In the name of Allah the most gracious, the most merciful Dental Material Direct placement restorative materials

Esthetic material or white filling are becoming very popular. Used at the anterior part of the mouth where esthetics appearance was the first concern and a light material in the mouth. Direct placement is meant by , the cavity is drilled and the filling is directly placed in the cavity and the patient goes home. There is no need to take impressions , casts or models and send them to the lab. So thats why its (direct). An example of indirect material or indirect placement of a material is crown or bridges, or inlays/onlays. Where you are preparing your tooth or cavity , take an impression , send it to the lab. In the lab they make a cast or a model ,a constructive restoration for you , send it back to you. You cement it or attach it to the teeth whether it is a cavity , crown , bridge , partial/complete denture. So when there is an extra step involving impression material to be made in the lab is referred to as (indirect). Most people now want to replace their old amalgam filling with white fillings due to their esthetic appearance. This is an example where 1. amalgam is to be replaced with composite resin material
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lecture # 3

recontour the tooth (when tooth doesnt look normal) such as peg lateral. They are reshaped and recontoured by adding composite and shaping it

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midline diastema incisors , they can be closed up by using composite until there is contact between them. Some cases it is not possible if the space is too large, both teeth will look too big.

**But mostly we use them out of necessity. There is caries attached to teeth whether it involves labial, lingual, mesial, distal or occlusual surface. It is used as a restorative material. This is the primary reason why we use filling. Class 5 cavity involve the cervical part of the tooth at the labial surface. Class 3 cavity involve the mesial surface or distal surface of anterior teeth class 2 cavity involve mesial or distal surface of posterior teeth

The material is provided in different shades. You can select the shade you need by using a shade guide. Also the shade guide can help you select the shade of porcelain when doing a crown or bridges.

There are several materials termed esthetic materials :

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most popular is composite (or tooth colored material) glass ionomer cement(GIC) but the shade of it is not as good as composite glass ionomer cements been modified called resin modifiedGIC

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modified composite- Compomers

all these materials are tooth colored material meaning they have shades similar to tooth structure. The best is composite.

Composite Is a mixture of many components. Major components are : 1. resin matrix 2. fillers
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agent that connects the resin with the filler

4. pigment to add shade

resin matrix- different types of resins are available. In composite the major resin component are (bisphenol A-glycidylmethacrylate). Main component

1. bis-GMA

2.UDMA 3.Low molecular weight monomers

Fillers- are made up of 1. 2. 3. Silica Quartz Glasses made up of barium

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Strontium

All found in the resin matrix. Now why use fillers ? to improve strength of material, increase wear resistance and minimize shrinkage, if shrinkage occurs it will lead to micro leakage. We do this because composite undergoes polymerization shrinkage so we try to minimize this. Different sizes of fillers are to be added so different types of composites. This is one way to classify the composite according to the fillers. Also there is a certain ratio of fillers to be added to the resin matrix.

Coupling agent- as we said binds the filler to the matrix and reduces wear Pigments- to produce different colors and shades

Macro-filled composite : large amount of fillers added. Size of filler reached up to 100 Micro-filled composite : smaller amount of filler added. Hybrid composite : both small and large fillers used. Providing straight, well resistant and good esthetic surface. Smaller fillers can bind much better to the matrix compared to larger fillers. Thats why mirco fillers have smoother surface. Macro fillers which have larger particles have rough surfaces. Therefore micro fillers are better to be used at the anterior part of the mouth. They can be polished and finished much easier and there surface are much smoother and shiny.

So each type of composite material depending on the size of the filler will affect the property and have different uses, whether in the anterior or posterior part (strength or esthetics)

Polymerization of composite Monomers join together to form polymers which means we need 1. Initiation 2. Activation 3. Propagation 4. Termination Tight chains will connect the monomers together to form a stronger , stiffer material. Before polymerization starts the material is soft like a paste , you can shape it to fill it in your cavity., when you allow it to sit it will polymerize. It can be either chemical cure (mixing two components together paste+paste) or light cure (1 paste and subjecting it to light) the light will start activation and initiation of the reaction. So the type of polymerization depends on the type of material and the way it sits. At the end regardless of which type of sitting reaction we will end up with a polymer formed by monomers joined together. Again, a material can be auto-classified by the way it sits
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Chemical cure (self-cure): a system which needs two components , a base and a catalyst. Mixing them together will allow the

reaction to start. So one component should have the initiator(realease of free radicals) and the other component should have the activator(starting polymerization).

