PREFACE

The constant desire of the dental profession to achieve esthetics, has led to development of
various tooth coloured materials. Composite restorative materials represent one of the many
successes of modern biomaterials research, since they replace biological tissue in both appearance
and function.Though resin composites are inevitable tooth coloured restoratives, there is still a void
in understanding the underlying composition, chemistry, properties etc., which plays a major role to
aid in material selection as well as for better clinical success.
“DENTAL COMPOSITES – All you need to know” is a concise textbook exclusively on dental
composites with emphasis on recent and future researches. The uniqueness of this book is that, it
combines the material science of composites from various international standard textbooks along
with the information obtained through recent research articles worldwide and explains the way how
composites have evolved through ages till date. I humbly accept my limitations regarding the
shortcomings in the book and I sincerely welcome the constructive suggestions from the readers of
this book at [email protected].

Dr. K. Palani Selvi MDS.,

Conservative Dentist & Endodontist

 ACKNOWLEDGEMENT

Its been a long-awaited dream to author a book on my name!!

Foremost, I want to offer this endeavour to The Almighty, for the wisdom
he has bestowed upon me, the strength and good health in order to finish
this book. My profound gratitude to all my Teachers for the enlightment and
guidance they seeded. Above ground, I am indebted to my Parents whose
values helped me to only grow with age. And finally, I acknowledge My
Husband and My Lovely Daughter who served as my inspiration to pursue
this undertaking.

Dr. K. Palani Selvi MDS.,

Conservative Dentist & Endodontist
 TABLE OF CONTENTS

INTRODUCTION
An esthetic restorative material must simulate the natural tooth in
colour, translucency and texture, yet must have adequate strength and
wear characteristics, good marginal adaptation and sealing, insolubility,
and biocompatibility. These materials must also remain colour stable and
maintain external tooth morphology to provide a lasting esthetic
restoration.
By far the most commonly used restorative materials in the anterior part
of the mouth are resin-based composites (also called composite resins,
resin composites or simply composites). Resin composites are currently
the direct restorative materials that best fulfil the requirements of excellent
esthetics and durability. The reasons for such expanded usage of these
materials relate to improvements in both their ability to bond to tooth
structure (enamel and dentin) and their physical properties. The possibility
of bonding a relatively strong material (composite) to tooth structure
(enamel and dentin) results in a restored tooth that is well sealed and
regains much of its strength.
Composite restorative materials represent one of the many successes
of modern biomaterials research, since they replace biological tissue in
both appearance and function. The advances in the restorative materials
and bonding techniques have changed the concept of “EXTENSION FOR
PREVENTION” as “RESTRICTION WITH CONVICTION” The advent of
composite resin restorative materials has led the way towards achieving
this goal.

Dental composite is defined as a “Highly cross-linked polymeric

material reinforced by a dispersion of amorphous silica, glass,
crystalline, or Organic resin filler particles or short fibres bonded to
the matrix by a Coupling agent.”
Composite material consists of three fundamental parts: an organic resin
matrix with a complementary initiator of polymerization, an inorganic filler
and a coupling agent. Each component of the composite is critical to the
success of the dental restoration.. These materials have been the focus of
a great deal of research in recent years with the goal of improving
restoration performance by changing the initiation system, monomers,
fillers, coupling agents, and by developing novel polymerization strategies.
Over the last 40 years, the routine use of dental amalgam is gradually
decreasing due to poor aesthetics of amalgam especially for anterior
restoration, mercury toxicity, environmental consideration arising from
mercury disposal, potential dental fracture, secondary caries and marginal
leakage10. Dental composites are among the synthetic resins and now
considered to be a potent alternative to dental amalgam. Longevity and
survival studies in posterior teeth continue to show that amalgam has
better track record than composites.

Contemporary composite materials are being constantly upgraded and

have significantly improved physical and mechanical characteristics in
comparison with previous generations, especially concerning the
hardness, firmness, elasticity, resistance to bending, breaking, torsion and
wear. However, since cross linking in net formation during polymerization
leads to volumetric shrinkage and, consequently, polymerization stress that
can affect the creation of a marginal gap and also compromise the
longevity of the restoration, stress compensation represents the biggest
scientific and clinical challenge.
The state-of-the-art composition of dental composites has been
changing rapidly in the past few years. Current dental composites have
adequate mechanical properties for usage in all areas of the mouth. The
future of composite materials is mirrored in several directions.

FIG 1: RESIN COMPOSITES -EVOLUTION

Resin composite - State of the art, Jack L. Ferracane, Department of Restorative Dentistry,
Oregon Health & Science University , Portland Dent Mater (2010) , USA. 11 Beginnings of the
dental composite revolution – Stephen C. Bayne, JADA August 201310
EVOLUTION & HISTORY
The composition of resin-based dental composites has evolved
significantly sincethe materials were first introduced to dentistry more than
50 years ago.

In 1871, Thomas fletcher introduced silicates and was

prepared from alumina-silica glass powder and phosphoric acid
liquid. Although the silicates were anti-cariogenic, it frequently
was associated with early clinical failure due to dissolution in the
oral fluids, loss of translucency, surface crazing, and lack of
adequate mechanical properties.
 In 1951, a Swiss chemist Oscar Hager developed the first
dimethacrylate molecule, which allowed for a cross-polymerized
matrix.

In 1956, Rafael Bowen developed a large molecule,

hydrophobic dimethacrylate monomer (Bis-GMA or Bowen’s
resin), a key advance in resin chemistry. Bis-GMA forms the basis
of present-day composites because of its limited shrinkage and
fracture resistance. Bowen’s resin possessedthe viscosity of
honey, and therefore limited the amount of filler particles that
couldbe incorporated.

1962: Dr. Rafael Bowen of the ADA research unit at the

national bureau of standards developed new type of composite
resin material. Subsequent experiments incorporated Triethylene
Glycol Dimethacrylate (TEGDMA) as a diluent to reduce viscosity.
This monomer combination has become one of the most widely
used matrix monomer combinations for dental composite to date.
Both of these monomers contain two reactive double bonds, and
when polymerized, form covalent bonds between the polymer
chains known as a cross-link.

1969: Dr. Bowen added fibre filler in experimental

combinations to formulate the first composite resin. The resin
BISGMA was developed at the NATIONAL INSTITUTE OF

HEALTH. Cross-linking improved mechanical and physical

properties. It was first used in a composite in 1969.

In 1970, composite materials polymerized by electromagnetic

radiation appeared, doing away with mixing and its drawbacks. At
 first, an ultraviolet light source (365 nm) was used to provide the
required light energy, but its shallow polymerization and iatrogenic
side-effects led to its replacement by visible light (427-491 nm),
which is currently in use and undergoing further development.
e.g. Prima – Fil, Nuva –Fil
1972: The first visible light curing system (Foto-Fil) was
introduced which had greater rate & depth of polymerization.
They were also more resistant to wear & stable in water.
Mid 1970: the filler size was reduced to 5-8nm, which resulted
in smoother restorations than earlier ones.
1976: micro filled composite resins were developed which
were highly polishable colloidal silica of diameter 0.5mm or less
was used as filler. This is the Second generation of composite.
1980: microfilm-resin properties were altered into a
heterogeneous mix. BISGMA resin was improved by adding a
patented resin UDMA resins for posterior use appeared. e.g. P-
10: auto –cured, p-30: light –cured.

Mid 1980: Advancements in filler technology was achieved by

blending conventional sized filler particles (1-5 micrometre) with
micro fine particles – 0.04 mu resulting in hybrid composites. This
is the Third generation of composites.

- The filler size was reduced gradually to an average of 1

micrometre diameter. These were introduced by KERR Company
as Herculite, which was intended for universal use in both anterior
and posterior regions.
- The first generation of Indirect Lab Processed Microfill
Composite Resin System was introduced to overcome the problem
of wear in posterior composite resins. But they had a low flexural
strength and wear resistance.

1991: Mega-filled composite with glass ceramic inserts coated

with silane for restoration stiffness and increased strength in
posterior composite were introduced.
1992: Introduction of Fiber-Reinforced Composites which
were composed of woven glass or polyethylene fibers that were
hand impregnated in composites for increased strength
1996: Flowable Composite developed for special handling
properties were introduced. Filler content in these has decreased
the viscosity of mix.
 1997-98: Packable posterior composites were introduced
based on the Primm-Polymer Rigid Inorganic Matrix Material
in which the ground filler of the traditional composites was
replaced by ceramic fibres with spaces in between filled by resin.
They had the advantage of reduced polymerization shrinkage and
increased wear resistance.
1998: New pre-impregnated fibre reinforced composites were
introduced in which fibres and resinous matrix phase were
coupled during manufacturing process resulting in fibres uniformly
impregnated with matrix. The strength was increased 7 times.
1998: Introduction of Compomer, which combined the
properties of GIC & COMPOSITES. Bonding is achieved by
means of a primer, applied to a clean unetched enamel and
dentin. Filler is a reactive silicate glass (72) containing fluorides.
1998: Introduction of packable resin material based on
Ormocer technology organically modified ceramic.
1998: Introduction of ion releasing composite Material: which
releases fluoride, hydroxyl, and calcium ions in dependence on
the pH adjacent to the restorative material. This functional fluoride
ion release increases with increasing pH.
1998: Introduction of Ion-releasing composite material
1999: Single crystal-modified composites.
2002: The revolution in nanotechnology - Nanocomposites was
introduced.
2006: Silorane based composites came into use.
2008: Smart dental composites with pH control mechanism
2012: Chlorhexidine impregnated Anti-Bacterial Composites
2014 : Composites for Tissue Regeneration
2015: Self-Healing Composites
2018 : Composites with a protein repellent coatings

2019: Anti-Bacterial Composites with Cellulose nanocrystal / zinc

oxide nanohybrids
 FIGURE 2 –HISTORY OF COMPOSITES
Beginnings of the dental composite revolution – Stephen C.Bayne
,JADA August 201310
 BASIC COMPOSITION
COMPOSITION OF DENTAL COMPOSITES:
Dental composites are highly cross-linked polymeric materials
reinforced by a dispersion of glass, crystalline or resin filler particles and
/or short fibres bound to matrix by silane coupling agent, the basic
structural components of a dental resin based composite are:
a) Organic Matrix or Organic Phase,
b) Filler or Disperse Phase,
c) Coupling Agent
d) Activator – Initiator System
e) Inhibitors
f) Optical Modifiers

1. MATRIX:
Most of the dental composites use a blend of aromatic or aliphatic
dimethacrylate monomers such as BisGMA, TEGDMA and UDMA that
form a highly crosslinked polymer structure in composite and sealant
materials. The matrix used mostly is BisGMA.It has particularly a high
viscosity which makes it very difficult to blend and manipulate. To reduce
the viscosity of BisGMA & TEGDMA are mixed in ratio of 75:25 or 50:50.
These dimethacrylate monomers also have the advantage of producing
extensive cross linking among polymer chains. The majority of modern
RBCs are based on a BisGMA/TEGDMA matrix, although additional
organic monomers have been incorporated.

1,6-bis (methacryloxy-2- ethoxycarbonylamino)-2,4,4-trimethylhexane

(urethane dimethacrylate; UDMA) is a high molecular weight methacrylate
monomer which may be incorporated in place of BisGMA to modify the
mechanical and rheological properties of the material.

FIGURE 3 – RESIN MATRIX AND FILLERS - EM VIEW

 2. FILLER:
Fillers from the inorganic component of resin matrix, the incorporation
of which greatly improves material properties, provided the filler particles
as well as bonded to matrix. The filler particles are most commonly
produced by grinding or milling quartz or glasses to produce particles
ranging in size from 0.1 to 100µm. Particles that are about 0.04µm are
referred to as MICROFILLERS. All these improvements occur with an
increase in the volume fraction of filler. Composites are often classified on
the basis of the average size of the major filler component .in addition to
filler volume level, the size distribution, index to refraction, radiopacity and
hardness are also important factors in determining the properties and
clinical application of the resultant composites. To incorporate maximum
amount of filler into the resin matrix, distribution of particle sizes is
necessary. It’s obvious that if a single particle size is used, even with clear
packing a space exists between particles. Smaller particles can fill up
these spaces thus resulting in a continuous distortion of filler affording for a
maximum amount of filler loading.

Most composites contain colloidal silica as filler incorporated in

generally affected by the relative surface area of the filler particle.

TABLE 1: TYPES OF FILLERS IN COMPOSITES

EFFECT OF FILLERS:

Fillers increase the strength of composites

 They reinforce the resin matrix resulting in increased hardness,
strength and decreased wear
Fillers reduce the polymerization shrinkage
The addition of fillers reduces the thermal expansion and
contraction
Fillers improve the workability by increasing the velocity
Addition of filers cause reduction in water resorption, softening
and staining
Fillers increase radio opacity and diagnostic sensitivity through
incorporation strontium and barium glass.
Mechanical properties such as compressive strength, tensile
strength and modulus of elasticity are increased.
Fillers increase the abrasion resistance of composite restorative
materials.

Various fillers used are:

Glass fibres
Beads
Lithium aluminium silicates

Types of Fillers:
Composite resins use 3 types of fillers
- Ground quartz
- Colloidal silica
- Glasses or ceramic containing heavy metals

Quartz fillers:
They are obtained by grinding or milling quartz. They are mainly
used in conventional composites. They are chemically inert & very hard
thus making the restoration more difficult to polish & causing abrasion of
the opposing teeth or restorations. 2
FIGURE 4 - QUARTZ FILLERS
 Colloidal silica: They are referred as “micro fillers” and are obtained
by a pyrolytic or a precipitation process. They are added in small amounts
(5 wt. %) to modify the paste viscosity. Colloidal silica particles have large
surface area (50–300m square/g), thus even small amounts of micro fillers
thicken the resin. In microfilled composites it is the only inorganic filler
used.3

FIGURE 5 – SEM MICROGRAPH OF FILLERS

Glass / ceramics containing heavy metals:

These fillers provide radio-opacity to the resin restoration. Its refractive
index is 1.5 to match that of the resin. The most commonly used is barium
glass. It is not as inert as quartz in an aqueous medium. Owing to the
clinical need for the radiopacity, radiopaque heavy metal glass fillers have
replaced quartz in most new macro filled composites. 1
FIGURE 6 – GLASS CERAMIC FILLERS
 Radiopaque fillers :
The most commonly used radiopaque elements are barium, strontium,
zinc, zirconium and ytterbium. Bowen and Cleek invented barium glass
fillers in 1969. These barium fillers have number of advantages and
disadvantages.
The Advantages are
a)Good radiopacity
b)Fine particle size (0.4 to 0.6 µm)
c)Good index refraction relative to resins (increases aesthetics)
d)Lower cost
e)Readily available in pre-ground fillers.

The Disadvantages are

-More soluble, softer, and more difficult to attach to the resin matrix.

Bowen invented strontium glass filler in 1980, compared with barium

filler it is stronger, less soluble, harder and more abrasive to enamel and
more difficult to grind into fine particles. Zirconium is harder than heavy
metal glass but not as hard as quartz. Zirconium fillers can also be coated
with silica to improve attachment to the matrix.1

FIGURE 7 – ZIRCONIA BASED FILLERS

TABLE 2 – COMMERCIALLY AVAILABLE FILLERS
 3. Coupling Agents:
Bonding between the organic oligomer and inorganic filler will
determine the properties off a composite. This bonding is completely
accomplished by coupling agents.
FIGURE 8: Silane coupling agent

Silanes: This allows the flexible polymer matrix to transfer

stresses to the stiffer particles. A properly applied coupling agent can
impart improved physical and mechanical properties and provide
hydrolytic stability by preventing water from penetrating along the
filler –resin interface. Most commonly used coupling agents are:
1. Titanates
2. Zirconates
3. Organosilanes such as R-Methacrylpropyl Silane.
The methacrylate groups of Organosilane compound form covalent
bonds with resin when it’s polymerized thus completing the coupling
process. This bond can be degraded by water absorbed by the composite
during clinical use.
TABLE 3 – COMMERCIAL DENTAL SILANES
 4. Activator –Initiator System:
Methacrylate monomers polymerize by addition mechanism initiated by
free radicals generated by chemical activation or by external energy
activation by light or heat. Thus there are 2 types of resin systems:
A) Chemically Activated Resins:
They are supplied as two pastes one of which contains benzoyl
peroxide initiator and the other a tertiary amine activator (N, N-dimethyl P-
toluidine) which react with each other to form free radicals thus initiating
addition polymerization reaction. They are usually cured with a light
source. The disadvantage with this system was the incorporation of air
when the 2 pastes were mixed.
B) Light Activated Resins:
First light activated systems used UV light for free radical initiation. The
initiator was benzoyl methyl ether. The UV light activated systems are
replaced by the present day visible light activated (VLC) composites.
The initiator in the visible light activated systems is Camphoroquinone
present at 0.2% wt or less. The light curable dental composites are
supplied as a single paste contained in a syringe containing photo initiator
and an amine activator. They do not interact with each other until exposed
to light. However, exposure to visible light of appropriate wave length (468
nm) causes excitation of the photo initiator and an interaction with the
amine to for free radicals that initiate addition polymerization the amine
accelerator suitable for interaction with Camphoroquinone such as 0.15%
dimethylaminoethyl methacrylate is used.
TABLE 4
 TABLE 5

5) Inhibitors:
Inhibitors prevent or minimize spontaneous or accidental
polymerization of monomers. They have a strong affinity or reactivity with
free radicals. A typical inhibitor used commonly is butylated
hydroxytoluene used in a concentration of around 0.01% by weight. Thus,
inhibiters extend the storage lifetime for all resins and they ensure
sufficient working time.
6) Optical modifiers:
 To ensure optimal aesthetics of a composite restoration the
translucency of the filler must be similar to the tooth structure. For this the
index of refraction of the filler must match to that of the resin. The
refractive indices if BisGMA & TEGDMA are 1.55 and 1.46 respectively
and that of a mixture of these two would result in an effective refractive
index of 1.5, which is sufficient for an effective translucency. Translucency
or opacity is provided to stimulate dentine and enamel. To adjust this
opacifiers are added. All optical modifiers affect light transmission ability of
a composite.
They include metal oxides in minute quantities that improve the shade
and translucency of dental composites. Titanium dioxide and aluminium
oxide are added in minute amounts0.001-0.007% by weight to increase the
opacity they are highly effective opacifiers.
 POLYMERISATION SYSTEMS AND MECHANISM
CHEMICAL ACTIVATION:
The polymerization reaction of self-cured composites is chemically
initiated at room temperature with a peroxide initiator and an amine
accelerator. Polymerization of light-cured composites is triggered by visible
blue light. The photo-initiators used are described in the section on
Initiators and Accelerators1. Dual-cured products use a combination of
chemical and light activation to carry out the polymerization reaction. At
this stage, an active free radical species, designated as R• in the foregoing
scheme, is first formed as the initiating species. This free radical adds to a
monomer species generating an active centre monomer radical.
* The initiation stage is followed by the propagation stage during which
rapid addition of other monomers molecules to the active centre occurs to
provide the growing polymer chain.
* The propagation reaction continues to build molecular weight and
cross-link density until the growing free radical is terminated. The
termination stage may take place in several ways as indicated, where n
represents the number of mere units.2
* The polymerized resin is highly cross-linked because of the presence
of dysfunctional carbon double bonds. The degree of polymerization
varies, depending on whether it is in the bulk or in the air inhibited layer of
the restoration.
FIGURE 9 - POLYMERISATION
 * Polymerization of light-cured composites varies by the distance of the
light from the restoration and the duration of light exposure. The
percentage of double bonds that react may vary from 35% to 80%.

* The degree of polymerization is higher for laboratory composites that

are post-cured at elevated temperatures and varied light intensities. During
polymerization, molecules have to approach their “neighbours” to form
chemical bonds with them. Reduction of volume, or shrinkage, is generally
observed during polymerization because two factors are:

The Van der Waals Volume

The Free Volume

The Van der Waals volume is the volume of molecule itself derived from
the atoms and bond lengths. Reduction in the Van der Waals volume takes
place during polymerization because of a change in the bond lengths
(conversion of double bonds to single bonds). 3

FIGURE - 10

The free volume of a molecular species, whether a monomer or a

polymer, is the volume occupied by it due to its random rotational and
thermal movement. When monomers are converted to polymers, reduction
of the free volume occurs because the rotation of the polymer chain is
more restricted than in polymerized monomer molecules.2

FIGURE - 11 FREE VOLUME OF MOLECULAR SPACES

 FIGURE 12 – CHEMICAL POLYMERIZATION AT MOLECULAR LEVEL

Manufacturers have taken several steps to minimize the polymerization

contraction in methacrylate composites by one or more of the following
methods:

• Filling the monomer resins with pre-polymerized resins

• Maximizing the amount of inorganic filler
• Using high molecular mass methacrylate monomers
In addition, incremental placement of methacrylate composites in the tooth
cavity, necessitated by their limited depth of cure, controls shrinkage stress
so that clinical success of the modern-day methacrylate composite is quite
excellent.21
FIG -13 POLYMERIZATION MECHANISMS
 PHOTO POLYMERISATION :
The resin matrix also contains an initiator and a co-initiator to ensure
rapid polymerization of the methacrylate matrix, the activating agent used
is dependent on whether a chemical or light cure is required. Early RBCs
consisted of a two-paste system containing a benzoyl peroxide initiator and
a tertiary amine activator, which upon mixing underwent a chemical, or
auto-polymerization reaction [Philips, 1991; Darvell, 2006]. 19 However, the
use of chemical polymerization was limited by decreased colour stability of
the initiator chemistry, reduced mechanical properties due to increased
porosity produced on mixing of the two components [Leinfelder, 1987],
inconsistent extent of polymerization and also clinically unacceptable times
to realise cure [Lutz & Philips, 1983].
The development of “on demand” photo-activated resin matrix formulations
during the 1970s containing a benzoin methyl ether that initiated
polymerization via ultra-violet (UV) light at a wavelength of 340-380nm was
a major advancement in dental technology [McCabe& Walls, 1990a].21UV
polymerization was rendered redundant due to significant concerns
regarding UV-induced tissue damage, poor light transmission through both
the tooth and RBC structure producing a low monomer conversion and
also instability of the light output intensity [Lutz & Philips, 1983].
The majority of modern RBCs consist of a diketone-amine system which
absorbs visible (blue) light irradiation at a wavelength of 450-500nm to
initiate a free-radical addition polymerization reaction which results in the
formation of a rigid three-dimensional polymer
structure [Cook, 1992]. 23 Camphoroquinone (CQ) is a commonly used diketone-based photo
initiating molecule which contains a conjugated dicarbonilic group (Figure 1.4a), whilst photolysis of
the C-C bond within CQ produces carboxyl radicals [Alvin et al., 2007]. 21CQ is present at
approximately 0.05-0.50wt% in standard resin formulations [Cook, 1992; Asmussen & M Peutzfeldt,
2002; Alvin et al., 2007] to reduce the energy level required to initiate polymerization to correspond
with radiation within the visible range.

FIGURE : 14 - STAGES OF PHOTO POLYMERIZATION

 CURING OF RESIN – BASED COMPOSITES
The first composites were cured by a chemically activated
polymerization process – known as cold cure or self-cure resins. They
were available as two pastes, which had to be mixed. The disadvantage in
this system was incorporation of air bubbles during mixing that weaken the
structure and trap oxygen, inhibiting polymerization during curing. Later
different curing systems using light as a source came into existence. They
are as follows,
A) U-V light cured composites –polymerization is initiated by U-V light
B) Visible light cured composite- visible light-blue light in the range of
470nm wavelength is used for polymerization
Dual cured composite-they are combination of self-cured
composite and light cured composite.
VISIBLE LIGHT CURING SYSTEMS:

The composite to be cured by light contains a photosensitive

initiator system and a light source for activation. These systems
are not sensitive to oxygen inhibition as the chemically cured
systems. The photo initiator used most commonly is
CAMOHOROQUIONOE that absorbs photons 474 nm ranges.
The three light sensitive initiators, Camphorquinone (CQ),
Phenyl-Propanedione (PPD), And Trimethylbenzoyl-Diphenyl-
Phosphine Oxide (TPO) acted as the triggers that set off
polymerization in all of the available products when light was
applied. CQ was the most commonly used initiator in all
applications. The colour of the initiators is quite different. While
CQ worked very well with the lights available, the colour was an
issue for manufacturers.

Although the intense yellow was mitigated by the polymerization, it

represented a problem with colour matching composites to teeth prior to
the cure. TPO is the least “coloured” of the initiators and made possible
clear flowable resins to seal. Clear sealants use TPO as an initiator.
FIGURE 15 – PHOTOINITIATORS
 Camphorquinone : Camphorquinone (CQ), a blue light
photoinitiator, is commonly used in dental resin formulations. CQ is
di-2, 3-diketo-1, 7, 7- trimethylnorcamphane with molecular weight of
166.2 and has an absorption peak around 469nm. CQ is a ‘Type II’
photoinitiator (i.e., H-abstraction) where, upon photoexcitation, it
abstracts a hydrogen from the tertiary amine H-donor to yield a
reactive, initiating radical centered on the amine and a relatively
unreactive camphorquinone-centered radical. As hydrogen
abstraction only proceeds while the Type II photoinitiator remains in
its excited state, the lifetime of which is often short, the radical
generation quantum yield for these compounds can be low the
drawback in the usage of this method is the yellow colouring and
stability of CQ. A common issue that must be considered when
choosing a photoinitiator is the maximum absorption wavelength
(λmax), the molar extinction coefficient (ɛ) of the photoinitiator, and
the dissociation efficiency of the photoinitiators, which all determine
general applicability. (Sobhi, 2008) .
* The combination of the photosensitizer camphorquinone (CQ)
and co-initiator ethyl 4dimethylaminobenzoate is widely used in
dental resin and adhesive formulations (Musanje et al., 2009) 16. It is
essential to select photoinitiators with absorption spectra that
overlap with the emission spectra of the lamp. In Light Emitting
Dioxide (LED) curing lights, the broad emission spectrum ranges
from 380 to 515 nm with maximum emission between 460-480 nm.
 * The absorption range corresponds to visible blue light between 400-
500nm (λmax = 470 nm). The co-initiator or photo sensitizer is normally a
tertiary aliphatic amine reducing agent, which reacts with camphorquinone
in its excited triplet state to generate free radicals. Although several amine
reducing agents are capable of providing electrons for charge transfer
during the initiation process, dimethylaminoethyl dimethacrylate
(DMAEMA) is commonly used. The efficiency of this is dependent upon its
chemical structure and functional groups and affects clinically important
properties such as the rate of polymerisation, the depth of cure and the
final monomer conversion.
* Optimum correlation between photoinitiator and co-initiator type and
concentration will maximize photon absorbance efficiency which may in
turn maximize depth of cure of a filled system. The photoinitiator
concentration should be limited in order to obtain an optimum photo-curing
reaction with high monomer conversion since excessive un-reacted
photoinitiator, products of their photolysis, and any un-reacted monomer,
may cause cytotoxicity (Pagoria et al., 2005).
* Furthermore, the concentration of camphorquinone effects the
aesthetics of a restoration as exceeding a critical concentration limit of
camphorquinone will lead to yellow discoloration and any un-reacted
molecules may return back to the ground state (Ogunyinka et al., 2007)
which will cause discolouration of the final polymer. Such discoloration may
reduce aesthetic quality.18 In acidic compositions such as enamel-dentin
adhesives or self-adhesive cements containing acidic
monomers, another problem may occur: The acid-base reaction of the
acidic monomers with the amine-based co-initiator may detrimentally affect
the formation of radicals. In order to eliminate these disadvantages,
various other substances were investigated with regard to their possible
use as a substitute for amine.

2) 1-PHENYL-1, 2- PROPANEDIONE (PPD):

The 1-Phenyl-1, 2- Propanedione (PPD) has been suggested as a way to
improve the polymerization kinetics and to reduce the “yellowing effect” of
the photo-initiator. The absorption peak of this molecule is mainly in the
near UV-Vis region and extends slightly into the visible region. PPD is a
viable alternative in the formulation of photocured resin cements because it
allows the reduction or elimination of CQ, which is yellowish, without
impairing the degree of conversion, especially considering the high
demand for aesthetic restorations.
* Its absorption spectrum extends from below 350 nm to approximately 490
nm. Both LED and QTH are effective in curing the resin cements
containing PPD or CQ, However, many Light Curing Units are available on
the market and each one emits light in different regions of the
spectrum.The Resin Based Composites (RBCs) that only contain CQ/TA
system, only require the blue spectral range (420-540 nm); however, if the
RBCs contain CQ plus TPO and/or PPD, then light in both the blue (420-
540 nm) and violet (360-420 nm) ranges are required.
* Not all curing lights deliver the required colour(s) of light and using a
spectrally mismatched combination of LCU and RBC is possible. QTH
LCUs have a broad spectral range corresponding with the broad spectral
absorption of CQ. Both of these photo-initiators (CQ and PPD) can be
used without any co-initiator in light curable dental composites, but to
decrease their concentrations they are used with different co-initiators.
* The reason is simply that too high of a photo-initiator concentration
affects the colour of the dental composite. Therefore, to enhance the
photoinitiator efficiency at lower concentrations, different coinitiators are
added.
3) PHOSPHINE OXIDES:
Most of the existing photoinitiator systems for cationic polymerization
are based on the use of certain onium salts such as diphenyliodonium,
triphenylsulfonium, and alkoxypyridinium salts. However, these salts do not
absorb significantly above 300 nm unless additional chromophores are
incorporated into the salt structure. This requires multi-step synthetic and
purification procedures. Naphthacene (APO), 9- anthracene (APO), and 9-
anthracene (BAPO) like diphenylphosphine oxide, can be especially useful
in extra white shades of resin-based composites, often required in
bleached teeth since they can eliminate the unwanted yellow effect of CQ.
ACYLPHOSPHINE OXIDES (APO) are photoinitiators that undergo
homolytic α-cleavage at the carbonyl-phosphorus bond to generate two
free organic radicals4. The absorption characteristics of APO typically
show enhanced absorption in the near UV/visible range. The absorption
maxima is around350-380 nm and tails around the 420 nm region
(Hristova, 2005).
MAPO and BAPO undergo fast photolysis leading to the formation of
free radicals: benzoyl, phosphinyl and phosphinyl diradical5. These
radicals show very good reactivity and the capability to initiate the
polymerisation of such monomers as styrene and acrylates. BAPO
photoinitiators are superior to MAPO and are extremely effective as they
can generate four radicals from the α-cleavage of the triplet excited state.
Lucirin TPO seems to be an interesting molecule despite its shorter
wavelength absorption as it may provide the potential to be a more
aesthetic and a more efficient photoinitiator due to less absorption in the
visible region and its much higher molar extinction coefficient, respectively.
Lucirin TPO (2,4,6-trimethylbenzoyldiphenylphosphine oxide), which
absorbs light in the transition area between the visible and the UVA range
(λ max = 385 nm) and forms radicals by bond fission Ilie and Hickel (2008)
demonstrated the potential for Lucirin TPO to replace camphorquinone in
adhesives with regards to degree of conversion and hardness. 17Other
investigators have also reported the possibility of improved conversion with
Lucirin TPO due to the much higher molar absorptivity (Neumann et al.,
2005).
* Additionally, using camphorquinone or other photoinitiators
synergistically, which have higher wavelength absorption, may aid curing at
greater depths. Nevertheless, RBCs containing such initiators are limited
to relatively thin specimens, which may not be a problem in flowable
composites and adhesive layers of restorations.

