carbon nanotube filler to a commercial
composite (Durafill) yielded a material with good dispersion of the SWCNT,
along with a significant increase in flexural strength compared with that of
the unaltered composite material (Zhang et al., 2008).

117. Liquid crystals
• Liquid crystals are structurally
intermediate between liquids and solids
• Transforming from a highly organized
state at room or mouth temperature to
an isotropic amorphous state when
photocured, with sufficient expansion to
offset the contraction that accompanies
the formation of covalent bonds.
• Used as Fillers as well as matrix in
composites.

118. Quantum dot materials
• Quantum dots are a unique
class of semiconductor
particles, ranging from 2-10
nanometers (10-50 atoms) in
diameter.
• The core-shell quantum dots
have unique shells that
stabilize the material, improve
quantum yield and reduce
photo-degradation.

119. Quantum dot composites
• Quantum dots exhibit high fluorescent brightness, stable, long
lasting, and have narrow emissions

120. Self-repairing Composites:
• One of the first self-repairing synthetic materials reported,
interestingly shows some similarities to resin-based dental materials ,
since it is resin based.
• This was an epoxy system which contained resin filled microcapsules. If
a crack occurs in the epoxy composite material, some of the
microcapsules are destroyed near the crack and release the resin.
• The resin subsequently fills the crack and reacts with a Grubbs catalyst
dispersed in the epoxy composite , resulting in a polymerization of the
resin and repair of the crack.

121. Conclusion
• The field of composite dental restoratives continues to propose and
achieve significant and exciting advances in resin formulation, filler
loading and modification, and curing methodologies and
mechanisms.
• While most of the advances remain in the research stage, the future
both in regards to research and in clinical practice remains bright
with exciting new developments translated into practice at an ever-
increasing rate 121

122. • Properties of packable dental composites. J Esthet Dent. 2000;12(4):216-26.
• Dental Ceramics and Ormocer Technology - Navigating the Future!-A.Sivakumar
• Polyacid-modified composite resins (“compomers”) and their use in clinical dentistry-John W. Nicholson∗
• Text book of operative dentistry:Summit
• Text book of operative dentistry:Sturdvent
• Esthetic Dentistry:Ascheim Dale:Second edition
• Text book of operative dentistry-vimal .k .sikri
• Jada-1997
• J am dent asso 132(5); 639-645,2001
122
References

123. • 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
• Dental Materials Volume 20, Issuse 9, Pages 789-795, November 2004
• Journal of Esthetic and Restorative Dentistry Vol 11 issuse 5,pages 234–249, September 1999
• Dental Materials 19 (2003) 449–457
• Fiber-reinforced composites in clinical dentristry: Quintessence Books; 2000.
• JDR:91- 1178-1783-December 2012
123