Base: composite and benzoyl peroxide as initiator Catalyst: composite and tertiary amine as activator These two require manual mixing to form a homogenous mix. The reaction will start after one min it will become hard. The problem with this mixing is manual !! you can easily make mistakes and incorporate air bubbles. The air bubble will cause a weak material. So the improvement is to use the light cure method. No mixing is required. One paste is supplied in a syringe. When you place this paste in the cavity you can shape it the way you want. When you want it to sit you subject it to light (blue light with a certain wave length) 400-500nm provided by certain machines. The wavelength used is determined by the components of the composite. They add certain components which are sensitive to certain light so that the material can sit. These materials are Diketone and Organic amines. when subjected to light they start the polymerization reaction. No mixing is required so this will minimize any errors. Even though these are sensitive to blue light , they can be sensitive to normal light (daylight) bacause blue light is part of the whole light spectrum. So if left on the table it will start to sit for a longer period of time. So the composite material should be covered, you take only a small amount you need and using bit by bit still while using it you should cover it.
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Dual cure: it is a combination of chemical and light. When do we use these material??? Lets say you have a very large class 2 cavity.. the gingival floor is very deep. So even if you use light, the light may not reach to the bottom of the cavity and if the material doesnt cure well it will become weak. You need to make sure the light reaches the layer of composite in the deep cavity. If you are not sure the light will reach you have 2 choices : 1. Use chemical cure material
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Dual cure material- it will start sitting when you subject light to it and it will continue to sit chemically.

Classification of composite 1.Macrofilled First generation Filler particle size 10-100 m Difficult to polish Stronger than composites with smaller particle 2.Microfilled Filler particle size 0.04 m in diameter Volume of filler is 35-50% (smaller compared to other composites due to the larger volume of several small particles as opposed to one large particle of the same weight) Lower physical properties but better esthetics.

3.Small-particle composite You cant add large amount of it because the particles have a large surface area even though they are small. Only 50% can be added of the filler so 50% of the matrix is occupied. Particle size 1-5 m Used to be used for posterior restorations but have been replaced by hybrid composite 4.Hybrid Most commonly used now. Mixture of macro and micro fillers (75-80% by weight) Micro hybrid composite: contains 2 particle sizes ,small 0.5-3 m and micro fine fillers 0.04 m. the two different sizes of particles allow to add more of the smaller particles which is to be filled in between the larger particles to produce better properties Hybrids have high polish ability and strength so they can be used for anterior and posterior restorations. Good esthetics 5.Flowable Low-viscosity, light cured Can be lightly filled (40%),or more heavily filled (70%). Usually lightly filled ! Particle size 0.07-1 m Delivered into cavity using a syringe Weaker and wear more compared to hybrids Used for PRR (preventive resin restoration) in very shallow class1 cavities in pits and fissure on occlusual of teeth to explore the staining seen with a hand piece to see if there is a cary Pit and fissure sealing, deep in fissures

 Liners (cushion stress caused by polymerization shrinkage of over lying composite) Class V cavities 6.Pit and fissure sealant Range from no filler to more heavily filled composites similar to flowable composites Low viscosity Preventive material 7.Packable composite Highly viscous Heavily filled condensed just like amalgam Stiff and strong Posterior restorations (as a substitute for amalgam) Shrink less due to higher filler content. The component responsible for shrinkage is resin so the more filler you add the less resin there is so you minimize the shrinkage. 8.Smart composite Combat caries by having the ability to release fluoride, calcium, hydroxyl ions when acidity increases to help in remineralization to fight caries Effectiveness has not yet been proven therefore not commonly used 9.Core build up composite This means you have a badly destroyed tooth. You want to restore it and place a crown on it. If you dont have enough tooth structure to place a crown on it , you need to restore this tooth a little bit with core build composite.

 The best material here is amalgam because its the strongest and the alternative to amalgam is composite Heavily filled Replace lost tooth structure in teeth needing crowns Colored to distinguish then from natural tooth structure Some composites are used as a temporary material to place a crown over it. For example when you want to make a crown you take an impression, send it to the lab and the lab will make a crown for you. So during this time the patient cant go home without a prepared tooth. You need to place something temporary (temporary crown). You will learn this later in the crown and bridge course. Composite Acrylic both can be used for temporary crowns. However, composite can produce better shape, wears less, shrinks less and produces less heat when polymerized. Its is more expensive than acrylic thats why its not used commonly and also brittle. For your information There is a new composite having nano fillers , which are smaller than micro fillers. They say they have a better esthetics appearance and better strength. It is still under research !! Physical properties Biocompatibility Polished composites are tolerated by soft tissue (smooth surface) Bonding agents protect pulp by sealing tubules for sensitivity Strength Larger filler composites are stronger intension and compression

Wear Lower filler content increases wear. Composites wear more than amalgams. Polymerization shrinkage Composite shrink away from cavity walls. They space away from cavity wall which micro leakage can occur. Post operative sensitivity occurs. Minimized by incremental placement by 2 ways : 1. By the manufacturer adding the fillers 2. Adding the composite in the cavity layer by layer. Thermal conductivity Doesnt conduct heat very well. The rate at which it conracts and expands is different from enamel and dentine. This will lead to micro leakage. Elastic modulus depends on the amount of filler. If you increase filler you increase the stiffness of the material Water absorption the more resin you add the more it absorbs water Radiopacity material responsible to be clear (radio pace) are strontium and barium. They are visible on radiograph Quartz is radiolucent. Usually at the anterior part of the mouth , give a better shape. It will not appear on the radiograph.

Best of luck to all !!

Amineh Al-Farraj