4. THIOXANTHONE DERIVATIVES: Thioxanthone (TX) and their

derivatives are bimolecular Type II photoinitiators for free radical
polymerization. Photoinitiation by these compounds is based on the
reaction of their triplet excited states with a hydrogen donor thereby
producing an initiating radical. On the other hand, they suffer from
diffusion-controlled limitation of reactivity and from deactivation by back
electron transfer. 2- Mercaptothioxanthone (TX-SH) possesses an
absorption characteristic similar to the parent thioxanthone with a
maximum at 383 nm. TX-SH can be used as a photoinitiator for the
polymerization of vinyl monomers in the presence and absence of air. This
odorless new photoinitiator is very attractive, since it does not require
anadditional hydrogen donor and initiates the polymerization of both
acrylate and styrene monomers in the presence and absence of air. In
addition, TX-SH possesses excellent optical absorption properties in the
near UV spectral region, ensuring efficient light absorption from most UV-
curing tools. 17

5) ACYLGERMANE DERIVATIVES:
Dibenzoyl germanium derivatives are synthesized starting from various
dithioacetal protected benzaldehydes by a coupling reaction with different
dialkyl dichlorogermanes and subsequent oxidative cleavage of the
protecting group. They show a significantly stronger blue light absorption
than CQ. They are used as amine free visible light photoinitiators and
undergo photodecomposition under formation of radicals. Recently, organic
ketones containing germanium were introduced as a new class of
cleavable photoinitiators for free radical polymerization under visible light
irradiation. In a process analogous to acylphosphine oxides, these
photoinitiators (upon irradiation) undergo R-clevage to produce free
radicals capable of initiating polymerization of methacrylates. BTG (in
combination with suitable onium salts such as iodonium and pyridinium
salts) is an efficient photoinitiator for cationic polymerization. The proposed
initiation mechanism involves the photogeneration of germyl and benzoyl
radicals in the first step. Subsequent oxidation of germyl radicals by onium
salts yields germanium ions capable of initiating the polymerization of
monomers. The efficiency of the latter step is controlled by the redox
potential of the onium salt.
Typical acylgermane photoinitiator, benzoyltrimethylgermane (BTG) in
conjunction with an iodonium salt was shown to be active in initiating
cationic polymerization of various monomers at wavelengths up to 450 nm.
They are storage stable and show a significantly improved bleaching
behaviour over CQ. An analysis of dental composites containing Ge-1 or
Ge-2 as photoinitiators also showed that they offer considerable
advantages compared to CQ amine-based materials. Apart from
demonstrating quicker curing and excellent bleaching behaviour, these
materials require a much lower concentration of the photoinitiator to
achieve comparable mechanical properties 11.
* When dibenzoyldiethylgermane Ge-2 is used as a photoinitiator, the
benzoyl (B·) and germyl (G·) radicals produced by photolytic fission are the
radicals that initiate the polymerization reaction. Structural variations of
germanium compounds, bis-(4-methoxybenzoyl) diethylgermane was
selected as the optimum photoinitiator and protected by a patent under the
name of Ivocerin.
* IVOCERIN is characterized by intensive absorption of light in the
visible region and high photo reactivity. It imparts an excellent bleaching
behaviour to composite resins. The radicals required to initiate the
polymerization reaction are created by light-induced cleavage of Ivocerin.
Additional co- initiators or accelerators are not required. The quantum
efficiency of radical formation in conjunction with Ivocerin is many times
higher than that in conjunction with camphorquinone.

6) HEXA ARYLBIIMIDAZOLE DERIVATIVES:

Hexaarylbiimidazoles (HABIs), a class of photoinitiators first synthesized
by Hayashi and Maeda, a visible light-active photoinitiators specifically for
thiol–ene systems. Upon irradiation, HABIs undergo homolytic cleavage to yield two -lophyl
radicals that are unreactive with oxygen and show slow recombination rates, attributable to steric
hindrance and electron delocalization 13. HABI photoinitiators show no initiation activity in (meth)
acrylate formulations without the presence of a hydrogen-donating coinitiator. Thiols are commonly
used as coinitiators in conjunction with HABIs, where hydrogen abstraction by the HABI-derived
lophyl radicals yields initiating thiyl radicals, suggesting a particular suitability for HABI
photoinitiators in thiol–ene formulations. Unfortunately, commercial HABIs often exhibit poor
absorption in the visible spectrum, sometimes requiring a photosensitizer, and low solubility in
common resins and organic solvents 15 Conversely, despite their relatively low visible light
absorptivity, HABI photoinitiators afford rapid thiol–ene photopolymerization rates. Moreover, minor
structural modifications suggest pathways for improved HABI solubility and visible light absorption.
7) SILANE BASED DERIVATIVES: High-molecular weight,
soluble and formable polysilanes have found application as photoresist
materials, photo- conductors and photoinitiators in radical polymerization.
These applications are mainly based on the polysilanes which have strong
ultraviolet absorption in the 300–350 nm region depending on the nature of
the organic substituents. Upon irradiation at this band, polysilane undergo
rapid photodegradation yielding both silyl radicals and silylenes. It has
been reported by West et al. that polysilanes are effective photoinitiators
for the free radical polymerization and it was assumed that the initiating
process consists of the reaction of silyl-type radicals with vinyl monomers.
Recently, it was shown that in conjunction with pyridinium or iodonium
salts, polysilanes can be used as photoinitiators for the cationic
polymerization of cyclic ethers such as cyclohexene oxide and vinyl ethers,
such as n -butyl vinyl ether. Polysilanes with appropriate absorption
characteristics can be used successfully as a radical source in conjunction
with the specially designed allylic salts to initiate cationic polymerizations
via addition fragmentation mechanism. Emission absorption matching of
the LCU light output and photoinitiator light absorption is critical to
adequate polymerization.The success of this technology hinges on
matching the spectral emission of the LCU with the requirements of the
photoinitiator system to convert the monomers into a polymer network.

ABSORPTION- EMISSION SPECTRUM OF COMMONLY USED

PHOTOINITIATORS:
The spectrum of absorption by these initiators was not a problem when
quartz-halogen was the only available source. However, with the
introduction of the LED light the initiator became a factor in the cure as
single wave LED lights, most of which emitted in the 430 to 500 nm range,
did not interact well with TPO, which absorbs in the 350 to 430 nm range.
 FIGURE – 16 SPECTRUM OF DIFFERENT PHOTOINITIATORS

a)Absorption spectrum

b)Emission spectrum

CURING LAMPS:
Curing of composites is a complex mechanism. Light is used to activate
the photo-initiator system in
the light curing units. Clinical efficiency of a light curing unit is crucial for
obtaining the
optimal polymerization and a successful outcome.

EVOLUTION:

According to Strassler H. E, in the early 1960s, the first light

curing resin composites were
introduced, this led to the development of the first curing light.
The first dental curing light was developed in the 1970s. It was
the Nuva Light (developed by Dentsply/Caulk) that used ultra
violet light in order to cure the material. This was discontinued
because of the use of UV light. Also, these lights were not very
effective due to the shorter wavelengths that limited the depth of
cure.
According to Frederick A, during the early 1980s advances in the
area of visible light curing took place.
Only a few years following the introduction of UV radiation for
curing dental restoratives, the ability of using visible radiation was
introduced: February 24, 1976. On that day, Dr. Mohammed
Bassoiuny of the Turner School of Dentistry, Manchester, placed
the first visible light-cured composite restoration on Dr. John
Yearn, the then head of department. This advancement led to a
curing device that now uses blue light.
The next type of curing light that developed was the quartz-
halogen bulb. This device had longer wavelengths of the visible
light spectrum and allowed for greater penetrating curing light and
light energy. The halogen curing light replaced the UV curing light.
The 1990s presented great improvements in light curing devices.
It improved previous devices as well as developing new devices.
As there were advancements with dental restorative materials,
the technology to cure these materials improved as well. The
main focus was to improve the intensity in order to be able to cure
faster and deeper.

• In 1998, the plasma arc curing light was introduced. It uses a

high intensity light source, a fluorescent bulb containing plasma, in order to
cure the resin-based composite. It claimed to be able to cure material in 3
seconds. However, on average it took between 3 to 5 seconds.
IDEAL REQUIREMENTS OF CURING LIGHT:
 Broad emission spectrum
Sufficient light intensity
Minimal drop off energy with distance
Multiple curing modes
Durability
Sufficient duration for multiple curing cycles
Large curing footprints
Easy to repair

GENERATIONS OF LIGHT CURING UNIT:

The light curing units are classified into the following five generations:
1st Generation- Ultra-Violet Light
2nd Generation- Visible Light Curing Units
3rd Generation- Plasma Arc Units
4th Generation- Light Emitting Diodes
5th Generation- Lasers
a) Ultra violet light:
• Like many advances in dentistry, the technology for using light to
polymerize resin- based materials did not originate within the profession,
but instead was an existing technology that was adapted for dental use.
• The first photo-curing units were designed to emit ultraviolet light
(about 365 nm) through a quartz rod from a high pressure mercury source
and were introduced in the early 1970s. This development was seen as a
revolutionary step in dentistry, for it allowed a “cure on demand” feature,
which was previously unattainable using the selfcuring products. Typical
exposure durations were 20 seconds, but 60 seconds provided enhanced
results.
• Filled, photo-curable composites as well as sealant materials were
available, and were used in very innovative ways to not only restore
carious processes, but to also repair tooth fractures and provide easily
performed aesthetic results.
• The photo-initiating system relied on benzoin ether-type compounds,
which broke down into multiple radicals, without need of an intermediary
component. The spectral distribution of light sources of the time with the
absorption spectrum of the initiator helps to correlate these two
parameters. Although some of the restorations placed using this early
technology have proven to be remarkably successful, in general the
procedure was fraught with many issues.
Drawbacks:
1) Because of the limited ability of light to penetrate deep within the
material, incremental build-ups were required instead of bulk placement,
and were limited in depth.
2) In addition, concerns were voiced about the potential for harmful effects
of the short wavelength energy being exposed to human eyes (corneal
burns and cataract formation) as well as possible changes in the oral
microflora.
FIGURE 17 : UV – LIGHT CURING UNIT

b) Visible light curing units:

Quartz tungsten halogen lamps:

Curing of dental composites with visible light with visible blue

light was introduced in 1970s. They have quartz bulb with a
tungsten filament that irradiates U-V and white light. The source
of this blue light is normally a halogen bulb combined with a filter,
so that blue light in the 410 nm-500 nm region of the visible
spectrum is produced.
Light in this range of wavelengths is the most effectively absorbed
by the photo-initiator (camphorquinone) that is present in the resin
component of light activated dental composites. This light then
causes excitation of the camphorquinone, which in combination
with an amine produces free radicals. This results in
polymerization of resin monomers at the molecular scale.
The quartz bulb contains a tungsten filament which heats up in
the halogen gas. The light from the bulb is collected by reflecting
 it from a silverized bulb from behind the mirror toward the path
down the fiber-optic chain to the tip. The surface of the mirror
should be kept clean. When this surface gets heated up, vapours
from the mercury, bonding agent solutions or moisture might get
condensed over it. The surface should be routinely cleaned using
alcohol or methyl ethyl ketone solvents on cotton swabs to renew
its effectiveness.
Macroscopically, the dental composite hardens, typically after light
exposure times ranging from 20 seconds to 60 seconds. The blue
light is delivered to the dental treatment area using various types
of light guides. These guides may be fused rigid glass fiber
bundles or molded polymer guides. Some guides use a flexible
pipe containing a transparent liquid to transmit the light.
Although halogen bulb based light curing units are most
commonly used to cure dental composites, this technology has
many drawbacks. Halogen bulbs have a limited effective lifetime
of around 50 hours. This implicates a reduction of curing
efficiency over time by aging of the components.
Many Quartz Tungsten Halogen lamps used in dental offices
operate beneath the minimum power output specified by the
manufacturers. The insufficient maintenance of the light source
and especially the light tip may deteriorate the performance of the
light curing unit further over time.
The clinical implication of this for the dentist is a negative effect
on the physical properties of composites with an increased risk of
premature failure of restorations. The lower effective limit of
irradiance for halogen technology based Light Curing Units used
in dental practice has been suggested to be 300 mWcm2. Some
halogen Light Curing Units available presently exceeds an
irradiance of 1000 mWcm2. This can be attributed to the
insufficient maintenance by the clinicians.

Drawbacks of Quartz Tungsten Halogen :

This type of curing light however has certain drawbacks:

• High temperatures that the filament generates. This makes the unit
large in order to house the fan. The fan generates a sound that may
disturb some patients, and the wattage of the bulb is such (e.g. 80W) that
these curing lights must be plugged into a power source, that is, they are
not cordless.

• Furthermore, this light requires frequent monitoring and replacement

of the actual curing light bulb because of the high temperatures that are
reached. (For example, one model uses a bulb with an estimated life of 50
hours which would require annual replacement, assuming 12 minutes' use
per day, 250 days per year).

• Also, the time needed to fully cure the material is much more than the
Light Emitting Diode curing light. This implicates a reduction of curing
efficiency over time by aging of the components.

FIGURE 18 - Quartz tungsten halogen lamp

C) PLASMA ARC CURING LAMPS:

This unit has been developed after the technology used by The
United States National Aeronautics and Space Association
 (NASA) in aeronautical engineering. Plasma arc curing lamps
emit light at higher intensities and were primarily designed to save
irradiation time as an economic factor. Plasma Arc Curing lamps
emit light from glowing plasma, being composed of a gaseous
mixture of ionized molecules such as xenon molecules and
electrons.
Plasma Arc Curing units are characterized by high intensities in a
narrow range of wavelengths around 470 nm. Due to the
described high energy output of plasma arc systems, the
manufacturers of these lamps repeatedly claimed that 3 seconds
of Plasma Arc Curing irradiation would achieve similar material
properties compared to 40 seconds curing with Quartz Tungsten
Halogen lamps. However, this claim has been fully rejected.
Today, recommendations for Plasma Arc Curing lights are based
on 3 x 3 seconds.

FIGURE 19 - PLASMA ARC CURING LAMPS

D)LIGHT EMITTING DIODES:

•Light Emitting Diodes, such as those encountered as

indicators in car dashboards, have lifetimes of over 10,000 hours
and undergo little degradation of light output over this duration
of time. Also, Light Emitting Diodes require no filters to produce
blue light.
• The spectrum flux of Light Emitting Diode is concentrated over a
much narrower bandwidth than that of Quartz Tungsten Halogen or
Plasma Arc Curing.
• Several generations of Light Emitting Diode light-curing units
have been introduced over the last few years.
• The 1st generation Light Emitting Diode lights generally
were low in intensity and did not cure materials completely. The
alternative photo-initiators used in bleach shades and the incisal
(translucent) shades of composites and in sealants and bonding
agents could not be activated by these “blue-light” units.
• The 2nd generation Light Emitting Diode light-curing units
(Bluephase, Elipar Freelight 2, L.E. Demetron 1, Radii, Allegro,
SmartLite iQ, Cure) have a single, high-powered diode with multiple
emission areas. These units show a large surface area of emission
and high-energy output.

FIGURE 20 – 2nd GENERATION LED LIGHT CURING UNITS

 * The 3rd generation Light Emitting Diode light-curing units (UltraLume
5) have two or more diode frequencies and they emit light in different
ranges to activate CQ and alternative photo-initiators.

The halogen bulbs operate with a hot filament, the Light Emitting
Diodes use junctions of doped semiconductors (p-n junctions) for the
generation of light.

In gallium nitride Light Emitting Diodes under forward biased

conditions, electrons and holes recombine at the Light Emitting Diodes p-n
junction leading to the generation of blue light. A small polymer lens in
front of p-n junction partially collimates the light.
 FIG 21 - UltraLume 5

In the recent years, the development of high power Light Emitting

Diodes is comparable to the advances we have seen with the high
tech computer technology. The use of high power Light Emitting
Diodes have shown high outputs even with single diodes. However,
the heat generation with these has become a major concern in the
clinical field.

New LEDs GC has developed the G-Light, a curing light which

utilizes the very latest in Light Emitting Diode technology. Many
new dental materials do not contain the light initiator
camphorquinone and thus cannot be cured by conventional 'blue
light' Light Emitting Diodes.
The G-Light's blue and violet Light Emitting Diodes give you two
different wavelength peaks at the same time, ensuring an
optimum curing of all of your Visible Light Curing unit materials.
With a high intensity, narrow spectrum of light, it emits the
maximum amount of light energy right to the tip of the hand piece.
This rechargeable light can be used over 400 times for 10
seconds without any reduction in its intensity. Its constant light
energy guarantees efficient and deep curing every time

FIG 22 - G-Light
 Lasers:
Laser (Light Amplification by Stimulated Emission of Radiation) light is
defined as being coherent, unidirectional, monochromatic, collimated and
potentially high-energy yielding. Theodore H. Maiman developed the first
lasers. It was a pulsed laser, in 1960. Since then, dental interest in lasers
has been of keen interest. Dental lasers were introduced and recognized
as a tool for better patient care in the early 1990s.The wavelength of the
argon laser (between 450 and 500 nm) has been used effectively to
polymerize composite resins because it enhances the physical properties
of the restorative material compared with conventional visible light
curing.Lasers produce little heat, because of limited infrared output. The
Argon Laser is useful in Class II composite restorations, not only because
of the decreased curing time needed, but also the small fiber size allows
for easy access of the curing light to the interproximal box area and
provides a highly satisfactory result for the completed restoration. A major
limitation of arc and laser lamps is that they have a narrow light guide (or
spot size). This requires the clinician to overlap curing cycles if the
restoration is larger than the curing tip.
FIG 23- ARGON LASER LAMP
 FACTORS ASSOCIATED WITH THE LIGHT CURING UNIT: As
mentioned above, the first resin composites used in dentistry were
chemically activated and then being developed to be photo-initiated with
ultraviolet wavelengths. Currently, the resin composites are mostly cured
by using curing lamps in the visible wavelengths.19 The intensity of the
light lamps decreases depending on the quality and age of the light source,
orientation of light tip, distance between it and the restoration; presence of
contamination.
FIG 24 – FACTORS INFLUENCING LIGHT CURING MECHANISM
TIP SIZE: Curing tips are available in various sizes. Light guides are
available in diameters of 3 mm, 8 mm, 10 mm, 11 mm, 13 mm, and 14 mm.
In a light-curing unit that has a standard diameter tip (11 mm), the light
energy is more diffused, whereas in a light-curing unit with a smaller tip (3-
mm turboguide), it is more concentrated (Figure 2). These small-diameter
tips of light-curing units increase the output of light energy by 8-fold but
also raise the temperature of the restoration and tooth structure during
curing. Therefore, they should be used cautiously. Also, the light intensity
from the light-curing unit tip falls off from the center to the edges, forming a
bullet-shaped curing pattern (Figure 3). This variability in light intensity
across the curing-tip face can cause improper curing of RBCs in proximal
box restorations and extensive restorations.Recently, it has been
suggested to use an R value to describe the light guide shape rather than
words such as “normal” or “turbo.” An R value is the ratio between the
entry diameter and exit diameter of the light guide tips. A higher R value tip
is more efficient if the tip to composite distance is less than 5 mm. For
more than 5 mm, tips with a lower R value are better. The R value also
influences the curing depths of the RBCs.
FIG 25 – CURING TIPS
 TYPE OF LIGHT-CURING UNIT: Each light-curing unit has its own
wavelength specifications, advantages, disadvantages, and curing
efficiency. It has been observed that more light is absorbed by the RBCs
with the laser units and scattering is greater with the quartz-tungsten-
halogen (QTH) units. Due to the broad wavelength spectra available for
QTH units, the decrease in light penetration caused by increased light
scattering of shorter wavelengths is compensated by the longer
wavelengths, which can easily transmit through the material and reach the
deeper layers. Although the lights of laser units have better absorption, the
devices have limited bandwidth and emit wavelengths closer to the
absorption peak of the photoinitiator. Thus, QTH units are more efficient
than laser ones for visible light-cured RBCs. Conversely, due to its inherent
property of coherency, there is no loss of power in the distance in laser
units as seen in QTH units. Therefore, they are the units of choice for
inaccessible areas.

EXPOSURE TIME: Adequate curing of RBCs and dentin bonding

agents not only depends on curing-light units but also on the exposure
duration or exposure time. A standard time of 20 secs is usually required to
cure to a depth of 2.0 mm to 2.5 mm by most curing-light units having a
power density of 800 mW/cm2. For a unit emitting 400 mW/cm2 an
exposure time of 40 secs is required to cure through a 2-mm thick layer of
an RBC. Thus, increasing the power density of the lamp reduces the
required exposure time at a given depth and also increases the rate and
degree of cure. Also, because the energy density is a product of intensity
multiplied by exposure time, the same energy can be consumed at high or
low intensities by modifying the exposure time to maximize the energy
efficiency. An exposure time of 40 secs is considered optimal for all curing-
light units used for RBCs. The required exposure time can be influenced
by the type of light-curing unit, shade of RBCs, and RBC formulation.
Thus, a universal exposure time as recommended by the manufacturers
cannot be used for all clinical scenarios and operating conditions. It has
been observed that exposure times longer than those recommended are
required to optimize the flexural strength for an incremental thickness of an
RBC.
LIGHT SOURCE (LAMP OUTPUT INTENSITY): The lamp intensity is
determined by its power rating and light- guide diameter. An adequate
energy density (i.e., intensity multiplied by exposure time) is required for
proper curing of RBCs. Therefore, lamp output intensity should always be
maintained for a longer clinical life of the curing unit. Usually, light output of
the lamp and its curing effectiveness reduces with time. This is mainly
caused by the alternate heating and cooling of the tip surface, leading to
dulling or clouding of the tip due to the condensation of mercury vapours,
vapours from bonding system solvents, or moisture. At times, the resin
adheres to the tip during curing, scattering the light, and reduces the
effectiveness of curing-light unit. Therefore, it is important to routinely clean
the mirror surface with cotton swabs dipped in alcohol or methyl ethyl
ketone solvents or by using a rubber wheel on a slow-speed handpiece.
This tends to preserve and renew the reflection effectiveness of the bulb.
ANGULATION OF LIGHT TIP: A light beam creates a circular spot of
light when held perpendicular to the restoration surface. The wand tip of
the curing-light unit should always be parallel to the restoration surface to
achieve maximal light intensity at the surface. As the wand is tipped, the
circular shape changes to an ellipse (greater surface area) and thus
decreases the light intensity as energy is spread over a greater area.

BEAM SPREADING: The light beam usually disperses from its origin
from the curing- light unit tip, leading to inhomogeneous distribution of light
intensity. Thus, as the wand is moved away from the resin surface, both
the light intensity and amount of curing decreases. At distances beyond 6
mm for QTH lights, the output may be less than one third that at the tip.
This inhomogeneity can result in inhomogeneous polymerization below the
light guide tip. Therefore, it is necessary to “step” the light across a large
restoration so as to adequately cure the entire surface. Also, to permit
closer approximation to an RBC restoration, light-transmitting wedges have
been promoted for interproximal curing and light-focusing tips to access
proximal boxes. A simple test to check for beam spreading is to note the
diameter of the light spot. If the diameter that is created by a light beam
directed perpendicularly onto a surface from a distance of about 100 mm is
the same as the diameter from that of the wand tip, then there is no beam
spreading. It is also advocated to use an exposure time of 60 secs with
larger emitting tips.
DISTANCE OF CURING TIP : The light intensity striking the RBC
restoration surface is inversely proportional to the distance from the tip of
the fiber optic bundle of the curing light to the composite surface. Also, for
all light-curing units, the depth of cure generally decreases as the distance
from the tip increases. Ideally, the tip should be within 3 mm of the RBC to
be effective. For the darkest shades, increments should be limited to 1 mm
of thickness. While both intensity and depth of cure decrease with
increasing distance, the relationship between these factors and distance
may not be similar for all curing lights.

PROPERTIES OF CURING:
DEGREE OF CONVERSION: (DEGREE OF POLYMERIZATION):
It’s the percentage of carbon –carbon double bonds that have been
converted to single bonds to form a polymeric resin. A 65% conversion is
considered to be good. The higher the degree of conversion, better will be
the strength and wear resistance. Conversion of the monomer to polymer
depends on resin composition, transmission of light through the material,
concentration of sensitizer, initiator and inhibitor. Due to faster
polymerization of visible light cure resins there are chances of building up
residual stresses.

The total amount of resin polymerized depends on several factors:

• Transmission of light through the material: This is controlled by
absorption and scattering of light by the filler particles, as well as any tooth
structure interposed between the light source and the resin. For this
reason, microfilled composites with smaller and more numerous particles
will not cure to as a great depth as conventional composites.
• Amount of photoinitiator and inhibitor present for polymerization to
take place at any depth, a particular amount of photons must be available.
This is directly related to the intensity of light and time of exposure.
• Time of exposure: Manufacturers recommend curing times for each
material and shade. This depends on the output of the particular curing
device. Thus, 80 to 240 seconds is required with a low intensity light
whereas to achieve the same result, a high intensity light requires only a
20 to 60 second exposure.
WAVELENGTH EMISSION OF SELECTED CURING LIGHTS: It is
important to emit the curing light with high power density and at a suitable
wavelength. Insufficient light curing can cause degradation of the adhesive
interface, colour changes in the material, and cell cytotoxicity.

TABLE 6 - WAVELENGTH EMISSION OF SELECTED CURING LIGHTS

 DEPTH OF CURE: The intensity of the light source decreases as the
distance between the tip of the light and the surface of the composite
increases. Hence to obtain maximum polymerization, depth of cure
becomes important. The light source should be held at a distance of not
more than 1mm from the surface of the restoration. The depth of cure is
relevant to light- cured composites since the penetration of the light
through the material depends on various factors – composite related and
light related.
COMPOSITE RELATED FACTORS include
- Shade
- Translucency
- Filler particle size, load and distribution
LIGHT RELATED FACTORS include
- Light intensity
- Irradiance
- Spectral distribution
- Exposure time
The depth of cure for the visible light-activated composites of
2-3mm is possible with a good light source and good technique.
Light output from a source can be measured in terms of irradiance.
IRRADIANCE is equal to the power (energy/ time) per unit area.
Improved irradiance improves the penetration depth of the light
source. Irradiance falls within the body of a composite material
because of absorption and scattering by the resin and filler particles
and by the tooth substance. As the light hits the composite, it is
reflected, scattered or absorbed and this limits the amount of
penetration that is achieved. Since the depth of cure is limited, there is
always the possibility that the deeper layers of the restoration will not
be cured. This is especially true in the gingival seat of a deep class II
cavity. This uncured resin gets washed out, resulting in microleakage,
secondary caries, and fracture owing to poor foundation for the
restoration. The more intense the light source, the more the photons
available for the absorption by the photosensitizers hence more
Camphoroquinones are raised to the excited state, which react with
the amine to form more free radicals for polymerization.
At the top surface, polymerization is more efficient because of the
ample number of photons. However, deeper in the composite,
attenuation of light leads to a potential gradation of the cure within the
depths of the material.
 Hence, the tip of the light source should be placed as close as
possible to the surface of the restoration. The light intensity on the unit
surface area drops off with the inverse square of the distance between
the light source and the resin.
The effort should be made to prevent contamination of the light tip
with composite material, as this will reduce the curing efficiency of the
light source with subsequent use. Fanning over a large surface area
should be avoided as it is impossible to calculate the length of
exposure of any particular area of the surface.
To ensure adequate polymerization, one spot at a time should be
cured taking care to overlap these spots. Most light curing requires
minimum of 20 seconds under optimal conditions of access. The
problems of light penetration can be slightly overcome by increasing
curing times.
Curing again after completion of recommended procedure (post
curing) for 20-60 seconds may slightly improve the surface layer.

FIG 26 – DEPTH OF CURE AND DEGREE OF CONVERSION

POLYMERIZATION SHRINKAGE: All composites shrink while

hardening in order of 2-3% volume. This is referred to as a polymerization
shrinkage. It usually does not cause significant problems with restoration
cured in preparation having all enamel margins. However, when a tooth
preparation extends on to the root surface polymerization shrinkage can
cause gap formations at the junctions of composite and root surface, as
the force of polymerization of composites is greater than the initial bond
strength of composites tooth structure. Polymerization in composite resins
is accompanied by a shrinkage of 1 to 1.7%.
This creates tensile stresses as high as 130 kg/cm2 which severely strains
the bond and can lead to marginal leakage. Sometimes it may also cause
the enamel at the restoration margin to crack or fracture. The total
polymerization shrinkage between light activated and chemically activated
resins do not differ. However, the pattern of shrinkage is different –
shrinkage is towards center of the bulk in chemically activated composite
resins and toward light source in light activated composite resins. The
polymerization shrinkage is highest in case of the microfilled composites
because of the higher resin content.

TABLE 7: FACTORS THAT INFLUENCE THE COMPOSITE RESIN

POLYMERISATION PROCESS.

This problem though cannot be eliminated, can be minimized this

polymerization contraction depends on two factors:
1) The quality of bond
2) The shape of the Cavity preparation-C- factor configuration.

APPROACHES TO REDUCE BUILD UP OF FTRESS:

1. Reducing volume contraction by altering chemistry and /or

composition of the resin system
2. Clinical techniques designed to offset the effects of
polymerization shrinkage.
 CLINICAL TECHNIQUES TO OFFSET EFFECTS OF
POLYMERIZATION SHRINKAGE:
During curing, shrinkage of composite resins leaves the bonded cavity
surfaces in a state of stress and the unbounded surfaces undergo
relaxation by shrinking towards the bulk end of the material. The stress
thus created may be 7mPa in the composite. When the composite is
bonded to only 1 surface as in facial veneer stresses are released by flow
from unbounded surface. But stress relief within 3- dimensional bonded
restoration is limited by its configuration factor, or c- factor.
C-FACTOR:
It was first analysed by Feilzer in 1987 and in terms of the ratio of the
surface area of the bonded surfaces to the surface area of the unbonded
surfaces. The highest is the c-factor the greater the potential for bond
disruptions from polymerization effects. Most technique sensitive
preparations to restore successfully are class v, 5 bounded and 1 free
surface, thus resulting in the maximum stresses. A veneer on the other
hand has five free and only 1 bounded surface. The magnitude of
development of stresses is influenced by the rate at which the composite is
cured (Kinimoto, Ttori, Ebisu Journal of Dentistry 1999). Light cured
materials demonstrated twice the magnitude of stress compared to self-
cured material. Also, heavily filled composite materials exhibits higher
stress. Maximum stresses developed are at internal line angles and stress
on the lateral walls increases with depth of the cavity. Unrelieved stresses
in composite resins cause bond disruption as well as marginal gaps
around restoration that increase microleakage.
FIG 27 – C FACTOR FOR VARIOUS CAVITY DESIGNS
 CLINICAL TECHNIQUES TO REDUCE C-FACTOR:

a) INCREMENTAL BUILD UP AND CONFIGURATION: Since

difficulties imposed by the cavity configuration (C-factor) play an
important role in stress development, many researchers have
suggested the use of “incremental layering techniques” for resin-
composite restoration to reduce the polymerization shrinkage stress
and cusp deflection. The rationale is that shrinkage may be less
detrimental when there are fewer bonded cavity walls involved at
each stage of the restoration procedures.

