COMPOSITE RESIN including Durafill VS (Kulzer) and Renamel (Cosmedent).

 They continue to
have properties that are virtually the opposite of the macrofills: excellent
Dental composites typically are composed of three chemical materials: an
polishability and aesthetics. However, most did not exhibit the strength
organic matrix, an inorganic matrix, and a coupling agent. Because
required for use in occlusal load-bearing areas, with one notable exception: a
composite resins require a bonding procedure for durability and reliability,
microfill formulated for posterior teeth called Heliomolar (and later
they must be biocompatible and bond well to both enamel and dentin. Direct
Heliomolar HB) (Ivoclar Vivadent).
restorative materials also are required to resist masticatory forces and
demonstrate mechanical properties similar to those of natural teeth. During the 1990s, hybrids and the layering of composites became popular.
The earliest hybrids were not easily polishable. Subsequent products (such as
HISTORY OF COMPOSITE RESINS
the original Esthet-X [Dentsply Sirona]) were stronger, but their aesthetics
Composite Dentistry Historical Breakthroughs did not match today’s composite resin options.

A brief history of composite restorations begins in the middle of the 20th

Bulk-fill composites have become accepted by a larger population of
Century. Dr. Michael Buonocore discovered that phosphoric acid can
increase mechanical bonding to tooth structure in 1955. 1 RL Bowen is
credited with the invention of dental composites in 1962.2
In the 1970s, the first commercially successful restorative composite resins
(Concise [3M] and Adaptic [Dentsply Sirona]) were introduced. They were
considered macrofills, containing very large filler particles and measuring
zero to 5 μm. The irregular-edged, large particle size made them very
difficult to polish even though they were rather strong. The formula for
Concise is still sold in the United States under the Henry Schein label, and,
curiously, it is named Composite.

dentists in the 2010s. Companies have promoted less polymerization

shrinkage and a higher depth of cure up to 4.0 mm.The first highly accepted
flowable bulk fill, SureFil SDR flow (Dentsply Sirona), was limited to use
as a base under restorations. Newer flowable bulk-fill agents, including
Tetric EvoCeram Bulk Fill (Ivoclar Vivadent) and Estelite Bulk Fill Flow
(Tokuyama Dental America), require no capping layer of another composite.
They show higher strength and aesthetics; however, some bulk fills can be
more translucent. This can be a positive or negative attribute, depending on
the situation.

In the 1980s, microfill Revolutionary Change

composites made their debut,
This year, 2019, marks the introduction of several products that will buck the PHYSICAL PROPERTIES OF COMPOSITE RESINS
trends of the last 20 years in restorative dentistry. The first, Tokuyama
Work and Setting Time
Universal Bond (Tokuyama Dental America), is a truly universal agent that
bonds to virtually everything. This includes direct, indirect, light-cure, self-  For light-cured composites, curing is considered to be “on demand.”
cure, and dual-cure materials in self-etch, total-etch, and selective-etch Polymerization is initiated when the composite is first exposed to the curing
modes. What makes this material a paradigm shifter is that no light curing, light. Stiffening takes place within seconds after light exposure by a high-
primers, or activators are needed. The clinician mixes equal parts A and B, intensity curing light source.
applies it to dentin and enamel, and air dries it to polymerize the bonding
agent prior to adding the composite of choice. Many dentists have not used a A thin layer of air-inhibited, unpolymerized material remains on the surface
bonding agent without light curing since the early days of Tenure (DenMat) of the polymerized layer, which is advantageous for subsequent incremental
about 20 years ago. placement during layering. It is useful to protect the surface of the contoured
restoration with a transparent matrix, to minimize the amount of
Also, 2019 brings the introduction of another truly groundbreaking material, unpolymerized resin in the final restoration.
Omnichroma (Tokuyama Dental America). This is the first omnichromatic
composite resin-based material that will match any tooth, any shade, on any For most composites that are initiated by visible light, bright operatory lights
patient. In an era when many composite materials require having multiple can initiate cure prematurely if the composite is left unprotected on a mixing
shades available for use in any given clinical situation, Omnichroma poses a pad.
unique opportunity for dental offices that cannot stock dozens of product Within 60 to 90 seconds after exposure to ambient light, the surface of the
shades for financial or space reasons. It is ideal for any office that values a composite may lose its capability to flow readily against the tooth, and
quick, easy system that creates attractive, functionally sound restorations. further work with the material becomes difficult.
• Omnichroma does not attempt to match the value of the tooth shade The setting times for chemically activated composites range from 3 to 5
the way other composites do by using pigments and dyes minutes.
• however, Omnichroma fillers change the way that light is Polymerization Shrinkage and Stress
transmitted. Ambient light is altered along the red-to-yellow area of
the color spectrum, allowing it to match the color of the patient’s As explained in the section on Polymerization Reactions, all composites
surrounding dentition. It includes UDMA/TEGDMA monomers and undergo volumetric shrinkage upon setting. Typical shrinkage values are
260-nm silica and zirconia fillers. listed in Table 9-3. Volumetric shrinkage results in the development of
contraction stresses as high as 13 MPa between the composite and the tooth
• The Omnichroma paste is opaque-white prior to curing, making the structure.
material more visible for the clinician during manipulation. The
application of a light source during curing causes the material to
blend with the color of the surrounding tooth.
• The Omnichroma paste is opaque-white prior to curing, making the
material more visible for the clinician during manipulation. The
application of a light source during curing causes the material to
blend with the color of the surrounding tooth.
PROPERTIES
 Thermal stresses place an additional strain on the bond to tooth structure.
Thermal changes are also cyclic in nature, and although the entire restoration
may never reach thermal equilibrium during the application of either hot or
cold stimuli, the cyclic effect can lead to material fatigue and early bond
failure.
The thermal conductivity of composites with fine particles (25 to 30 × 10−4
cal/sec/cm2 [° C/cm]) is greater than that of composites with microfine
particles (12 to 15 × 10−4 cal/sec/cm2 [° C/cm]) because of the higher
conductivity of the inorganic fillers compared with the polymer matrix

This stress can exceed the tensile strength of enamel and result in stress Water Sorption
cracking and enamel fractures along the interfaces. The water sorption of composites with hybrid particles (5 to 17 μg/mm3) is
Adding the composite in 2-mm increments and polymerizing each increment lower than that of composites with microfine particles (26 to 30 μg/mm3)
independently can reduce the net effect of polymerization shrinkage. because of the lower volume fraction of polymer in the composites with fine
particles.
 Net shrinkage stress is less because a smaller volume of composite is
allowed to shrink before successive additions. A recent paper has The quality and stability of the silane coupling agent are important in
reviewed the clinical and laboratory properties of several low minimizing the deterioration of the bond between the filler and polymer and
shrink/low-stress composites. the amount of water sorption.

