The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
1. S UO
Esthetic Restorative Materials
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INDIAN DENTAL ACADEMY
Leader in continuing Dental
2. S UO
Esthetic Restorative Materials
• Dent 730 -- Dr. Stephen Rosenstiel,
• Course Director
• Lecturer -- Dr. Peter Monaghan
• monaghan.15@osu.edu
• Sources for Lecture Information:
• Sturdevant et al, 3rd ed: 207 - 287; 534 - 625
(review)
• Craig, 10th ed: 244 - 280 (review)
• Exam questions to cover all sources
• Sit in your assigned seats!
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Filler Particle Incorporation
• Initially mechanically retained
• Lost after wear or resin matrix
• Silane coupling agent
• Chemically bonds fillers to matrix
• Silane bond to glass
• C=C bond to resin monomers during
polymerization
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Filler Loading
• Macrofils up to 80 w% or 50 v%
• Microfils up to 50 w% or 35 v%
• Hybrids up to 80 w% or 50 v%
• Filler pre-polymerization
• Heterogeneous filler
• React filler and resin
• Grind to powder
• Mix with unreacted filler
• Increase filler loading to 75 w% or 42 v%
• Poor bonding to matrix
• NOTE: Volume %age is the critical factor
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Chemical Cure Resins
• Also know as Self or Auto Cure
• Requires mixing
• Incorporation of air voids
• Benzoyl Peroxide or Benzene Sulfinic Acid
• Aromatic tertiary amine
• Color instability with time
• Production of free radical species
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Ultraviolet Light Cure Resin
• Benzoin alkyl (methyl) ether
• 365 nm UV light (EMR)
• Minimal mixing required
• Slow reaction
• Long curing times
• 30 day shelf life after activation
• Production of free radical species
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Visible Light Cure Resin
• Camphorquinone
• Aliphatic tertiary amine
• 470 ± 20 nm light (EMR)
• No mixing required
• Fast reaction
• Short curing time
• Long shelf lived
• Production of free radical species
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Dual Cure Resins
• Visible light cure reactants
• Self cure reactants
• Most require mixing
• Uses
• Resin cements
• Cervical increments in Class II, III, or IV
situations
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Free Radical Species
• Highly reactive
• Unstable
• Attack and open C=C bonds in monomers
• Vinyl polymerization
• Initiate polymerization
• Cause chain growth
• Cause chain crosslinking
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Bonding to Tooth Structure
• Enamel
• Conditioning (etching) of enamel
• Wetting with low viscosity resin
• Dentin
• Smear layer
• Conditioning of dentin
• Wetting with low viscosity resin
• Poor with sclerotic dentin
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Conditioning (Etching) of
Enamel
• 20 - 50% phosphoric acid
• 20 to 120 seconds
• Rinsed with water
• Dried with air
• Up to 10 µm penetration
• Surface irregularities
• Surface area increase
Tubular Dentin
Etched Enamel
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Conditioning of Dentin
• Removes or restructures smear layer
• Dissolves inorganic component of dentin
• Exposes and denatures collagen
• Phosphoric acid
• Dentin primer
• Hydrates collagen
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Wetting with Low Viscosity
Resin
• Low viscosity resin
• HEMA-rich
• Surrounds collagen
• Polymerized for 20 seconds
• Strong mechanical interlock
• “hybrid layer”
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Clinical Uses of Composite
Resin
• Class III and IV restorations
• Anterior teeth
• Class I and II restorations
• Anterior teeth
• Posterior teeth
• Class V restorations
• Anterior teeth
• Posterior teeth
• Preventive resin restoration
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Class III and IV Composite
Resin Restorations
• Isolation
• Lingual or facial access
• Break cervical and facial or lingual contact area
• Preserve incisal half of contact (Class III)
• Bevel accessible enamel margins
• Pumice cleansing of area
• Matrix and Wedge (prewedging helpful)
• Incremental build-up including bonding
• Initial cure from cervical direction
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Class I and II Composite Resin
Restorations
• Narrow cavities with enamel margins
• Isolation
• Minimally break contacts (Class II)
• Prewedging required (Class II)
• Bevel accessible enamel margins
• Pumice cleansing of the area
• Matrix and Wedge
• Incremental build-up including bonding
• Initial cure from the cervical direction (Class II)
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Class V Composite Resin
Restorations
• Isolation, rubber dam with 212 retractor or cord
• Caries removal
• Bevel of accessible enamel margins
• Cementum margin at right angle
• Pumice cleansing of the area
• Incremental buildup including bonding
• Initial cure from the cervical direction
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Preventive Resin Restoraion
• Sealant
• Isolation
• Pumice cleansing of the area
• Conditioning of the enamel
• Bonding of sealant resin
• Selective caries removal plus sealant
• Isolation
• Remove caries with minimal preparation
• Pumice cleansing of the area
• Conditioning of the enamel and dentin
• Incremental buildup including bonding and
sealant
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Finishing of Composite Resins