Incremental curing also enhances the degree of cure as thin sections

undergo higher degree of cure due to lower light attenuation, thus
the net degree of conversion is greater. This yields better
mechanical properties but higher shrinkage as well; however, the
C-factor changes as well.

In class I cavity, for example, by using a single increment, the resin

composite would polymerize within five bonding surfaces (one base
and four surrounding walls) while free shrinkage would only occur
at the upper surface, producing a very high level of stress between
the bonded surfaces. However, by using an incremental technique,
the bonded/unbonded ratio would be reduced and, consequently,
the stress level within the cavity might be lower, preserving the
bonded area.
According to Park et al. the bulk filling technique yielded significantly
more cuspal deflection than the incremental filling techniques,
concluding that cuspal deflection resulting from polymerization
shrinkage can be reduced by incremental filling techniques to
obtain optimal outcomes in clinical situations. Lee et al. observed
that cusp deflection increased with increasing cavity dimension and
C-factor, thus the use of an incremental filling technique or an
indirect composite inlay restoration could reduce the cuspal strain.
C-factor was shown to be an influencing factor for dentin adhesion ,
however, using an appropriate layering technique , high bond
strengths to deep cavity floors can be achieved.

It was concluded that the incremental filling technique increased the

deformation of the restored tooth and could produce higher
polymerization stresses at the restoration interface compared with
 bulk filling. Multiple increments showed to induce greater cuspal
movement than a bulk increment in cuspal deflection
measurements of premolars.

- According to Loguercio et al. some evaluated effects of

polymerization shrinkage such as gap width, adhesive bond,
strength and the cohesive strength of the resin composite were not
reduced by the filling technique under the different C-factor
cavities.
- Despite the controversy over the advantages of incremental build-up
of resin composites, this technique has been broadly
recommended in direct resin-composite restoration, because it is
expected to decrease the C-factor, allowing a certain amount of
flow to partially dissipate the shrinkage stress.

FIG 28- LAYERING TECHNIQUE

b) STRESS ABSORBING LAYERS WITH LOW ELASTIC LINERS :

Flowable composites are low viscosity resin-based restorative
materials, less rigid and could have a modulus of elasticity 20–
30% lower than conventional hybrid composites . The use of a
flowable resin composite as an intermediate thin layer has been
suggested as a mean of overcoming polymerization shrinkage
 stress based on the concept of an “elastic cavity wall” suggested
for filled adhesives.
- According to the “Elastic cavity wall concept” the shrinkage
stress generated by a subsequent layer of higher modulus resin
composite can be absorbed by an elastic intermediary layer,
thereby reducing the stress at the tooth restoration interface
manifested clinically as a reduction in cuspal deflection . However,
actual implementation of such a “stress absorbing ” material is
problematic.
- Restorative materials encompass a wide variety of shrinkage and
elastic modulus values. Flowable resin composites have shown
shrinkage stress comparable to conventional resin composites,
supporting the hypothesis that the use of flowable materials does
not lead to marked stress reduction and the risk of debonding at
the adhesive interface as a result of polymerization contraction is
similar for both type of materials.
C) LIGHT CURING PROCEDURES: Diverse photoactivation protocols
have been advocated to reduce the polymerization stress . In theory, stress
release by viscous flow before the vitrification stage would be allowed to
occur without compromising the final polymer properties. Therefore, initial
light exposure at lower irradiance values might lead to the formation of a
reduced number of polymer growth centres, reducing the reaction rate and
decreasing stress development due to the increased opportunity for resin
flow before the vitrification stage. There are many types of alternative light-
curing methods.

Three sited curing technique : (Quint Int.1986) The first increment is

cured through a light- reflecting wedge. Large second increment and small
third increment is cured from the buccal and lingual directions in order to
ensure that the shrinkage vectors run towards the cavity margins. A fourth
increment is added to the occlusal surface.
FIG 29 – THREE SITED CURING TECHNIQUE
 Soft start curing: Curing begins with a low intensity and finishes with a
high intensity. There is a slow initial rate of polymerization and high initial
level stress relaxation during the early stages and ends at maximum
intensity once the gel point has reached.
Ramped cure technique: Here the intensity of curing is ramped up in
step wise or linear or exponential modes.
Pulse Delayed curing: The restoration is initially cured incompletely at
a low intensity. Then contouring of the resin is done and a second
exposure for final cure is done. This delay allows for stress relief or
relaxation.
FIG 30 – DIFFERENT CURING METHODS

Few important considerations:

Some different outcomes may appear among various studies, which
may be related with
- the light curing type used
- the irradiance used at the beginning of the light
curing procedure
- and/or the period without irradiance.
Although the alternative light-curing protocols may not significantly
affect final properties of the hardened material, some considerations
should be noted.
(i) The flowability of a material, during an extended preset stage,
may have minimal consequences, because most shrinkage
stress is developed during and after the vitrification stage.
Therefore, opportunities for polymer relaxation would be
restricted during the short period of light activation.
(ii) Concurrent experiments on degree of C=C conversion (DC) and
stress development show that soft-start irradiation procedures
 give somewhat lower DC levels, associated with reduced stress.
(iii) A reduced polymerization rate is associated with decreased
cross-link density (CLD), manifest as greater solvent-softening
and/or lower final elastic modulus .

c)PREHEATING: Recently, preheating resin composites have been

advocated as a method to increase composite flow, improve marginal
adaptation and monomer conversion. The benefits of preheating
composites may have an impact on daily restorative procedures as well,
with the application of shorter light exposure to provide conversion values
similar to those seen in unheated conditions.
The reasons for increased conversion are based on many factors;
Increased temperature, decreases system viscosity and enhances radical
mobility, resulting in additional polymerization and higher conversion. The
collision frequency of unreacted active groups and radicals could increases
with elevated curing temperature when below the glass transition
temperature . Therefore, at raised temperatures, in theory, it would be
possible to obtain higher degree of conversion before the vitrification point,
decreasing the magnitude of stress.
c) NOVEL FORMULATIONS FOR REDUCING SHRINKAGE
STRESS: The development of resin composite has mainly focused
on filler technology, while the composition of the polymer matrix
remained principally unchanged since the introduction of Bis-GMA
resin . Shrinkage is an inherent property of dimethacrylate-based
formulations. However, recently, novel monomer combinations and
alterations of the resin-composite formulation have been developed
and evaluated with the goal of decreasing polymerization shrinkage
stress. The most recent modification on the polymer matrix is based
on using ring opening polymerization of the silorane molecules,
instead of free radical polymerization of dimethacrylate monomers .
Silorane resin reveals lower polymerization shrinkage compared to
the dimethacrylates. These “cyclic” monomers have provided
particularly interesting and commercially viable results. Such
monomers “open” their molecular structures with local volumetric
expansion and this may partly or totally compensate for volumetric
shrinkage from C=C or similar polymerization. Schneider et al.
found that phenyl-propanedione, substituting for part of the
camphorquinone content, reduced the stress development rate
without compromising the final degree of conversion and
degradation resistance of the composite.Besides change in the
 resin matrix composition, studies have demonstrated reduced
shrinkage stress through alterations in filler content.
• Condon and Ferracane suggested that addition of nonbonded 40 nm
colloidal silica might act as stress- relieving sites through plastic
deformation. They also verified that composites with nanofiller
particles treated with a nonfunctional silane developed 50% less
stress than composites fully treated with the functional coupling
agent.
• Another possible approach is inclusion of a component readily
allowing plastic deformation during stress development, such as
ultrahigh molecular weight polyethylene (UHMWPE) fibres.
• The current dental resin composites based on dimethacrylates are
inevitably linked with shrinkage that can compromise the success
and longevity of the restoration and, consequently, clinicians have
to coexist with the polymerization shrinkage-stress phenomena. On
the other hand, methods for shrinkage stress evaluation are
bringing important contributions and the outcomes are being
applied to novel formulations and clinical techniques.

OXYGEN INHIBITED LAYER

The polymerization reaction is strongly inhibited by free radicle
scavengers such as oxygen. The inhibition resulting from oxygen diffusing
from atmosphere into curing resin is responsible for formation of a soft,
sticky superficial layer on freshly polymerized resin, referred to as Oxygen
Inhibited Layer (OIL). The oxygen inhibited layer is primarily composed of
unreacted monomers and oligomers and possesses a liquid-like
consistency. This layer not only readily adopts the overlying material to
increase contacting area but also allows materials on both sides to cross
the interface and blend together to form an inter-diffused zone where
copolymerization can take place to produce a chemical bond.
* Depending on the type of composite used, the thickness of this OIL is
between 10 and 200 μm.1-3. Based on the principle of molecular
interaction, one might easily reason that an OIL should improve the
interfacial bonding between two contacting polymers.
* The resin in the OIL has the same composition as the uncured resin,
except that the photoinitiator system, commonly camphorquinone (CQ)
and amine, has been consumed or decomposed. The rate of CQ
decomposition was found to be irradiation energy dependant. The CQ half-
life decreases with higher-intensity irradiation.
 * The OIL contains significantly reduced levels of CQ photo initiator.
They also imply that a long curing time may negatively impact the ability of
the oxygen inhibited layer to be post-cured. Extremely high thickness of
the OIL of traditional composites (37 plus/minus16 mm) prevented effective
interdiffusion of fresh composite (photoinitiator) into the inhibited layer,
resulting in under polymerization and lower bond strength.
The OIL adversely affects the prognosis of composite restorations since
it reduces surface hardness, wear resistance, and marginal adaptation of
composite restorations. It cannot be completely removed by occlusal
adjustment, finishing, or polishing procedures after curing, and the partial
remnants of the OIL reduce the quality of the final restoration. Therefore, in
order to minimize the OIL as much as possible, its formation can be
reduced by curing the composite after inhibiting oxygen contact either
through the use of a Mylar strip, application of glycerin to the composite
surface or polishing the restoration.

• A Mylar strip or plastic matrix can be used for proximal and bucco-lingual
cavities, but The surface hardnesses of composites cured using a Mylar
strip were initially lower than those of composites polished after being
cured in the air, however, after six days, no differences remained.
• Glycerin application is more effective for complicated occlusal cavities
and areas with limited access. When using glycerin, the final curing is
completed through the glycerin. The glycerin is then rinsed off prior to
finishing and polishing. The result is a harder composite surface that is
easier to finish.
• Surface polishing : Removal of 0.2 mm of material from the surface of
the composite via polishing led to a large increase in surface hardness
compared to that observed with no polishing. This result is due to exposure
of the solid surface under the OIL after removal through polishing. The
subsurface under the OIL is not influenced by oxygen, and its temperature
increases more than that of the surface during polymerization, resulting in
a greater degree of conversion when the OIL was removed via polishing,
there were no differences in hardness. On the other hand, there was no
interaction between measurement time and curing method. Polishing
results in a higher surface hardness than that produced when a matrix is
used, is effective in preventing discoloration and is advantageous in
achieving a satisfactory surface and marginal adaptation.

• However, there is a lack of studies that quantitatively compare the effects

of Mylar strip use, application of glycerin, and surface polishing.
 CLASSIFICATION: Composite resins have undergone enormous
improvements and advanced since their introduction in 1956.they have
thus been classified in various ways.
1. Filler particle size and distribution:
A) BASED ON PRIMARY PARTICLE SIZE- BY STURDUVENT:
FIGURE 31: CLASSIFICATION BASED ON FILLER SIZE
 1. Mega fill – very large individual particles or inserts for posterior
composites
2. Macrofill – 10 to 100 µm
3. Midifill – 1-10 µm
4. Minifill -0.1-1 µm
5. Microfill-0.01-0.1 µm (fine finishing)
6. Nanofill_ 0.005 – 0.01 µm

B) SKINNERS’S CLASSIFICATION Based on mean particle size of

major filler :

Traditional Composites ( Macrofilled) 8-12 µm

Small particle filled composites – 1-5 µm
Microfilled composites 0.04-0.4 µm
Hybrid composites 0.6- 1 µm

1. TRADITIONAL COMPOSITES: They were developed in 1970 and

are also referred to as conventional or macro filled composites. The filler is
finely ground amorphous silica and quartz. Average size of fillers is 8 to 12
µm and the filler loading is generally 70-80%wt or 60-70% by volume, the
properties such as water sorption, polymerization shrinkage, and thermal
expansion are less than those of unfilled resins. A major clinical
disadvantage of traditional composite is the rough surface due to abrasive
wear of the soft resin matrix exposing the more wear resistant filler
particles. They are most susceptible to occlusal surface wear and thus are
inferior to be used in stress bearing area
2. SMALL PARTICLE FILLED COMPOSITE: They contain fillers of
size range between 0.5-3 µm (1-5 µm) and high filler loading up to 80-90
wt. % compared to the traditional composites. The filler used is amorphous
silica; glasses. Colloidal silica in 5% wt. is added to adjust the viscosity.
The physical & mechanical properties such as compressive strength is
superior to traditional composites and the other micro filled composites.
Coefficient of thermal expansion is two times that of tooth and
polymerisation shrinkage is less, wear resistance is improved. The addition
of heavy metal containing glasses make them radio opaque. They are
indicated for high stress and abrasion prone areas e.g.: class IV.
 3. MICROFILLED COMPOSITE: These composites contain colloidal
silica particles of 0.01-0.04 µm as inorganic filler. To the increase the filler
loading:
(1) Colloidal silica particles are sintered to obtain larger agglomerate
that has a reduced surface area thus allowing more filler without
compromising the rheological properties.
(2) Polymerised composite is ground to get smaller particles that are
used as fillers into the composite resin in the range of 60-70 wt. %.
The bond between cured matrix and composite filler is weak,
facilitating wear by chipping mechanism. Thus, micro filled
composites are not indicated for stress bearing areas.
(3) Due to greater amount of resin, water sorption, coefficient of
thermal expansion is more and elastic modulus is decreased. They
provide the smoothest surface finish. Thus, they are preferred for
restoring teeth with class III and V cavities.
4. HYBRID COMPOSITES: These composites are developed in an
attempt to produce better surface finish than Small Particle Filled
composites but retaining their properties. Hybrid composites contain two
kinds of fillers particles – colloidal silica and ground particles of glasses
containing heavy metals up to 75-80 wt.% The smaller filler particle size as
well as greater amount of micro fillers increases the surface area. Their
physical and mechanical properties are intermediate to those of traditional
and small particle filled composites. They are indicated for both aesthetic
anterior & stress bearing posterior regions.
FIG 32– CLASSIFICATION BY LUTZ& PHILLIPS (1983)
 FIG 33 – CLASSIFICATION BY ANUSAVICE

FIG 34 – TYPES OF COMPOSITES BASED ON FILLERS

C) Homogenous composite- composite simply (consists of filler and

uncured material)
 Hetreogenous composite - composite consists of procured
composite or any other filler.
Modified - composites includes novel filler modifications in addition to
conventional fillers.
2) Handling Properties:
A) FLOWABLE COMPOSITE: The filler content is reduced by 20-25%
compared to traditional hybrid composites, which decrease the velocity
and makes the composite flowable.
B) PACKABLE /CONDENSABLE COMPOSITES: The filler instead of
being incorporated into composites as ground particles is present as a
continuous network/scaffold of ceramic fibres composed of alumina and
silicone dioxide.
3) Polymerization method:
A) SELF CURE/AUTO CURE/CHEMICALLY CURED COMPOSITES
B) U-V LIHT CUREDCOMPOSITES- polymerization is initiated by U-V
light
C) VISIBLE LIGHT CURED COMPOSITE-visible light –blue light of 470
nm
D) DUAL CURED COMPOSITE-they combine self-curing and light
curing composite
4) Use:
A) ANTERIOR COMPOSITE
B) POSTERIOR COMPOSITE
C) CORE BUILD UP COMPOSITE
D) LUTING COMPOSITE.
5) ACCORDING TO CHRONOLOGICAL DEVELOPMENT:
1. FIRST GENERATION COMPOSITE RESINS: They consist of macro
ceramic reinforcing phases in the resin matrix. They have the highest
mechanical properties and highest surface roughness
2. SECOND GENERATION COMPOSITE RESINS: They consist of
colloidal and micro ceramic phase in a continuous resin phase. They
exhibit the best surface texture of all composite resins and better
wear resistance than first generation composites.
3. THIRD GENERATION COMPOSITE RESINS: They are hybrid
composites in which there is a combination of macro and micro
ceramics as rein forcers in a ratio of 75: 25.the properties are
intermediate to those first and second-generation resins.
4. FOURTH GENERATION COMPOSITE RESINS: They are also
hybrid types that contain heat cured irregularly shaped, highly
reinforced composite. Macro particles with a reinforcing phase of
micro ceramics. They are highly technique sensitive.
5. FIFTH GENERATION COMPOSITE RESINS: They are hybrid
composites in which the resin matrix is reinforced with micro
ceramics and macro, spherical, highly reinforced heat cured
composite particles. They have wettability and consecutively
improved bonding to continuous phase.
6. SIXTH GENERATIN COMPOSITE RESINS: These are hybrid
composites in which continuous phase is reinforced with a
combination of micro (colloidal) ceramics and agglomerates of
sintered micro ceramics. They have the best mechanical properties.
They exhibit the least shrinkage and the wear and surface texture
similar to fourth generation composite resins.
◆◆◆

MODIFICATIONS OF
CONVENTIONAL COMPOSITES
Composite dental restorations represent a unique class of biomaterials
with severe restrictions on biocompatibility, curing behaviour, aesthetics,
and ultimate material properties. These materials are presently limited by
shrinkage and polymerization induced shrinkage stress, limited toughness,
the presence of unreacted monomer that remains following the
polymerization, and several other factors. Fortunately, these materials
have been the focus of a great deal of research in recent years with the
goal of improving restoration performance by changing the initiation
system, monomers, and fillers and their coupling agents, and by
developing novel polymerization strategies.
A) MODIFICATION IN RESIN MATRIX:
As composite restorative materials continue to evolve and improve,
some manufacturers are looking at moving away from traditional
chemistries. The search is on for a more biocompatible restorative material
that has less polymerization shrinkage and a higher degree of conversion
(DOC), leaving less unreacted monomer in the restorative matrix.
Multi methacrylates: Because the conventional dimethacrylate
monomers have worked well in many regards, one target of current
research is to select, synthesize, and evaluate dimethacrylates that
preserve the desirable attributes of the conventional restoratives while
simultaneously addressing their shortcomings. These new monomer
systems show promise for maintaining or improving properties such as
conversion, water sorption, volume shrinkage, and shrinkage stress, with
the overarching goal of creating a restorative material with improved
performance and service lifetime.20
Bisphenol A core, provides both high strength and toughness to the
resulting polymers. Hence, the development of dimethacrylate derivatives
of bisphenol A has been an active research area, where modifications of
bisphenol A based dimethacrylate systems have included the use of
pendant bulky (aromatic) constituents (Ge et al., 2005) as well as pendant
alkyl urethanes (Khatri et al., 2003) to increase molecular weight and
thereby decrease volume shrinkage.
Fluorinated derivatives of BisGMA incorporation into
BisGMA/TEGDMA resins has resulted in greater hydrophobicity and
reduced water sorption (Pereira et al., 2007), but no significant
improvements in mechanical properties. Numerous other methacrylate
monomer types are already being developed and evaluated that would
achieve this end. Derivatives of urethane dimethacrylate have been
synthesized to increase molecular weight, reduce water sorption, and/or
increase mechanical properties by incorporating aromatic or aliphatic
groups .20
Polyhedral oligomeric silsesquioxane methacrylates (POSSMA)
were evaluated as alternatives to BisGMA (Fong et al., 2005), and it was
found that small amounts of POSSMA (210 wt.%) did indeed improve the
mechanical properties of these resins, while dimethacrylates based on
cycloaliphatic epoxides showed kinetics and mechanical properties
comparable with those of BisGMA (Shi and Nie, 2008).23
Methacrylated beta cyclodextrin derivatives have also been
evaluated as alternatives to BisGMA and were found to exhibit flexural
strength and volume shrinkage comparable with those of BisGMA
/TEGDMA (Hussain et al., 2005). Many previously developed
dimethacrylate materials exhibit excellent properties with regard to
modulus, water sorption, conversion, and so forth. When one considers
that a dental restorative material must balance numerous properties, the
dimethacrylate materials to date generally result in trade-offs among resin
viscosity, polymer properties, and monomer conversion. 24

Ultra-rapid Monomethacrylates: The paradigm for inclusion of

monovinyl monomers into dental resins was changed with the
development by Decker of a novel class of monovinyl (meth) acrylate
monomers that exhibited greatly enhanced polymerization kinetics and
significantly improved mechanical properties. These monomers contain
secondary and tertiary functionalities such as urethanes, carbonates, cyclic
acetal, morpholine, cyclic carbonates, hydroxy/carboxy, oxazolidones, and
aromatic rings that lead to their unique polymerization and polymer
property behaviour. 21 These monomers exhibit rapid polymerizations that
rival and often exceed those of equivalent di (meth) acrylates, and the
polymers exhibit a high glass transition temperature. Additionally, the mono
(meth) acrylates exhibit high conversion, limiting the potential for leachable
monomer. These materials showed great promise when utilized as
diluents, and several Monomethacrylates were evaluated as alternatives to
TEGDMA .

Acidic Monomers: Recent developments in methacrylate resins have

investigated the incorporation of acidic functional groups into the monomer
structure. Incorporating acidic monomers in relatively small mole fractions
into methacrylate resins may enable a separate adhesive layer to be
eliminated and result in improved overall performance.
FIG 35 – STRUCTURE OF METHACRYLATE MONOMERS
 MODIFYING THE RESIN MATRIX CHEMISTRY
A) SILORANE: Silorane-based RBCs possess a modified resin consisting
of siloxane and oxirane (epoxy) functional groups. The cyclosiloxane
imparts hydrophobicity whilst the cycloaliphatic oxirane monomer
possesses a high reactivity and reduced shrinkage during polymerization
compared with conventional methacrylate-based resins
 FIG 36- STRUCTURE OF SILORANE

The subsequent polymerization shrinkage of Silorane RBCs has been

reported to be significantly less than that of conventional RBC materials.
The cationic ring-opening reaction of siloxane monomers has previously
been described as ‘living’ polymerization as the free-radicals are not
extinguished as rapidly as those in conventional RBCs. Silorane-based
RBCs have also been identified to possess an increased hydrolytic stability
compared with conventional RBCs due to the presence of hydrophobic
siloxane- monomers which reduce water sorption, solubility and diffusion
coefficient.

FIG 37 – RING OPENING POLYMERIZATION

 B) ORMOCERS: Organically modified ceramics (Ormocers) are
organic-inorganic hybrid materials composed of a methacrylate-
functionalised organic phase and inorganic glasses or ceramics
synthesised by sol-gel processing of organofunctional metal alkoxides,
such as Ti, Al or Zr, to produce functionalised alkoxy silane. Subsequent
hydrolysis and condensation produces a three dimensionally branched
oligomeric Si-O-Si network where the organic and inorganic components
are combined at a nanoscopic or microscopic scale.

FIG 38 – ORMOCER RESIN

 A number of commercial Ormocer have been produced based on a
methacrylate-functionalised polysiloxane, such as urethane- or carboxy-
functionalised methacrylate alkoxysilanes and a SiO2 network, with the aim
of reducing polymerization shrinkage and increasing biocompatibility.
ORMOCERS exhibit reduced cytotoxicity, improved flexural strength and
modulus of elasticity based on amine or amide dimethacrylate
trialkoxysilanes and which also possessed a nano particulate fraction,
namely ZrO2 clusters or SiO2 organosols.
C) THIOL-ENE MATERIALS: Oligomeric thiol-ene monomers also
offer an alternative as a novel low-shrinkage RBC material exhibiting as
much as a 92% reduction in shrinkage stress compared with conventional
RBC resins. The thiol-functionalised oligomers were produced by photo
polymerization using monomers such as triallyl-1,3,5-triazine-2,4,6-trione
(TATATO), pentaerythritol tetra(3-mercaptopropionate) (PETMP),
trimethacrylolpropane tris (3- mercaptopropionate) (trithiol) and
pentaerythritol tetracaptropropionate (tetrathiol). In contrast with the free-
radical chain propagation mechanism of conventional methacrylate-based
RBCs, thiol-ene polymerization occurs via a step-growth addition reaction
initiated by a rapid free-radical transfer process. Consequently, the gel-
point is not reached until a relatively high monomer conversion is
achieved, which relieves contraction stresses. In addition, reported that the
increased monomer conversion of thiol-ene materials reduced monomer
elution and also eliminated oxygen inhibition. However, the flexural
strength of conventional BisGMA/ TEGDMA RBCs was identified to be
superior to those of thiol-ene materials.

FIG 39– THIOLENE POLYMERIZATION

 D) SPIRO-ORTHOCARBONATES (SOCS)
The use of expanding monomers, known as Spiro-orthocarbonates
(SOCs) have been a further approach devised to reduce polymerization
shrinkage stresses, which is reduced via cationic ring-opening
polymerization which promotes a volumetric expansion.

FIG 40-DOUBLE RING OPENING POLYMERISATION

E) STRESS-DECREASING RESINS: A new technology has been

developed in the form of what is described as a stress-decreasing resin; it
is based on the incorporation of a molecular chain that acts as a means of
absorbing polymerization shrinkage stress by acting as a
spring/polymerization modulator. Based on the scientific evidence gathered
to date, the ‘polymerization modulator’ reduces stress build-up on
polymerization without a reduction in the polymerization rate or conversion.
It is claimed that, by use of the polymerization modulator, the resin forms a
more relaxed network and provides a significantly reduced polymerization
stress. A commercially available example of this new technology is a
‘Smart Dentin Replacement’ known as SDR™ from DENTSPLY. It should
be noted that this material is primarily designed to act as a dentine
substitute such that the cavity is filled up to the dentino-enamel junction
with this material and then a resin composite veneer is placed over the
top.19
FIG – 41 STRESS DECREASING RESINS

FILLER MODIFICATIONS
In addition to research on the photo initiation process and the
monomers used, research on fillers constitutes a large potential source of
improvement in composite based dental restoratives. In fact, a significant
fraction of the practically implemented improvements in composites in
recent decades has occurred in the nature, type, size distribution, and
surface modification of the filler.4An excellent review focused on the
inorganic filler component of dental composites and related filler
composition, morphology, and loading content with properties conveyed to
composites. 9
FIG 42 – FILLER MODIFICATION
Nano fillers in Dental Composites:
* Significant attention has been devoted to Nano filled materials, including
improvements realized by the incorporation of Nano fillers into commercial
composite materials and research aimed at the development of new Nano
fillers. A recent review focused on Nano filled dental composite materials
(Soh et al., 2006), and a separate report centered on how nanofillers affect
composite mechanical properties and behave distinctly differently
compared with micro¬ or macro scale fillers (Crosby and Lee, 2007).29
* Nano sized fillers can be categorized as either isolated discrete particles,
with dimensions of approximately 5 to 100 nm, or fused aggregates of
primary nanoparticles, where the cluster size may significantly exceed 100
nm. The enormous rise in filler surface area and the corresponding
thickening effect on composite paste consistency associated with
decreasing filler size limit the content of discrete nanoparticles to relatively
low loading levels, whereas high contents of nanoparticle clusters are
manageable with appropriate surface treatment.
* A spatially resolved Nano indentation study examined Filtek Supreme XT
(A3 Dentin) as a Nano filled composite and demonstrated significant
differences in the dynamic complex modulus as a function of positioning
within the matrix, within a filler cluster, or at the matrix filler interface (Ilie et
al., 2009). A study on the influence of mono, bi, and trimodal distributions
of fillers on the wear properties of composites showed that filler size and
shape significantly influence wear resistance, with the inclusion of Nano
sized filler a critical feature, often leading to enhanced properties (Turssi et
al., 2005). A similar dependence of toothbrush abrasion resistance on the
presence of nanoparticles in commercial dental composites has been
shown (Cavalcante et al., 2009). A systematic study of the sol-gel
synthetic approach was used to produce nearly monodisperse silica
particles of adjustable size from 5 to 450. Silanization conditions were
identified that yield uniform surface coverage regardless of particle size,
and dental composites were formulated by incorporation of the
nanoparticles alone or in combination with a barium glass filler so that
particle dispersion and resin/filler adhesion potential could be examined
(Kim et al., 2007). 31 The introduction of bonded or nonbonded nanofillers
in a hybrid composite was evaluated in terms of its effect on abrasion and
attrition wear of the composite. While the use of nonbonded nanofillers
does provide a means to reduce polymerization shrinkage stress in dental
composites, it may also reduce wear resistance. Resin viscosity was a
cofactor with composites based on the lower viscosity resins, which
achieve higher degrees of conversion, performing better in wear studies
than higher viscosity resins with the same filler (Musanje and Darvell,
2006). 29The presence of low to moderate amounts of Montmorillonite
clays as a nanoscale layered silicate filler in a model dental resin was
examined, with attention given to dispersion and exfoliation potentials
dependent on loading level and polarity (Discacciati and Orefice,2007) 31
FIG 43: NANOCLUSTERS AND NANOMERS
 MODIFICATION IN FILLER SURFACE TREATMENT: A proper surface modification of fillers
actually alters its chemical structure, wetting ability and its optimal activity. Several physical and
chemical approaches have been suggested to modify the filler surface for an optimal compatibility
between two different phases.
A.: Physical surface modification methods include the use of ultraviolet laser and flame
oxidation; these methods have limited application in the field of dental composites.
B: Chemical modification techniques include those that involve chemical reaction that alter the
surface of the particle. Chemical modifications are achieved by reaction with small molecules, such
as silane coupling agents, or grafting polymeric chain or brushes through covalent bonding to the
hydroxyl groups existing on the particles.
TABLE 8 – CHRONOLOGICAL IMPROVEMENT IN FILLER SURFACE TREATMENT
 D) MODIFICATIONS IN POLYMERISATION MECHANISMS:
Novel polymerization mechanisms: Conventional radical-mediated
chain-growth polymerization of dimethacrylates has found incredible utility
in composite restoratives; however, it is fundamentally limited in several
aspects. The chain-growth polymerization mechanism leads to early
gelation (Kloosterboer, 1988), while the methacrylate consumption is linked
to a defined volume reduction associated with the consumption of each
methacrylate (Patel et al., 1987). Improvements in the methacrylate
monomer structure, as noted previously, have the potential for addressing
many of the shortcomings of current composites; however, an even greater
potential lies in completely changing the reaction mechanism, either by
changing the active center (from radical to cationic), by changing the
nature of the network / molecular-weight evolution (by changing to a step
growth reaction or by changing to a covalent adaptable network), by
changing the nature of the reactive chemistry (by going to ring opening
species), or by changing the physical behaviour that arises during
polymerization (by inducing phase separation). Exciting research has
focused on bringing each of these developments to dental restorative
materials, and their efforts are summarized here
Thiol-Ene Photopolymerization: Work has also focused on utilizing
the thiol-ene photo polymerization mechanism as a means for
circumventing the problems with conventional methacrylate polymerization.
The thiol-ene polymerization reaction is ideally suited for dental restorative
materials, since these reactions are rapid photopolymerizations that
achieve high functional group conversion, are not inhibited by oxygen, and
proceed via a step-growth polymerization mechanism in which propagation
and chain transfer alternate (Cramer and Bowman, 2001; Hoyle et al.,
2004, 2010; Lu et al., 2005; Hoyle and Bowman, 2010). The step-growth
nature of the polymerization results in uniform polymer networks with
narrow glass transition regions and reduced brittleness. Also, the gel point
conversion is significantly higher in thiol-ene networks as compared with
methacrylate networks, because of the step growth polymerization. Thus,
shrinkage that occurs before gelation, which now represents a large
fraction of the total shrinkage, can be accommodated by flow rather than
stress evolution, and hence thiol-ene systems exhibit significant reductions
in polymerization shrinkage stress (Carioscia et al., 2005; Lu et al., 2005;
Cramer et al., 2010). Though thiol-ene systems exhibit a number of very
attractive properties, including high glass transition temperature, results to
date have demonstrated that they also exhibit reduced flexural modulus
and strength relative to BisGMA/ TEGDMA controls (Carioscia et al., 2005,
2007; Lu et al., 2005; Fairbanks et al., 2009; Cramer et al., 2010). Utilizing
thiol-ene systems in combination with methacrylate systems in
methacrylate-thiol-ene systems is one method to combine the advantages
of both the thiol-ene and methacrylate systems. Methacrylate-thiol-ene
systems were demonstrated to exhibit cure time and flexural modulus and
strength equivalent to those of BisGMA/TEGDMA, while achieving
increased levels of conversion and exhibiting dramatic reductions in
shrinkage stress (Cramer et al., 2010). The reductions in shrinkage stress
in methacrylate-thiol-ene formulations are greater than for bulk thiol-ene
systems. The increased reduction in shrinkage stress is due to the hybrid
nature of the polymerization. The reaction often proceeds in two relatively
distinct stages. The first stage is dominated by methacrylate homo
polymerization with chain transfer to thiol. The second stage is
dominated by thiol-ene polymerization (Lee et al., 2007a,b).
FIG 44: THIOLENE MECHANISM

Hybrid Polymerization Reactions: Hybrid polymers are formed

from comonomers with different reactive groups that polymerize via
different curing mechanisms and are often utilized to synergistically
achieve desired properties. Typically, polymerizations occur in parallel
to form an interpenetrating polymer network (IPN) or, more generally,
a material that is formed from two distinct polymerizations that
generally have significant bonds between the two materials.
The order of the reactions can be controlled by the selective addition of
inhibitors of each polymerization type or through manipulation of the
initiating wavelength-initiator combination. Here, the incorporation of vinyl
ether monomers is desirable, since they exhibit high reactivity, no oxygen
inhibition, and low toxicity and irritation properties. An additional benefit of
hybrid polymerization is that reduced shrinkage stress can often be
demonstrated, particularly when one polymerization type largely precedes
the second polymerization (Carioscia et al., 2007) In this manner, the gel-
point of the entire system is delayed, allowing flow and relaxation to occur
and accommodating any shrinkage without stress generation during the
intervening period.

