Review Article International Journal of Dental Materials 2019; 1(2)

Recent Advances in Dental Composites: An Overview

Dara Lavanya1,*, Divya Buchi1, Satyanaryana Raju Mantena2, Madhu Varma K3,
D. Bheemalingeswara Rao2, Vinay Chandrappa4
1
Undergraduate student, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India.
2Professor, Department of Prosthodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra
Pradesh, India.
3Professor, Department of Conservative Dentistry and Endodontics, Vishnu Dental College, Bhimavaram,

Andhra Pradesh, India.

4Professor, Department of Pedodontics and Preventive Dentistry, Vishnu Dental College, Bhimavaram,

Andhra Pradesh, India.

I N F O R M A T I O N A B S T R A C T

Composite resins are widely used aesthetic materials in restorative dentistry.

Article History These materials were introduced to overcome the inherent shortcomings of
amalgam restorative materials. Dental amalgams are unesthetic and toxic.
Received 06 November 2019 Earlier composites lack in mechanical properties to withstand the masticato-
ry forces. Various filler particles have been added to composite resins to im-
Accepted 12 November 2019
prove their physical and mechanical properties. Filled composite resins ex-
Available online
hibit high compressive strength, abrasion resistance, ease of application and
15 November 2019
high translucency. Depending on the filler size and shapes, various compo-
sites have been developed until now. This article is a review of numerous
types of composites that are technologically advanced to modify their proper-
K E Y W O R D S ties.

1. Introduction

Composites The acrylic resin was introduced to the dental profession in the mid-1950’s,
Fillers and it replaced the silicate cement soon from the dentistry as a direct aesthet-
Condensable composites ic restorative material. Since their introduction, acrylic-based materials have
Flowable composites continued to play a significant role in restorative and prosthetic dentistry [1-
Nanocomposites 3]. The advantages of these acrylic resins include tooth-like appearance, ease
Self-adhering composites of manipulation insolubility in oral fluids, and low cost. However, these mate-
Fibre reinforced composites. rials could not accomplish the requirements of restorative materials as they
undergo considerable shrinkage during the polymerization process leading to
marginal leakage. In addition, they were having poor wear resistance, high
water sorption, and a high coefficient of thermal expansion. Quartz powder
was incorporated as a filler to address the inherent drawbacks of the resins.
These fillers occupy the spaces between the polymer chains and improve the
physical and mechanical properties, which are primarily influenced by the
volume fraction of inert fillers [1-5]. However, the early composites were lack
of proper bonding between the polymeric resin and the filler particles. In
1962, Dr L. Bowen invented a new dimethacrylate resin, such as Bisphenol A
Glycidyl methacrylate (Bis-GMA) and an organosilane coupling agent, which
provides a bond between filler particles and the resin matrix [4-6]. This inven-
tion led to the evolution in resin-based direct aesthetic restorative materials.

Correspondence: *Corresponding author Email Address: [email protected]

How to cite this article: Lavnya D, Divya B, Mantena SR, Madhu Varma K, Bheemalingeswara Rao D, Chandrap-
pa V. Recent Advances in Dental Composites: An Overview. Int J Dent Mater 2019;1(2): 48-54.
 International Journal of Dental Materials 2019;1(2): 48 -54