 Volumetric polymerization shrinkage for low-shrink universal Solubility

composites measured by a pycnometer varies from 0.9% to 1.8% The water solubility of composites varies from 0.25 to 2.5 mg/mm3.
whereas that of low-shrink flowable are 2.4% to 2.5%. When an Inadequate light intensity and duration can result in insufficient
ACTA lino meter was used, the values were 1.0% to 1.4% and 2.6% polymerization, particularly at greater depths from the surface.
to 2.9%, respectively. The polymerization stress was 1.2 to 1.6 MPa.
During the storage of micro hybrid composites in water, the leaching of
 In comparison, traditional universal composites have been reported inorganic ions can be detected; such ions are associated with a breakdown in
to have polymerization stress of 0.8 to 2.4 MPa and flowable were interfacial bonding.
reported to have stress values ranging from 1.3% to 3.2%.
Microfilled composites leach silicon more slowly and show a 100% increase
This creates tensile stresses as high as 130kg/cm2 which severely strains the in amount during the second 30-day period (14.2 μg/mL).
bond and can lead to marginal leakage.
Color and Color Stability
Thermal Properties
The color and blending of shades for the clinical match of esthetic
The linear coefficient of thermal expansion (α) of composites ranges from 25 restorations are important. Principles can be applied specifically to
to 38 × 10−6/° C for composites with fine particles to 55 to 68 × 10−6/° C composites for determining appropriate shades for clinical use.
for composites with microfine particles. The α values for composites are less
than the mean of its constituents added together; however, the values are The color of dental restorative materials is most commonly measured in
higher than those for dentin (8.3 × 10−6/° C) and enamel (11.4 ×10−6/° C). reflected light using a color measuring instrument or a visual method.
MECHANICAL PROPERTIES OF COMPOSITE RESINS indicated, because their acidity would impede the chemical activation of the
resin cement.
Mechanical Properties
Enamel and Dentin
Although composites take advantage of selected properties of each
constituent material, the physical and mechanical properties of the The bond strength of composites to etched enamel and primed dentin is
composites are different from those of the separate phases typically between 20 and 30 MPa. Bonding is principally a result of
micromechanical retention of the bonding agent into the etched surfaces of
Strength and Modulus
enamel and primed dentin.
The flexural and compressive moduli of microfilled and flowable composites
Enamel Bonding- Bonding to enamel occurs by micromechanical retention
are about 50% lower than values for multipurpose hybrids and packable
after acid etching is used to preferentially dissolve hydroxyapatite crystals in
composites, which reflects the lower volume percent filler present in the
the enamel outer surface
microfilled and flowable composites.
Dentin Bonding- The high water content in dentin represents an extra
Knoop Hardness
challenge for the establishment of an interdiffusion zone. To manage this
The Knoop hardness of composites with fine particles is somewhat greater problem, primers have hydrophilic components, such as HEMA, that wet
than values for composites with microfine particles because of the hardness dentin and penetrate its structure.
and volume fraction of the filler particles.
CLINICAL PROPERTIES OF COMPOSITE RESINS
A microhardness measurement such as Knoop can be misleading on
composites with large filler particles (>10 μm in diameter), in which the
small indentation could be made solely on the organic or the inorganic phase.
Bond Strength to Dental Substrates
Bonding of composites to tooth structure and other dental substrates
Indirect (Laboratory) Composites - A microretentive bonding surface is
obtained with alumina sandblasting. Etching with 37% phosphoric acid is
used to clean the surface from debris, prior to the application of the resin
cement. Etching with hydrofluoric acid is not recommended, because it
causes degradation of the composite surface.
Amalgam - Adhesive systems, filled adhesives, and resin cements can be
used in association with amalgam in the so-called bonded amalgam
restoration. The bonding between the adhesive and the amalgam is achieved
by the establishment of an interpenetration zone.
Fiber Posts - Bonding fiber-reinforced resin posts to radicular dentin is one
of the most challenging situations faced by the clinician. Adhesive
application is critical, because it is virtually impossible to control moisture
inside the root canal. The use of self etching adhesives systems is not
 PROPERTY CRITERIA
Light intensity at the surface is a critical factor in completeness of cure at the
surface and within the material. The tip of the light source should be held
Maintenance of color (18 No more than 5% failures within 1 mm of the surface to provide optimum exposure. More opaque
months) shades reduce light transmission and cure only to minimal depths (1 mm). A
standard exposure time using most dental curing lights is 20 seconds.
Marginal discoloration (18 No more than 5% failures
months) A 40-second exposure improves the degree of cure at all depths, and is
required to obtain sufficient cure with the darker shades. Because the light
Marginal integrity (18 months) No more than 5% failures
beam is partially collimated and does not spread sufficiently beyond the
diameter of the tip at the emitting surface, it is necessary to “step” the light
Caries—recurrent or marginal No more than 5% across the surface of large restorations so the entire surface receives a
(18 months) complete exposure.