Ring-opening Polymerization: The implementation of ring-

opening polymerization in dental restoratives has long been sought, even
going back to Bowen’s original work (Bowen, 1956), for many reasons. The
primary reason that ring-opening polymerization has received attention is
underpinned by the unique shrinkage behaviour observed in these
polymerizations. Whereas methacrylate (and thiol-ene)
photopolymerizations involve the conversion of a carbon = carbon double
bond into single bonds, the ring-opening reaction relies on the opening of a
cyclic structure to facilitate intermonomer bonding and crosslinking.
Inherent to the cyclic structures is that significantly less volume
shrinkage occurs when rings are opened. A recent exciting development
in ring-opening polymerization is the commercial release of the cationically
photopolymerizable silorane material (Filtek LS) by 3M/ESPE (Weinmann
et al., 2005). The resin chemistry relies on the ring-opening polymerization
of a combination of proprietary and readily available cycloaliphatic
monomers. The silorane terminology derives from the novel monomer
composed of a cyclic siloxane core appended with 4 oxirane reactive
groups. The cyclohexene oxide-type oxirane rings are significantly more
reactive compared with a simple epoxy analog, and the very hydrophobic
siloxane structure effectively balances the potential hydrophilicity of the
polyether backbone generated by the ring-opening polymerization. The
cationic reaction is activated by a visible-light photoinitiator system with
camphorquinone as photosensitizer, a tertiary aromatic amine as a photo
reductant, and an iodonium salt as an electron donor that creates the
active cationic species. The filler selection, the filler surface treatment, and
the adhesive required for bonding the composite to dentin and enamel are
also designed to accommodate the cationic curing process. A successful,
cationically initiated dental restorative material certainly represents a
significant challenge, as implied by the fact that Bowen initially tried and
abandoned cationic epoxide materials before developing BisGMA in his
seminal work on dental restorative materials (Bowen, 1956). The cationic
silorane and free-radical methacrylate materials provided comparable
properties initially and after water storage, with the silorane demonstrating
a better retention of initial mechanical properties during extended storage
in alcohol. The oxirane ring-opening polymerization process is quite
exothermic, since it relies on the relief of the substantial ring strain to
provide the driving force for the polymerization process.
The advantage of low polymerization shrinkage associated with ring-
opening polymerization arises due to an inherently lower molar shrinkage
coefficient, as well as greater concentrations of chain ends in comparison
with methacrylate polymerizations. Monomers containing suitably placed
cyclopropyl groups capable of undergoing ring opening based on free-
radical re-arrangement mechanisms have been developed for dental
applications (Moszner et al., 2006). Here, a vinyl group next to the highly
strained bicyclic structure facilitates the re-arrangement that generates a
single lower energy ring. Based on this approach, experimental dental
composites that involved free-radical copolymerization of the ring-opening
monomers with conventional dimethacrylates were evaluated to
demonstrate that composites with good mechanical strength and much-
reduced polymerization shrinkage compared with control materials were
available. Several bicyclic monomers that engage in either radical or
cationic double-ring-opening polymerization have been developed and
examined for their potential to reduce polymerization shrinkage in dental
materials (Miller et al., 2005; Moon et al., 2005; Chappelow et al., 2008). A
detailed mechanistic study of 2-methylene-7-phenyl-1,4,6,9-
tetraoxaspiro[4.4]nonane, a bicyclic monomer known to provide ring-
opened polymer, indicated significant issues, including susceptibility to
moisture-induced side-reactions in cationic and radical-assisted cationic
polymerizations (Ge et al., 2006). It is worth noting that new reaction
mechanisms, other than free radical methacrylate, must also consider
stable adhesion between the restoration and the tooth.

FIGURE 45 - SILORANE RING OPEN POLYMERIZATION

 PROPERTIES OF COMPOSITES

1. Viscosity:
The viscosity of the composite resin has significant clinical implication
and can vary from 18-1370 N/m2.Posterior composite cannot be
manipulated in the same way as amalgam. Composite are rather viscous,
sometime sticky and cannot be condensed to create a film interproximal
contact area. The difficulty of establishing a good contact may allow mesial
drifting of adjacent teeth, food impaction and periodontal problems.it is
desirable to apply posterior composite resin with a syringe but it may not
always be possible, as these materials tend to have a high filler fraction,
which makes them very stiff and not suitable for syringe application.in
some cases an amalgam carrier may be used to place the viscous heavy
filler composite.
The wetting ability and preparation coefficient of these condensable
composites is low and tends to induce void inclusion, poor adhesion and
an insufficient marginal seat. This problem may be solved with an
intermediate enamel/dentin bonding agent that provides a better
penetration coefficient and improved seal. It is essential that the dentist
adapt his methods to compensate for the problems associated with the
viscosity of composites. It’s generally agreed that separating teeth during
cavity preparation even before and during filling procedure is an absolute
necessity for the realization of a proper contact area.
A simple procedure for pre-treatment separation of teeth is the
placement of an orthodontic elastic ring in the pre-operative session. A
fast-aggressive method of separation is the use of ivory separators at the
time of treatment. Another clinical technique for overcoming the problem of
maintaining tight proximal contacts is to create space with the use of early
wedging (Albem 1985). During tooth preparation both interproximal area
may be wedged to achieve maximum tooth separation. On wedge is
moved while the other is placed more securely to maximize tooth at the
proximal box. The composite is then condensed onto the wedged and
burnished area of the wedged proximal box, care must be taken to
condense and cure no more than 1mm thickness at a time. The wedge is
then removed from the cured site of the unfilled proximal box. The
composite is added in a similar fashion to fill this box followed by the final
addition to complete the occlusal portion.
2. Polymerization shrinkage:
One of the most destructive force of the composite resin tooth structure
bond is the stress induced by curing shrinkage. The polymerization
reaction of the liquid resin components of a composite resin into a solid
matrix results in polymerization shrinkage with measurement invitro
reported to range from 0.2 -0.9% linear shrinkage and 1.2-1.4% shrinkage.
The relatively high volumetric shrinkage of the hybrid composite (3.5%)
may need some explanation. Although higher filler contents may reduce
the shrinkage to some extent, the maintenance of the viscosity require
more TEGDMA diluent which in turn results in more polymerization
shrinkage than the large BISGMA molecules. The filler in composite resins
function to reinforce the polymer. They have high modulus of elasticity and
end to minimize the shrinkage. However, they do not prevent the build-up
of the internal stresses along the matrix particle interfaces.in many cases
either adhesive and /or cohesive failure occurs. Cohesive failure results in
voids or micro cracks within the resin phase (Davidson 1985).
Polymerization shrinkage is not usually a problem for small cavities
when enamel etching is used. The adhesive forces on the margins in the
margins of the cavity preparation are the larger than the forces produced
by the polymerization shrinkage. Even though the restorations strained,
opening of margins does not occur. If afterwards the margins and the
additional grooves are sealed with a tissue sealant, a leak proof restoration
may be obtained. When a composite resin is placed in a large cavity the
mass to be polymerized is so large that the shrinkage forces prevail and
produce a marginal opening even when the enamel etching technique is
used. Also at the very critical gingival marginal area, the enamel required
for the etching is not available.
With the availability of bonding agents reported to have improved bond
strength to enamel and dentin, the effect of concentration forces on the
tooth structure due to polymerization shrinkage deserves more
consideration. Contraction stresses of 2.8 to 7.3 MPa have been reported
for composites resin (Davidson and Degee 1985). These polymerization
stresses can produce cracks in the enamel. The fracture characteristically
occurs at the juncture of middle and gingival third (Albus 1985). The stress
generated by polymerization is usually less than the tensile strength of
enamel, which is about 20-40 MPa (Hgdahl and Gjerdet 1977). But the
larger the cavity and larger the mass of the compromised during
preparation and surface conditioning and may result in cohesive failure of
the enamel adjacent to the restoration. While good marginal adaption may
be obtained initially, the surrounding enamel wall may not be strong
enough to resist the polymerization contraction forces if the restoration is
large. After 12 months these fractures crumble. Such, pain and discomfort
upon chewing contractions forces may play a role in postoperative
sensitivity, pain and discomfort upon chewing.
Concerning shrinkage, Davidson (1984) recently stressed the adverse
relation of cavity design, preservation of adhesion and preservation of
surface contour. When the material is held firmly from all sides and walls
do not yield, the shrinkage stress can approach the value of the tensile
strength of the materials, adhesion is challenged. The still unsolved
polymerization contraction is the over possibilities of the contraction with
flow towards adhesive interface allowing stresses to be reduced and the
adhesion preserved. It is also clear the composite restorations covered by
the tooth structure on all side except one will be less exposed to wear than
the restoration lying open from all sides but one. Here again we observe
opposite interest regarding preservation of adhesion and preservation of
anatomical shape. The conclusion can be drawn with respect to the two
paramount variables curing and cavity design. We cannot serve both the
preservation of adhesion and the anatomical shape.
Photoactive composites contract towards the external surface of the
restoration close to the light source, in contrast to the chemically activated
resins in which shrinkage occurs towards the centre of the material.in both
cases internal stresses are developed in the restoration (Krejei and
others, 1986). Also, for photo activated composites the degree of
polymerization decreases as the distance increases from the surface
nearest the curing unit. This results from the decrease of available photo
activating light intensity at increasing depths resulting from attenuation of
the light in its passage through the composite. Incomplete polymerization
in the depth of the restoration may lead to retention failures and adverse
pulp tissue reactions.

To obtain optimal use of these photo activated composites, success

must be achieved through the application technique.it is important that
shrinkage be directed towards the cavity wall and contraction toward the
exposed surface must be avoided.
It is important that shrinkage be directed towards the cavity wall and
contraction towards the cavity wall and contraction towards the exposed
surface must be avoided.it seems likely that the best way to maintain
adhesion to the cavity floor is by incremental placing of light curing
composites. If the first increments are placed in such a way that free
contraction and flow can proceed toward the dentin and are not obstructed
by adverse forces coming from the enamel composite interface, the dentin
–composite bond can gain strength, (Davidson, 1985).
The incremental technique is only practicable with light curing
composites because of their rapid curing. Layering with many small
increments can minimize curing shrinkage, but requires much time and
patience. The adhesion between subsequent layers is adequate, as there
are large number of reactive methacrylate groups to react with the
incremental surfaces. Combining the transparent light present at the curing
tip in a lateral or proximal direction (Krejcei and others, 1986). Since resin
shrinkage vectors are towards the light source, the composite materials
shrink in the direction of the proximal margins.
Effect of a novel monomer (MSAA) - A methacrylate derivative of
styrene-allyl alcohol copolymer-in reducing polymerization stress.
(JADA vol.131, April 2000-john R)

Recently researches have devoted greater attention to the effect of the

composite formulation itself on polymerization shrinkage.
• The methacrylate derivative of styrene-allyl alcohol copolymer of MSAA
has been proposed as an adjunctive to the common Bis-GMA.
• BisGMA/MSAA combination-50% by wt. of the resin present.
• Diluted with TEGDMA-made up the rest of 50% of the resin
• Silane treated fillers-78% by wt.
• This (experimental) material has been found to be yield improved
compressive strength and degree of conversion.
• Also showed significant decrease in polymerization in polymerization
stress by 20%
• The mobility of the methacrylate groups seems to be able to reduce
internal stresses, possibly by producing a structure that is more prone to
change molecular conformation or by redirecting the stress towards the
free surfaces.
• Thus, development of novel monomers will lead to a variety of new
composites whose advantages are based not on the reduction of
shrinkage but on reduced polymerization stress.
• The molecule consist of a carbon chain backbone with an average of
6 pendant methacrylate groups flanked by aromatic rings.
 3. Thermal conductivity:
Lower for microfilled than the fine particle composites. Since organic
matrix is a good thermal insulator. The values of either of the composites
are much lower than those of metallic restorations and closely match those
of enamel and dentin. Hence composites provide good thermal insulation
for pulp.
4. Thermal Expansion: The coefficient of thermal expansion may vary considerably,
depending on the quantity of inorganic filler present. the higher the amount of organic matrix the
higher the coefficient of thermal expansion, since the polymer has a higher value than thee filler.as a
result microfilled products can have the value as high than the filler.as a result the microfilled
products can have the value as high as 70x10 -6/o C as compared with a value of approximately
35x 10-6/o C for tooth structure. These microfilled products will have a greater change in
dimensions, which changes the tooth substance exists thermal cycling can cause microleakage by
percolation of fluid down the interface.
5. Water sorption: Water sorption swells the polymer portions of
the dental composite and promotes diffusion and desorption of any
unbound monomer. Water and the other small molecules potentially
plasticize as well as chemically degrade the matrix into monomer or the
other derivatives. Beef esterase has been shown to produce chemical
decomposition of polymer matrices into FCHO and or low molecular
monomer species. The consequences for the properties of the composites
is obvious. The biological consequences of small, release of these
materials is not known. The microfilled composites have greater potential
for being disclosed by water soluble stains. Water sorption is accompanied
by the swelling of composite but this has not been as effective way to
counteract polymerization shrinkage. However, the effect of water sorption
on the degradation of properties of composites is irreversible.
6. Radiopacity: For a composite to be radiopaque it must be
containing an element with high atomic number such as barium, strontium,
bromine zinc, yttrium or iodine since carbon, H, O and Si are not sufficient
high to attenuate x rays. Microfilled composites are filled with silica and
some fine particles are filled with quartz (SiO2). Fine particle or hybrid
composite containing sufficient amount of heavy metal glasses are
radiopaque and are identified as such by the manufacturer. Argument
exists whether radiopacity is an advantage in diagnosis, nevertheless one
should be aware that not all composites appear radiopaque on dental
radiographs. For a composite used for class II filling, must be radiopaque
for the following reasons (roulette 1988):
a) Diagnosis of secondary caries: the composite material must have
at less slightly greater than enamel. If this is then case,
 dematerialized area on the cervical margins of filling could be
detected.
b) Diagnosis of overhanging margins.
7. Compressive strength and tensile strength: The
compressive strength is substantially higher than tensile strength. Of
composites, however its clinical significance is unknown as no clinical data
were available which could indicate that high compressive strength is
required to resist occlusal forces. Nonetheless it is wise it avoids
placement of these materials in stress bearing areas, as the occlusal
contacts should be supported by enamel in spite of the placement of a
restoration. Another important topic is that of bevelling. Occlusal contacts
must be checked before bevelling. If the bevelling process extends the
margins to the area of contact with the opposing tooth it results in the
composite being placed in function, and as the composite is weaker than
the tooth the probability for chipping of the restoration is increased. Finally,
when the cavity preparation does not provide sufficient space for a bulk of
composite, amalgam –like isthmus fractures may occur. The compressive
strength of the fine particle composites is higher than those of the
microfilled composites as the strength generally increase linearly with the
volume fraction of filler.at the same volume fraction of inorganic filler,
decreasing the particle size increases the strength. However, the particles of the
Microfill composites increases the viscosity of the materials.so that only low volume fractions of filler
are possible and thus their compressive strength are lower than those for the fine particles
composites.
8. Elastic modulus: The materials elastic modulus or stiffness is
of concern well.in composite it is dominated by the amount of filler and
increases exponentially with the volume fraction of filler. The lower filler
content of the microfilled or reinforced microfilled composites results in
elastic moduli of not one quarter to one half of the more highly filled fine
composites. The stiffness is important in application where high biting
forces are involved and wear resistance is essential.
There is now evidence that teeth deform more than previously
suspected. Dental composites with high elastic moduli may not be able to
accommodate to some changes in tooth shape associated with flexural
forces. This limitation could resist in deboning of the composite resin from
enamel or dentin. This situation is more critical for cervical restoration on
facial surfaces where flexural stresses may produce large deformation.
Flexible restorations would be clinically more retentive because of
improved accommodation to flexural forces. The opposite requirement
would be true for large MOD restorations. Composites in these cases
should be very rigid and thus minimize tooth flexure of remaining cusps.
9. Bond strength: The maximum bond strength of composites to
acid etch enamel is about twice as high as bind strength to dentin. Dentinal
bonding agents are as effective as enamel bonding agents and thus
separate enamel bonding agents need not be purchased. The bond
strength of composites to acid etched enamel is the range of 3500 lbs/in2.
(24MPa) and the variation in the values for bond strength to dentin. Bond
strength to dentin after removal of the smear layer from the cavity
preparation (mainly collagen with hydroxyapatite particles) ranges from
700lbs/in2 (5 MPa) to 3500lbs/in2 (24MPa) with many products reporting
values from 2300lbs/in2 (16 MPa) to2600 lb/in2 (15MPa). The wide
variation resists from difference in morphology of dentin and the amount of
intertubular dentin and the penetrating of the bonding agent into the
dentin.it should be pointed out that a bond strength of 2900lbs/in(20 MPa)
is estimated to be required to prevent marginal gaps as a result of
polymerization shrinkage .it should also be noted that the cohesive shear
strength of dentin is about 5200lbs/in2 (36 MPa).
Etching of enamel is recommended and most bonding procedures
recommend removal of smear layer of collagen on the dentin, resulting
from cavity preparation. Before application of the bonding agent, some
bonding agents require polymerization before placement of the composite
and some polymerized as the same time as composite. Both chemical and
light –initiated systems are available. Considerable controversy exists in
the area: The polymerization stresses are of same magnitude, as the bond
strengths to dentin and thus marginal leakage may not be entirely
prevented. Therefore, dentinal bonding of direct composite in still
inadequate and should be used in conjunction with acid etching of enamel
bonding to enamel and mechanical retention in cavity preparation.
10) Wear resistance of composites: Wear resistance of
composites on posterior occlusal surface has received considerable
attention in clinical studies. There are at least 5 types of composite wear
events.
1. Wear by food contact (contact free area or CFA wear)
2. Impact by tooth contact in centric (occlusal contact area or OCA)
3. Sliding by tooth contact in function (functional contact is or FCA)
4. Rubbing by tooth contact interproximal (proximal contact is or PCA)
5. Wear from oral prophylaxis method (tooth brush or dentifrice
abrasion)
 The relative contribution of these processes is poorly understood.
Several mechanisms of wear have been hypothesized based on the
clinical information collected from contact free area or relatively small
posterior occlusal restorations.
1. Micro fracture theory: (Karl.F. Leinfelder) proposes that high
modulus filler particles are compressed into the adjacent matrix during
occlusal loading and this creates micro fractures in the weaker matrix. With
the passage of time these micro fractures become connected and surface
layers of composites are exfoliated.
2. The hydrolysis theory (K.J. Siderholm, 1981) proposes that silane
bond between the resin matrix and filler particle is hydrolytically unstable
and becomes debonded. This bond failure allows surface filler particles to
be lost.
3. The chemical degradation theory: (Wu.W. Cobb En 1981)
proposes that materials from food and saliva are absorbed into the matrix,
causing matrix degradation and sloughing from the surface.
4. The protection theory (S.C. Bayne, D.F. Taylor, H.O.
Heyman.1992) proposes that the weak matrix is eroded between the
particles.
If a posterior occlusal restoration is narrow enough, occlusal contact
area wear is significantly reduced or eliminated and wear is due to almost
entirely to food bolus contact (CFA wear).it now appears that CFA wear
resistance is not related to composites mechanical strength but rather to
filler spacing. Filler particles are much harder than the polymer matrix and
thus resist wear very well. If filler particles are closely spaced then they
shelter the intervening matrix polymer. This is called Micro Protection. In
microfilled composites the particles are very small and the inner particle
spacing is very small.as s result micro fills even with their low filler contents
show very good contact free wear resistance. However, if their strength is
low, then they do not resist direct tooth contact wear forces very well.
Composite restoration with relatively narrow cavity preparation minimize
food bolus contact and provide sheltering of the restoration, this process is
called Macro Protection.
The size of the anticipated restoration is a good indication for the
discretionary use of posterior composite materials. If the cavity preparation
is wide and located in molar teeth, then the restoration will be more
susceptible to wear. Large extensive posterior composite restorations that
include total occlusal contact coverage are more prone to failure due to
both impact and fatigue (FCA wear).
 ADVANCES IN DENTAL
COMPOSITES
It has long been a goal of clinical and material science to improve the
direct resin dental restorative process. Unlike amalgam, the forerunner of
today’s direct restoratives, requires multiple steps and exacting techniques
to achieve the best results. In the past few decades, composite materials
have been developed to allow the dentist to be able to more simply and
efficiently restore teeth in the anterior and posterior. The chemistry of
composite resins has changed significantly since their introduction more
than 5 decades ago. There is much room for the improvement and further
development of resin based dental materials. A new quality of dental
composites may, however be created if nanotechnology is used and other
new developments in material science and biomaterials are considered in
composites in the future. Various newer composites in dental use include:
1. Posterior composites
2. Bulk fill composites
3. Packable composites
4. Flowable composites
5. Compomers
6. Indirect composite resins
7. Fiber reinforced composites

1. POSTERIOR COMPOSITES
Introduction:
Acid etching techniques have made it possible to place anterior
restorations, which meet patient’s high functionality requirements. Because
of composites good mechanical properties, they were recommended for
posterior use in the late 1960.theninspired several clinical studies on
conventional composites using the U.S. Public Health Service (USPHS)
criteria-also known as Ryge criteria as the main evaluation tool (Ryge.G,
1980). Investigations conducted in the conventional composite resin
especially wear; colour stability and marginal leakage were clinically
unacceptable in posterior teeth.
During the last decade, new formulations have been presented. The
average sized filler was reduced drastically and submicrometric particle
sized distribution of the fillers were used to optimize the filler load to
improve the mechanical and wear characteristics.

Hence in addition to providing aesthetics, the use of posterior resins

has been noted to increase the fracture resistance of restored teeth. These
improvements coupled with better particle surface treatments for bonding
to the resin component have bought firs year average wear values to
between 10-3 µm for posterior composite resins. A goal in restorative
dentistry is to make highly wear resistant occluding surface that do not
cause wear on opposing dental structures.

PRESENT STATUS:
New composite resins specifically developed for posterior use have
been introduced. These never formulations possess the following general
composition features and improved properties.

• Radiopaque fillers:
• Small sizes of primary filler particles and inclusion of dispersed micro
filler.
• Increased amount of filler and corresponding decrease in resin matrix
• Greater strength and stiffness.
• Reduced porosity
• Reduced water sorption
• Compatibility with new enamel/dentin bonding agents.
• Polymerization by visible light

More recent clinical studies of composite restoration in class I, II

cavities are in progress and long-term reports are encouraging.in fact the
ADA council of Dental materials, instruments and equipment’s has given
acceptance status to several composite materials for limited use in
conservative class I &II preparations in the absence of significant occlusal
stress. However as of this writing the ADA any composite material as an
amalgam substitute. Proper operative procedures and material
manipulation are essential to ensure optimal results.
 FIGURE 46 – POSTERIOR COMPOSITE RESTORATION

Indications:
Probably the major clinical pitfall associated with posterior composite
resins is occlusal wear and loss of anatomic form. The amount of wear
encountered clinically is dictated by many circumstances including
composite material composition, curing methods, size and arch location to
mention only a few.
Recent research has shown that wear resistance increases,

1. As faciolingual cavity size decreases

2. With light cured composite materials
3. With small particle size composite material
4. The more mesial in the posterior dental arch the material is placed.

Accordingly, the small particle filled visible light cured materials may be
used posteriorly primarily in

1. Aesthetics is of prime importance

2. Facio-lingual dimensions of the cavity preparatory are restricted.
 3. The gingival cavosurface margin is placed in intact enamel.

Until long term clinical observations relative to the durability of

composite materials in the posterior region are available, posterior
composite materials should only be planned under following
circumstances.

1. Where aesthetic requirements are primarily essential i.e., in maxillary

and mandibular canines and premolars.
2. In situations where the bucco - lingual width of the cavity preparation
can be restricted
3. When the patient is fully informed as to the experimental nature of
the posterior materials.

4. When the dentist is prepared to minimize the technique sensitivity of

the materials by means of a meticulous controlled clinical procedure
involving

• Conservative cavity design

• Pre-wedging and customized matricing techniques
• Controlled pulp protection
• A controlled insertion technique which minimizes the need for
extensive finishing procedures

FIG 47 - A controlled insertion technique

 The other indications are as follows:
1. Classes I, II cavities can be appropriately isolated and where some
centric contacts on tooth structure is present
2. Class v defects
• Hypoplasia
• Hypo calcification that is essentially objectionable
or is cavitated
• Carious lesions that is cavitated
• Abrasion and erosion that is uncontrollably
sensitive, excessively deep pulpally (threaten
ing the integrity of the tooth) or aesthetically
objectionable
3. Class VI cavities (faulty pits on sealed occlusal
cusps)
4. Veneers for metal restorations
5. Repair of fractures area
6. Interim restorations
7. Restoration of weakened tooth that can be
strengthened by bonded restorations.
Contraindications: Composite materials generally are not
recommended for direct posterior classes (I, II, IV) restorations under the
following conditions.
1. The operating sight cannot be appropriately isolated
 2. All occlusal surface contacts will be on the composite material;
3. Heavy occlusal stresses
4. Deep sub gingival area those are difficult to prepare or restore.
ADVANTAGES:
1. Aesthetics
2. Conservation of tooth structure
3. Improved resistance to micro leakage
4. Strengthening of the remaining tooth structure
5. Low thermal conductivity
6. Completion in one appointment
7. Less expensive compared to gold or porcelain restorations
8. No corrosion

Disadvantages:
1. Very technique sensitive
2. High coefficient of thermal expansion than tooth structure
3. Low modulus of elasticity
4. Biocompatibility of some components unknown
5. Limited wear resistance in high stress areas
6. Finishing procedures are prolonged and tedious
7. Postoperative sensitivity

Clinical considerations: Posterior dental composites are monitored in

clinical studies in terms of USPHS (United States Public Health Sciences)
categories of interest.

1. Colour matching
2. marginal integrity
3. bulk fracture
4. post-operative sensitivity
5. biocompatibility
6. improving wear resistance

1. Colour matching: Depends on not only proper initial colour match,

but also on the relative changes, which occur with time. Both restoration
and tooth structure are known to change colour with time. Both the
restoration and tooth structures are known to change colour with time.
Chemical changes in matrix polymer cause the dental composite to appear
more yellow. UV light, oxidation and moisture accelerate this process.
 Newer systems that are visible light cured contain higher filer content
are modified by UV composite is relatively colour stable, tooth structure
undergoes a change in its appearance with time due to dentin darkening
from aging. Aged tooth structure appears more opaque and dark yellow
This challenge is to match this rate and type of colour change of the
restoration with the tooth structure. A colour mismatch that appears after
several years is difficult to avoid.
Another important consideration for aesthetics is a gradual transition in
colour and translucency between the restoration and tooth structure. This
goal is accomplished in two ways. Bevelling the enamel to blend with any
colour difference associated with margin over about 0.5-1mm rather than
making it abrupt.it also produces more surface area for a well bonded
margin that does not leak. Marginal leakage leads to accumulation of
subsurface interfacial staining that is difficult or impossible to remove and
which creates a marked boundary for the restoration appearance.
As long as margins are well bonded and no marginal fractures occur,
there should be good resistance to secondary caries. Although not well
documented most secondary caries seems to occur along proximal or
cervical margins where enamel is thin, less well oriented for bonding,
difficult to access during the procedure, and potentially subject to flexural
stresses as well.
Bayne et al 1992 in their clinical study of failure in posterior composites
initiated that for well controlled insertion techniques the incidence of
secondary caries after 10 years can be as low as 3%. Under these
circumstances, the primary reason for composite failure is poor aesthetics
or excessive wear. Cross sectional studies of dental practices include that
caries level are high as 25-30% have been observed after 10 years for
composite placed during the 1970s and early 1980’s.
The principle concern for posterior composites has been that occlusal
wear could occur at a high rate and continue over long periods of time,
exposing the underlying dentin and leading to secondary caries or
sensitivity. There is now excellent evidence from clinical incidence that the
rate of occlusal wear tends to decrease over time with total wear
approaching an average limitation value of about 250 j/m over about 5
years. Wear resistance composites still wear but take longer to achieve
that level of wear. There is only rare evidence that composites actually
wear to appoint of exposing dentin. Moreover, after many years of clinical
service, worn restorations can be repaired by rebounding new surface onto
the old composite to replace a worn or discoloured surface.
 2. Marginal Integrity: Marginal integrity of composites is very good
under most circumstances. Clinical appearance is affected by the nature of
the margin. Butt joint margin of well bonded restorations wear more slowly
and create meniscus appearance against the enamel. As beloved
composites wear, thinned ledges of material are produced that are prone
to fracture.

3. Bulk fracture: Bulk fracture of posterior composites is very rare.

When bulk fracture may be the most prevalent failure for high copper
dental amalgam restoration, it is only rarely observed for intracoronal
composite restorations.