Composite resins are complex, tooth-colored filling 2-micrometre dimensions. Resin is then allowed to
materials that offer excellent esthetic potential and infiltrate into these spaces or chambers. This concept
acceptable longevity without the need for extensive provides a basis for fabricating packable or condensa-
tooth preparation, allowing minimally invasive prepa- ble posterior composite resin resulted in advantages of
ration or sometimes no preparation at all. They repre- better reproduction of occlusal anatomy, better mar-
sent one of many success of modern biomaterial re- ginal adaptation, ease in achieving a good contact point
search. However, the early formulations of these resin [8]. The physical and mechanical behaviour of these
composite materials had numerous drawbacks such as materials is better than that of hybrid-composites and
poor handling characteristics and polymerization similar to that of silver amalgam [9]. However, the clin-
shrinkage. To address this, various types of filler parti- ical performance of these materials is identical to that
cles with different volume fractions have experiment- of the hybrid composites [5,10,11]. Condensable com-
ed with the resins. This led to the development of ma- posites are indicated in class II cavities.
co-filled, small-filled, micro-filled and hybrid compo-
sites [4]. Although, these materials showed better im- 2.2 Indirect composite resins
provements compared to earlier versions but not up
to the standard. The quest of researchers on improv- The indirect composites such as inlay and onlay sys-
ing its properties led to the development of newer tems were developed to address the major clinical
versions of composite resins. Therefore, this review problems associated with the direct posterior compo-
focused on discussing various composite resin materi- site resins. The first generation indirect composite res-
als developed in recent years. ins were introduced in the 1980s by Touti and Mor-
mann. Indirect composite resin restorations exhibit
superior marginal adaptation, contour, and proximal
2. Recent advances in composites
contact as it is fabricated on a die rather than directly
in the cavity preparation [4,8]. The number of highly
2.1 Condensable composites or packable improved indirect resin restorative systems have been
composites or polymer rigid Inorganic ma- introduced with unusually good properties like wear
trix material (PRIMM) resistance, esthetics, control over polymerization
shrinkage, and marginal adaptation [4].
These are one of the new advancements in posterior
composites, developed by Dr Lars Ehrnford of Sweden 2.3 Organically modified ceramic oligomers
in 1995. This system is composed of a resin matrix (ORMOCER)
and an inorganic ceramic component. Unlike in con-
ventional composites; in this system, the resin is in- ORMOCER is an acronym for organically modified ce-
corporated into the fibrous ceramic filler network ra- ramics. They are considered to be molecule-sized hy-
ther than including the filler particles into the compo- brid structures consisting of inorganic, organic copoly-
site resin matrix. The filler mainly consists of Alumini- mers. Organic reactive monomers are bound to inor-
um oxide, Silicon oxide glass particles or barium alu- ganic –si-o-si- network. These molecular hybrids con-
minium silicate or strontium glasses. Further, colloidal sist of, for example, methacrylate-terminated chains
silica ultrafine particles are also incorporated to con- grafted on to a central cyclic polysilioxane 2-3nm par-
trol the handling characteristics such as viscosity, re- ticles. These nanoparticles are dispersed on a molecu-
sistance to flow, condensability and reduced stickiness lar scale [2, 12]. These are high molecular weight, flexi-
[7]. ble, relatively low viscosity crosslinking molecules.
The large spacing between crosslinks resulting from
The glass particles are liquified to a molten state, and curing produces a low-level polymerization shrinkage,
it is forced through a die to form thin strands of glass while the inorganic network provides abrasion re-
fibers with a diameter of approximately 2-3 microme- sistance through its glass-like structure and low water
tres. These glass fibers are then reheated to an ade- sorption due to its hydrophobicity [2,12,13].
quate temperature after pulverizing them into small
space particles. This results in the superficial fusion of Because of their unique composition, ORMOCER-based
glass fibers at selected sites (silanation) and forms a dental materials offer characteristic advantages in
continuous network of small chambers or cavities with comparison to conventional composites. They include;
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 International Journal of Dental Materials 2019;1(2): 48 -54