Maintenance of interproximal 95% showing no observable RADIOPACITY

contact (18 months) broadening of contacts
It is very difficult to locate enamel-composite margins radiographically
Postoperative sensitivity Thorough history of adverse because of the relatively low radiopacity of composites.
sensitivity to hot, cold, and biting
 Barium
stimuli
 Strontium
Failure (18 months) No more than 5%  Zirconium
 Quartz
Wear between 6 and 18 months No more than 50 µm  Lithium-aluminum glasses
 Silica
Some microhybrid composites achieve some radiopacity by incorporating
DEPTH OF CURE (LIGHT-CURED COMPOSITES) finely divided heavy-metal glass particles. Others use ceramic particles
containing heavy metal oxides. In the nanofilled composite, radiopacity is
Light intensity decreases as the light source is moved away from the surface achieved by using nanomeric zirconia (5-7 nm) or by incorporating the
of an object. Furthermore, as the light travels through a scattering medium zirconia in the nanoclusters along with silica.
like a composite with filler particles, the light intensity is reduced.
A number of factors influence the degree of polymerization at given depths
from the surface after light curing. The concentration of photo-initiator or WEAR RATES
light absorber in the composite must be such that it will react at the proper
Under clinical conditions, a composite restoration comes in contact with
wavelength and be present in sufficient concentration. Both filler content and
other surfaces such as the opposing tooth, food particles, and oral fluids,
particle size are critical to dispersion of the light beam.
which can result in surface wear and degradation.
Another important consideration is the particular shade and opacity of the
Composites are ideal as an anterior restorative material where wear rates are
composite used. Many shades are intentionally opacified and have more
low. For posterior teeth amalgam has long been the standard direct filling
pigments to mask discolored tooth after removal of carious tissue.
material. Due to the increasing demand for esthetics, concern about mercury
toxicity and aggressive marketing, there is an increasing interest in the use of 3. To build-up cores (post core).
composites for class I and II restorations. 4. Bonding of orthodontic brackets, etched cast restorations, ceramic
crowns, posts, inlays,
Many in vitro wear studies have been reported but because there are many
5. onlays and laminates.
different methodologies used, standardization and direct comparison of these
6. Pit and fissure sealant.
results with actual clinical performance is not available. It is advisable to
7. Esthetic laminates.
look at controlled clinical studies when choosing a composite, particularly
8. Repair of chipped porcelain restorations.
for posterior restorations.
TYPES
BIOCOMPATIBILITY OF COMPOSITE RESINS
Base on curing mechanism
The resin components are cytotoxic in vitro. Composites release some resin
components for weeks after insertion. Thus composites resins have  Self cured materials
biocompatibility issues from three aspects.
 Light cure materials
 Inherent chemical toxicity of the material on the pulp.
 Pulpal involvement due to microleakage.  Dual cure materials
 Allergic potential on contact with the oral mucosa. Based on Viscosity
 Allergic potential for personnel handling the material.
 Chronic inflammatory response in the periodontium when  Conventional
compared to amalgam in animal studies (monkeys).
 More cytotoxic than amalgam in vitro studies.
 Resin composite components have been shown to cause
immunosuppression or immunostimulation and to inhibit DNA and
RNA synthesis.
 Concerns over estrogenicity of Bisphenol A and its dimethacrylate
In cases where the pulp is exposed some form of pulp capping overlayed
with a glass ionomer liner is recommended.
Issues concerning estrogenicity have not been proven to be of sufficient
concern under intraoral conditions. Studies have proved that bisphenol A is
estrogenic in vitro tests that measure this effect using breast cancer cell
growth.
USES
 Flowable
USES:
 Packable
1. Restoration of anterior and posterior teeth (directly or indirectly).
2. To veneer metal crowns and fixed partial dentures (prosthodontic Based on filler particles size (According to Willems (1993))
resins).
 Fine Particle size > 3 µm
  Ultrafine Particle size < 3 µm 2. Prosthodontic composites (for fabrication of inlays, veneers, crowns and
 Microfine Average particle size — 0.04 µm FDPs)
 Nano Nano range (5–100 nm or 0.005–0.01 µm) 3. Provisional composites (for temporary crowns, FDPs, etc.)
Based on filler particle size 4. Luting composites
• Macrofillers (10-100 µm) 5. Repair composites (intraoral repair of fractured ceramic or acrylic or
• Midifillers (1-10 µm) composite veneer

• Minifillers (0.1-1 µm) RESTORATIVE COMPOSITE RESINS

• Microfillers (0.01-0.1 µm) The first tooth colored restorative

system were developed in the late
a) Homogenous 1950s and early 1960s by Bowen
b) Heterogenous
c) Agglomerated Nanofillers (0.005–0.01 µm)  Generally Macrofilled
Resins (chemically
• Hybrid (range of sizes which usually includes micro or nanofillers activated)
with macro, midi or mini fillers  U-V light Activated
Based on applications and commercial availability  Visible Light Activated
Systems
1.Restorative composites—direct intraoral restorations  Hybrid Composites
 Hybrid composites (Fig. 11.2)  The Nanocomposites

• Macrofilled hybrids
• Midifilled hybrids
• Minifilled hybrids
• Nanofilled hybrids
 Microfilled (Fig. 11.3)
 Nanofilled composites (Fig. 11.4)
 Flowable (Fig. 11.5) SUPPLIED AS
 Packable Composites used for restoring teeth are usually supplied as a kit containing
 Core build-up composites the following:
• Composite resin (either chemical or light cured)
• Etching liquid (37% phosphoric acid)
 • Bonding agent • Inhibitors (0.01%)—Prevents premature polymerization, e.g.
butylated hydroxytoluene (BHT).
• Shade guide
• UV absorbers—to improve color stability
• Opacifiers—(0.001 to 0.007%) e.g. titanium dioxide and aluminum
• Color pigments—to match tooth color.

• Chemically activated composite resins are available as Two paste

(base and catalyst) system Supplied in small jars or syringes (Fig.
11.6).
• Powder-liquid systems Powder (inorganic phase plus the initiator)
is supplied in jars.
• Liquid (BIG-GMA diluted with monomers) in bottles.
RESIN
• Light activated resins are available as Single paste form in dark or
MATRIX
light proof syringes (Fig. 11.5).
Dental composites use
a blend of
monomers that
are aromatic or
aliphatic

dimethacrylates.
Triethylene glycol dimethacrylate (TEGDMA) is added to control the
viscosity.
COMPOSITION AND STRUCTURE
Bis-GMA was developed by RL Bowen (Bowen’s resin) in the early 1960s.
In addition they contain
Its properties were superior to those of acrylic resins. However, it had a few
• A curing system—Chemical or light curing chemicals. limitations like
  A high viscosity which required the use of diluent monomers 6. Reduces thermal expansion and contraction

 Difficulty in synthesizing a pure composition 7. Improves clinical handling (increased viscosity makes them easier to
handle clinically).
 Strong air inhibition to polymerization
8. Imparts radiopacity
 High water sorption because of diluents used
Important attributes of fillers
 Polymerization shrinkage and thermal dimensional changes still
existed  Amount of filler added (filler loading)

 Like other resins it does not adhere to tooth structure  Size of particles and its distribution