4. Post-operative sensitivity: Another clinical concern for all filling

material procedures has been the onset of post-operative sensitivity. Actual
causes of this event are poorly researched but are hypothesized to be due
to either,
• Marginal diffusion of spaces which induce fluid flow within dentin.
• Dimensional changes of the restoration itself, contraction resulting
from polymerization shrinkage and /or expansion from water sorption can
cause flexure of bonded cusps and produce pain.
• Incidence of post-operative pain sensitivity for posterior composite
restorations is less than 1%. In most cases it occurs within the limit 6
months to 1 year of the procedure and subsides within 6 months if initial
onset
• Only rarely must a posterior composite be removed to manage the
problem.

5. Biocompatibility: There are limited problems of biocompatibility for

most composites with respect to the dental pulp. Although the
unpolymerized materials are potentially cytotoxic and, may even been
classified as carcinogenic, they are very poorly soluble in water and are
polymerized into a bound state before there is significant time for
dissolution and diffusion. Monomers, which do not polymerize mat diffuse
slowly out of the restoration but the concentration at any given time is low
that the materials do not appear to represent any practical risk.as noted
with mercury migration from dental amalgam restorations, concentration
and time are the key factors in assessing biohazards. However, these
events still need to be examined more closely. From long term clinical
studies there is no evidence of any clinical problems resulting in pulp death
or soft tissue changes.
 6. Improving wear resistance of composites: Although many
approaches have been made towards improving wear resistance, the
greatest effort has been in the modification of filler particles. The use of
large (50-100 micrometre) hard ceramic filler particles resulted in
generalized wear rates of 100-150 micro meter per year. Under such
conditions, masticatory stress are transferred to the filler particles and onto
the resin matrix. The resultant micro cracking of the polymeric supporting
material caused a substantial weakening of the composite resin surface.
The first improved posterior composite resin (P-10, 3M) consisted of
substantially smaller filler particles (3-5µm) and an appreciable increasing
in the dispersed phase. The resultant formation exhibits an annual wear
rate of nearly 50% less than the prior formulation. The next, major
modification consisted of submitting barium silicate glass (NUVAFIL, L.D.
Caulk and co) for the traditional quartz filler. Such a modification further
reduced the wear rate.as compared with the harder fillers, such as quartz,
the sifter filer particles tends to absorb the masticatory energy rather than
transferring most of it to the supporting resin matrix.
Furthermore, the use of barium glass rather than quartz rendered the
restorative material radiopaque. Today most of the commercially available
posterior composites contain filler particles that range from 1-3 micrometre.
Although the composition of the filler particles varies considerably the
majority of them consists barium silicate glasses. Recently a limited no of
manufacturers has reduced the size of the filler particle less than 1
micrometre.by grinding the filler for longer periods, it has been possible to
reduce their size half a micron on diameter. Although such a process
considered more expensive than those used for generating particle of 1-
5micrometre, the results have been quite dramatic by reducing the size of
the filler particle this level, the surfaces of the composite resin are
considerable smoother. Commonly the polished surfaces are
indistinguishable from enamel. In addition to generating a highly reflective
surface the use of enamel these small filler particles tends to result in
mechanical characteristics similar to those associated with large sized filler
particles tends.
Recently a no of manufacturers has begun investigation the use of
spherical type of filler particle as the dispersed phase in posterior
composite resins. The basic advantage of this concept is that stress
concentration between the filler and the matrix particle is dispersed more
uniformly.in this case of irregularly shaped particles, the masticatory
stresses becomes concentrated in areas where the particle is angulated.
Presently at least one posterior composite resin pallique (Tokuyama,
Japan) is currently available to the dental profession. Invitro studies have
shown this material to be highly resistant to wear when used to occlusal
surfaces.in addition to increasing wear resistance, the use of small
spherical particles (1-2 micrometre) ends to produce a surface highly
reflective of light.
The investigating of spherical particles for use in posterior composite
resin is just beginning. Although initial results are quite encouraging,
considerably more research must be carried out. for e.g. the range in sizes
of the dispersed phase of the spherical particles should be optimized in
such a way that the interparticulate space in minimized.
Still one more way of controlling the wear resistance of posterior
composite resin is using ceramic or glass in the composite resin. This
unusual concept was developed by Dr. Rafael Brown who developed a
biphasic glass for the use as mega or macro fillers. Specifically, the
technique consists of first filling the cavity preparation with a wear
resistance posterior composite resin prior to light curing, however one or
two large filler particles (1-2 mm diameter) are inserted into the surface of
the composite resin. Care is taken first to insert the particles in such a
manner so that their surface remains above the level of the unpolymerized
composite resins. After curing the restorations, the extruded filler particles
and supporting resin are contoured to normal anatomic form. The
advantage of this particular system relates to possible increase in wear
resistance of the composite resin. During mastication, the occlusal
stresses are directed towards the macro sized filler particles rather the
resin matrix.
FIGURE 48: MACRO- MEGAFILLERS BY BOWEN
 Although studies have been discussed widely, no studies have been
published regarding the long term clinical performance. Recently a
modification of this system has been introduced, identified as a Glass
Ceramic insert (lee pharmaceuticals). This new material system is made of
beta quartz and is shaped like small cones or tapered cylinders as
compared with the original inserts, this particular system is considerably
easier to handle. Procedurally the ceramic inserted into the surface of the
composite resins where contact will be made with the antagonist cusps.
The inserts are available in a range of sizes, which affords the clinicians an
opportunity to deal with all sizes of cavity preparation. Although the exact
technique for the use has been worked out, little or no published
information is currently available regarding long term clinical behaviour.
Finally the most significant changes in filler content come from the effort
of Dr.Lars Ehrnford of Sweden. Rather than incorporating the filler particles
into the composite resin matrix, he had devised a unique system by which
the glasses commonly used as filler particles. Barium aluminium silicate
and strontium glasses are typical examples.
FIG 49- COMPOSITE INSERTS

Quintessence international 1999.30.249-257 (UNTERBRINK &

LIENBERG) have given following recommendation for posterior
composites application:

• Keep the 1st layer thin using flowable composite in keeping with the
concept of an “elastic cavity wall” and “filled adhesives”.Shrinkage stress of
subsequently applied resin composite can be absorbed by as relatively
elastic initial layer.
 • For any cavity exceeding 30% of intercuspal distance the 2nd rule of
posterior composite placement is:
Do not connect the buccal and lingual enamel in a single layer.

Two options for layering are:

a) Placement of two or more oblique or vertical layers.in very wide
cavities approximately 1mm of composite can be applied to both walls and
a groove is left in the central fissure to be restored with the final layer.
b) Use of successive cuspal build up technique.

The following guidelines need to be taken into consideration for

posterior composites

1. Occlusal cavity less than 1/3 of B-L tooth width-horizontal layering

technique.
2. Occlusal cavity more than 1/3 of the B-L tooth width-oblique layering
technique

FIG 50 a – OBLIQUE LAYERING TECHNIQUE

 3. Proximal cavity within the contact point area-horizontal layering
technique

FIG 50 b- HORIZONTAL LAYERING TECHNIQUE

4. Proximal cavity outside the contact point area- 3 sited light curing
technique (Lutz 1986) It has been postulated that contraction takes place
towards the light source in light cured composites. Inorder to guide the
shrinkage towars the cavity walls, 3- sited light curing has been developed.
In this method using the light transmitting wedges, the composite is cured
from the buccal and lingual walls in addition to the occlusal side.
STEPS:
- 1st INCREMENT : Cured through the light- transmitting wedges
gingivally – proximally.
- LARGER 2nd & 3rd INCREMENT : cured from the buccal and lingual
sides and ensures shrinkage vectors towards the cavity margins
- FINAL INCREMENT : occlusal curing

FIG 51 – THREE- SITED CURING

 2. BULK-FILL COMPOSITES
Glass ionomer cements (GICs) can be considered the first bulk-fill
restorative materials, as they have been available for decades as a bulk-fill
dentin replacement for large cavities. With a coeffcient of thermal
expansion similar to dentin and the ability to remineralize tooth structure,
GICs have been the choice for many clinicians in deeper lesions where
adhesive dentistry doesn’t fare as well. The “sandwich technique,” first
described by Dr. John McLean in 1985, used GIC to bond composite resin
to teeth. Since that time, GICs have been widely used in large cavities to
replace lost dentin in a “bulk” fashion and are covered with a surfacing of
composite resin. GIC restorative materials are typically used to restore
teeth in non-stress bearing areas due to poor physical properties. In
addition, most GICs are not as aesthetic as composite resins. By adding
resin to GICs, the resulting class of materials, resin-modified glass
ionomers, demonstrates improved aesthetics and physical properties
without compromising the bioactivity of fluoride release and adhesion.

FIG 52 – BULK FILL COMPOSITES

Incremental vs bulk placement: Traditionally, clinical placement of
composite resins has been done using an incremental technique. Because
of polymerization shrinkage, as well as the inability to light cure composite
materials beyond a certain depth, it has been generally recommended to
place composite resin in increments of 2 mm or less.
Also, incremental placement of posterior composites has been
associated with porosity and voids within the composite. With advances in
polymer chemistry, photo activation, and curing light technologies that we
currently see with today’s composite resin materials, incremental
placement is no longer the only option. Most bulk-fill composite materials
are placed in up to 4-mm increments and can cure to that depth as well,
replacing both enamel and dentin. It is critical when light curing bulk-fill
composites that adequate light energy is delivered to the composite.
FIG 53- INCREMENTS IN BULK CURE
 In many cases, there will need to be an increase in curing time with
LED curing lights with irradiance values of between 600 and 2200
mW/cm2.

The composition and translucency of these materials has been altered

in various ways to allow for increased depth of cure while exhibiting less
polymerization shrinkage and shrinkage stress than previous generations
of composite materials.

Some of the ways these changes in the behaviour of composite resins

have been accomplished include increased amounts of or different photo
initiators to allow for increased curing depth and newer types of monomers
and elastic fillers that minimize the shrinkage when the material is
polymerized.
As early as 2001, studies comparing incremental versus bulk-fill
placement of composite showed there is no difference in cuspal deflection
or marginal integrity when comparing techniques of placement. The main
clinical issue with bulk-fill materials is depth of cure.
It is also important to note that directional curing from the buccal and
lingual (palatal) aspects after removal of the matrix helps increase the
ability to cure composite at the gingival margin of the proximal box in a
Class II restoration.
Bulk-Fill Flowables: They were developed mainly in response to
requests for special handling properties for composite resins rather than
any clinical performance criteria. Hence their physical properties had
limitation. A modification of the small particle-filled and hybrid RBCs has
resulted in the so called flowable RBCs. Flowable composites were
introduced in the late 1990s. They are characterized by a low viscosity that
allows the composite to be applied through small-gauge needles and are
recommended for preventive resin restorations.
FIG 54- BULK FILL FLOWABLES
 In 2010, bulk-fill flowable composites were introduced to the dental
marketplace, the first being Surefl® SDR® (Smart Dentin Replacement)
(DENTSPLY Caulk, www. dentsply.com). Since then, many other bulk-fill
flowable composites have followed (e.g., Tetric EvoFlow®, Ivoclar Vivdent,
x-tra Base, VOCO America, Venus® Bulk Fill, Heraeus Kulzer, HyperFil™
DC, Parkell, Beautifil-Bulk Flowable, Shofu, www.shofu.com; Filtek™ Bulk
Fill, 3M ESPE,).

FIG 55- COMMERCIAL BULK FILL FLOWABLE

These materials are indicated for use as a bulk-fill base (dentin
replacement) beneath posterior. Placing that amount of material in a single
increment is a significant time saver, and although the concept sounds
quite simple, there are several important requirements a material must
meet for this particular indication. According to the manufacturers, these
include increased depth of cure, a viscosity that will readily adapt to the
internal walls of the cavity without the need for manipulation of the
material, and low polymerization shrinkage stress. Because of their
translucent nature and decreased percentage of filler particles, bulk-fill
flowable composites require a conventional nanohybrid composite material
to be placed as the “enamel-capping layer”.

Sonic Bulk-Fill Composite Delivery

 Another recent development in bulk- fill composites combines
advances in material formulation with a novel delivery system. SonicFill™
(Kerr Dental) consists of a proprietary composite resin and a sonic
handpiece that fits onto a traditional highspeed handpiece coupler.
FIGURE – 56

The sonic energy generated by the handpiece causes a dramatic

change in the viscosity of the composite resin so that during
placement, it behaves similarly to a flowable liner in its ability to adapt
to the internal surfaces of the cavity preparation. Although the
restorative material is around 86% filled by weight, special additives in
the composite allow the filler particles to slide very readily over one
another when activated by the sonic energy in the handpiece. It can fill
all the intricate line angles and point angles of the most complex
posterior cavity preparation in a very precise and uniform fashion.
Once the sonic energy is removed, the composite resin gradually
returns to a higher viscosity, which is suitable for sculpting the
restoration to its most precise morphologic form. The material is then
light cured and finished using traditional techniques. Another unique
property of SonicFill is that it has a polymerization shrinkage of
approximately 1.6% and can be bulk filled to a depth of 5 mm while
still having greater than 97% full cure at its deepest point. SonicFill
does not require a separate nano microhybrid layer as the last
occlusal increment.
 3.PACKABLE COMPOSITES
INTRODUCTION: Increased demand by patients and clinicians for
esthetic restorations coupled with the public’s concern about
mercury have resulted in an escalating use of resin composite
materials. Resin composite is now often utilized to restore tooth
surfaces previously accomplished with silver amalgam. Packable
(a.k.a. moldable or condensable) resin composites are the product of
vast amounts of research money and time focused on the
development of a resin-based amalgam substitute with sufficient
physical properties to withstand posterior occlusal forces.
Unfortunately, clinical and laboratory data are mixed concerning the
long-term success of packable resin composite restorations.

FIGURE 57- PACKABLE COMPOSITE RESTORATION

Desirable characteristics:

Nonsticky, wets tooth surfaces, easily transferable and

packable.
Moisture tolerant
Should not show much elastic recovery (viscoelasticity)
High critical shear strength (to hold the proximal contact of
matrix band)
No access problems for cure (uses bulk cure, chemical cure,
or has excellent visible light depth cure)
 Cures rapidly to final hardness but with minimal residual stress
Little or no shrinkage on curing
Easily carved, burnished (smoothened)

The quality of being nonstick is important to facilitate transfer of the

material from packing containers to the prepared cavity. The material also
must wet the tooth surfaces. To eliminate stickiness, experiments with the
first few packable composites in the early 1980s altered filler
characteristics. Unfortunately increasing the filler particles lead to the
development of packable composites with higher viscosity making the
handling of these materials relatively difficult and this lead to porosity and
insufficient wetting of the particles by the resin matrix and difficulty to
extrude the material through small bore syringes.

The early version of packable composites was available by admixing

PRIMM (Polymeric rigid inorganic matrix material), fused glass fiber
powder with conventional composites. Early research showed that levels
as low as 5- 10% admixed PRIMM eliminated that tackiness. It produced
improvement in mechanical properties only under a few circumstances
hence it was not approved as an effective material.
The result from PRIMM experiments demonstrated that small additions
of novel filler would increase the filler surface area, absorb more matrix
material and eliminate the stickiness. The first few packable composites
products used fused particle agglomerates, fibrous filler additions and
better filler particle packing arrangements. All of these reduce the
viscoelasticity of composites. Since these materials are nonsticky,
sculpting/ carving is most easily accomplished with a burnishing
instrument.

This concept provided the basic for fabrication of packable/

condensable posterior composite resin. This consists of a resin and a
ceramic component. The fibers which are composed of alumina and silicon
dioxide are superficially fused together at selected sites, which generate a
continuous network with small chamber/ cavities in between. After
silanating these particles these particles, the manufacturer infiltrates the
space with BisGMA/ UDMA resin.

May 1997 Karl F. Leinfelder: Recently a new concept was developed

that provides the basis for fabricating a packable or condensable posterior
composite resin. The New system called PRIMM was introduced. The
features include
 • It consists of a resin and ceramic component. Rather than a ground
filler the inorganic phase consists of a continuous network or scaffold of
ceramic fibers, the diameter of individual ceramic fibers is 2.0µm or
smaller.
• After silanating the fibers, the space within the fibrous network is filled
with Bis-GMA or UDMA resin. Depending on the use any resin could be
infused into the network including acrylic.
• If the ceramic fiber component is maximized, most of the resin will be
located inside the scaffolding matrix. Because of this the curing shrinkage
of the restoration containing PRIMM can be substantially reduced.
• Since the surface of the ceramic fibers is silanated the polymerizing
resin does not pull away from the surface. Any defects as a result of
polymerization shrinkage will be localized in the small chambers formed by
the fibers.
• The wear rate is only several micrometers more than that for enamel.
• The consistency of the loaded or resin- infused PRIMM material is
similar to freshly triturated mass similar to amalgam. But the carrier has to
be Teflon coated because of the alumina fiber. Material is condensed like
amalgam.
• Excess material is removed with a cleoid- discoid or Hollenback
carvers. The restoration is then light cured for 30 sec and polished. The
material can be cured to a depth of nearly 6mm possibly due to the light
conducting properties of the individual ceramic fibers.

HANDLING CHARACTERISTICS:
The composite mass is inserted just like amalgam. Alumina fibers might
scratch the nozzle of the amalgam carrier. So it should be made with wear
resistant polymer. The injected increment is condensed in a conventional
manner. The material can be cured to depth of 6mm using a conventional
light-curing unit due to light conducting properties of the individual ceramic
fibers.

The PRIMM network is infiltrated with the resin component. The resin tries
to shrink away from the fibers during polymerization but as the fibers are
silanated the polymerizing resin does not pull away from the surface.
There has been a wide range of packable composites introduced in the
past 2 years.
1. Solitaire
2. Alert
3. SureFill
4. Filtek P60
5. Prodigy Condensable
6. Pyramid
7. Glacier
8. Synergy compact

SOLITAIRE : It is the first packable composite introduced in 1997.

It consists of crushed barium aluminosilicate glass surfaced with small
particles of a similar composition. These particles are bonded at
elevated temperature creating large particles with coarse texture.

FIG – 58 SOLIATIRE PACKABLES

The matrix monomer used here was polyglass monomer/

multifunctional methacrylic ester resin. It shows of 6-8 µm annually.
The unique geometry of the filler component creates an unset
composite with packable behaviour. This is because of the friction
caused by the sliding of one particle against another. The porous
character also allows matrix resin to interlock with the particles.
Greater the forces applied during condensation better is the packing
ability. So, the clinician should use a large condense which
conveniently fit within the confines.
 ALERT:
This is an acronym for Amalgam Like Esthetic Restorative Treatment.
ALERT condensable composite is a highly filled poly- ceramic material with
a carefully balanced combination of conventional fillers and chopped glass
fibers.

FIG 59 a- ALERT – PACKABLE COMPOSITES

These posterior composite mimics the handling and feel of amalgam

and can be cured to a depth of 5mm. it is easier to place and make contact
compared to other composites. Its packable consistency result from the
incorporation of chopped microglass fiber in addition to the standard hybrid
composite fillers. Individual fibers are less than 6 µm in diameter and
greater than 20 µm in length. The hybrid filler is crushed Barium
boroalumino silicate glass and colloidal silica. The overall combination
produces a consistency similar to triturated amalgam. These are available
in packets and carried with an amalgam carrier and inserted into the cavity.

Carriers are coated with plastic/ polymer else scratching of the normal
carrier may impart grey colour to the composite. After injection the
condensation is done in a similar way as amalgam. This is one packable
composite for which the manufacturer recommends bulk curing into a
thickness of 5mm. The monomer used in this is dimethacryalte of
Ethoxylated Bisphenol- A polycarbonate resin.
BENEFITS:

An esthetic composite that truly handles as easy as amalgam.

Good resistance to packing for forming proximal contacts.
Low wear rate
 A full 5mm depth of cure makes bulk filling simple
High strength and low polymerization shrinkage.

SUREFIL:
This possess excellent handling characteristics that are attributed to the
high packing efficiency of the composite filler particles. It contains a
Urethane modified Bis-GMA resin. It contains 3 different sized filler
particles (midifiller, minifiller and microfiller). This permits a high a packing
density. As a result of this it exhibits good packing behaviour and amalgam
like properties. Has got good clinical wear. It helps in establishing tight
proximal contacts. The particles in this are made of a patented fluoride
infused glass (Barium borofluro alumino silicate glass and silica). It can be
cured in bulk (5mm).

FIG 59 b - SUREFIL - PACKABLE COMPOSITES

MECHANICAL AND PHYSICAL PROPERTIES: Packable resin

composites possess the same advantages other resin composites
have over silver amalgam such as low thermal conductivity, the
ability to be bonded to tooth structure, absence of galvanic currents,
and esthetics. Manufacturers’ market packable resin composites
suggesting they can be placed in bulk, have less polymerization
shrinkage, decreased microleakage, and increased fracture
toughness and wear resistance compared to traditional hybrid
composites.

Polymerization: Traditional light-cured hybrid resin composites cannot

be bulk placed because of excessive polymerization shrinkage and the
inability to adequately light-polymerize the resin beyond a 2mm depth.
Manufacturers prescribe bulk placement of packable composites claiming
decreased polymerization shrinkage due to increased filler loading and a
reported depth of cure reaching 5mms. However, certain packable resin
composites demonstrated polymerization contraction similar to or higher
than conventional hybrid composites. The completeness of polymerization
of some packable resin composites was significantly less with bulk cure in
comparison to standard incremental polymerization.

Microleakage: Increased viscosity and filler particle content requires

more force and increases the difficulty to adapt the resin composite to the
cavity wall. Stiffness of the material has been shown to be directly
proportional to microleakage. The stiffness and inability to flow during the
polymerization process might cause increased polymerization stresses to
form accounting for the increased contraction and microleakage. Using a
flowable restorative resin composite liner has been recommended to
compensate for the increased microleakage. Flowable resin used under
packable composite improves adaptation to cavity walls and decreases
microleakage at both enamel and dentin margins. However, the technique
is linked to a decrease in strength of the final restoration.

Fracture Toughness: The fracture toughness for packable

composites is product specific. Some packable resin composite materials
have demonstrated fracture toughness greater than hybrid composites and
others significantly lower. Resistance to crack propagation can be related
to fracture strength and micro-hardness and is important in resisting
catastrophic failure of the composite over time. The increase in filler
particle load in packable composites demonstrated a weak correlation to
the resistance to microfractures. Fracture strength was similar for packable
and nonpackable composites. Microhardness varies among packable resin
composites and is in the range of nonpackable resin composites

Wear resistance:

Historically occlusal wear has been a major concern with posterior

composites. Microfilled resin composites initially developed for posterior
restorations exhibited poor long-term wear to attrition with wear resistance
rates significantly less than conventional hybrid resin composites
Brackmier et al. demonstrated that the least localized wear occurs with the
nonpackable resin composites compared to packable resin composites.
 Packable resin composites were unable to improve cuspal stiffness any
more than conventional resin composite or amalgam restorations (54).
Cuspal deformation of packable resin composite was similar to that of
hybrid composite (42).

Silver amalgam, indirect cast metal, and ceramics are still the
restorative materials of choice for larger posterior restorations with
faciolingual dimensions greater than one-third the intercuspal width (54).
Many operators are used to the handling characteristics of amalgam and
want a material that handles and performs similarly.

TABLE 9 – PROPERTIES OF PACKABLE COMPOSITES

Packable resin composites have some physical properties superior to

microhybrid resin composites but are not significantly better at restoring
posterior teeth. More in vivo long-term data are needed to determine if
packable resin composites are ultimately better than hybrid resin
composites for posterior restorations. Leinfelder et al. concludes based on
mechanical properties alone that packable resin composites do not yet
equal silver amalgam and are not a substitute in all situations.

Indications and Contraindications: Packable resin composites

were developed to restore surfaces that previous resin composites
could not. However, certain principles still hold true.
 - The need for an esthetic restoration should be one of the major
indications.
- The faciolingal width of the cavity preparation should be no larger
than one-third the intercuspal distance and replacement of cusps
with packable resin composite is contraindicated.

- A class II restoration should ideally end on sound enamel. If

enamel is not present at the cervical margin other procedures such
as an “open sandwich technique” should be used.

- In this procedure, glass ionomer is placed as the initial increment

filling the first couple of millimeters of the box. Glass ionomer’s
predictable bond to dentin reduces microleakage compared to a
resin–dentin margin. Centric stops should be on tooth structure.
Clinical signs of excessive wear of bruxing and grinding should be
absent.

- One of the most critical factors for long-term success is the ability to
isolate with a rubber dam. Avoiding saliva and blood contamination
of the prepared enamel and dentin surfaces is vital to achieving a
proper bond.

- Packable resin composite should not be viewed as a time saver

as bulk placement of packable resin composite is not
recommended and may compromise the long-term success of the
restoration.

The introduction of packable resin composites provides another option for the restoration of
posterior teeth. They were introduced with the goal of producing handling characteristics similar to
amalgam; however, the mechanical properties are still more similar to microhybrid resin composites.
Currently, numerous packable resin composites are marketed with differing mechanical properties.
Careful product selection is necessary due to the wide variation. Excellent isolation, meticulous
placement, and specific procedures and techniques (open sandwich) are advised.

FIGURE – 60: COMMERCIAL PACKABLE

COMPOSITES
 4.FLOWABLE COMPOSITES
Flowable composites were introduced in late 1996. They are
broadly similar to resin cements and pit and fissure sealants, with filler
loading and particles size less than hybrid composites resulting in
material of low viscosity. Filler content is generally less than 50 % by
volume, so polymerisation shrinkage will be greater than for more
heavily filled materials. The modulus of elsaticity will also be lower
than for conventional resin composite materials. This may allow the
material to flex and flow under the conditions thought to occur in class
V cavities and the flow of the materials may alos be useful in
absorbing stresses caused by polymerisation shrinkage. Flowable
composites are available in a range of shades; some versions even
include pink for use in making areas of gingival recession (Pink
Revolution). A number of formulations contain fluoride, although the
clinical benefit of this is not quantified.
Claimed advantages of flowable materials are that they are fast
and easy, that excellent access and placement can be achieved using
the syringe tips in which they are supplied. Flowables should not be
used in situation involving high stresses or associated with wear.
 WEAR RESISTANCE : Wear resisitance depends on

Inter particle spacing, called the Protection hypothesis

Extent of filler particle density

Inter particle spacing is reduced with small filler particles such as

microfillers, even though the percentage of filler by volume may be
only 35 – 50% that is why microfilled composites shows good wear
resistance and as most of the flowables are MICROFILLED ( 0.02
-0.04 µm) or MINIFILLED ( 1.0 – 0.1µm).
e.g., AELITEFLO 17.2 ±13.2 µm
FLOW RESTORE 5.3 ± 3.5 µm
FIG 61- FLOWABLE COMPOSITES
TABLE - 10
 Flowable materials were developed principally to provide their own
particular handling charateristics rather than with any particular physical or
clinical performance property in mind and as a result, there is little known
abput their performance. In a study flowables are compared with hybrid
composites with respect to physical properties.

MAJOR CLINICAL INDICATIONS :

(i) Preventive resin restorations (for minimally invasive occlusal
Class I ):
Flowable composite resin materials are ideal to restore what have been
termed, “Preventative Resin Restorations” (PRR’s) because these are the
most minimal of the Class I types and the needle tip placement into these
small preparations assures a well-adapted restoration. Nonetheless,
angled incremental deposition is important in order to minimize the
contraction force from the setting
composite. According to a survey conducted by Savage et al., flowable
composites are one of the most widely used restorative materials for
PRR’s with more than 30% of paediatric dentists using a flowable
composite or a combination of flowable and packable composite.

(ii) Pit and Fissure Sealants:

According to evidence based review done by Jean et al., flowables are
the first choice of materials for pit and fissure sealants. However, for
effective placement and long-term retention of these materials proper
cleaning of pits and fissures, appropriate acid etching of surfaces and
maintaining a dry field uncontaminated by saliva until the sealant is placed
and cured is mandatory. Jafarzadeh et al., compared the retention of
flowable composites with conventional resin-based sealants and
concluded that flowable composites had better retention when used as pit
and fissure sealants. Dukic et l., concluded that flowable composite resins
should be used in combination with dentine bonding agents as they can
improve the strength of the adhesive bonding to enamel in fissures and
reduce marginal microleakage and improve retention rate.

(iii) Cavity Liners:

There is a growing trend of using flowable composites as cavity liners.
However, postoperative sensitivity is still a major concern. Although many
clinicians have been successful in reducing postoperative sensitivity,
clinical research shows no difference in postoperative sensitivity between
solely using an adhesive as compared to just using a flowable composite
as a liner. Payne et al., concluded that flowable composites are a good
choice as cavity liners. They adapt well to the microstructural irregularities
of the cavity preparation prior to restorative composite placement. Rainer
et al., evaluated the use of flowable composite liners in large extended
class I restorations and concluded that large Class I restorations without
dentin support showed high amount of marginal enamel fractures. Lining
with flowables improved the initial marginal integrity.

(iv) Minimally invasive Class ii restorations and inner layer for

Class ii posterior composite resin placement in sealing the gingival
margin to avoid deficiencies:
For conservative preparation of Class II interproximal caries with only
initial caries on the proximal surface and no caries on the occlusal surface,
a facial approach for the cavity preparation will leave the marginal ridge
intact. Flowable composites are also ideally suited for such facial approach
Class II cavity preparations. Another use for flowable composites is in
conjunction with placement of viscous packable composites. Leevailoj et
al., evaluated packable composite resin placement with and without a
flowable composite and found that there was significantly less
microleakage in teeth restored with the flowable composite resin as the
first increment in the proximal box. Hence, the placement of an inner layer
of flowable composite below the final restorative packable material can
reduce microleakage at the gingival margins.
 (v) Class V Abfraction lesions:

These are small angular Class V lesions attributed to the forces of tooth
flexure. When restored with a stiff hybrid composite resin, the clinical
success rate was only 70%. The high failure rate was attributed to the
stiffness of the composite used. Thus, using a flowable composite resin
with a lower biaxial flexural strength than traditional hybrid composites was
assumed to improve the clinical success of these restorations. A one-year
clinical study evaluating Class V restorations using a flowable composite
demonstrated that all restorations were intact and showed no signs of
postoperative sensitivity after one year. Many studies have concluded that
the use of flowable composites for non-carious Class V lesions is a good
choice.

