Esthetic Restorative Materials 4

Chapter 8—Introduction to Composite Restorations 219
Packable Composites
Packable composites are designed to be inherently more
viscous to afford a “feel” on insertion, similar to that of
amalgam. Because of increased viscosity and resistance to
packing, some lateral displacement of the matrix band is pos-
sible. Their development is an attempt to accomplish two
goals: (1) easier restoration of a proximal contact and (2)
similarity to the handling properties of amalgam. Packable
composites do not completely accomplish either of these
goals. Because of the increased viscosity, it is typically more
difficult to attain optimal marginal adaptation, prompting
some clinicians to first apply a small amount of flowable com-
posite along proximal marginal areas to enhance adaptation.
Flowable Composites
Flowable composites generally have lower filler content and
consequently inferior physical properties such as lower wear
Fig. 8-3 Scanning electron micrograph of polished surface of a microfill resistance and lower strength compared with the more heavily
composite (×300). filled composites. They also exhibit much higher polymeriza-
tion shrinkage. Although manufacturers promote widespread
Class V cervical lesions or defects in which cervical flexure can use of these products, they seem to be more appropriate for
be significant (e.g., bruxism, clenching, stressful occlusion).32 use in some small Class I restorations, as pit-and-fissure seal-
ants, as marginal repair materials, or, more infrequently, as
the first increment placed as a stress-breaking liner under
Hybrid Composites posterior composites. Additionally, flowable composites are
Hybrid composites were developed in an effort to combine the being used as first small increments in the proximal box of a
favorable physical and mechanical properties characteristic of Class II restoration in an effort to improve marginal adapta-
macrofill composites with the smooth surface typical of the tion. This approach is somewhat controversial but may be
microfill composites. These materials generally have an inor- indicated in conjunction with the use of thicker, packable
ganic filler content of approximately 75% to 85% by weight. composites, where optimal marginal adaptation is more dif-
Classically, the filler has been a mixture of microfiller and ficult to achieve.
small filler particles that results in a considerably smaller Some manufacturers also are currently marketing flowable
average particle size (0.4–1 μm) than that of conventional composites as bulk-fill materials, to be used to restore most,
composites. Because of the relatively high content of inorganic if not all, of a tooth preparation in posterior teeth. The manu-
fillers, the physical and mechanical characteristics are gener- facturers claim reduced polymerization shrinkage stress,
ally superior to those of conventional composites. Classic which may occur because of the low elastic modulus of the
versions of hybrid materials exhibit a smooth “patina-like” flowable materials. However, the physical properties of flow-
surface texture in the finished restoration. able composites are generally poor, and the long-term perfor-
Current versions of hybrid composites also contain ultra- mance of such restorations is not yet proven. Whether or not
small nanofillers, resulting in superior characteristics. These flowable composites are used for bulk-filling, they should
newer versions of hybrid composites are called nanohybrid never be placed in areas of high proximal or occlusal stress
composites. because of their comparatively poor wear resistance. More
heavily filled composites are far superior for restorations
involving occlusal or proximal contact areas.
Nanofill
Nanofill composites contain filler particles that are extremely
small (0.005–0.01 μm). Because these small primary particles
Glass Ionomer
can be easily agglomerated, a full range of filler sizes is pos- Conventional Glass Ionomers
sible, and optimal particle packing is facilitated. Alternatively, Glass ionomers were developed first by Wilson and Kent in
many classic hybrid composites have simply incorporated 1972.33 Similar to silicate cements, their predecessors, the
nanofillers into the existing filler composition, thereby opti- original glass ionomer restorative materials were powder/
mizing the material further. Consequently, high filler levels liquid systems. Glass ionomers have the same favorable
can be generated in the restorative material, which results in characteristics of silicate cements—they release fluoride into
good physical properties and improved esthetics. The small the surrounding tooth structure, yielding a potential anti-
primary particle size also makes nanofills highly polishable. cariogenic effect, and possess a favorable coefficient of thermal
Because of these qualities, nanofill and nanohybrid compos- expansion.34,35 In contrast to silicate cements, which have
ites are the most popular composite restorative materials in phosphoric acid liquid, glass ionomers use polyacrylic acid,
use. These composites have almost universal clinical applica- which renders the final restorative material less soluble.
bility and are the primary materials referred to as composites Although conventional glass ionomers are relatively
throughout this book. technique-sensitive with regard to mixing and insertion

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Chapter 8—Introduction to Composite Restorations 219

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