Drawbacks of TEGDMA include  Shape of fillers

1. High shrinkage.  Index of refraction

2. Contributes to reduced shelf-life by migration in to the plastic walls.
 Radiopacity
3. Being hydrophilic it makes the composite susceptible to moisture
leading to thickening or softening of the paste in certain climatic  Hardness
conditions.
Filler size
FILLER PARTICLES
The size of the fillers affect the surface smoothness and the wear resistance.
Most of the important properties of the resin is determined by its filler The smaller the fillers the greater the surface smoothness.
content. Composite fillers are classified by material, shape and size.
Filler loading
They are broadly classified into 3 groups:
Filler loading refers to the amount of fillers that can be practically
• Macrofillers incorporated into the resin. The amount of filler that can be added depends
on the type of filler and the purpose for which it is intended.
• Microfillers
In order to increase the filler amount in the resin, it is necessary to add the
• Nanofillers
fillers in a range of particle sizes. If a single particle size is used, a space will
Functions of fillers Addition of filler particles in to the resin significantly exist between the particles. Smaller particles can then fill-up these spaces,
improves its properties thus increasing the filler content.
1. Improves strength
2. Reduces shrinkage
3. Reduces Wear Shape of fillers
4. Surface smoothness and esthetics Based on shape 3 types of fillers are used—irregular, spherical and fibrous
5. Reduces water sorption Refractive index
 1. One method is to sinter(fuse)the colloidal silica particles,
thereby reducing surface area. These are known as
agglomerated silica.
2. Addition of prepolymerized fillers This is the more common
method. Also known as ‘organic fillers’. They are prepared
by adding 60 to 70 wt.% of silane coated colloidal silica to
the monomer, which is held at a slightly higher temperature
to reduce its viscosity. It is then heat cured and ground.
For esthetics, the filler should have a translucency similar to tooth structure.
Silica nanoparticles
To achieve this, the refractive index o fthe filler should closely match that of
the resin. These are currently the smallest filler particles used in dental composites.
Nanoparticles are defined as particles between1 and 100 nanometers in size.  
Measurement of filler content—volume versus weight percentage
Incorporation of silica nanoparticles into the composite resins have improved
Filler content is designated in percent volume (vol.%) or percent weight(wt.
many of the properties of composite resins, particularly wear resistance and
%).Weight percent is usually higher in value than percent volume. The
polisha bility. Nanoparticles in composites can be used in 2 forms.
volume percentage may be a more reliable indicator of filler content than the
weight percentage. • Nanoparticle
FILLERS TYPES • Nanoclusters
Composite resins may contain a variety of fillers Manufacture of fillers
Ground quartz Filler particles can be generated:
 They were mainly used in conventional composites. They are 1. by crushing, grinding, and sieving large blocks of ceramic,
chemically inert and very hard. 2. by condensation of SiO2 from the vapor phase as small droplets of
microfiller, or
Glasses or ceramic containing heavy metals 3. by precipitation of filler particles from solution (sol-gel). The
 These fillers provide radiopacity to the resin restoration. smallest fillers can only be manufactured in a practical way from the
 Boron silicates vapor phase or by sol-gel processes.
 Lithium aluminum silicates COUPLING AGENTS
 Ytterbium trifluoride
 Colloidal silica Coupling agents bond the filler particles to the resin matrix. The earliest
composites did not use coupling agents. This resulted in microscopic defects
They have the same composition and refractive index as quartz but not as between the filler and surrounding resin.
hard or abrasive. This is due to their ‘amorphous’ (or noncrystalline) form.
They are referred to as‘microfillers’ Functions of coupling agents:

METHODS TO INCREASE MICROFILLER LOADING 1. They improve the properties of the resin through transfer of stresses
from the more plastic resin matrix to the stiffer filler particles.
2. They prevent water from penetrating the filler-resin interface.
 3. They bond the fillers to the resin matrix thereby reducing the wear.  The earliest systems used ultraviolet (UV) light for curing. Light
The most commonly used coupling agents are organosilanes activation put control of the working time in the hand of the dentist.
POLYMERIZATION (SETTING) MECHANISMS Limitations of UV light curing were
They polymerize by the addition mechanism that is initiated by free radicals 1. Limited penetration of the light into the resin.
as described in resins. The free radicals can be generated by chemical 2. Lack of penetration through tooth structure.
activation or external energy (heat, light or microwave).
Visible-light activated resins
Based on the mode of activation of polymerization, there are three main
types  They are also more widely used than the chemically activated resins.

A. Chemically activated resins DUAL CURE RESINS

B. Light-activated resins A combination of chemical and light curing is used to overcome some of the
C. Combination of the above (dual cure). drawbacks of light curing. Dual cure resins are supplied as two pastes. When
CHEMICALLY ACTIVATED COMPOSITE mixed together a slow setting reaction is initiated. These resins are used for
RESINS cementing crowns or bulk restorations where there is limited or no light
penetration. After the initial light cure, the remainder of the resin cures over a
This is a two-paste system period of time by the chemical process.
• Base paste contains CURING LAMPS
• Catalyst paste  A number of curing lights are manufactured. Most use visible light in the
blue spectrum (between 400 and 500 nm). In some units the light source is
Setting
remote and is transmitted to the site of restoration through a light guide
When the two pastes are spatulated, the amine reacts with the benzoyl which is a long, flexible fiber-optic cord. There are also hand held light
peroxide to form the free radicals which starts the polymerization. curing devices which transmit the light through short light guide.

Disadvantages Important features of curing lamps

1. No control of curing time. 1. Spectral range - Light emitted by curing lamps should fall in the
2. No control of curing shrinkage. photoabsorbtion spectral range of camphorquinone.
3. Hand mixing increases possibility of voids. 2. Light intensity - Light intensity should be high for a shorter curing
time and greater depth of cure
LIGHT ACTIVATED COMPOSITE RESINS
Types of lamps
Under normal light they do not interact. However, when exposed to light of
the correct wavelength the photo initiator (camphorquinone) is activated and 1. QTH (Quartz-tungsten-halogen)
reacts with the amine to form free radicals which then start the
 The earliest visible light lamps. The light source is a tungsten-
polymerization.
halogen-quartz bulb. The intensity of light gradually reduces with
UV light activated systems time (aging) and so calibration is required at intervals.
2. LED (Light emitting diodes) • Type of light High intensity lights

 This is increasingly popular as a light source in all spheres including • Thickness of resin
dentistry ever since the discovery of the blue diode in the 1990s. Its
• Distance from light
advantages also include low power consumption (can even be
operated by batteries), no heat generation (eliminating cooling fan), TYPES OF COMPOSITE RESINS
and low noise (due to the absence of cooling fan).
Traditional Composite
3. PAC (Plasma arc curing)
Traditional composites are also referred to as
 These lamps generate an intense white light by ionizing xenon gas to ‘conventional’ or ‘macrofilled composite’
produce a plasma. Filters are required to remove heat and the (because of the large size of the filler
unwanted wavelengths. Their high power allows faster cures as well particles). Traditional composites are rarely
as greater depth of cures. used currently and have been largely replaced
by other hybrids. However, their discussion will continue largely for
4. Argon laser
comparison to the newer composites.
 These produce light of the greatest intensity. They emit light of a
Composition
single wavelength around 490 nm and therefore do not require filters.
They do not produce little heat because of the limited infrared. Ground quartz was most commonly used as filler. There is a wide
However, these lamps are more expensive. They have a narrow light distribution of particle sizes. Although average size is 8 to 12 µm, particles
tip (spot size) requiring clinicians to increase number of overlaps in as large as 50 µm may also be present. Filler loading: 70-80 wt.% or 60-70
case of a larger restoration. vol.%.
DEGREE OF POLYMERIZATION AND DEPTH Properties
OF CURE
 Compressive Strength It is four to five times greater than that of
The total amount of resin polymerized depends on unfilled resins (250 to 300 MPa).
several factors.  Tensile Strength It is double that of unfilled acrylic resins (50 to 65
MPa).
• Transmission of light through the material
 Elastic Modulus It is four to six times greater than the unfilled
• Shade of resin Darker shades require longer resins (8 to 15 GPa).
exposure time  Hardness It is considerably greater (55 KHN) than that of unfilled
resins.
• Amount of photoinitiator and
 Water Sorption It is less than that of unfilled resins (0.5 to 0.7
inhibitor present
mg/cm2 ).
• Curing time Manufacturers  Coefficient of Thermal Expansion The high filler-to resin ratio
recommend curing times for each reduced the CTE (25 to 35 × 10–6/°C) significantly.
material and shade.
Disadvantages
• Intensity of light Light intensity is
measured in milliwatts/cm2
Although the conventional composites were superior to unfilled resins, they Colloidal silica is used as the microfiller and is the only type of filler present
had certain disadvantages in this type. The problem with colloidal silica was that it had a large surface
area that could not be adequately wetted by the matrix resin. Thus, addition
 High surface roughness of even small amounts of microfillers resulted in thickening of the resin
 Polishing was difficult matrix. Thus, it was not possible to achieve the same filler loading as
conventional composites.
 Poor resistance to occlusal wear
Manufacturers tried to
 Tendency to discolor—the rough surface tends to stain. overcome this problem by