TABLE 11 -Ideal Properties Of flowables With Their Clinical

Significance And Clinical Indications.
 5.COMPOMERS
(Polyacid- Modified Resin Composites)

Introduction
Compomer is resin –ionomer hybrid restorative material marketed
as multipurpose material, as resin that may release fluoride but have
only limited glass ionomer properties.it contains major ingredients of
both composite resin component and glass ionomer cements
(polyalkenoate acid and glass filler components) except for water.
They have a limited dual setting mechanism, dominant setting
reaction ids the resinous photopolymerization and no acid base
reaction can occur until the material absorbs water.
Composition
The compomers presently available contain two different resins
for the matrix and the glass particles as fillers common to composite
resin and glass ionomer. The resin component contains functional
groups of polycarboxylic acid and methacrylate combined in one
molecule. This provides meth acrylic groups for cross linking and
carboxyl groups to undergo an acid base reaction in the presence of
water and metal ions. Fluoride containing glasses, typical of glass
ionomer comprise the principle fillers to which may be added glass
particles similar to those in composite resins. There may be also
other fillers providing additional fluoride release and radiopacity.eg,
DYRACT, DYRACT AP., COMPOGLASS, F-2000.
i) DYRACT XTRA:
It is characterized by a unique singe component Compomer restorative
material and a newly developed primer/adhesive liquid for enhanced
adhesion to tooth tissues and improved seal of the cavity.
Matrix:
1) UDMA-urethane dimethacrylate monomer
2) TCB resins consists of a new monomer of dual functionality, made
up of a butane tetra carboxylic acid backbone with a polymerizable HEMA
Side chain. It contains 2 methacrylate group and 2 carboxyl groups. The
former forms cross link with the other methacrylate terminated resins when
initiated through polymerization while the latter group undergo acid base
reaction to form a salt with metal ion and waters.
Fillers:
Contains solely glass ionomer fillers (Calcium Fluro aluminosilicate
glass). Finely milled glass with mean particle size of 2.5 µm accounts for
72% by the wt. of the composition with 13% fluoride.
Primer/adhesive consists of three resins:
PENTA, a patented dipentacrylthritol pentacrylate phosphoric acid,
which contains an acidic monomer made up of phosphoric acid with a
polymerizable methacrylate group attached and is responsible for the
formation of ionic bonds to the inorganic art of the tooth. TEGDMA and an
elastomeric resin to increase the cross linkage among the different
monomers and elasticity of the cured primer/adhesive. Acetone-solvent
(carries the resins, wet the tooth surface and assists the penetration of the
resin in the dentin surface).
FIG 63 – DYRACT - XTRA COMPOMER

ii) DYRACT AP:

Ingredients are basically similar to the original Dyract. The organic
matrix has been modified by adding a small amount of a highly cross-
linking monomer which brings an enormous increaser in hardness and
strength of the matrix almost equal to that of a hybrid resin composite.
Filler: strontium fluoro silicate glass of mean particle size reduced to
0.8 micrometre from 1.5 µm and a loading of about 73% by mass.
 Adhesive used is prime and bond. Similar to Dyract AP, in addition
acetylamine hydrofluoride to deliver an additional amount of fluoride to
teeth.it has an increased ability to absorb the stresses caused by chewing
and temperature fluctuations.

FIG 64 - DYRACT AP

iii) F-2000:
Resin matrix : comprised of 3 monomers:
1. The dimethacrylate functional oligomer derived from citric acid (CDMA)
2. Glyceryl dimethacrylate also called hydroxy propylene dimethacrylate
(GDMA).
3. High molecular mass hydrophilic polymer.

CDMA oligomer has a great ratio of methacrylate groups to carboxyl

groups, which allows greater cross linking of the resin matrix. GDMA is
chemically functionally similar to GEMA with a hydrophilic hydroxyl group,
which acts as a diluent fir the CDMA and copolymerizes the oligomer. The
molecular mass hydrophilic polymer rapidly takes up a controlled amount
of fluid from the oral cavity which facilitates the transport of fluorides. Due
to its large size and flexibility, acts as a modified that account for clinical
handling characteristics.
Fillers: Fluoro-aluminosilicate glass with average particle size of about
3micrometrer of about 10 µm. Small amount of colloidal silica with a
loading of 84% by mass.
Primer/adhesive are hydrophilic in nature contain resin monomer
(HEMA), methacrylate modified polyacrylic acid and maleic acid in an
aqueous solution of water. They are volatile and highly and highly suitable
for use on moist dentin surface.
FIG 65- F 2000 COMPOMER
 iv) Compoglass:
Resin matrix: Propoxylated Bis-GMA, urethane dimethacrylate, tetra
ethylene glycol dimethacrylate, cycloaliphatic carboxylic acid
dimethacrylate.silanized spherical mixed oxide, ytterbium trifluoride.
Fillers: A combination of methacrylate monomers and conventional
glass ionomer fillers with a mean particle size of 0.5 micrometre which
produces an additional stability to the cross linkage with improvements in
physical properties.
Adhesive : Single component- hydrophilic
FIG 66- COMPOGLASS

Chemistry of setting reaction:

There is dominant light initiated free radical polymerization followed by
a later acid base reaction. The setting reaction occurs in 2 stages:
 a) Stage 1 reaction is typical of light activated composite resins
forming resin network enclosing the filler particles. The light curing
mechanism leads to hardening of the material in the cavity.
b) Stage 2 reaction occurs slowly after placement in the cavity. Water
sorption will occur for onto 2-3 months and in the presence of
carboxyl groups from the Polyacid and metal ions from the
ionomer glass, there will be a relatively slow ionic acid base
reaction. Hydrogels will form within resin structure and there will be
slow and low-level release of fluoride.

Clinical properties
1. Adhesion:
In Dyract AP restorative system there are 2 mechanisms for adhesive
bonds to the cavity wall.
First Mechanism : self-adhesive property of the material.50% of the
reactive units of the patented TCB monomer consists of hydrophilic
carboxyl (-COOH) groups. Such polyelectrolytes can form ionic bonds to
both enamel and dentine. The functional carboxyl groups can form ionic
bonds with the calcium ions of the tooth surface. Some secondary valence
bonding like hydrogen bonding may occur as well.
Second mechanism is adhesion to the tooth surface through
primer/adhesive system. The hydrophilic phosphate group of the PENTA
resin in the adhesive will form ionic bonds with the calcium ions of the
hydroxyapatite.
In addition, when light cured, the three resins in the adhesive will
undergo free radical addition polymerization. The cross-linked resin forms
a reinforced zone, similar to the hybrid zone of the surface dentin, and
makes both enamel and dentin compatible for the actual restoration. In has
been noticed that if adhesive is not applied before restorative material, the
adhesion to enamel and dentin will be reduced by a factor 2 and 4
respectively.
2. Strength and wear performance:
In order to withstand high chewing forces in the oral cavity, a filling
material intended for long term use needs to have high compressive and
flexural strength. Dyract has got more initial and long term compressive
strength, dimetral tensile strength and traverse than conventional and resin
modified glass ionomers. GIC-140 MPa, composite -300 MPa, Compomer
200-250 MPa. Dyract AP and Cytec Aplitip showed a wear value similar to
that of composites, may be due to introduction of smaller, submicrometer
fillers in newer compomers.in one clinical study, the wear value of Dyract
was 43.3 µm in six months and 72.7 µm in 12 months, which is about 3
times the wear rate of a hybrid composite, prima TPH. After 24 months
wear values of Dyract and TPH were 113 µm and 63.9 µm respectively.
3. Fluoride release:
Dyract shows fluoride release for more than 12 months and maintains
the same ate of diffusion. Fluoride uptake by adjacent enamel in contact is
shown to be 20 µm. Thus, producing anticariogenic properties. Like glass
ionomer cement it acts as a fluoride reservoir and absorbs fluoride when
exposed to fluoride ion sources like fluoridated dentifrices when exposed
to fluoride to fluoride ion sources like fluorinated dentifrices which is slowly
released into the surroundings after the ion source is removed.
Compoglass F has 50% more fluoride release than is original Compoglass
due to finer particle size of the fluoride glass and incorporation of additional
fluoride in some of the primer/adhesive systems.it is shown that more
fluoride is released in acidic solution (pH 3-4.5).
4.Optical properties:
The aesthetics qualities of material are determined by its own colour
and opacity. Dyract AP is available in a range of twelve different shades,
which follow the via shade guide. F-2000 and Compoglass and F-
Compomers have speciality shades for primary teeth. Dyract AP has
radiopacity of 5 which 2.5 times to that of dentin and slightly higher than
enamel. This value is desirable for radiographic detection of recurrent
caries and offers an easy method for documentation of dental work.
5.Handling and manipulation:
Easy to manipulate, supplied in capsule which require no mixing. The
gun is used for easy dispensing directly to cavities and surface. The
consistency makes it easy to apply and contour without stickiness thus
less time is required for final finishing. Like other curing materials,
polymerization shrinkage is aproblem.it has got polymerization shrinkage
similar to hybrid resin composites. So incremental placement is advised for
Dyract. - 3mm or less ,2mm or less for newer compomers and then each
to be cured for at least 40 seconds. Finishing can be done immediately
after curing using fluted tungsten carbide finishing burs or polishing discs.

6.INDIRECT COMPOSITE RESINS

In early 1980s, Mormann and Touati and colleagues pioneered the
use of composite resins for the fabrication of indirect inlays and onlays. In
the mid-1980s, Touati and Pissis developed the concept of metal
composite inlays and bridges after the silanating technique, which enabled
a strong bond between polymer and metal because of a very thin (0.1mm)
aluminium oxide layer.
FIG 67 – INDIRECT COMPOSITE RESTORATION

Indications:

Metal free dentistry

Aesthetics
Decreased wear of opposing dentition conservative tooth
preparation

Contraindications:

Bruxism
Opposing porcelain
Long span fixed partial dentures
High caries rate
Difficult moisture control adhesion

Properties:

• Flexural strength: 60-80 MPa(low)

• Modulus of elasticity: 2000-3500 MPa (low)

• Low wear resistance (owing to a low percentage of inorganic filler

particles and a high percentage of exposed resin)
• High polymerization is by light, heat and pressure or argon laser.

• Fragile and subject to chipping and colour variation.

The lower the percentage of inorganic particles, the lower the mechanical
properties of the composites resulting in failure of first generation
laboratory composites. Uses: For inlays, onlays and laminates and
implants supported prosthesis.

Classification:

FIRST GENERATION INDIRECT COMPOSITES: (Low filler and high

matrix load) They are microfilled composite resins, with 66% resin content
and 33% inorganic particles. Particle size of 0.04-0.4 µm inorganic filler are
round in shape and consist of colloidal silica.The lower the percentage of
inorganic particles, the lower the mechanical properties of the composites
resulting in failure of first generation laboratory composites. Uses: For
inlays, onlays and laminates and implants supported prosthesis.

TABLE 12: FIRST GENERATION INDIRECT COMPOSITES

Disadvantages :

- Poor In vitro and clinical performance

- Deficient bonding between organic matrix and inorganic fillers
leading to unsatisfactory wear resistance, high incidence of bulk
 fracture, marginal gap, microleakage, and adhesive failure.

Measures to solve these problems included increasing of inorganic filler

content, reduction of filler size, and modification of the polymerization
system.

SECOND GENERATION INDIRECT COMPOSITE

RESINS:(High filler and low matrix loads)

The clinical failures endured with first-generation composites and the

limitations faced with ceramic restorations led to the development of
improved second generation composites. The improvements occurred
mainly in three areas: structure and composition, polymerization technique,
and fiber reinforcement. They are suitable alternatives to ceramics in some
clinical situations. The second generation are micro hybrid composite resin
(sometimes called ceramic polymers) with a high density of ceramic filler
particles. They consist of Resin matrix 33% and inorganic filler content of
66% by volume filler content differs from that of first generation I-form of
(longer, whereas the generation are round), size (bigger 1-5 µm) and
composition (mainly silica and barium glasses and ceramics).
TABLE 13: SECOND GENERATION INDIRECT COMPOSITES

3. Targis Ivoclar-Vivadent
 4. Sinfony 3M-ESPE

5. SR Adoro

A) ARTGLASS : Artglass Launched in 1995 By Heraeusl Kulzer

COMPOSITION: Filler- 70wt% filler of bariumsilicate glass of 0.7µ.

Matrix- 30wt% organic resin. Additional to conventional bifunctional
molecules, Artglass contains four to six functional groups which provides
the opportunity for more double-bond conversions.

POLYMERISATION: Photo-cured in a special unit using a xenon

stroboscopic light (UniXS, Heraeus/ Kulzer). The system emits 4.5 watts as
usable luminous power, while the emission range is between 320 and 500
nanometers. The high intensity is emitted for only 20 milliseconds, followed
by 80 milliseconds of darkness. This type of light exposure increases
polymerization potential. The short excitation time followed by a longer
period of nonexposure allows the already cured resin molecules to
partially relax, and more of the nonreactive double-bond carbon groups are
made available for reaction.

KEY NOTE: Can be used to fabricate inlay, onlays and crowns

with/without metal substrate (ranges from nickel-chromium to gold-based
metals). Bonding to the metal substrate is achieved by applying an
acrylonitrile copolymer (Kevloc), a flexible copolymer, to the metal surface
before placing and curing the restorative material.

ADVANTAGES:

• Wear resistant
• Better marginal adaptation
• Better esthetics
• Superior proximal contact
• Can be repaired intraorally
• Flexural strength-132±14MPa
 FIG 68 a: ARTGLASS (Kulzer)

B)BELLEGLASS HP: Belleglass HP introduced by Belle de St. Claire

in 1996.

COMPOSITION: Filler-Silanatedmicrohybrid fillers of 0.6 µ. Base and

surface composites are available which are used on dentin and enamel
respectively. Five different shades of enamel composites are available.
The base composite has barium glass fillers (78.7% wt and 65% volume)
Surface material has borosilicate fillers which provide enhanced optical
characteristics are used (74%wt and 63% volume). Resin matrix of dentin -
bis-GMA, whereas, for enamel - a combination of a hydrocarbon saturated
methacrylate diurethane of TEGDMA & aliphatic dimethacrylate.

FIG 68 b : BELLEGLASS HP Indirect Composite

POLYMERISATION: Uses two different curing units. This gives the

advantage of incremental buildup and resembles the natural tooth with the
hard, translucent, enamel covering the more opaque and softer dentin,
able to absorb the stresses. The base composite is light cured, with a
conventional light cuirng unit which stabilizes the restoration during build
up and reserves unreactive surfaces for bonding. The surface composite is
heat cured. The polymerization is carried by heating in an oven at 140oC
at 80 psi for 20 minutes. The atmosphere is maintained oxygen free and
under nitrogen gas pressure.
 KEY NOTE: The reduction in size of the filler improves the polishability
and smoothness of the material. Newer composite like “Foundation” has
been modified to have a filler diameter of 30 µ in the base composite,
which will allow for further reduction in polymerization shrinkage.

C) TARGIS:

A remarkable new metal-free system with the strength of a PFM (1000

MPa). Its strength, natural esthetics, wear-compatibility and fit make it the
new standard for restorations indicating posterior bridges, crowns, inlays
and onlays.This Ceramic Optimized Polymer, is a highly-filled bondable
material forms bond to metal substructures which combines the esthetics
of ceramics with the flexural strength and shade control of a resin.

COMPOSITION: It contains approximately 77wt% of filler [ceromer]

trimodal and has barium glass of particle size of 1µ. Spheroid silica filler
-0.25 µ and colloidal silica – 0.015-0.05 µ. Matrix- conventional monomers
3wt% of organic resin.

POLYMERISATION: Targis is coated with glycerin gel (Targis Gel) to

prevent formation of oxygen-inhibited surface layer and placed in the
curing unit Targis Power (IvoclarVivadent) for the following cycle: light
emission in the first 10 min along with increase of temperature to 95oC for
25mins, and cooling for 5 min. TARGIS power curing unit provides light
emmision of 10 min at a temperature of 95ºC followed by Cooling 5min.
FIG 68 C: TARGIS (IvoclarVivadent)

ADVANTAGES:
• Durable
• Abrasion resistant and Stable
• Excellent polishability
• Ease of adjustment
 • Enamel like transluscency and fluorescence
• Low degree of brittleness and fracture

KEY POINTS: TARGIS is a veneering composite material that can be

used with / without framework material and also used to fabricate adhesive
inlays/onlays/ veneers and anterior crowns.

D)SINFONY (3M ESPE)

COMPOSITION : Polyfunctional metharylate monomer and ultra-fine

glass or glass-ceramic powder. Pyrogenic silica is also used as a
microfiller. It is a form of amorphous silicon dioxide with a primary particle
diameter of < 0.05 µm, produced in an oxy-hydrogen gas flame.

POLYMERISATION: The proprietary system consists of two

polymerising units improves the property. (Visio alpha, Visio beta). Visio
alpha is equipped with a halogen lamp whereas the Visio beta is equipped
with four fluorescent tubes. The polymerization wavelength ranges from
400-550nm. The polymerization mode for alpha source is 15 seconds
whereas that of beta source is 40°C for 15minutes. The other non-
proprietary unit used is Hyper LII which is a high – intensity polymerization
unit equipped with two metal halide lamps. The wavelength is in the range
of 250-600nm and with an intensity of 150W for 60 seconds.

KEY POINTS: Used for full veneering of fixed and removable

prostheses on metal frameworks, for inlays / onlays, individual crowns,
glass fibre reinforced bridges and for the customization of prefabricated
teeth. Pyrogenic silica has large surface area (up to 350 m2/g) and are
used to control the rheological properties of the composite. The microfiller
particles can insert themselves into the gaps between the macrofillers.
 FIG 68 D: SINFONY (3M ESPE)

E) SR Adoro (Ivoclar Vivadent)

COMPOSITION: The dentin and enamel materials constitute the main

components. components of this system include SR Link (to bond to metal
frame work), a liner, dentin material, stains, incisal material and Opaquer.
SR Link comprises a monomer that contains a highly hydrophobic aliphatic
hydrocarbon chain and a phosphoric ester with a methacrylate function.
Matrix-of dentin and incisal material consists of UDMA instead of Bis GMA
and TEGDMA and the copolymer filler load is about 63% by weight. A
copolymer is produced by grinding a microfilled composite into particles of
approximately 10-30 µm and later incorporated into inorganic microfillers.
Upon polymerization, the copolymers become completely integrated into
the composite and a homogeneous composite with a high loading of
inorganic microfillers is obtained. The liner has 49% by weight barium
glass filler particles.

KEY NOTE: Targis system has continuously been revised and the,
application could now be defined for SR Adoro The phosphoric acid group
of the molecule is a strong acid, which reacts with the metal or the metal
oxide, forming a phosphate. The phosphates form a passivating layer on
the metal surface. After the metal oxide reaction has been completed, the
layer becomes very inert. The methacrylate group of the phosphoric acid
reacts with the monomer components of SR Link, forming a copolymer and
thereby providing a bond to the veneering resin.
 FIG 68 E: SR Adoro (Ivoclar Vivadent)

INTERMEDIATE INDIRECT COMPOSITE RESINS: They are also

micro hybrid light cured composites. They cannot be classified as second-
generation composites because they do not feature all the required
characteristics like

1) High mechanical properties

2) High percentage in volume of inorganic micro particles
3) Bond to metal

Used for inlays and laminate veneers. Metal- resin bonding can be
mechanical or chemical.
Mechanical: macro mechanical retention (beaded metal, metal mesh,
pitted metal). Micro mechanical retention (sandblasting or etching).
Chemical: intermediate interface such as tin plating or ceramic
coating is fused to metal surface E.g. Silicoating, Rocatec (Espe),
Adhesive Silicoa.

TABLE 14: THIRD GENERATION INDIRECT COMPOSITES

 1.Clearfil CR Inlay: Clearfil CR Inlay (Kuraray Co., Ltd.) is a hybrid
composite resin that is filled 86.5% by weight. Available in six
shades, this light-cured composite resin has been formulated with
extra body to make condensing and carving easier. Its heavier body
allows for build up and minimizes sag. The inlay is processed in the
CRC-100Curing Oven. The inlay is bonded into place with CR Inlay
Cement,a dual-cured luting composite resin. Light irradiation for 40
seconds per surface sets the cement and stabilizes the inlay, and
additional chemical curing beneath the restoration ensures a secure
bond. It is recommended that vinyl polysiloxane impression material
be used because of its low deformation, and extra-hard plaster
stoneis recommended for the model. Intraoral repairs can be
accomplished with Clearfil Photo posterior light-cured composite
resin.

2.Coltene Inlay System (Coltene AG): It was first designed for

direct/indirect application. Separating medium is placed on a tooth
prepared with divergentwalls and without undercuts. A composite resin
inlay is fabricated directly in the tooth removed and placed in aspecial oven
that provides heat at 120'C and light for 7minutes, followed by cooling for 1
minute. The material recommended to lute the restoration is Brilliant
Dentin, a hybrid composite resin with shades that correspond to the Vita-
Lumin guide. This system also has been adapted for indirect use. An
impression is made, and a working model is poured. A light-cured
composite resin inlay, onlay, or labial veneer is fabricated on the model,
heat treated, and bonded to the prepared tooth. The inlay may be
fabricated in the office, avoiding the need for temporization, or the dentist
may place a provisional restoration and have the patient return after the
restoration has been fabricated in the office or dental laboratory. Intraoral
repairs can be accomplished with brilliant light-cured hybrid composite
resin.

3.TrueVitality: True vitality (Den-Mat, Inc.) is a hybrid composite resin

with three curing modes: heat curing, self-curing, and light curing. It is
reported to be a true universal material that can be used for a wide array of
clinical applications, ranging from simple direct restorations to more
elaborate indirect procedures such as inlays, onlays, fixed partial dentures,
crowns, and laminate veneers. The manufacturer indicates that it also
allows dentists to perform indirect inlays and onlays in the office without
requiring special equipment. TrueVitality is reported to have a wear rate
less than half that of amalgam; high compressive, tensile, and flexural
strengths; a 3 mm depth of cure; and low water sorption. It is radiopaque
and comes in a wide variety of Vita-Lumin shades.

4.Cristobal: Cristobal (Dentsply Ceramco, Inc.) is a patented

bioglasspolymer material designed for fixed prosthetic
restorations,including single crowns with or without metal support, fixed
partial dentures, fixed partial dentures on implants,inlays, onlays, and
laminate veneers.Cristobal is composed of barium glass particles, 74.2 %
by weight, with an average particle size of 0.7 Micron mts in a matrix of bis-
GMA, TEDMA and UDDMA. It is reported to have very low polymerization
shrinkage (0.12% after 24 hours), a low wear rate (less than 5 pim per
year) and high compressive and flexural strengths. Cristobal's cure rate is
reported tobe92.6 % by light cure alone. The manufacturer has suggested
that this material can be used for three-unit anterior fixed partial dentures
without the use of reinforcing media.

7.FIBER REINFORCED COMPOSITES

Fiber-reinforced composites were introduced by Smith in the 1960s.

Polyethylene fibers, carbon/graphite fibers, Kevlar®, and glass fibers were
tested. Glass and polyethylene are the commonly used fibers in dentistry.
Fibers act as crack stoppers and enhance the proprety of composite. The
resin matrix acts to protect the fiber and fix their geometrical orientation.
Boron oxide, a glassforming agent is present at 6–9 wt% in E-fibers and <1
wt% in S-fibers. E- and S-fibers are the ones most commonly used in
dentistry.76

FIG 70 – FIBER REINFORCED COMPOSITE SYSTEM

 The fibers can be arranged in one direction (unidirectional), with the
fibers running from one end to other in a parallel fashion. Alternatively, the
fibers can be arranged in different directions to one another, resulting
either in a weave- or mesh-type architecture. When the directional
orientation of the fiber long axis is perpendicular to the applied forces, it
will result in strength reinforcement.

Forces that are parallel to the fiber orientation will produce matrix-
dominated failures and consequently yield little reinforcement.77
Multidirectional reinforcement is accompanied by a decrease in strength in
any one direction when compared with unidirectional fiber.

Conventional composite resins consist of micron and submicron glass

or ceramic particles “Floating” in a resin matrix. They are discrete particles
not connected to each other.

In fiber reinforced materials long continuous fibres about 10µm in

diameter are used to provide the bulk of the mechanical properties to the
resin material. It resists stress better in multiple directions while
maintaining flexibility so does not become brittle like ceramics.
FRCs can be classified primarily as
1. Laboratory based
2. chair side based

TABLE 15: LAB PROCESSED INDIRECT FIBER COMPOSITES77

TABLE 16: DIRECTLY PROCESSED FIBER COMPOSITES77

TABLE – 17: CLASSIFICATION OF FRC COMPOSITES

 FCRs are broadly classified as

- Resin pre- impregnated

- Unimpregnated

FRC SUBSTRUCTURE:

The nature of overlying composite (providing shape and anatomic

contour), its wear resistance and its aesthetic qualities are the factors
influencing the effectiveness of FRC system in restorative dentistry. The
FRC framework replaces the classic metal framework of a porcelain fused
to metal prostheses, while a particulate composite applied over this FRC
substructure corresponds to the porcelain applied in a traditional
restoration.This 2-phase polymer prosthesis combines the best
characteristics of the FRC (i.e. strength and resistance and aesthetics).
FRC prosthesis can be of 2 types:

1. Complete coverage prostheses

2. Intracoronal prostheses

1.COMPLETE COVERAGE PROSTHESES:

Tooth preparation: (Guidelines)
- Deep Chamfer/ shoulder preparation with minimally tapered axial
walls and smooth continuous finish lines with 90 ◦ to 120 ◦
 cavosurface angle are recommended.
- Axial reduction on the facial and lingual surfaces of 1.2 to 1.5mm.
- A minimum of 1.5mm of occlusal reduction for adequate material
thickness
Additional preparation features include proximal step on axial walls
adjacent to edentulous space as well as occlusal isthmus. The proximal
steps should be 2- 3mm wide and not more than 1mm deep. The isthmus
is a shallow channel- 0.5mm deep and 2-3mm wide. These features create
additional room for the FRC substructure. The proximal box allows for
sufficient material at the connector area and also provides a positive stop
to place the pontic FRC support.
The occlusal isthmus allows for a continuous beam configuration of
FRC over each abutment tooth and across the edentulous space. For
anterior tooth preparations it should exhibit a step or double shoulder
configuration on the lingual surface so as to avoid creating a retainer with
an over contoured lingual axial surface. Working casts and dies are made
with conventional methods and materials.
Prosthesis Fabrication: involves 4 steps
1. FABRICATION OF THE COPING:
- A thin coping of opacious body particulate composite is adapted to the
dies to include a cervical collar. A notch is placed in each of the copings at
the mid proximal level of the axial surfaces that face the edentulous area.
- Corresponding to the proximal step placed in the tooth preparation
and will stabilize the FRC material when it is placed the 2 copings.

2.PLACEMENT OF THE PONTIC BAR FRC CONNECTOR:

- FRC is available in omg strips measuring 3mm or 6mm in width and
0.3mm in thickness that can be cut to the desired length with ceramic
scissors. A bar of FRC is formed by combining 5-7 strips of 6mm width cut
to the appropriate inter abutment length.
- A special Bis-GMA gel is placed into the notches of the coping to
enhance bonding between the coping and unpolymerized FRC. The
connecting bar is then placed and bounded into the notches of the
composite coping with light polymerisation.
3.DEVELOPMENT OF THE FRC ENVELOPING SUBSTRUCTURE:
- Along single strip of 3mm wide FRC is than bonded to one end of the
already polymerised pontic bar. The long strip is then adapted and light
polymerised continuously along the bar and around the axial surface of the
copings.
 - This is done in a stepwise fashion: only one segment of the FRC strip
at a time is placed in the desired position and then selectively polymerized
and bonded.
- Additional strips of FRC are cut to size, placed and bonded to the
buccal, lingual and cervical surface of the FRC bar that spans the
edentulous area.
- A continuous occlusal strip is bonded to the occlusal surface of one
coping, over the occlusal aspect of the FRC in the edentulous areas and
across the occlusal aspect of the 2nd coping. The stepwise construction of
the FRC substructure results in the creation of a miniature pontic
composed of bonded and light polymerised layers of FRC.

4.ADDITION OF THE PARTICULATE COMPOSITE OVERLAY:

This outer layer of composite is built incrementally. After final light
polymerisation, shaping, finishing and polishing, the FPD is placed in an
oven at 110◦C and 29 – inch vacuum for 15 min to maximize strength and
physical characteristics.

FIG 71 : STEPS IN PRSOTHESIS FABRICATION WITH FRC

 2.INTRACORONAL PROSTHESIS: Intracoronal prostheses or FRC
partial coverage prosthesis allows a more conservative design when the
abutment teeth are unrestored or have modest intracoronal restorations.
- The abutment teeth with no existing restorations are prepared
with a Class II composite inlay design with a short proximal step.

- Since the FRC cannot be placed apical to the contact area and
only particulate composite would be used to fill the box apical to
contact and this would provide no benefit to the overall restoration.

FIBER- REINFORCED SYSTEMS:

i) Preimpregnated
e.g., TARGIS/ VECTRIS
SCULPTURE / FIBERKOR
 ii) Non- impregnated
e.g., BELLE GLASS HP / CONNECT
RIBBOND, GLASSPAN

LABORATORY BASED, PREIMPREGNATED FRCs

They were first introduced in 1998. Preimpregnated FRCs are the
ones in which fibers and resinous matrix are coupled during the
manufacturing process resulting in uniformly impregnated fibers into
the matrix. Fibers used are GLASS or POLYEHYLENE fibers.
Strength of FRC is 7 times the particulate composite. There is an
increase in the flexural strength and tensile strength.
1.TARGIS / VECTRIS: Introduction of the revolutionary TARGIS system
in 1996 in U.S., was the breakthrough posterior crown and bridge
restorative system that offers you the strength of a PFM- exceptional
aesthetics, wear compatibility and precise fit, without metal.The Targis
system, with its exclusive highly filled TARGIS CEROMER (ceramic
optimized polymer) composition, along with VECTRIS, a fiber reinforcing
composite framework, can be used with confidence for metal-free posterior
bridges, crowns, inlays, and onlays.
FIG 72- TARGIS/ VECTRIS SYSTEM

Consists of two major components:

1. Targis – forms the bulk of the restorations

2. Vectris – fiber framework. Various types of fibers

- PARALLEL glass fibers in a resin matrix for pontics

- Woven fibers for single crowns and abutments.
PROPERTIES:
 *Flexural strength:
Vectris pontic - 860MPa
Vectris weaves – 430- 500Mpa
* Elastic modulus: 30 – 40Gpa much better than conventional
composite resins
* TARGIS DENTIN AND ENAMEL LAYERS:
Strength :147 – 160Mpa
Elastic modulus: 10Gpa
Targis base: less resistance to stress deformation with low elastic
modulus (5Gpa)

*Crucial links in the system is the bonding of the Targis to the Vectris. If
the bonding interaction is weak, then delamination may occur when bridge
or crown is stressed.

Weak bonding may be due to

• Targis base has low elastic modulus
• If the layer of Targis is not thoroughly cured and carefully bonded to
each other.

FABRICATION:
Fiber reinforced network is light cured in vaccum under pressure to
adapt the material to the abutments and pontic, reduce porosity and
improve the cure of the resin materials. After the framework is formed, a
bonding agent and first layer of Targis (Targis base) is applied. Subsequent
layers of dentin and enamel Targis composite resin are placed to form the
final contours of the restoration. The entire completed restoration
undergoes a final cure using heat and light.

FIG 73 – FABRICATION STEPS IN TARGIS/ VECTRIS SYSTEM

 ADVANTAGES:
1. Good aesthetics, and restorations have good
translucency
2. Good choice for use in situations where high stress precludes the
use of a ceramic material or where the patient insists on using no metal in
the mouth.
3. Requires less surface area on the abutment teeth when compared to
metal or ceramic as it has ability to bond to the tooth structure.
4. Act as a shock absorber when used in implant supported
restorations as it transfers less stress to the bone.
5. Does not abrade the opposing enamel.
Questions remain with respect to the colour stability, wear, delamination
problems well as sensitivity possibly due to the dimensional changes in the
material because of a high coefficient of thermal expansion.