• Hand operated devices
• Composite resin carvers,
scalers, scalpel blades
• Abrasive finishing strips
• Rotary instruments
• Multi-fluted carbide burs
• Diamond points
• Rubber wheels and points
• Various discs
• Pastes
• Alumina and diamond grit
abrasives
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Finishing of Composite Resins
• Best finish
• Against a Mylar strip with no polishing
• Not always possible
• Excellent finish
• Sof-Lex Discs
• Medium rubber wheels and discs
• Fine finishing diamonds (Micron)
• Average finish
• Other discs
• Burs
• Stones
• Other rubber wheels and points
• High Luster
• Pastes
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Wear of Composite Resins
• Microfracture Theory
• Hydrolysis Theory
• Chemical Degradation Theory
• Protection Theory
• Combination Theory
• Any and all processes occur
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Protection Theory of Wear
• Micro-protection
• Inter filler particle distance controls wear
• Large → high wear
• Small → low wear
• Soft matrix ablates
• Filler particles slough
• Macro-protection
• Inter-particle wear continues until opposing
teeth come into enamel vs enamel contact
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Traditional Classification -
Glass Ionomer Cements
• Type I - luting agents
• < 20 µm film thickness
• Type II - low stress bearing restorative materials
• < 45 µm film thickness
• Type III - pit and fissure sealants
• 25 - 35 µm film thickness
• Type IV - high stress bearing restorative materials
• > 45 µm film thickness
• Includes metal-reinforced materials
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Use Classification -- Glass
Ionomer Cements
• Luting agents
• Restorative materials
• Metal mixtures - no chemical bond with metal
• Cermet materials - chemical bond with metal
• Liners - thin layers under restorative materials
• Bases - thick layers under restorative materials
• Sealants - pit and fissure sealants
• Resin modified materials
• Light cure
• Dual cure
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Polysalt Gel Stage
• Final matrix
• Can take months to complete
• Mainly aluminum ions
• Low mobility
• Depleted calcium ions
• Silica gel
• Binds the initial matrix to the unreacted glass
• Tooth-like optical properties
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Resin Modified Polymerization
• Identical to the resin polymerization
• Free radical species are generated
• Polymers result from growing chains
• Acid-base reaction is slow (if present)
• Incremental addition
• Less susceptible to dehydration
• Less swelling on setting -- more microleakage
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Bonding to Tooth Structure
• Carboxylic acid groups
• Bond to calcium ions
• Chelation -- covalent/ionic bond
• Bonds to sclerotic dentin
• Methacrylate functionality
• Needs dentin bonding agent
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Clinical Use
• Luting agents
• Bases and liners
• Restorations
• Dentin Conditioner
• Polyacrylic acid
• Gently rub the dentin
• Rinse/dry gently
• Not indicated for luting
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Glass Ionomer Cement
Luting Agents
• Produce thin films
• Release fluoride ion
• Displaced zinc phosphate and zinc polycarboxylate
cements
• Short setting time
• Follow manufacturer’s directions
• Mixed “en mass”
• Clean up at the rubbery stage
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Glass Ionomer Cement
Bases and liners
• Cover and bond to dentin
• Reduce post operative sensitivity
• Seal well
• Conditioner indicated
• Can be conditioned (etched) with phosphoric acid
• Release fluoride
• May promote dentinogenesis
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Glass Ionomer Cement
Restorations
• Fluoride ion release
• Conditioner indicated
• Bonds to tooth
• Class V
• No or minimal preparation
• High success
• Sandwich technique
• Composite resin veneer
• Class I or II
• Low to average success
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Finishing of Glass Ionomer
Cement Restorations
• Similar to composite resins
• Same armamentarium
• Do not over-wet
• Do not desiccate
• Wait until opacity disappears
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Guidelines for Successful Glass
Ionomer Cement Restorations
• Remove all caries
• Good, clean finish lines
• Control moisture
• Avoid contamination
• Follow manufacturer’s directions
• Take care with finishing not to ditch cementum
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New Materials Update
• Conventional bonding agents
• Primer
• Hydrophilic monomers
• Water, alcohol, acetone
• Low viscosity resin
• “One-step” bonding agents
• Primer-resin
• Hydrophilic monomers
• Volatile solvent
• Low viscosity resin
• All still require phosphoric acid conditioning!
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New Materials Update
• Flowable Composite Resins
• Low viscosity
• Less filled (50 w%)
• Class V restorations
• Liners for condensable resins
• Condensable Composite Resins
• High viscosity
• Higher filler loading
• Fiber or “star”-shaped particles
• “Feel like amalgam”
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New Materials Update
• Laser and Plasma Lights
• High intensity light
• Proper wavelength
• Programmable
• Full on
• Ramp power
• Pulse power
• Designed to delay gel point
• More flexible restoration