MICROFILLED COMPOSITE 1. Using prepolymerized

or organic fillers
The microfilled composites were introduced soon after the traditional (see section on
composites. They were developed to overcome the problems of surface fillers).
roughness of traditional composites. The resin achieved the smoothness of 2. Using silica in cluster
unfilled acrylic direct filling resins and yet had the advantage of having or agglomerate
fillers. form.
These composites are primarily used for esthetic restorations in stress free Filler size
areas and in areas close to the gingiva where a smooth finish is required for
reduced plaque accumulation. Synonyms Also referred to as microfine The colloidal silica is 200-
composites. 300 times smaller than the
quartz fillers of conventional composite. Size ranges from 0.04 to 0.4 µm.
Filler content
With the inclusion of prepolymerized (organic) fillers, the filler content is 70
wt.% or 60 vol.%. However, the actual inorganic filler content is only 50 wt.
%.
HYBRID COMPOSITE RESINS
The hybrid type forms the majority of the composites used in dentistry
currently. These were developed to obtain better surface smoothness than
that of the conventional large particle composites, yet maintain the properties
COMPOSITION of the latter. Hybrid composites have a surface smoothness and esthetics
competitive with microfilled composites for anterior restorations. The
hybrids are generally considered as multipurpose composites suitable for
both anterior and posterior use.
  NANO AND NANOHYBRID COMPOSITE RESINS
A new type of composite resin based on nanosized filler particles has been
recently introduced. Nanocomposites (Fig. 11.6) are similar to the
microfilled, comprising of uniformly sized nanofillers. Nanohybridslike the
conventional hybrids, come in a range of filler sizes including nanofillers.
They can be used for both anterior and posterior restorations. Nanohybrids
are generally stronger than the nanocomposites. However, nanocomposites
have improved polish ability. Continued development along these lines might
eventually lead to the phasing out of conventional hybrid and microfilled
composites. However, further research is required to establish the efficacy of
the nano and the nanohybrid composites.
Filler volume
The total filler
content is 75–80
wt.% or 60–65
vol.%. The overall
filler loading is
not as high as
small particle
composites
because of
the higher
microfiller
content.
Filler type Two kinds of filler particles are employed. Filler volume and type
1. Heavy metal glasses Average particle size is 0.4 to 1 µm. 75% of The predominant
the ground particles are smaller than 1.0 µm. fillers are zirconium/silica or
2. Colloidal silica Size—0.04 µm. It is present in higher concentrations nanosilica particles
(10 to 20 wt.%) and therefore, contributes significantly to its measuring approximately 5 to
properties. 25 nm and nanoaggregates of
approximately 75 nm. The
The hybrids are generally considered as multipurpose composites suitable for
aggregates are treated with silane
both anterior and posterior use. They are widely used for anterior
so that they bind to the resin. The aggregates and nanoparticles filler
restorations, including class IV because of its smooth surface and good
distribution gives a high load, up to 79.5%
strength. The hybrids are also widely employed for stress bearing
restorations.  Packable Composites
Packable is a term used for composite pastes that have very high viscosity
and low surface tackiness. These materials are not condensable like
amalgams, but can be compressed and forced to flow using flat faced
instruments. These composites are recommended for use in classes 1
and 2 cavity preparations. They are composed of light-activated,
dimethacrylate resins with fillers (porous or irregular particles) that
have filler loading of 66% to 70% by volume. The interaction of the
filler particles and modifications of the resin cause these composites
to be packable.
Important properties include greater depth of cure, lower polymerization
shrinkage, radiopacity, and lower wear rate (3.5 µm/year). Several packable
composites are packaged in unit dose capsules. A bulk-fill technique is
recommended by manufacturers but has not yet been demonstrated effective Flowable composites
in clinical studies. have a low modulus of
elasticity, which may
make them useful in
cervical abfraction
areas. Because of their lower filler content, they exhibit higher
polymerization shrinkage and lower wear resistance than universal
composites. The viscosity of these composites allows them to be dispensed
by a syringe with a needle tip for easy handling. Gentle heating of higher
viscosity composites can improve their flow and enable them to be placed as
flowable composites.
Laboratory Composites
Crowns, inlays, and veneers bonded to metal copings can be prepared with
Flowable Composites
composites processed in the laboratory, using various combinations of light,
Flowable composites, heat, pressure, and vacuum to increase the degree of polymerization, density,
which are light- activated, low- mechanical properties, and wear resistance.
viscosity composites, are
For increased strength and rigidity, laboratory composites can be combined
recommended for cervical
with fiber reinforcement. Restorations are usually bonded with resin cements.
lesions, restorations in deciduous teeth, and other small, low- or non-stress-
bearing restorations. They contain dimethacrylate resin and inorganic fillers
with a particle size of 0.4 to 3.0 µm and filler loading of 42% to 53% by
volume (see Table 9-2). The newest generation of flowable composites Core Build-Up Composites
contains nanofiller particles at a volume loading somewhat lower than If sufficient tooth structure remains to retain and support a full-coverage
universal or multipurpose composites. Recently, self-adhesive flowable restoration, but extensive regions of dentin have been lost to disease, the core
composites have become available. of the tooth can be restored before final preparation and impression.
Composites are commonly used in this application. Core composites are Provisional Composites
available as selfcured , light-cured, and dual-cured products. Core
Provisional restorations maintain the position of the prepared tooth, seal and
composites are usually tinted (blue, white, or opaque) to provide a
insulate the preparation and protect the margins, establish proper vertical
contrasting color with the tooth structure. Some products release fluoride.
dimension, aid in diagnosis and treatment planning, and help to evaluate
candidates for esthetic replacements. Provisional inlays, crowns, and fixed
partial dentures are usually fabricated from acrylic resins
or composites. Provisional restorations fabricated from
composites are generally harder, stiffer, and more color
stable than those made from acrylics.
MANIPULATION AND PLACEMENT OF
COMPOSITE RESINS