3.SCULPTURE/ FIBREKOR: This system also involves veneering the

composite resin (Sculpture) to a resin impregnated glass fiber network
(Fibrekor) fibers available in 15cm lengths of various widths. Sculpture is
polycarbonate based composite resin.
STEPS IN FABRICATION: • Sculpture resin is alied to the abutment
and cured. Notch is created for placement of the initial piece of fibers for
pontic, additional fiber material is then wrapped around the abutment
pontic areas and cut to the proper length reinforce the abutments and
pontic area. The sculpture composite resin is then layered on the fiber
network using dentin and enamel shades and light cured in a pressurized
inert atmosphere. (Nitrogen). Final cure is achieved in a vaccum using
heat.
ADVANTAGES:
• Fiber frame has a strength values of 500Mpa.
• Good aesthetics and customization of the restoration can be
accomplished.
• Degree of cure for Sculpture is higher than that for Targis due to the
pressurized nitrogen atmosphere used for curing. This eliminates the
chance for oxygen inhibition of curing which improves the surface and
overall degree of polymerisation making it more wear resistant.
• Less chances of debonding from fiber framework and within the
Sculpture layers.
FIG 74 – FABRICATION STEPS IN SCULPTURE/FIBERKOR SYSTEM

CLINICAL APPLICATION:

• Splinting • Inaly/ onlay bridge

• Maryland bridge
• Cast partial denture and complete denture
• Crown and bridges
 NON-IMPREGNATED FIBER SYSTEMS

i) BELLE GLASS HP/ CONNECT: BelleGlassHP is a high quality direct

composite material. It is truly the best of the new class of indirect heat and
pressure cured restorative systems, bringing together proven technology
along with the most innovative and advanced science of any indirect
composite system. It incorporates a specific filler size and particle
distribution that helps to achieve thermal expansion, flexibility and stress
response characteristics similar to natural dentin. It is a submicron filled
resin used to fabricate inlays, onlays, crowns, and abutments for fixed
partial dentures.

Available in variety of dentin and enamel shades.

Cured like Sculpture, i.e. light and heat are applied and enclosed
in pressurised chamber filled with nitrogen.

A multiple unit bridge is fabricated by connecting the abutments with a

braided polyethylene polymer fiber called CONNECT. Resin is flowed into
the fiber weave and cured onto abutments. Pontic is fabricated by layering
Belle Glass onto the fibers. Entire restoration is cured in the pressurized
nitrogen chamber. Overall mechanical properties of Connect system are
significantly less than Vectris and Fiberkor systems so less long -term
success of fixed partial dentures.

PROPERTIES: 1. Flexural strength of Belle Glass is 147Mpa. Strength

of resin infiltrated Connect fibers range from 220- 340Mpa.
2. Elastic modulus: 8- 10 Gpa
3. Wear rate equivalent to enamel wear rates.

ii) RIBBOND:
It is across-linked leno stitch weave of polyethylene fibers. Can be used
chair side or in laboratory to fabricate composite resin bridges like Belle
Glass/ Connect system. Resin is applied by hand to impregnate the weave
resulting in a flexural strength of approximately 200 – 275 Mpa, with elastic
modulus of 8 Gpa.
FIG 75 – RIBBOND FRC
USED PRIMARILY AS:

1. Periodontal splinting material.

2. Reinforcement and repair of provisional restorations.
3. Complete/ partial removable dentures
4. Endodontic posts/ cores
5. Orthodontic appliances
6. Crack tooth syndrome
FIG 76 –STEPS IN RIBBOND FRC

GLASS SPAN:
 It is a braided glass fiber used to fabricate fiber reinforced crowns and
bridges.

Used in dental laboratory or chair side

Low viscosity resin is applied to the fibers and then cured

Flexural strength: 266- 321Mpa

Elastic modulus: 14 Gpa
FIG 77- GLASS SPAN FRC RESTORATION

SUMMARY : The other factors that affect the modulus of FRC are the
physical and chemical properties of the composite and the interfacial
adhesion and matching of the modulus between the fiber and the overlying
veneering composite. It has been suggested that the interfacial bonding
between the polyethylene fibers and matrix is weak. It has been proved
that the use of resin pre-impregnated silanized glass fibers results in the
best mechanical properties.
 RECENT ADVANCES IN COMPOSITES

The development and implementation of composite dental restorative

materials rely on a comprehensive understanding of each component of
the composite and consideration of methods for changing each
component. Unfortunately, demands on these restorations with regard to
mechanical properties, placement, and need for in situ curing leave
significant room for advancements, particularly with respect to their
mechanical properties, polymerization shrinkage and polymerization-
induced stress, thermal expansion mismatch, fracture, abrasion and wear
resistance, marginal leakage, and toxicity.
1. Ceromers
2. Smart composites
3. Ormocers
4. Giomers
5. Nano composites
6. Anti - microbial Composites
7. Self- healing composites
8. Trimodal technology
 1. CEROMER
The term Ceromer stands for ceramic optimized polymer and was
introduced by Ivolclar to describe their composite Tetric Ceram. They are
microfilled hybrid resins or universal composite resins. This material
consists of a paste containing barium glass (≤ 1µm), spheroidal mixed
oxide, ytterbium and silicone di oxide (57 vol %) in dimethacrylate
monomers. (BISGMS and urethane methacrylate. They set by
polymerization of C=C of the methacrylate. They must be bonded to the
tooth structure. The properties of the ceromers are identical to those of the
composites and they exhibit fluoride release lower than conventional glass
ionomers or compomers.

FIG 78– TETRIC N CERAM

In 1996 a ceromer was developed for indirect composite restoration

Targis (vivadent).

It consists ofn77% of wt. filler and 23% of wt. organic resin.

The filler is trimodal and consists of Barium glass with a mean
particles size of 1 µm. Spheroidal silica filler –mean size 0.25 µm
as well as colloidal silica filler- 0.015 -0.050 µm
The resin matrix consists of conventional monomer superior
properties are claimed as a result of optimized chemical
composition.
 USES:

Ceromer can be used for veneers, inlays/onlays without metal

framework.
Also, can be used with fibre reinforced composite framework
for inlay/onlays crowns and bridges and for crown and bridges
including implant restorations on a metal framework.
Ivoclar in cooperation with several universities has developed
advanced polymer systems and ceramic fillers from which high
performance ceromers have been produced. These ceromers
combine the advantage of that ceramics with those of state of art
composites.

Composition: Ceromers are composed of specially developed and

conditioned fine particles ceramic fillers of submicron size (0.044 and 1
µm) which are closely packed (75 -85 weights %) And embedded in an
advanced temperable organic polymer matrix.

Advantages: On the basis of their composition and structures,

ceromers combine the advantages of ceramics and composites like:

Durable aesthetics
High abrasion resistance
High stability
Ease of final adjustment
Excellent polish ability
Effective bond with luting composite
Low degree of brittleness
Conservation of tooth structure.
 2.SMART COMPOSITES
There is no single material in dentistry that is ideal in nature and fulfils
all the requirements of an ideal material. As the quest for an “ideal
restorative material” continues, a newer generation of materials was
introduced. These are termed as “smart’’ as these materials support the
remaining tooth structure to the extent that more conservative cavity
preparation can be carried out. Mostly all the materials were designed to
act in a passive way with no interactions with the oral environment. This
was to ensure the materials could survive longer and to allow them to be
used for long periods. Then, it was realised that some materials were able
to act in an 'active' way. For example, the ability to release and absorb
fluoride, which can positively react in an oral environment.
DEFINITION : McCabe defined Smart materials as
"Materials that are able to be altered by stimuli and transform back into
the original state after removing the stimuli". The stimuli can be derived
from temperature, pH, moisture, stress, electricity, chemical or biomedical
agents and magnetic fields.
PROPERTIES : Smart materials sense changes in the environment
around them and respond in a predictable manner. In general, these
properties are:
• Piezoelectric — when a mechanical stress is applied, an electric current
is generated.
• Shape memory— after deformation these materials can remember their
original shape and return to it when heated.
• Thermo chromic — these materials change colour in response to
changes in temperature.
• Photo chromic — these materials change colour in response to changes
in light conditions.
• Magneto rheological — these are fluid materials become solid when
placed in a magnetic field.
• PH sensitive — materials which swell/collapse when the pH of the
surrounding media changes.
• Bio film formation— presence of bio film on the surface of material
alters the interaction of the surface with the environment.
PREREQUISITES FOR SMART BEHAVIOUR:
• Material interacts with environment - Stimulated by changes in
ambient condition
• Some reactivity essential - But must not destroy integrity
 • Any reaction must be reversible or time limiting - Function/longevity of
the material must be acceptable
• Inert materials cannot be smart - Traditional approaches to materials
development are inappropriate for ‘smart’ behaviour
CLASSIFICATION: Smart materials have the capability to sense and
react according to the environment. An important aspect of smart materials
used in various areas of dentistry is their excellent biocompatibility. Smart
materials can be mainly classified into passive and active materials.
Passive materials respond to external change without external control.
They also possess self-repairing characteristics. Active materials sense a
change in the environment and respond to them.
TABLE 18 – CLASSIFICATION OF SMART MATERIALS

AMORPHOUS CALCIUM PHOSPHATE (ACP)

ACP is an antecedent in the biological formation of hydroxyapatite
(HAP). It has both preventive and restorative properties, which justify its
use in dental cements and adhesives, pit and fissure sealants and
composites.
Advantages
1. It acts as a reinforcement of the natural defence mechanism of the tooth
only when needed.
2. It has long life and there is no wash out.
3. Patient compliance is not required.
 Mechanism of action: At neutral or high pH, ACP remains in its
original form in the oral environment. But when the surrounding pH drops
to a level where it can demineralize the tooth surface, i.e., at or below 5.8
(critical pH), ACP converts into crystalline HAP, thus replacing the HAP
crystal lost to the acid. These released ions will merge within seconds and
form a gel. In less than 2 min this gel becomes amorphous crystals,
resulting in calcium and phosphate ions. Crystalline HAP is the final stable
product in the precipitation of calcium and phosphate ions from neutral or
basic and it neutralizes the acid and buffer the pH.
FIG 79– MECHANISM OF ACTION OF ACP

ARISTON pH CONTROL
It was introduced by Ivoclar-Vivadent. It is a light-activated alkaline,
nano filled glass restorative material. It releases calcium, fluoride and
hydroxyl ions when intraoral pH values drop below the critical pH of
5.5 and counteracts the demineralization of the tooth surface and also
aids in remineralisation. Ariston is an ion releasing composite material,
which releases fluoride, hydroxyl and calcium ions as the pH drops
in the areas immediately adjacent to the restorative material. This is
said to neutralize the acid and counteract the decalcification of
enamel/dentin. The material can be adequately cured in bulk
thickness up to 4 mm. It is recommended for the restoration of class 1
and class 2 lesions in both primary and permanent teeth.
FIG 80– Ariston pH control
 FLUORIDE RELEASING COMPOSITES
They contain Methacryloyl fluoride – Methyl methacrylate copolymer in
pit and fissure sealant where fluoride delivery lasted for 2 years.
Diethylaminoethyl methacrylate is incorporated into dental resin system .
Fluoride is released by hydrolysis at a rate of 2- 5µg/cm2/day for 1 year.
Fig 81: FLUORIDE RELEASING COMPOSITES

Self-repairing/Self-healing composite
This is an epoxy system which contained resin filled
microcapsules. If a crack occurs in the epoxy composite material,
some of the microcapsules are destroyed near the crack to release
the resin. The resin subsequently fills the crack and reacts with a
Grubbs catalyst dispersed in the epoxy composite, resulting in
polymerization of the resin and repair of the crack. Similar systems
were demonstrated to have a significantly longer duty cycle under
mechanical stress in situ compared to similar systems with the self-
repair. Capsule-based materials incorporate a healing agent that is
held and protected in discrete spherical shells, which are ruptured by
damage. The self-healing mechanism is activated by the release and
reaction of the healing agent at the damage site. However, after
release, the healing agent is depleted, so it only works for a single
local healing.

FIG 82- SELF HEALING MATRIX – GREBB’S CATALYST

PROPERTIES:

Fluoride released is lower than glass ionomer but more than that of
compomers.

Flexural strength : 118MPa

Flexural modulous: 7.3 GPa

Fracture toughness : 1.9 MNm-3/2

Mean wear rate: 7194 µm

 3.ORMOCER

INTRODUCTION: Dr . Herbert Wolters from Fraunhofer Institute for

Silicate Research introduced this class of material in 1994.
ORMOCER the acronym of Organically Modified Ceramics is a newer
material for all the filling indications in the anterior and posterior area
which serve as an optimum and upto date replacement for amalgam,
composite amd compomers. This class of material represents a novel
inorganic- organic coploymers in the formulation that allows for
modification of its mechanical parameters.
FIG 83: ORMOCER – ADMIRA FUSION

The inorganic – organic coploymer is synthesized from multi-functional

urethanes and thioether (meth) acrylate alkoxysilanes as sol-gel
precursors. Alkoxysilyl groups of the silane permit the formation of an
inorganic Is-O-Is network by hydrolysis and poly- condensation reactions.
The methacrylate groups are available for photochemical polymerization.

COMPOSITION:
•The essential difference between ORMOCER and the previously
available composites is found in the matrix. The matrix of conventional
composites mainly consists of low molecular monomer components –
BisGMA. On light activation only 60- 70 % of the free monomers can be
converted. Throughout the lifetime of the restorartion they can be eluted.
• The matrix, consisting of ceramic polysiloxane( siliconoxygen- chains)
presnets a whole new approach. Instead of dimethacrylate monomer of
traditional composites, ORMOCER has a biocompatible polysiloxane net
with low shrinkage even prior to light curing. The inorganic network
formation starts by hydrolysis and precedes polycondensation of Si (OR)3
groups. Starting with silane, polysiloxanes with polymerisable groups are
formed.
• The filler particles are 1- 1.5µm in size and the material contains 77%
filler by weight and 61 by volume. SILICON DIOXIDE filler, serves as a
basic substance. It is modified originally by adding polymerisable side
chains in the form of methacrylate groups. Throughout bonding of the
methacrylate molecules to the carrier medium, the methacrylate molecules
can no longer be eluted during incomplete polymerization.

FIG 84- COMPOSITION OF ORMOCER

PROPERTIES:

Permanently release Fluoride, calcium and phosphate ions that

sela the adjoining cavity margins.
Biocompatible
Physical properties as given by Wolter are

- Bending strength : 100- 160 MPa

- Modulus of elasticity : 10- 17GPa
- Water uptake : < 1.2%
- Solubility in water : not detectable
- Shrinkage : 1.7 – 2.5 vol%
 - Coefficient of thermal expansion : 17 – 25 x 10-6/ºC
ADVANTAGES:
- Biocompatibility : After the palcement of the filling, ORMOCER
will not release any residual detectable substance and is therefore
biocompatible.
- Reduced polymerization shrinkage : 1.8%
- High abrasion resistance : owing to its excellent abarsion
resistance the material can be used in the posterior area that is
exposed to masticatory load and ensure outstanding long- term
stability of the filling in this load- bearing area.
- Lasting esthetics : Unlike amalgam, ORMOCER is a tooth
coloured restorative material, which is available in 12 finely
graduated shades. Due to their chemical – physical characteristics,
these materials have long- term protection against
discolouration.
- Anticariogenic property : It provides additional protection against
dental decay by strengthening the tooth substance through
permanent release of enamel hardening minerals like calcium and
phosphate ions that protect the adjoining cavity margins.
- Fast and safe handling: The innovative one- step bonding “ Etch
and Prime 3.0 with their water- based bonding, the etching of the
dental enamel with phosphoric acid gel otherwise required is not
necessary,as well as separate rinse and dry steps are redundant.
With only one single liquid that contains the pyrophospahte, all
steps of the procedure etching, priming and bonding can be
carried out in one step and a safe and durable adhesive bond
between tooth and filling is created.
 4.GIOMERS
INTRODUCTION: Giomers are newly introduced hybrid aesthetic
restorative for dental restoration therapy. Hybrid materials for dental
restorative therapy. Hybrid materials combining the technologies of glass
ionomers and resin composites have been developed to help overcome
problems of conventional GICs such as moisture phase of GIC in the
restorative and are also known as PRG COMPOSITE.

CHEMICAL NATURE OF GIOMERS: Giomers are hybrid aesthetic

restorative materials with low moisture sensitivity, low initial
mechanical properties and inferior translucency: and at the same
maintain their clinical advantages such as fluoride release and
adhesiveness. These hybrid materials mainly include resin modified
GIC (RGMI’s) and compomers.

• Giomers employ the use of pre-reacted glass ionomer (PRG)

technology to form a stable material. The fluroaluminosilicate glass in
these materials is reacted with polyalkenioc acid in water prior to inclusions
into silica filled urethane resin. Although Giomers has been called a light
cure, one pack glass – ionomer restorative by the manufacturer, it should
be considered as light cured composite as it does not have a significant
acid base reaction as part of its curing process and cannot set in the dark.

• This technology also differs from compomers, in which a variable

amount of dehydrate polyalkenioc acid is incorporated into resin matrix and
the acid does not react with the glass until water uptake occurs into the
restoration. No doubt, Giomers contain essential components of glass
ionomer cements but they cannot be classified as compomers as the acid
base reaction has already occurred.

FIG 85 - GIOMER CHEMICAL NATURE

 One recently developed acidic solution is a self-etching primer that
contains acidic functional monomers, such as 4-AET phenyl-p bonding
systems currently available is known as REACTMER BOND (Shofu inc,
Kyoto, Japan), Reactmer bond is the glass ionomer based ,tricurable ,all in
one filled adhesive based on PRG technology and consists of 4-AET,4-
AETA,UDMA,HEMA,PRG filler, fluroaluminosilicate glass, acetone ,water
and initiator. This is a single application bonding system that combines
function of self-etching primer sand bonding agent.

Mechanism of bonding of Giomers based adhesives:

Recently, single application bonding systems that combine the function

of self-etching primer and bonding agent have been developed. Reactmer
bond is a single application bonding agent bases on PRG technology. The
adhesive in one application bonding systems is a hydrophilic solution that
is extremely effective in wetting tooth surface. The etching effect of these
systems is an MDP along the PRO fillers and other additives constitutes
Reactmer bond. This self-etching primer, which is belied to be a precursor
of the single application system, enables etching and priming of the tooth
surface simultaneously. For a single application bonding systems, applying
the adhesives does not create a deep etching pattern like applying
phosphoric acid does. Giomers based adhesive creates a thick b\hybrid
layer as compared to other single step adhesives between the restorative
and tooth substrate, though their bond strengths are lower than 2 step
bonding system, a thick layer of the adhesive of the single application
bonding system in submicron filler addition might assist in close adaption
of the restoration without gap formation.

COMMERCIAL FORMULATIONS: Giomers come in one paste form.

They are light polymerizing and require bonding agents for adhesion to
tooth structure. Currently available Giomer restorative includes
REACTMER (Shofu Inc., Kyoto, japan), FL-BOND, and BEAUTIFIL.

FIG 86-GIOMER COMMERCIAL FORMULATIONS

Indications: Giomers are mainly indicated for

1. Restoration of root caries

2. Non Carious cervical lesions
3. class v cavities
4. Deciduous tooth caries.

LIMITATIONS: Giomers are not as beneficial as GIC in patients who

are at risk for recurrent caries as long term fluoride release is questionable,
auj yap et al 2002, compared the fluoride release of giomer was less than
the composite resin in this study and light barriers such as wrapping of
light tips and use of Mylar strips further decreased the hardness value
 C.Huang et al 2002 compared the effect of water sorption on the extent
of marginal gap (VITREMER, FUJI 11 LC) two giomer beautiful, Reactmer
paste, two compomers (Compoglass F, F-2000) and 2 resins composites
(FILTEK Z 250, TETRIC CERAM) over a twelve-week storage period. Both
compomers exhibited delayed water sorption characteristics. Resin
modified GIC’s followed by compomers, whereas composites were
relatively stable. Giomers exhibited rapid and extensive expansion and
should be avoided in tooth preparation that involve thin unsupported
enamel.

ADVANTAGES:

Giomers have certain advantages clinically (IADR/AADR/CADR, San

Diego: Abst.No.0949, March 2002.)

1.Fluoride release: PRG composites /Giomers release substantial

amount of fluoride and are effective in prevention of secondary caries and
on top bond in inhibition of secondary caries in outer and inner wall
lesions. The results indicated that giomer based adhesives in prevention of
secondary caries, especially when used in combination with fluoride
releasing adhesive.Pashley D.H. and Tay F.R 2002 in a study found out
that regions of increased hydrophilicity or permeability within cured single
step adhesive layers that permit fluid ion conductance to occur under an
osmotic gradient. A. Itthagarun at al 2002 found that a single step
adhesive such as Reactmer-bond (giomer) is more permeable probably
because of the absence of a comparatively more hydrophobic surface
resin layer. He concluded that permeability of adhesive layers in bonded
dentin effects the potential of caries initiation by fluoride leasing
adhesiveness and restorative and restorative materials.

2. Fluoride recharging: The fluoride recharging effect on Giomers

significantly reduces the incidence of recurrent caries and also increases
thickness of caries inhibition zone. P. Senawogse 2002 evaluated the
rechargeable effect of current fluoride releasing restoratives: giomer with
2.2% NaF gel to conclude that fluoride recharging with sodium fluoride gel
significantly reduces depth of lesions restored with these restoratives and
the effect is more marked in Giomers.
 3. Biocompatibility: Giomers are biocompatible restorative material.
Sonda evaluated histopathologically the pulp tissue reaction of a Giomers,
in non-exposed monkey teeth to state the giomers are compatible
biologically with vital pulps.

4. Clinical stability and durability: Giomers are clinically stable

materials and meet requirements of clinical portion of ADA acceptance
program guidelines for dentin and enamel adhesive materials. Comparison
of retention, anatomical forms, caries, staining of restoration, marginal
discolouration, marginal adaptation, surface roughness and sensitivity of
giomer to a microfilled

5. Excellent aesthetics: The giomer have excellent aesthetics

comparable to composites and compomers.

6. Smooth surface finish: Giomers have better surface finish than

conventional GIC and resin modified GIC’s. The surface finish of giomer is
comparable to composites and compomers.

7. Excellent bonding: Single application bonding agents are most

recent development in adhesive dentistry. Perhaps a more descriptive term
for them is single solution product because that are etch, prime and bond
with the application of single solution that is applied to enamel and dentin.

They have greatly simplified and shortened the binding process. They
have slightly lower bonds strengths to dentin than those seen with three
step adhesives but the clinical the clinical performance may be well the
same.

Giomer have developed a special niche in restorative dental therapy

especially for the restoration of root caries, no carious cervical lesions,
class V cavities and deciduous tooth caries. Giomers have certain
advantages such as fluoride release and recharge, biocompatibility, clinical
stability, excellent aesthetics and smooth surface finish which have made
them popular restorative material.as per today’s knowledge, giomer are
promising restorative materials and are considered to be most interesting
development of near future.
 FIG 87 – GIOMER FLUORIDE RELEASE AND RECHARGE

FIG 88– GIOMER GENERATIONS

1ST GENERATION GIOMERS: The GIOMER group of restorative

materials and adhesive systems contain the unique PRG filler created
using either the Surface Pre-Reacted Type of glass-ionomer (S-PRG) or
Fully Pre-Reacted Type of glass-ionomer (F-PRG) technology. The initial
GIOMER group of restorative materials (BEAUTIFIL) contained the S-PRG
fillers and adhesive systems (FL-BOND) contained the F-PRG fillers.
Among the GIOMER products, “BEAUTIFIL”, an aesthetic direct restorative
material for anterior and posterior teeth and “FL-BOND”, a 2-step bonding
system, consisting of self-etching Primer and fluoride releasing bonding
agent have been clinically proven and researched extensively worldwide.
Their excellent long-term clinical performance has made GIOMER to be
recognized as a unique group of direct aesthetic restorative materials.

2nd GENERATION GIOMERS: SHOFU made further improvements on

the S-PRG technology, resulting in the development of modified “S-PRG
filler”, which consists of a trilaminar structure (a glass core and 2 surface
layers). This unique filler structure has a glass core of multifunctional fluoro
boro aluminosilicate glass, a layer of pre-reacted glass-ionomer phase,
which is reinforced with a surface modified second layer. With this
enhanced S-PRG filler, SHOFU has successfully developed “BEAUTIFIL
II”, a new versatile highly aesthetic direct restorative material for anterior
and posterior teeth, BEAUTIFIL OPAQUER a flowable opaque material for
masking discolorations and FL-BOND II a light cure fluoride releasing,
radiopaque, 2 step adhesive system.

5. NANOCOMPOSITES
These products are different from other types of composites in that they
contain nano- sized fillers. Particles of size of 1-100 nm in diameter exhibit
unique electronic, optical, photonic and catalytic properties. They display
properties intermediate between quantum and bulk material because of
their intermediate size and large surface area-to-volume ratios.
Nanoparticles of different sizes and shapes exhibit different absorbance
and fluorescence features. They are formulated with NANOMER and
NANOCLUSTER filler particles and are claimed to combine strength of a
hybrid and polish of a microfill, aclaim similar to that made by
manufacturers of universal composites and reinforced microfill.

COMPOSITION: Nanomers are discrete non- agglomerated and non-

aggregated particles of 20- 75 nm in size. Nanoclusters are loosely bound
agglomerates of nano- sized particles. Nanotubes have remarkable tenisle
strength and could dwarf the improvements that carbon fibers brought to
composites.

STRUCTURE: The spheroidal shape provides smooth and rounded

edges distributing stress more uniformly throughout the composite resin.
This phenomenon has been termed the “Roller Bearing” effect, and is said
to improve the sculptability and handling characteristics. Reduced
shrinkage :1.4-1.6%.

FIG 89-NANOMER, NANOCLUSTER, NANOTUBES

SALIENT FEATURES:
- Nano hybrid composites have nanometer sized particles combined
with more conventional filler technology.
- Nanofilled resins have approximately 60% volume filler loading,
making them as strong as the hybrid and micro hybrid resins.
- Nanofillers have a refractive index of 1.508.
- Nanomers are discrete non-agglomerated and non-aggregated
particles of 20-75 nm
- Nanotubes have remarkable tensile strength
- Nanocluster Loosely bound agglomerates of nano-sized particles

ADVANTAGES:
• Superior translucency and aesthetic appeal, excellent colour,
high polish and polish retention.
• Superior hardness and flexural strength
• About 50% reduction in polymerisation shrinkage
• Excellent handling properties
LIMITATIONS:
 The properties of nanocomposites are usually far from the
expectations, the main reason being,
- insufficient homogeneity
- lack of sufficient orientation
- improper adhesion
In spite of considerable difficulties nanocomposites have great
potentials especially in specific, niche applications.

SUMMARY:
The nanocomposites are relatively new composites consisting of
filler particles in nanometric dimensions (between 20 to 75 nm). The
main purpose of using fillers with nanometric dimension in these
nanocomposites is the improvement in the strength, wear resistance
and ability to polish.
The materials used to restore teeth must have enough strength to
resist again applied forces during chewing and remain strongly on
the related part of the teeth.The nanofilled composites present similar
mechanical and physical properties to those of microhybrid
composites, but when it comes to polish and gloss retention they
perform significantly better.
The main example of nanofilled composites is Filtek™ Supreme
Plus. However, several manufacturers are now incorporating nano-
sized particles into their formulations, resulting in the creation of yet
another category, the “nanohybrid” composites. Some examples are:
Premise (Kerr Dental), Aelite Aesthetic Enamel (Bisco, Inc), Clearfil
Majesty™ Esthetic (Kuraray America, Inc), and Artiste.
TABLE 19: COMMERCIAL NANOCOMPOSITES AND THEIR PROPERTIES
 6. ANTIMICROBIAL COMPOSITES
Antimicrobial properties of composites may be accomplished by
introducing agents silver or one or more antibiotics into the material.
Microbes are subsequently killed on contact with the materials or through
leaching of the antimicrobial agents into the body environment. Silver and
titanium particles were introduced into dental composites respectively to
introduce antimicrobial properties and enhance biocompatibility of the
composites. Alkylated ammonium chloride derivatives and chlorohexidine
diacetate have also been introduced as antimicrobial agent into dental
composites. There are sometimes problems with introducing antimicrobial
agents into composites, such as decrease of the antimicrobial properties
with the time or reduced ability of the composites to light cure.

TABLE 20: ANTIMICROBIAL AGENTS INCORPORATED INTO RESIN COMPOSITES

RESIN MATRIX
TYPE FILLER MODIFICATION
MODIFICATION

Acrylic -amine
-HF salts
Methacryloxyl
acid fluoride
Strontium fluoride MDPB
Released Ytteribium trifluoride Monomer
antimicrobial Silver ions Chlorhexidine
agents Ag – silica glass Benzalkonium
Zinc oxide chloride
Cetyl
pyridinium
chloride
Chitosan

Silver supported
fillers Triclosan
Non-
12- Quartenary
released
metharyloxyloxydodecyl ammonium
antimicrobial
pyridinium bromide polyethyleneimine
agents
MDPB QPE
 FIG 90– ANTI MICROBIAL COMPOSITE

ALTERATION IN RESIN COMPONENT

A) CHLORHEXIDENE 1%:
Addition of soluble antimicrobial agents into the resin matrix causes
immobilization of the antibacterial components into the resin matrix utilizing
an antibacterial monomer. CHX possess drawbacks such as
• Non-uniform release Toxic effect on released material.
• Population shifts of microorganism.
• Short lived antibacterial activity (1 week).
• Deterioration of physical & mechanical properties
• Porous structure of material.
B) QUATERNARY AMMONIA COMPOUND:
They are chemically bound to resin matrix. Antibacterial effect was
seen even after long term immersion in water. No adverse effect on
mechanical properties of Bis-GMA. It is an effective Bacteriostatic agent
against streptococci and acts as contact inhibitor. It has no effect on the
curing of primers and bonding agents.
C) MPC 2-methacryloyloxyethyl phosphorylcholine:
After the composite is exposed in the oral cavity, proteins are adsorbed
onto its surface, which serve as a prerequisite for bacteria attachment. The
adsorption of oral bacteria to the resin composite is mediated by the
adsorbed proteins. Biofilm is the source of infection with organic acids
leading to caries. Accordingly, it is desirable for the composite to be able to
inhibit proteins and repel bacteria attachment, thereby reducing biofilm
formation and caries. It was shown that most proteins were found to
adsorb to hydrophobic surfaces. In contrast, highly hydrophilic surface
coatings are used to inhibit protein adsorption and bacterial attachment.
 Recently, MPC was added into dental resins and bonding agents,
achieving a great protein-repellent property thereby preventing secondary
caries. MPC is one of the most common hydrophilic bioactive polymers,
which is a methacrylate with a phospholipid polar group in the side chain.
Various medical devices using MPC polymer have been synthesized and
used clinically.
It was reported that MPC is hydrophilic and there is lots of free water
but no bound water in the hydrated MPC polymer. The bound water would
lead to protein attachment. In contrast, the free water around the
phosphorylcholine group could repel proteins effectively, thereby inhibiting
proteins.

D) MDPB Monomer:(Methacryloxydodecyl pyridinium bromide)

The resin matrix contains MDPB monomer to exert anti bacterial
action. It inhibits bacterial growth and the plaque accumulation
without releasing the antibacterial components.