limited cure shrinkage, very high biocompatibility, tooth surface better and flows easily into the every
good manipulation properties, and excellent esthetics. undercuts and also forms in thin layers reducing the
These materials are indicated for class-I to V cavities, formation of air pockets at the tooth-restoration inter-
veneering of discoloured anteriors, repair of veneers, face [16, 20]. In addition, flowable composites exhibit
core build-up, orthodontic bonding adhesive, indirect superior chemical curing properties compared to the
inlays, and reconstruction of traumatically affected conventional composites.this is because of their lower
anteriors [2,12]. filler loading which would decrease the light scattering
through material and provide a better degree of con-
2.4 Fiber Reinforced Composites (FRC) version depth. Further, these materials contain a ger-
manium based photoinitiator which is more effective
Fiber reinforcement has further increased the poten- and has a much higher significant yield compared to
tial uses of composites within restorative dentistry. camphorquinone amine system [21]. Baoudi K et al.
Glass fibers, carbon fibers polyethylene fibers, aramid (2015) suggested in a systematic review that the flow-
fibers, etc., are the most commonly used fibers in den- able composites are the promising aesthetic restora-
tal composites [3]. These fibers can be oriented in dif- tive materials for the future and will become markedly
ferent directions; unidirectional, weave type, mesh useful material in various aesthetic restorative proce-
type, etc., in the resin matrix to improve the physical dures [22].
and mechanical properties of composites. The durabil-
ity of the fiber-reinforced composites mainly depends 2.6 Self-healing or self-repairing compo-
on essential factors including fiber loading within the sites
resin, adhesion of fibers to the matrix, the orientation
of fibers, volume of fibers in composite matrix, etc., Materials usually have a limited shelf-life and degrade
[3]. Silane coupling agents are commonly used to pro- over time due to different physical, chemical or biolog-
vide bonding between resin matrix and fibers [6]. The- ical stimuli. But researchers have developed materials
se fiber reinforced composites have shown improved which can repair themselves. The self-healing and self-
strength and stiffness and improved wear resistance. repairing composite is an epoxy-based system which
Their main applications are in periodontal splinting/ contains resin-filled microcapsules. These microcap-
post-trauma splint, fixed partial dentures, reinforcing sules may be destroyed and release the resin when the
or repairing dentures, fixed orthodontic retainers, epoxy resin undergoes crazing. The resin subsequently
root posts, and reinforced biomedical implants [3, 14]. fills these cracks and reacts with a Grubb’s Catalyst
Mohan M et al. (2019) compared the fracture tough- that is dispersed in the epoxy composite. This may
ness of fiber-reinforced composites with micro-hybrid eventually polymerize the resin and repair the crack
and nano-hybrid composites. They also reported that [23].
the FRCs exhibited more fracture toughness compared
to the other materials. They also suggested that these 2.7 Stimuli response materials
are the choice of the restorative materials for posteri-
or teeth [15]. These are also called “smart materials”. The properties
of these materials essentially depend on external stim-
2.5 Flowable Composites ulus such as temperature, pH, mechanical stress, mois-
ture, etc., These composite materials release fluoride,
These composites were developed mainly to improve calcium, and hydroxyl ions into the surroundings of
the handling properties for composites resins. These the filling depending on the pH. These materials re-
composites contain less filler content of traditional lease, especially when the pH is less than 5.5, a signifi-
hybrid composites with the same filler size. The resin cant number of ions than that at the neutral pH. There-
matrix was increased to reduce the viscosity of the fore, it provides additional caries protection [23-25].
mixture. Since the filler content was reduced, they lack
adequate strength to withstand high stresses [16] Due 2.8 Bellglass HP
to increase in resin content; these composites show
more polymerization shrinkage [16] and less elastic Bellglass HP is an indirect restorative material which
moduli and its use in high-stress bearing areas is ques- was introduced in 1996 by Belle de St. Claire. These
tionable [17-19]. However, these materials wet the materials have increased polymerization rate as they
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 International Journal of Dental Materials 2019;1(2): 48 -54