Composite cores have the following advantages as compared with

amalgam:
• They can be bonded to dentin
• can be finished immediately
• are easy to contour
• can have a more natural color under ceramic restorations.
Composite cores are bonded to remaining enamel and dentin using bonding
agents. A bonding agent recommended by the manufacturer of the core
material should be used because some self-cured composite core materials
are incompatible with some light-cured bonding agents. Retention of the final
restoration should not rely on the composite structure alone because adhesion
of the composite core to remaining dentin alone is insufficient to resist
rotation and dislodgement of the crown.
Steps in the manipulation of composite resin Types of Restorations
1. Temporary, intermediate and permanent
2. Direct and indirect
3. Esthetic and nonesthetic
Temporary restorations
Temporary restorations are often required before the placement of a
permanent restoration. Materials used for temporary restorations are expected
to last for only a short period of time, a few days or a few weeks at most. It
serves as an interim restoration while the pulp heals till the permanent
restoration can be fabricated and inserted.
Intermediate Restorations
Intermediate or holding type of restoration is particularly used in
pedodontics. For example, in rampant caries, it is desirable to remove all the
Placement of rubber dam composite resins caries quickly in order to change the oral health and arrest the caries process.
Once the initial ‘clean up’ has been done, the dentist can proceed with
placement of the permanent restorations. The interval between removal of the
caries and completion of final restorative work may take several months.
Requirements of a temporary filling material
1. It should have adequate strength to last a few weeks, but weak
enough to be dislodged easily.
2. It should be easy to insert and remove.
3. It should have adequate seal.
COMPOSITE RESTORATION OF COMPOSITE RESIN 4. It should have antibacterial properties.
5. It should have a therapeutic effect on the pulp.
Composites 6. It should have cariostatic properties.
Are a combination of two or more classes of materials. In dentistry, the most Permanent
common composite is a combination of a polymer and ceramic, where the
polymer is used to bind ceramic particles. The polymer functions as the Is expected much longer than the temporary and intermediate restorations.
matrix in dental composites and the particles are reinforcing materials. Therefore, it is expected to have much improved properties than the
temporary and intermediate restorations. Examples of permanent restorative
Restorations materials are direct filling gold, amalgam, composite resins, glass ionomer
cement, as well as porcelain, composite and cast metal inlays and onlays.
Is a tooth material is often lost as a result of caries and trauma. A restoration
is a material which substitutes the missing tooth structure and restores the Direct Restoration
form and function of the tooth
Are usually placed in increments. They are usually soft and plastic when 11. Potential for color instability and staining over time.
initially placed and harden later with time.
BONDING/BONDING AGENTS OF COMPOSITE RESIN
Indirect Restorations
History
These are usually fabricated outside the mouth on models of the tooth and
then cemented into place in the mouth.  In 1955, Buonocore published a paper entitled “A simple method of
increasing the adhesion of acrylic filling materials to enamel
Esthetic surfaces”.
 The “acid etch technique” used a combination of acid to etch the
An esthetic material is something which is pleasing to an individual. At one
tooth and a bonding agent to improve the retention of the composite
time gold fillings and crowns were considered esthetic. Today, however, an
resin to the tooth
esthetic material implies any material that is capable of reproducing that
color and appearance of a natural tooth. This paper is often regarded as the foundation of adhesive dentistry
Nonesthetic  Buonocore’s paper clearly outlined strategies to obtain bonding
Currently it denotes any material that is not tooth colored. This includes between filling materials and tooth structure.
amalgam, direct filling gold and metal inlays and onlays. These strategies included
Advantages of Composite Resin: 1. Development of new materials which have adhesive properties.
1. Highly esthetic tooth colored restorations possible. 2. Modification of present materials to make them adhesive.
2. Multiple curing systems allow choice of working time
3. Relatively ease of placement 3. Use of coatings as adhesive interface materials between filling and
4. Moderately strong and durable tooth.
5. Does not corrode when compared to amalgam. 4. Alteration of the tooth surface by chemical treatment to produce a
6. Easy to repair new surface to which present materials might adhere.
Disadvantages of Composite Resin: In this paper, Buonocore focused on the strategy no. 4 and the goal was
1. Highly technique sensitive achieved by enamel etching using 85% phosphoric acid.
2. High shrinkage The idea was not novel in that phosphoric acid or preparations containing
3. Does not bond to tooth structure; requires dentin bonding techniques phosphoric acid had been used to treat metal surfaces in order to obtain better
4. Sticks to instruments adhesion of paint and different resin coatings.
5. Not condensable like amalgam.
6. Possibility of microleakage and recurrent caries if improperly placed. So, Buonocore’s true contribution was that he made us aware of the fact that
7. Some materials exhibit slumping microscopic porosities created by phosphoric acid enhance the retention of
8. Not as wear resistant as other metallic restorative materials. dental materials.
9. Shorter life span when compared to other more durable restorative
In the late 1960s, Buonocore suggested that it was the formation of resin tags
materials like ceramics, DFGs, amalgam and cast metal restorations
that caused the principal adhesion of the resins to acid-etched enamel.
10. Higher allergic, inflammatory response, cytotoxic and other
biologically adverse when compared to amalgam.
As time went on, variations in duration of the acid-etching procedure and
concentration of the phosphoric acid, along with alternative acids, were
tested for the etching of enamel.
The current thinking is that a 30 to 40 percent phosphoric acid etch for 15
seconds is acceptable.
PHOSPHORIC ACID ETCHANT PROCEDURE
LIQUID GEL Acid etching of enamel is done for a minimum of 15 to20 seconds.
Most effective when the acid is activated by movement such as mixing. 
 The gel is made by adding colloidal silica to the phosphoric acid 30- Thorough rinsing for 10
40% usually 37% seconds removes acid and
dissolved calcium
FUNCTIONS OF ETCHANT
phosphates. 37 % Phosphoric acid
1. Selective demineralization of exposed enamel rods to form etch pits, is used to etch enamel, however,
creating the classic honeycomb effect. Resin flows into these etch other acids including nitric,
pits and forms resin tags (≈8µm length) providing bond strength 25 - polyacrylic, oxalic, pyruvic
30 MPa through mechanical interlocking. and maleic acids are
2. Increases the surface area and surface energy of enamel and effective.
removes the surface debris.
ETCH
3. High surface energy permits efficient wetting by the hydrophobic
resin which penetrates to form resin tags.
En
a me
l

TYPE I PATTERN
Is achieved when the acid targets the enamel rods which leaves an array of
small, regular pits with raised areas consisting of the inter-rod parts of the
enamel lattice.