FIG 91– MDPB CONTAINING ANTI MICROBIAL COMPOSITE

Alterations IN filler component

1. Addition of a silver component as a filler
a) silver – containing silica glass
b) silver zeolite/ silver apatite
c) silver supported zirconium phosphate/silver supported silica gel
2. Cellulose nanocrystal/Zinc oxide nanohybrids

1. SILVER:
- Anti-bacterial effect due to release of silver ions.
 - Hydro thermally supported into space b/w crystal
lattice network of filler particles.
- Supported in silica gel and thin film were coated
over surface composites e.g. Amenitop, Novaron
- Direct contact with bacteria.
- Antibacterial against streptococci.
- Oligodynamic action

2.CELLULOSE NANOCRYSTAL / ZINC OXIDE NANOHYBRIDS:

Strong antibacterial dental resin composites have been developed
through the introduction of cellulose nanocrystal/ zinc oxide (CNC/ZnO)
nanohybrids. ZnO has already been applied to some commercial oral
restorative products. Compared with Ag, ZnO possesses more similar
colour to natural tooth, which is suitable as dental filler to give resin
composites antibacterial properties.

- The direct addition of ZnO nanoparticle could not improve the

mechanical properties effectively. Therefore, cellulose nanocrystal/
zinc oxide (CNC/ZnO) nanohybrids were prepared.
- CNC extracted from natural plants is biocompatible, transparent, and abundant. It has
been widely studied in the area of biomaterials as a reinforcing agent with superior
mechanical properties.

Axial elastic modulus of 110–220 GPa

Transverse elastic modulus of 10–50 GPa

Tensile strength of 7.5–7.7 GPa.

Small amounts of CNC/ZnO nanohybrids can significantly inhibit the growth and the adhesion
of bacteria on the surface of resin composite restorations, and doesn’t compromise the mechanical
properties. The hypothetic advantage of the nanohybrids is to integrate the reinforcing effect of CNC
and antibacterial activity of ZnO together.

FIG: 92 PREPARATION ROUTE OF CNC/ZNO NANOHYBRIDS

 8. TRIMODAL TECHNOLOGY

Novel filler technology, using 3 different fillers--prepolymerized filler,

patented Point 4 filler, and 0.02-micron filler. Excellent polishability,
durability, and strength.
a) Fantasista : Its 4-part filler system combines the best properties of TMPT reactive organic
filler that polishes magnificently and maintains the finish long after other composite resins have
begun to dull. The best balanced combination of a nanofiller and a microfiller for strength, wear
resistance and easy hanling. A proprietary strontium filler for shade and translucency control. This
distinctive technology creates a unique restorative material with extraordinary handling properties,
cosmetics and long-term performance .
FIG 93 – TRIMODAL TECHNOLOGY - FANTASITA

b) ARTISTE: Based on Polyhedral Oligomeric Silsesquioxane(POSS).

These are 12-sided silicate cages produced from silane and functionalized
to copolymerize with other monomers. It shows advantages like
- Highly Polishable
- Excellent Polish retention
- Wear Resistance
FIG 94– ARTISTE -TRIMODAL TECHNOLOGY
 FIG 95 – ANATOMY OF POSS MOLECULE

c) Fusio:
Fusio™ Liquid Dentin is a 4-META (4-methacryloxyethyltrimellitic acid)
based flowable composite featuring nano-sized amorphous silica and glass
fillers. Fusio Liquid Dentin’s unique formula is both acidic (low pH value)
and hydrophilic. Upon contact with the tooth surface, the negatively
charged carboxylic acid groups of the methacrylate monomers bond to the
mineral ions in the tooth structure. As the carboxylic acid groups are
neutralized and the monomers polymerized they become incorporated into
the dentin surface enhancing both dentin bonding and sealing ability.
FIG 96 – FUSIO-TRIMODAL TECHNOLOGY
 d) ESTELITE SIGMA:
ESTELITE® SIGMA is a light-cured submicron filled resin composite
containing 82 wt.%, 71 vol% of filler. Every inorganic filler contained in
Estelite® Sigma is a spherical submicron filler Size range: 0.1 um-0.3um
that enables excellent polishability, gloss retention, wear resistance and a
wide range of the "chameleon effect". Together with its outstanding
mechanical strength, it offers superior aesthetics as well as the strength
required for posterior restorations. Estelite® Sigma provides an ideal
sculpting feature with a non-sticky consistency. There are 18 different
shades available
FIG 97– ESTELITE SIGMA -TRIMODAL TECHNOLOGY
 e) G-aenial :
The ability of a composite to scatter light and diffusely reflect it similarly to the natural tooth make it possible to
achieve a perfect match with the surrounding tooth structure. A composite material becomes invisible only when it has
this scattering property. Like the tooth, G-aenial contains different interfaces with different optical properties, resulting in
varied reflection of light. The excellent scattering ability of G-aenial is related to the extremely diverse structural
composition which results in it mimicking the reflectivity of a nature.
FIG 98: G-AENIAL

f) RAP TECHNOLOGY:ESTELITE® SIGMA QUICK utilizes Tokuyama's

patented innovative initiator system "Radical Amplified
Photopolymerization Technology" (RAP), to offer reduced curing time
and excellent stability to ambient light while maintaining the superior
aesthetic and physical properties.
FIG 99– RAP TECHNOLOGY

FUTURE PERSEPCTIVES
 COMPOSITE FOR TISSUE REGENERATION:
These are the materials which allows the partial or complete
regeneration of tissues in the human body. For dentin regeneration ,
modified polymer ceramic biomimetic composites may have a potential.
The development of advanced biomaterials finds more opportunities by
combining biomaterials in the form of biopolymers and bioceramics, either
synthetic or natural105 (Pérez, Won, Knowles, & Kim, 2013). Composite
materials, or hybrids, often show an excellent balance between the
strengths and weaknesses of their individual components providing overall
improved properties.

FIG 100-COMPOSITE FOR TISSUE REGENERATION

• An enamel inspired nano composites fabricated through amelogenin

supramolecular assembly for incorporation into dental materials have
been developed recently.
- To create synthetic enamel or repair, Lippert et al demonstrated that
hydroxyapatite layer can be deposited from solution in-vitro onto enamel.
Fluroapapatite nano rods of different size, shape and composition for
incorporation of dental materials or in the treatment and prevention of
caries.
 - Synthetic polymers or metallic agents, when combined with
hydroxyapatite, give rise to hydroxyapatite composites. The prime motive
behind the development and research of the hydroxyapatite composites is
to upgrade the mechanical properties of porous hydroxyapatite, or vice
versa, and also to create artificial bone grafts that may be partially
biodegradable, for the purpose of tissue engineering . Reinforcements
have been added to hydroxyapatite in order to improve reliability106.
These include particles, platelets, whiskers, long fibers, partially stabilized
zirconia, metal dispersoids, and polymers.
• Various additive materials have been used for the synthesis of
hydroxyapatite-based composites. The resultant composites have been
found to have superior properties as compared with the original
constituents (i.e., hydroxyapatite and polymers/ceramics). The formation of
apatite structure, average particle size, and in vitro activity is hugely
influenced by the addition of various materials in the composites
• The combination of hydroxyapatite and biopolymers is being considered
for innumerable applications in dentistry based on its desirable bio-
characteristics. These hydroxyapatite composite materials are used in
dental tissue regeneration, direct pulp capping and pulpotomy,
remineralization of enamel, dental drug delivery, and so forth.
 SUMMARY

Use of composites in dentistry is an example of the evolution of

technology in the best sense. Composites are stronger and more durable
than ever, while still being superior aesthetically. By understanding the
chemical and physical nature of composites, the clinician can choose
appropriate materials, manipulate them properly, and produce a high-
quality product for the patient’s dental needs. Today, the successful use of
tooth colored restorations certainly relies on proper selection of the
restorative material and technique. The current dental composites
improved clinical performance compared with their predecessors,
especially in posterior teeth and in stress bearing areas on anterior teeth.
However, it is also apparent that current formulations remain less than
ideal in terms of dimensional change during curing and long-term fatigue
and fracture resistance. Future research efforts will remain committed to
the development of non-shrinking polymer systems which can be mixed
with appropriate curing modifiers and fillers to produce restorative
materials with excellent qualities. Considerable effort should be expended
in the laboratory and clinic to ensure that the new materials handle and
perform at and above the level of existing materials. Weaknesses must be
identified, and further refinements in formulations will then take place to
maximize performance. Finally, continued development of fillers and
polymers containing therapeutic agents, such as fluoride, is likely to
produce composites which may have cariostatic properties like Glass
Ionomers. This conceptual evolution in materials and techniques gives
clinicians the option to treat a large range of problems faced in everyday
practice in a reliable, predictable, and conservative way.
◆◆◆
 REFERENCES
1. Sturdevant’s Art and science of Operative Dentistry,- Fifth Edition Theodore M. Roberson
,Harald O. Heyman, Edward J. Swift
2. Fundamentals of Operative dentistry, contemporary approach, -Second Edition, James B
Summit
3. Restorative dental materials– Rober G. Craig
4. Phillip’s Science of Dental materials – Kenneth J. Anusavice
5. Textbook of Operative dentistry – Marzouk
6. Contemporary Esthetic Dentistry- George freedman
7. Science of dental materials – Skinner’s
8. Change your smile – Goldstein Ronald E.
9. Textbook of Operative dentistry – Vimal K. Sikri
10. https://www.slideshare.net/indiandentalacademy.
11. Composite Materials: composition, properties and clinical applications: A literature review,
Brigitte zimmerli, Matthias Strub,Franziska Jeger,Oliver Stadler, Adrian Lussi, Schweiz Monatsschr
Zahnmed Vol.120,11/2010.
12. Resin composite—State of the art Jack L. Ferracane , Department of Restorative
Dentistry, Oregon Health & Science University , PortlandDent Mater (2010) , USA
13. Review: Resin Composite Filling, Keith H. S. Chan, Yanjie Mai, Harry Kim, Keith C. T. Tong,
Desmond Ng and Jimmy C. M. Hsiao
14. Beginnings of the dental composite revolution – Stephen C.Bayne, JADA August 2013
15. Bowen RL (1956). Use of epoxy resins in restorative materials. J Dent Res 35:360-369.
16. Bowman CN, Kloxin CJ (2008). Toward an enhanced understanding and implementation of
photopolymerization reactions. AIChE J 54:2775-2795.
17. Braga RR, Ferracane JL (2002). Contraction stress related to degree of conversion and
reaction kinetics. J Dent Res 81:114-118.
18. ADA Council on Scientific Affairs (1998) Statement on posterior resin based composite.
ADA council on dental benefit program Journal of the American Dental Association 129, 1627-1628.
19. Contemporary concepts on composite materials - Zrinka Tarle, Danijela Marovic, Vlatko
Panduric,Rad 514 Medical Sciences, 38(2012) : 23-38
20. Recent advances and developments in composite dental restorative materials – N.B
Cramer, J.W Stansbury and C.N Bowman, J Dent Res 90(4): 402-416,2011
21. Swift EJ Jr. (2001) Processed composites Journal of Esthetic and Restorative Dentistry
13(5) 284.
22. Composite Materials: composition, properties and clinical applications: A literature review,
Brigitte zimmerli, Matthias Strub,Franziska Jeger,Oliver Stadler, Adrian Lussi, Schweiz Monatsschr
Zahnmed Vol.120,11/2010.
23. Composite resins.A review of the materials and clinical indications, Adela
HervasGarcia,Miguel angel Martinez Lozano,jose cabanes vila,Amaya Barjau Escribano,Pablo fos
Galve –MedOral Patol Oral Cir buccal 2006;11:E 215-
24. Physical properties of current dental nanohybrid and nanofill light-cured resin composites-
Irini D. Sideridou, Maria M. Karabela, Evangelia Ch.Vouvoudi, dental materials 27(2011) 598–607)
25. Attia, R.m., W.m. Etman, and T.m. Genaid. "One year clinical follow up of a silorane-based
versus methacrylate-based compositeresin." Tanta Dental Journal 11.1 (2014): 12-20.
ScienceDirect.com.
26. Dent Oral Craniofac Res, 2017 Ning Zhang, Department of Orthodontics, School of
Stomatology, Capital Medical University, Beijing, 100050, China,.
27. Strong antibacterial dental resin composites containing cellulose nanocrystal/zinc oxide
nanohybrids Yazi Wanga, j. of dentistry 2019Leinfelder KF. New developments in resin restorative
systems. J Am Dent Assoc 1997; 128: 573-581.
28. Jandt KD, Sigusch BW. Future perspectives of resin- based dental materials. Dent Mater
2009; 25: 1001-1006.
 29. Manhart J, Chen H, Hamm G, & Hickel R (2004) Buonocore Memorial Lecture. Review of
the clinical survival of direct and indirect restorations in posterior teeth of the permanent dentition
Operative Dentistry 29(5) 481-508.
30. Deliperi S, & Bardwell DN (2002) An alternative method to reduce polymerization shrinkage
in direct posterior composite restorations Journal of the American Dental Association 133(10) 1387-
1398.
31. Ferracane JL (2008) Buonocore Lecture. Placing dental composites—A stressful
experience Operative Dentistry 33(3) 247-257.
32. Willems G, Lambrechts P, Braem M, Celis JP, Vanherle G. A classification of dental
composites according to their morphological and mechanical characteristics. Dent Mater 1992; 8:
310-319.
33. Matinlinna JP, Lassila LV, Ozcan M, Yli-Urpo A, Vallittu PK. An introduction to silanes and
their clinical applications in dentistry. Int J Prosthodont 2004; 17:155-164
34. Jeon IY, Baek JB. Nano composites derived from polymers and inorganic nanoparticles.
Materials 2010; 3: 3654.
35. Sarita Kangoa SKB, Annamaria CB, Surface modification of inorganic nanoparticles for
development of organic-inorganic nanocomposites-A review Prog Poly Sci 2013; 38: 1232-1261.
36. Lung CY, Matinlinna JP. Aspects of silane coupling agents and surface conditioning in
dentistry: an overview. DentMater 2012; 28: 467-477.
37. Plueddemann EP. Silane coupling agents. Springer 2013.
38. Deliperi S, Bardwell DN (2002) An alternative method to reduce polymerization shrinkage in
direct posterior composite restorations. J Am Dent Assoc 133: 1387-1398.
39. Hervas-Garcia A, Martinez-Lozano MA, Cabanes-Vila J, et al. Composite resins. A review
of the materials and clinical indications. Med Oral Patol Oral Cir Bucal. 2006;11(2): E215-E220.
40. Developments in Composite Dental Restorative Materials , N.B. Cramer,J Dent Res 90(4)
2011
41. Braga RR, Ballester RY, Ferracane JL (2005). Factors involved in the development of
polymerization shrinkage stress in resin-composites: a systematic review. Dent Mater 21:962-970
42. Decker C, Moussa K (1991a). A new class of highly reactive acrylic-monomers. 2. Light-
induced copolymerization with difunctional oligomers. Die Macromolekulare Chemie 192:507-522.
43. Hoyle CE, Lee TY, Roper T (2004). Thiol-enes: chemistry of the past with promise for the
future. J Polym Sci A Polym Chem 42:5301-5338
44. Ganster B, Fischer UK, Moszner N, Liska R (2008a). New photocleavable structures.
Diacylgermane-based photoinitiators for visible light curing. Macromolecules 41:2394-2400.
45. Ganster B, Fischer UK, Moszner N, Liska R (2008b). New photocleavable structures. 4 -
Acylgermane-based photoinitiator for visible light curing. Macromol Rapid Commun 29:57-62.
46. Lin SP, Shen JH, Han JL, Lee YJ, Liao KH, Yeh JT, et al. (2008). Volume shrinkages and
mechanical properties of various fiber-reinforced hydroxyethyl methacrylate-
polyurethane/unsaturated polyester composites. Compos Sci Technol 68:709-717.
47. Gomez ML, Previtali CM, Montejano HA (2007). Phenylonium salts as third component of
the photoinitiator system safranine O/triethanolamine: a comparative study in aqueous media.
Polymer 48:2355-2361
48. Hoyle CE, Bowman CN (2010). Thiol-ene click chemistry. Angewandte Chemie 49:1540-
1573. Hoyle CE, Lee TY, Roper T (2004).
49. Thiol-enes: chemistry of the past with promise for the future. J Polym Sci A Polym Chem
42:5301-5338. Hoyle CE, Lowe AB, Bowman CN (2010).
50. Thiol-click chemistry: a multifaceted toolbox for small molecule and polymer synthesis.
Chem Soc Rev 39:1355-1387.
51. Klapdohr S, Moszner N (2005). New inorganic components for dental filling composites.
Monatshefte für Chemie 136:21-45.
52. Lim BS, Ferracane JL, Sakaguchi RL, Condon JR (2002). Reduction of polymerization
contraction stress for dental composites by two-step light-activation. Dent Mater 18:436-444
53. Miller MD, Holder AJ, Chappelow CC, Eick JD (2005). A theoretical study of an expanding
monomer and an oxirane Part 1: Expanding monomer reactions. J Mol Struct: THEOCHEM
756:185-194
 54. Musanje L, Ferracane JL, Sakaguchi RL (2009). Determination of the optimal photoinitiator
concentration in dental composites based on essential material properties. Dent Mater 25:994-1000.
Nie J, Bowman CN (2002).
55. Xia Y, Zhang F, Xie H, Gu N (2008). Nanoparticle-reinforced resin-based dental composites.
J Dent 36:450-455.
56. Synthesis and photopolymerization of N,N’dimethyl,-N,N’-di(methacryloxy ethyl)-1,6-
hexanediamine as a polymerizable amine coinitiator for dental restorations. Biomaterials 23:1221-
1226.
57. Schroeder WF, Vallo CI (2007). Effect of different photoinitiator systems on conversion
profiles of a model unfilled light-cured resin. Dent Mater 23:1313-1321.
58. Soh MS, Sellinger A, Yap AU (2006). Dental nanocomposites. Curr Nanosci 2:373-381.
59. Pfeifer CS, Ferracane JL (2006). Pulse-delay curing: influence of initial irradiance and delay
time on shrinkage stress and microhardness of restorative composites. Oper Dent 31:610-615.
60. Sadowsky SJ (2006). An overview of treatment considerations for esthetic restorations: a
review of the literature. J Prosthet Dent 96:433-442.
61. Tezvergil A, Lassila LVJ, Vallittu P (2006). The effect of fiber orientation on the
polymerization shrinkage strain of fiber-reinforced composites. Dent Mater 22:610-616
62. Fonseca Lima1Kamila, Menezes Guedes de Andrade,Louise Esther da Cruz
Alves,Giulliana Panfiglio Soares,(2012) Influence of light source and extendedtime of curing on
microhardness and degree of conversion of different regions of a nanofilled composite resins, Eur J
Dent 6(2) 2012, 153-157
63. Sahar A. M. Abd El Halim, Effects of light curing and remineralization on micro hardness of
nano esthetic restorative materials, Journal of American Science, 8(1) 2012, 147-151
64. Cadenaro M, Antoniolli F, Codan B, Agee K, Tay FR, Dorigo Ede S, Pashley DH, Breschi L.
Influence of different initiators on the degree of conversion of experimental adhesive blends in
relation to their hydrophilicity and solvent content. Dent Mater 26(4) 2010, 288-294.
65. Jimenez-Planas A, Martin J, Abalos C, Llamas R, Developments in polymerization lamps,
Quintessence Int39 (2) 2008, 74-84.
66. Rueggeberg FA, Caughman WF, Curtis JW JR, Davis HC, Factors affecting cure at depths
within light-activated resin composites, J American Dentistry 6 (2)1993, 91-95
67. Rueggeberg F. Contemporary issues in photocuring, Compend Contin Educ Dent (25)
1999,
S4-S15
68. Yoon TH, Lee YK, Lim BS, Kim CW, Degree of polymerization of resin composites by
different light sources, J Oral Rehabil 29(12) 2002, 1165-1173.
69. Leprince JG, Palin WM, Vanacker J. Physico-mechanical characteristics of commercially
available bulk-fill composites. J Dent 2014; 42: 993-1000.
70. Czasch P, Ilie N. In vitro comparison of mechanical properties and degree of cure of bulk fill
composites. Clin Oral Investig 2013; 17: 227-235.
71. Ferracane J, Alex G, Margeas R. Question: Are bulk-fill composites a good idea? Inside
Dentistry. 2014;10(10):42-44
72. Salerno M, Derchi G, Thorat S, Ceseracciu L, Ruffilli R, Barone AC. Surface morphology
and mechanical properties of new-generation flowable resin composites for dental restoration.
Dental Materials. 2011;27:1221–28
73. Bukovinszky K, Molnar L, Bako J, Szaloki M, Hegedus C. Comparative study of
polymerization shrinkage and related properties of flowable composites and an unfilled resin.
Fogorv Sz Journal. 2014;107:3–8
74. Lokhande NA, Padmai AS, Rathore VP, Shingane S, Jayashankar DA, Sharma U.
Effectiveness of flowable resin composite in reducing microleakage - an in vitro study. Journal of
International Oral Health. 2014;6:111–14.
75. Balos S, Pili B, Petronijevi B, Markovi D, Mirkovi S, Sarev I. Improving mechanical
properties of flowable dental composite resin by adding silica nanoparticles. Vojnosanitetski
Pregled. 2013;70:477–83. DOI: 10.2298/VSP1305477B
76. Margeas R. New bulk-fill material simplifies restorations to one step. Inside Dentistry.
2014;10(10):86-90.
 77. Indirect resin composites , Suresh Nandini Journal of Conservative Dentistry | Oct-Dec
2010 | Vol 13 | Issue 4
78. Leena Verma and Sidhi Passi Case Report Glass Fibre-Reinforced Composite Post and
Core Used in Decayed Primary Anterior Teeth: A Case Report Hindawi Publishing Corporation Case
Reports in Dentistry Volume 2011, Article ID 864254, 4 pages doi:10.1155/2011/864254.
79. A. Senthilkumar, L. John Baruch, M. Francis Luther King, “Experimental Studies on
Mechanical Properties of Glass Fiber Reinforced Ceramic Matrix Composites” International Journal
of Emerging Technology and Advanced Engineering Volume 4, Issue 6, June 2014.
80. Zhang N, Ma J, Melo MA, Weir MD, Bai Y, et al. (2015) Protein-repellent and antibacterial
dental composite to inhibit biofilms and caries. J Dent 43: 225-234.
81. Cheng L, Weir MD, Zhang K, Xu SM, Chen Q, et al. (2012) Antibacterial nanocomposite
with calcium phosphate and quaternary ammonium. J Dent Res 91: 460-466.
82. Zhou C, Weir MD, Zhang K, Deng D et al. (2013) Synthesis of new antibacterial quaternary
ammonium monomer for incorporation into CaPnanocomposite. DentMater29: 859-870
83. Ilie N, Rencz A, Hickel R (2013) Investigations towards nano-hybrid resin-based
composites. Clin Oral Investig 17:185–193
84. Schaub KM (2010) The effect of a novel photoinitiator system (RAP) on dental resin
composites' flexural strength, polymerization stress, and degree of conversion. Dentistry School
Theses and Dissertations, Indiana University-Purdue University Indianapolis (IUPUI).
85. Schmidt C, Ilie N (2012) The mechanical stability of nano-hybrid composites with new
methacrylate monomers for matrix compositions. Dent Mater 28:152–159
88. Jakubiak J, Allonas X, Fouassier J, Sionkowska A, Andrzejewska E, Linden L et al (2003)
Camphorquinone-amines photoinitating systems for the initiation of free radical polymerization.
Polymer 44:5219–5226
89. Suh BI. New concepts and technology for processing of IRCs. Compend Contin Educ Dent
2003;24:40-2.
90. Indirect Composite Resin Systems: A Clinical Material RevieW Karl F. Leinfelder, DDS, MS,
and Douglas A. Terry, DDS, Inside dentistry , Nov/Dec 2006 , Volume 2, Issue 9
91. Leinfelder KF. Indirect posterior composite resins. Compend Contin Educ Dent. 2005:495-
503.
92. Chatzistavrou X, Lefkelidou A, Papadopoulou L, Pavlidou E, Paraskevopoulos KM, Fenno
JC, Flannagan S, González-Cabezas C,Kotsanos N and Papagerakis P (2018)Bactericidal and
Bioactive DentalComposites. Front. Physiol. 9:103.doi: 10.3389/fphys.2018.00103
93. Wang, Z., Shen, Y., and Haapasalo, M. (2014). Dental materials with antibiofilm properties.
Dent. Mater. 30, e1–e16. doi: 10.1016/j.dental.2013.12.001
94. Sauro, S., Osorio, R. (2013). Novel light-curable materials containing bioactive micro-fillers
mineral-depleted bonded-dentine interfaces. J. Biomater. Sci.Polym. Ed. 24, 940–956.
95. Siso SH, Hürmüzlü F. Physical properties of three different types of LC composite resins.
Acta Stomatol Croat. 2008;42:147–54
96. George R. Nanocomposites- A Review. J Dent & Oral Biosc. 2011; 2(3): 38-40 5. Kaur P,
Luthra R, Puneet. Nanocomposites - A step towards improved restorative dentistry. Ind J Dent Sci
2011;4(3):28-31
97. Kumar PS, Kumar S, Savadi RC, John J. Nanodentistry: A Paradigm Shift- From fiction to
Reality. J Ind Prosthodont Soc 2011;11(1):1-6
98. Ingle E, Gopal KS. Nanodentistr: A Hype or Hope. J Oral Health Comm Dent 2011;5(2):64-7
99. Mahalaxmi S. Composite Resins. In Materials used in Dentistry. 1st ed. Wolter
Kluwer/Lipincott Williams & Wilkins; 2013.
100. Esthetic Dentistry- A Clinical approach to Techiniques and Materials- Aschheim Dale,
second edition Indirect composite inlays and onlays by Dr David Penn.
101. Touati B, Aidan N. Second generation laboratory composites for indirect restorations. J
Esthet Dent.1997;9(3):108-118.
102. Miara P. Aesthetic guidelines for second-generation indirect inlay and onlay composite
restorations. Pract Periodont Aesthet Dent.1998;10(4):423-431.
103. Kanaparthy R, Kanaparthy A. The changing face of Dentistry: Nanotechnology. Int J
Nanomed. 2011;6: 2799-2804
 104. Lin, H. R., & Yeh, Y. J. (2004). Porous alginate/hydroxyapatite composite scaffolds for
bone tissue engineering: Preparation, characterization, and in vitro studies. Journal of Biomedical
Materials Research. Part B, Applied Biomaterials, 71(1),52-65 https: //doi.org/10.1002/ jbm.
105. D.A. Wahl, J.T. Czernuszka, Collagen-hydroxyapatite composites for hard tissue repair,
Eur. Cell. Mater. 11 (2006) 43–56.
106. Applications of Nanocomposite Materials in Dentistry Trends in restorative composites
research: what is in the future? Maas MS, Alania Y, Natale LC, Rodrigures MC, Watts DC, Braga
RR, Braz. Oral Res. 2017;31(suppl):e55

ABBREVIATIONS

S.No ACRONYM ABBREVIATION

1 AADR American association of dental research
2 ATES Allylethoxy silane
3 APS Aminopropyl trimethoxysilane
4 AET 4 -acryloxyethyl trimellitate.
5 AETA 4 -acryloxyethyl trimellitate anhydride
6 ADA American dental association
7 ACP Amorphous calcium phosphate
8 AET Acryloxy ethyltrimellitic acid
9 AETA Acryloxy ethyltrimellitic acid anhydride
10 ALERT Amalgam like esthetic restorative treatment
11 ANSI Amaerican national standards institute
12 APO Acyl phosphine oxides
13 BHT Butylhydroxytoluene
14 B-L Bucco-Lingual
15 BTG Benzoyl trimethyl germane
16 BIS-GMA Bisphenol A- glycidyl methacrylate
17 BIS-EMA Bisphenol A- ethoxylate dimethacrylate
18 CQ Camphoroquinone
19 CADR California association of dental research
20 CLD Cross linked density
21 CEROMER Ceramic optimized polymer
22 CDMA Citric acid dimethacrylate
23 CFA Contact- free area
24 CEJ Cemento enamel junction
25 C- factor Cavity Configuration factor
26 CNC/ZnO cellulose nanocrystal/ zinc oxide
27 DOC Depth of cure
28 DMAEMA Dimethylaminoethyl dimethacrylate
29 DOP Degree of Polymerization
30 ESPE Electro sensitive protective equipment
31 FCA Functional contact area
32 F-PRG Fully pre- reacted glass ionomer fillers
33 FPD Fixed partial denture
34 FRC Fiber reinforced composites
35 GIC Glass ionomer cement
36 GDMA Glyceryl dimethacrylate
37 GEMA Glyceryl ethyl methacrylate
38 HABI Hexaaryl biimidazole
39 HAP Hydroxyapatite
40 HEMA Hydroxy ethyl methacrylate
41 ISO International organisation for standardisation
42 JADA Journal of American dental association
43 J/m Joules per minute
44 LCU Light curing unit
45 Lbs Libra was balance /scales
46 LED Light emitting diode
Light amplification by stimulated emission of
47 LASER
radiation
48 MPa Megapascal
49 µm Micrometer
50 mW/cm2 Milliwatt- second per square centimetre
10-Methacryloyloxydecyl dihydrogen
51 MDP
phosphate
52 META Methacryloxyethyl trimellitate anhydride
53 MOD Mesio- Occlusal- Distal
Methacrylate derivative of styrene – allyl
54 MSAA
alcohol
12-metharyloxyloxydodecyl pyridinium
55 MDPB
bromide
56 MPC
2-methacryloyloxyethyl phosphorylcholine

57 MPS Methacryloxypropyl trimethoxy Silane

58 nm Nanometer
National aeronautics and space
59 NASA
administration
60 OTMS Octyltrimethoxy silane
61 OCA Occlusal contact area
62 OIL Oxygen inhibited layer
63 ORMOCER Organically modified ceramics
64 PRR Preventive resin restoration
65 PPD Phenyl - Propanedione
66 PCA Proximal contact area
67 PETMP Pentaerythritol Tetra(3- Mercaptopropionate)
68 PFM Porcelain fused to metal
69 pH Parts of hydrogen
70 PMMA Poly methyl methacrylate
71 POSS Polyhedral oligomeric silsesquioxane
Polyhedral oligomeric silsesquioxane
72 POSSMA
methacrylates
73 PRG Pre reacted glass ionomer
74 PRIMM Poly rigid inorganic matrix material
75 PETMP Pentaerythritol tetra(3- mercaptopropionate)
76 QTH Quartz Tungten Halogen Lamp
77 QPE Quartenary ammonium polyethyleneimine
78 RAP
Radical amplified photopolymerization
technology
79 RBC Resin based composites
80 RGM Resorbable graft material
81 SOC Spiro-orthocarbonates
82 SDR Smart dentin replacement
83 SiO2 Silicon di oxide
84 S-PRG Surface pre- reacted glass ionomer fillers
85 TCB Carboxylic acid modified dimethacrylate
86 TATATO Triallyl-1,3,5-triazine-2,4,6trione
87 TX Thioxanthone
88 TEGDMA Triethylene glycol dimethacrylate
89 TPO
Trimethyl benzoyl – Diphenyl- Phosphine
oxide
90 UDMA Urethane dimethacrylate
91 UDMS Urethane dimethacrylate silane
92 USPHS U.S. Public health service
93 UV Ultraviolet
94 VLC Visible light activated composites
95 Wt% Weight percentage