Criteria Used to Select Composite Material

Danielle Wilson

Charli Young

Leslie Clark

DH 276 Restorative Dentistry

February 28, 2017

market so how is anyone supposed to know which material is best? Examples of

these different materials are composite, glass ionomer, modified resin glass

ionomer, fuji, and compomers. Each of these materials is best suited for a

specific restoration, and each has its pros and cons. In order to select a

composite restorative material, one must investigate when each of the above

listed materials would be recommended for a specific type of restoration as well

as comparing different qualities including wear and erosion rates, compression

and flexibility rates, and how readily each accumulates plaque.

To begin, glass ionomers form an ionic bond with the tooth that is

sustainable in the long term. This reaction comes from acids and bases reacting

together, allowing ionic exchange and bioactive interaction between the tooth

and glass ionomer material. Glass ionomer also exhibits anti-microbial

properties, and allows for the long-term release of fluoride from the restoration

and into the tooth. However, when compared with composite material, glass

ionomer has an increased wear rate on occlusal surfaces. This increased wear

rate can be minimized by placing a surface sealant on the exposed surface of the

restoration. (Daniel H. Ward 2010)

Glass ionomer materials exhibit an expansion and contraction rate that is

similar to natural tooth structure, along with less polymerization shrinkage; which

therefore does not put as much stress on tooth structure, making glass ionomer a
good choice for long-term restorations; and a good choice for reducing post-

operative sensitivity in patients. (Daniel H. Ward, 2010)

Next, compomers are marketed as dental materials that combine

characteristics of composites and glass ionomers. Like glass ionomers,

compomers have fluoride-releasing qualities, however, it is a significantly lower

amount than is released by glass ionomers. Compomers also do not bond to

hard tooth tissue, but set by free radical polymerization provided by light curing.

So far, compomers are considered to be an inferior material when compared with

composites or glass ionomers as they have low compression and flexibility rates,

and dont seem to be long lasting as they exhibit a high wear rate.

Research has been done to find out how erosive different composite

materials are when exposed to soda over an extended period of time. A

universal nano-filler Filtek Z550, a posterior composite X-tra fil, two compomers,

a glass ionomer filling material, and a resin-reinforced glass ionomer restorative

being Fuji II LC were all involved in the experiment. (Bors 2014) Each material

was polymerized according to the manufacturer's instructions into plastic rings,

twenty slides of each material and immersed in artificial saliva at 98.6 degrees for

24 hours. After this initial submersion time in artificial saliva, each slide was

placed in coca- cola five times a day for 30 days. A profilometer was used to

measure the surface roughness of each material after this period of time. The

glass ionomer filling material showed the most erosion followed by the resin-

reinforced glass ionomer, Fugi II LC. The next material that showed erosion was

the nano-filler Filtek Z550 followed by X-tra fil and lastly the two compomers.
(Bors 2014) Out of the materials involved in this study, compomers would be the

best choice of restoration if a material is wanted to withstand erosion from acids.

Along with composite materials ability to stand up to erosion, research

has also been done on a composite material's ability to resist discoloration, and

the amount of color stability that the material retains. One huge advantage of

composites are that they are able to match the color of the tooth very well, and in

most cases, are aesthetically indiscernible from natural tooth. This is an

appealing quality from a patient standpoint, as their smile can look as natural as

possible. However, composites must be able to retain this quality in their color

stability. In the article Comparison of color stability of a composite resin in

different color media, color changes in composite was measured by immersion of

a light-cured composite (Filtek Z100, cited as the universal resin composite) in

different staining solutions such as tea and coffee. The composite color was

evaluated after one, seven, and fourteen days of immersion. It was found that

this particular composite was susceptible to color change, and was found to be

visibly perceptible, and therefore clinically unacceptable. Some stain

discoloration was able to be removed, such as stain from tea, however, stain

from coffee was more difficult to remove, and some stain remained when

removal was attempted. This means that patients must be aware of the staining

susceptibility of composite material, as it could be aesthetically compromised.

One thing that this article emphasized was the surface texture of the composite,

a more smooth surface allowed for less staining affinity, while a rough surface

had more affinity for stain. Some of this surface texture can be determined by
placement technique; not only should a composite surface be smoothed so that

there is less chance of biofilm retention, it should be smoothed to decrease

retention of stain as well.

A drawback of dental composites is that they tend to accumulate plaque

and biofilm more than glass ionomers. This is the primary cause for failure in

these restorations. According to an article titled Do Dental Resin Composites

Accumulate More Oral Biofilms and Plaque than Amalgam and Glass Ionomer

Materials, the percentage mutans streptococci of total CFU count in plaque was

higher on composite (mean 13.7) and amalgam (mean 4.3) than on glass-

ionomer (mean 1.1) restorations. (Zhang 2016) Studies are now being done to

create a composite that has protein-repelling strategies to prevent this biofilm

formation.

Each composite restorative material is recommended for a specific type of

restoration. In general, composite is the preferred restorative material for any

filling needing an aesthetic appeal, due to its ability to match tooth color almost

perfectly. Glass ionomers are the material of choice to place in an area that may

need an extra release of fluoride, specifically an area where the risk of secondary

caries is high. (Najeeb 2016) Fuji is used in the event a temporary filling material

is needed, especially for children or the elderly, but can also be used as a

cement. It self-cures, but does not set up as hard as a composite material would.

(GC America Products 2016)

Although there may be benefits to each composite restorative material,

there is generally one that stands out above the rest. The trick to this, is that the
composite restorative material of choice changes depending on the need and the

restoration. Through investigating when composite, glass ionomer, modified

resin glass ionomer, fuji, or compomers would be recommended for a specific

type of restoration as well as comparing different qualities including wear and

erosion rates, compression and flexibility rates, and how readily each

accumulates plaque, a reasonable and logical decision can be made as to which

material is the prime choice. Clinically, patient needs may differ, and it is up to

the dental clinician to determine on a case-by-case basis which composite

material best suits the needs of the patient.

Bor, A., Molnar-Varlam, C., & Szkely, M. (2014). The behaviour of composites,

glass ionomers and compomers in erosive conditions in vitro study.Acta

Medica Marisiensis,60(5). doi:10.2478/amma-2014-0042

Daniel H. Ward, D. (2010, April 1). Glass Ionomers: A Therapeutic Alternative to

Direct Composite Restorations . Retrieved from oralhealthgroup.com:

http://www.oralhealthgroup.com/features/glass-ionomers-a-therapeutic-alterative-

to-direct-composite-restorations/

GC America Products. (2016). Retrieved March 02, 2017, from

http://www.gcamerica.com/products/

Najeeb, S., Khurshid, Z., Zafar, M., Khan, A., Zohaib, S., Mart, J., . . . Rehman, I.

(2016). Modifications in Glass Ionomer Cements: Nano-Sized Fillers and

Bioactive Nanoceramics.International Journal of Molecular Sciences,17(7), 1134.

doi:10.3390/ijms17071134

Zhang, N., Melo, M., Weir, M., Reynolds, M., Bai, Y., & Xu, H. (2016). Do Dental

Resin Composites Accumulate More Oral Biofilms and Plaque than Amalgam

and Glass Ionomer Materials?Materials,9(11), 888. doi:10.3390/ma9110888

Malekipour, M. R., Sharafi, A., Kazemi, S., Khazaei, S., & Shirani, F. (2012).

Comparison of color stability of a composite resin in different color media. Dental

Research Journal, 9(4), 441446.