Etching
This is the most commonly used variety of etch used for fissure sealants

TYPE II PATTERN
Is achieved when the acid targets inter-rod substance, leading to variable
central protrusion and a notable degree of peripheral dissolution.

ENAMEL BONDING
Flow of low viscosity
adhesive resin into these
surface irregularities is
facilitated, creating a
durable, leakage-
resistant interface upon polymerization.

A TYPE III ETCH PATTERN : Bonding agents used for enamel bonding were made from resin combined
with diluents to lower viscosity
Is a result of neither the rods nor the inter-rod parts of the enamel being
selectively eroded by the acid. (Bis-GMA + TEGDMA)

This can be a result of using an inappropriate acid or trying to etch an DENTIN BONDING
By the late 1960s, Buonocore also proposed that bonding to dentin was
possible.Since then, dental adhesives that provide numerically higher bond
strengths and more substantive bonded interfaces to both enamel and dentin
have been developed.
The ability to bond reliably to enamel was then well-accepted, but dynamic,
variable nature of dentin poses significant challenges to developing
predictable resin-dentin bonding techniques. Early attempts to bond to dentin
resulted in poor bond strengths.

inappropriate area of enamel (i.e. aprismatic enamel)

It does not have a regular pattern and is less suited to most dental materials REASONS:
than type I or II etches 1. DENTIN’S COMPOSITION:
by weight,

 75 % - Inorganic material (hydroxyapatite)

 20 % - Organic material (collagen, other non collagenous
compounds)
 5 % - Water
2. DENTINAL TUBULES AND DENTINAL FLUID 3. STRUCTURAL VARIABILITY OF DENTIN
Dentinal tubules of vital teeth communicate directly with the pulp and RATIONALE:
house cellular extensions of odontoblasts.
 A bonding agent intended to join dentinal and composite adherends
These tubules contain fluid, which would be an impediment to bonding. must therefore be hydrophilic enough to displace the aqueous phase
from the dentinal surface for subsequent bonding, to the dentinal
Dentinal fluid under positive pressure from the pulp may affect diffusion of substrate.
monomers into etched dentin
 At the same time, however, it must comprise hydrophobic molecular
entities compatible with, and capable of bonding to, the resinous
restorative.
FIRST GENERATION (1950S) (no etch technique)
This generation was introduced mainly for bonding the acrylic resin
restorations, which were used at that time.
 Based on M-R-X model:
M=Methacrylate group
 
R= Hydrocarbon group
X= Glycerophosphoric acid dimethacrylate
 The phosphate group interacts with the Ca++ ions of the
Application hydroxyapatite.
 Un- bonded regions of dentin  The methyl group was able to bond (polymerize ) with the acrylic
beneath a restoration can permit sufficient tubular fluid movement resin restoration.
under functional or thermal stress to distort afferent nerves in the
pulp and elicit pain. These compounds are distinguished:
1. By the presence of hydrophilic functional amino acid groups capable
of chelating or ionic bonding to the apatite surface calcium and other
multivalent cations and to reactive amino groups in the organic
(collagen) domains of dentin
 2. By the presence of reactive vinyl groups capable of copolymerization Is usually a weak organic acid
with composite resin.
Example :
DISADVANTAGES:
 10% maleic acid
• The bond strength of these adhesives was poor (about 3 MPa).
 Low concentration of a stronger inorganic acid (e.g. phosphoric or
• No microleakage advantage compared with conventional unfilled 2.5% nitric acid ) or
resin.
 Chelating agent (e.g. 17% EDTA).
• It was markedly decreased after water storage (hydrolysis when
stored in water, it is not stable). Main Action:

2ND GENERATION ADHESIVES  Heavily alters or removes the smear layer, but does not remove
resin tags.
 The materials of this generation were developed in 1978.  Demineralizes peritubular and intertubular surface dentin up to a
 This generation was the start to invent of an adhesive system that depth of 5 microns and thereby, exposes collagen fibrils.
bonds the composite resin restorations, which had largely replaced  Depth of demineralization depends on type of acid, its
the acrylic resin restorations. concentration, and etching time.
Most of DBA of this generation were halophosphorous esters of unfilled  More mineralized peri tubular dentin is etched more deeply than
resin such as Bis- GMA (Bisphenol A glycidyl methacrylate) or HEMA the inter tubular dentin.
(Hydroxy ethyl methacrylate ) that attempted to bond to dentin via surface  Increases dentin permeability by 4 to 9 times.
wetting and interaction between their phosphate groups and calcium ion in 2. PRIMER (ADHESION PROMOTER, ADHESION ENHANCER, BI
the smear layer. FUNCTIONAL MONOMER, HYDROPHILIC MONOMER)
Disadvantages: Is usually a bifunctional monomer in a volatile solvent such as acetone or
 The bond strength of these materials range from 2-7 MPa. alcohol;
 It was hydrolyzed over time in the oral environment resulting in A bifunctional monomer is one that has a
debonding.
1. Hydrophilic end
3RD GENERATION ADHESIVES (1980s) 2. Hydrophobic end
These systems alter or remove the smear layer prior to bonding and produce Examples of bi functional monomers include:
bond strengths ranging from 16 to 26 MPa.
 HEMA- (hydroxyethyl methacrylate),
Most products use a three-component system consisting of a  NMSA - (N-methacryloyl-5-aminosalicylic acid),
1. Conditioner  NPG - (N-phenylglycine),
2. Primer  PMDM - (pyromellitic diethyl methacrylate), and
3. Adhesive  4-META- (4-methacryloxyethyl trimellitate anhydride).

1. CONDITIONER (CLEANER, ETCHANT) MAIN ACTIONS

  Links the hydrophilic dentin to the hydrophobic adhesive resin. In total etch, both enamel and dentine are etched together.
 Is able to do this because of its bi functional nature (i.e., primer's
hydrophilic end bonds to the wet dentin and its hydrophobic end
bonds to the adhesive resin) DENTINE ETCHING PROCEDURE:
 Promotes infiltration of demineralized peri-tubular and inter-tubular
15 sec 15 sec
dentin by its own monomers and those of the adhesive resin.
 Increases wettability of the conditioned dentin surface and increases
contact between the dentin and resin
With dentine, a deeper etch is not desirable. Enamel is etched for30 sec while
3. ADHESIVE (BONDING RESIN, SEALING RESIN) dentine is etched for 15 sec. first etchant is applied on enamel for 15 sec. and
then it is applied to dentine wait for 15 sec and rinse.
After the conditioned dentin surface has been primed, the bonding agent is
placed on top of the primed surface. EFFECTS OF DENTIN ETCHING
The bonding agent is an unfilled or partially-filled resin; and is a mixture of
the priming monomer and the key monomer present in the composite.
Main Action

 The Bonding Agent must be cured before the composite is placed.