are cured under pressure (29 PSI) at an elevated tem- hetics, and superior proximal contact [26,27].
perature of 1380C and in the presence of nitrogen gas.
The elevated temperature and the increased atmos- 2.11 Nanocomposites
pheric pressure not only increases the rate of curing
but also reduces vaporization potential of the mono- Nanotechnology consists of reducing components of
mers. Wear resistance of the Bellglass HP is increased material to nanometric scale for use in a new material,
due to curing in the presence of nitrogen gas. In addi- to improve the final characteristics. In nano-filled res-
tion, the rate of curing is also improved as nitrogen ins, the inorganic nano-fillers are added to organic res-
gas provides an oxygen-free environment. Oxygen acts in matrix to have the strength of inorganic material
as polymerization inhibitor and delays the polymeri- and flexibility and toughness of organic material
zation reaction and also reduces the translucency of [30,31]. These composites have approximately 60%
composites [26, 27]. volume filler loading, making the nano-filled resins as
strong as the hybrid and micro-hybrid resins. The
2.9 Self-adhering composites nanocomposites have nanofillers that contain nano-
modifier such as the nanomers and nanoclusters that
Self-adhering composites are also called as compo- result in increased flexural strength, increased modu-
bonds. Self-adhering flowable composite combines the lus of elasticity, improved wear resistance and hard-
advantages of both dental adhesives and restorative ness, decreased polymerization shrinkage and enhance
materials technologies (8th generation) in a single polishability of resin. Nanofillers may include colloidal
product [28]. The first compo-bond was introduced in silica or ormocers, such as Inceram X from Dentsply.
2009 by (Kerr Corp). Compo-bonds have the benefits Similar particles may be used in resin-based bonding
of self-etching dentin bonding agents and nano-filled systems. Nanoparticle filled dental particles may show
resins. They eliminate the precursory bonding stage an enhanced fracture toughness and adhesion to tooth
necessary to adhere, resin to tooth substrate, thus re- tissue [2,4,30,31].
ducing the chances of postoperative sensitivity. These
composites have properties similar to the convention- Nano filled, and nanohybrids are commonly available
al flowable composites. They also have the properties nanocomposites. The average particle size of Nano-
of 7th generation of dentin bonding agents; thus, they filled ranges from 1-100 nm, whereas nanohybrids are
act as shock absorbers beneath the resin-based com- comprised of larger particles of ranging from 0.4 to 5
posite restoration. As compo-bonds function both as microns. The properties of these composites are size
dentin adhesive and resin restorative both as dentin and shape determinant. These nanofillers present su-
adhesive and resin restorative material, a longer cur- perior properties than nanohybrids [1, 30].
ing time is necessary to ensure that both constitutes
are fully polymerized [29]. 2.12 Antimicrobial materials

2.10 Art glass Antimicrobial agents and antibiotics were introduced

into composites to provide antimicrobial activity
Art glass is a nonconventional dental polymer market- [24,32]. Recently, antimicrobial nanoparticles such as
ed since 1999. It is widely used in making indirect res- quaternary ammonium polyethylenimine [24,32], Sil-
torations such as inlays, onlays, and crowns. These ver [33-36], Zinc Oxide [37-39], Titania [40] and Chi-
materials exhibit improved wear resistance and other tosan [41] nanoparticles were experimented with
physical and mechanical properties due to the greater composites to impart antimicrobial characteristics.
level of crosslinking. The fillers used are radiopaque Microbes may be killed on direct contact with these
Barium glass with an average particle size of 0.7 mi- materials or through leaching of the antimicrobial ma-
crometres and colloidal silica, which enhance the han- terials into the oral environment. Silver and Titania
dling characteristics to a greater extent. A special light particles are commonly used into dental particles to
curing unit such as Xenon stroboscopic light-curing increase antimicrobial property and enhance biocom-
device with the emission ranges from 300-500 nm is patibility. Fatemeh K et al. (2017) reported that the
used for curing of these resins. The advantages of the- adhesives incorporated with silver nanoparticles
se materials include high wear resistance compared to showed greater bond strength. However, it was also
traditional composites, good marginal adaptation, est- reported that the bond strength was dependent on the
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composition of the adhesive resins [36]. 3. Alla RK, Sajjan S, Ramaraju AV, Ginjupalli K,
Upadhya N, Influence of fibre reinforcement on
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anhydrous calcium phosphate, tetra calcium phos- varhubli A, Dental Composite – A Versatile Restor-
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