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Midterm exam
15/11/2011 Tuesday 12.15 pm Location: 10H3,4, N2
Replacement of amalgam
Uses
Out of necessity
Composite resin
Composite: mixture of two or more components. Major components:
Resin matrix Fillers Coupling agents (silane), join filler and matrix Pigments
Components
Resin matrix:
bis-GMA (bisphenol A-glycidyl methacrylate). UDMA (Urethane dimethacrylate) These resins are made of oligomers (organic molecules) and low molecular weight monomers
Fillers: silica, quartz, glasses composed of barium, strontium etc. Why add fillers:
Add strength Increase wear resistance Reduce polymerization shrinkage
Size of filler? Ratio or weight of filler to resin matrix? Coupling agent: silane, binds filler to matrix and reduces wear. Pigments: to produce different colors and shades.
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Polymerization
Monomers join polymers Initiators and activators cause the reaction to begin. Side chains on polymers cross-link to form stronger material
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Polymerization
1.
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Polymerization
2.
Light cure: blue light (400-500 nm) is used to harden the composite. These light curable composites contain components that start to react once subjected to the light:
1. 2.
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Polymerization
3.
Dual cure: 2-paste system containing both types of initiators and activators. Advantage: light starts the polymerization rxn and the chemical reaction continues in areas were light cant reach them.
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Classification of composites
1. 2. 3. 4. 5. 6. 7. 8. 9.
Macrofilled Microfilled Small-particle composite Hybrid Flowable Pit and fissure sealant Packable composite Smart composite Core build up composite
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Macrofilled composites
First generation Filler particle size 10-100 m Difficult to polish Stronger than composites with smaller particles
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Microfilled composites
Filler particle size 0.04 m in diameter Volume of filler is 35-50% (smaller
compared to other composites due to the larger volume of several small particles as opposed to one large particle of the same weight)
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Hybrid composite
Mixture of macro and microfillers (75-80% by weight) Microhybrid composite: contains 2 particle sizes, small 0.5-3 m and microfine fillers 0.04 m Hybrids have high polishability and strength so they can be used for anterior and posterior restorations
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Flowable composites
Low-viscosity, light cured Can be lightly filled (40%), or more heavily filled (70%) Particle size 0.07-1 m Delivered into cavity using a syringe
Used for PRR Pit and fissure sealing Liners (cushion stress
caused by polymerization shrinkage of overlying composite)
Class V
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Packable composites
Highly viscous Heavily filled Stiff and strong Posterior restorations (as a substitute for amalgam) Shrink less due to higher filler content
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Smart composites
Combat caries by having the ability to release fluoride, calcium, hydroxyl ions when acidity increases Effectiveness has not yet been proven
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Physical properties
Biocompatibility
Polished composites are tolerated by soft tissue. Bonding agents protect pulp by sealing tubules Larger filler composites are stronger in tension and compression Lower filler content increases wear. Composites wear more than amalgams Composite shrink away from cavity walls Minimized by incremental placement. Can cause postoperative sensitivity, & pressure on tooth 27
Shrinkage outcomes
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Thermal conductivity
Coefficient of thermal Greater than tooth structure, causes expansion (CTE) debonding & leakage. Filler content CTE Elastic modulus Determined by amount of filler. Filler increases stiffness. Important in selection for anterior & posterior restorations Water sorption resin content water sorption Radiopacity Barium, strontium radiopacity. Quartz (radiolucent) used as filler in anterior composites to improve shade
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Dispensing and cross-contamination: composites are usually dispensed in syringes. Disposable small containers are used to avoid cross-contamination. Once composite is dispensed, it should be covered with a light-protected container
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Isolation
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Single paste, light activated composite Instruments for placing composite Syringe for injecting composite
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Etching
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Resin to resin bonding: proper isolation, no contamination is necessary for proper bonding of successive composite layers. The surface layer is a thin layer of unpolymerized composite (airinhibited), is removed by polishing
Enamel etching
Bonding agent Composite (bonds chemically to bonding agent) 2nd layer of composite, etc.
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Light-curing:
Should be held as closely as possible to composite 20-40 seconds for thin layers Thicker layers, darker shades, deeper locations require more time
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Finishing and polishing: sandpaper discs, fine, ultra-fine diamonds. For gingival or interproximal areas, scalpel knife, abrasive strips and needle-shaped diamond burs are used. Polishing pasts can also be used. Surface sealers: unfilled resin maybe added after cleaning and etching the surface. It is thought to be useful to reseal margins opened by polymerization shrinkage, or surface porosities.
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2.
3.
4.
Eye protection: light-shielding protective device, glasses for patient. Heat generation: may cause pulp irritation in deep
cavities (1 mm or less of dentine).
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Compomers
Composites modified with polyacid (polyacid-modified resin). The resin contains MMA and polycarboxylic acid. Light activation chemicals are included and also fluoride containing glasses. Fluoride release is small compared to conventional GIC due to resin binding the glass fillers after light activation. Setting rxn occurs in 2 stages Same as light-cured composite Acid-base rxn Bonding to tooth structure occurs as in composites
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Indirect composites:
inlays, onlays, veneers. Preparation is done in the clinic, followed by an impression and construction of the restoration on a die, then cementation in the preparation. With resin cements and bonding agent.
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Shrinkage occurs outside the cavity, therefore less stress is created as opposed to direct restorations
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Shade taking
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Continue,
A neutral background should be used (e.g. blue apron) Female patients should be asked to remove lipstick, and colorful clothes should be covered Several tabs are held close to patients teeth and kept moist. Separate shades for cervical part of the tooth might be necessary.
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Continue,
Any surface characteristics should be replicated if the patient demands that the restoration matches existing teeth. A photograph of the patients teeth and adjacent shade guide tab maybe helpful.
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Reference
Dental materials, clinical applications for dental assistants and dental hygienists Chapter 6
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