 Combines with the primer monomers to form a resin-reinforced

hybrid layer ( resin-dentin inter diffusion zone ) from 1 to 5 microns
thick.
• 37%Phosphoric acid-etching removes the smear layer and smear
 Provides methacrylate groups to bond with the subsequently placed
plugs , opens the dentinal tubules and decalcifies the inter-tubular
resin composite.
and peri-tubular dentin.
To summarize, the application of third-generation dentin bonding agents
involves three steps:
1. Etching with an acidic conditioner
2. Priming with a bifunctional resin in a volatile solvent
3. Bonding with an unfilled or partially-filled resin.
4th Generation Adhesives

 Even these products use a three-component system consisting of a

conditioner, primer, and adhesive. • Hydroxyapatite crystals are dissolved, leaving a collagen meshwork.
 Etch dentin and enamel simultaneously with conditioner (usually • Etching time for enamel is not critical, whereas it is critical for
phosphoric acid) which is called total etching. dentine.
ETCHING PROCESS
 • If dentine is over-etched, the depth of demineralization is greater • The
than the ability of the bonding agent to penetrate, leading to nano ideal dentin
sized spaces through which leakage can occur, this is termed as surface for wet
“nanoleakage” bonding is
visibly moist
• The collagen meshwork can collapse and shrink due to the loss of
but without
inorganic support.
an excess of
• Prevention of dentin from collapsing is easily achieved by keeping water leading
the dentine moist/by not drying it. to a meniscus
on the surface.
• This is an important consideration for total-etch adhesive systems.
• Over wet
• After acid etching, the tooth should be thoroughly washed, and not dentin (pooling of water) must also be avoided as excess
completely dried so that network of collagen fibers that is exposed water will dilute resin primer and out-compete it for sites in
remains suspended in water from the air-water syringe used to wash the collagen network, preventing hybridization
the acid off .
• This surface can be created clinically by blot drying with
• This is the optimal state of the collagen network for bonding. blotting paper, removing excess surface water without
OTHER REWETTING AGENTS desiccating the surface.

 Aqueous solutions of HEMA such as Aqua-Prep. • Glistening appearance  moist (correct)

 Gluma Desensitizer (Contains glutaraldehyde, which stabilizes • Matt appearance  dry (wrong)
collagen layer.  After the etchant is rinsed off, a primer containing solvent such as
acetone, ethanol and/or water and one or more bi functional resin
monomers is applied.
PRIMER
Primer resins such as hydroxyethylmethacrylate (HEMA) contain 2
functional groups—
1. Hydrophilic group
2. Hydrophobic group.
The hydrophilic group has an affinity for the dentin surface, and the
hydrophobic (methacrylate) group has an affinity for resin.
Curing of primer is not an easy process because both dentinal fluid and
oxygen which are present either in the dentin or in the air jet used for drying,
inhibit polymerization.
To avoid such situation the primer should contain a solvent that evaporates METHOD OF APPLICATION OF PRIMER
easily and removes water without the need for excessive drying
 Apply primer according to recommended number of coats from 1 to
PRIMER (WATER/ALCOHOL) 6
ADVANTAGES:  Light agitation of primers can enhance diffusion into demineralized
dentin.
 Not adversely affected by overly moist or dry dentine and therefore,
less technique sensitive than acetone-based systems.  Forceful scrubbing, however, should be avoided.
 The viscosity remains more consistent over (storage) time as their  Residual solvent may act as a contaminant and adversely effect
solvents are less prone to evaporation. bonding. Solvent must be thoroughly evaporated with a gentle
stream of compressed air. Avoid a forceful air blast as it may
DISADVANTAGES:
displace resin.
 Slightly lower bond strength to dentine.
 When the primers are lightly rubbed into the surface of the moist
PRIMER (ACETONE) collagen, the hydrophobic groups cluster in the center of droplets,
while the hydrophilic groups orient toward the surrounding water
Significant increase in bond strength when wet bonding is performed matrix.
correctly.
 If one would try to polymerize the primer while there is still a lot of
Disadvantages:
water or solvent present (blue regions) polymer spheres would form
 Excessively moist dentine prevents the effective penetration of the within the collagen mesh, and the bond strength would become
acetone-based primer. rather low.

 This is referred to as the "overly wet phenomenon".  It is therefore important at this point to remove as much as possible
of the water matrix. Blowing air on the primed surface does such a
 Acetone is volatile and tends to evaporate from the dispenser over removal.
time, increasing the viscosity of the bonding agent with storage,
reducing its ability to penetrate demineralized dentine.  Air pressure forces the primer deeper into the tubules and facilitates
its infiltration into branches from the tubules.
Mode of Action:
PRIMER
 These solvents are used as water chasers.
NOTE :
 They displace the dentinal fluids in dentinal tubules and also the
water that suspends the collagen exposed from acid-etching dentine  Acetone- and ethanol-based primers dry readily whereas drying
(wet bonding technique), bringing with it the resins. water-based products may require a few more seconds.

 Once this is achieved, the solvent is evaporated.  Hybridized dentin will appear shiny -- additional primer or
primer/resin should be applied if dull areas are evident after drying.
 The primer wets and penetrates the collagen meshwork and also
increases surface energy, and wettability, of the dentin. ADHESIVE
  Finally the adhesive resin is applied which may be Bis GMA,
UDMA with TEGDMA and HEMA and cured for 10 sec.

 The adhesive resin copolymerizes with the primed dentin and also
with composite resin applied over it.

 A bonding agent is placed on the primed surface region of

conditioned tooth surface.

 The resin should be thinned with an applicator than with an air jet to
avoid oxygen inhibition

 Because light activating compounds are contained commonly in the

bonding resin, the primer and bonding resin are cured simultaneously
for the minimum time recommended by the manufacturer.
DENTINE BONDING PROCEDURE
1. Apply etchant to enamel and dentine and wait for 20 sec and rinse
dry gently for 2 sec and blot dry. Leave moist
2. Apply primer to enamel and dentin dry gently for 5 seconds
3. Apply adhesive to enamel and dentin. Light cure for 10 seconds

MANIPULATION
1. Acid etch the enamel for 15 secs
2. Extend it on the dentin for 15 secs
3. Rinse with water for 15 secs
4. Apply bonding agent and leave it for 20-30 secs
5. Remove excess air with air syringe
6. Light cure for 10-20 secs
7. Apply composite resin in increments it should be 2 mm
8. Light cure the increments for 40 secs
9. Polish the surface