Resin Composite Restorations I Dr.

Ghada Maghaireh Material Considerations Resin composite has four components: Polymer matrix based on bis-GMA or UDMA or a combination of the two materials. Filler particles which is a type of glass. Silane coupling agent. An initiator. Classification of Composites Filler content. Filler particle size. Method of filler addition. Matrix composition (bis-GMA or UDMA). Polymerization method. Filler Particle Size Microfilled resin composites Hybrid resin composites Nanofilled resin composites Microfilled Resin composites Composite filler particle size in average is 0.04 m. Can be polished to a higher luster and smoother than other composites. Indicted in Class V restoration. Not indicated in Class IV restorations because they are not strong. Hybrid Resin Composites Consist of a blend of submicron (0.04m) and small particles (1 to 4 m) fillers. Higher level of filler loading and thus improvement in physical properties. Can be polished to high luster but not to the extent of microfilled. Class III and Class IV restorations.

Nanofilled Resin Composites Filler size range from 0.005 to 0.01 m. Very high filler loading with maintaining workable consistency. Can be polished to a high luster and has superior physical properties. Method of Activation (Polymerization) 1963: Chemical-cured polymers (two pastes are mixed together to start the polymerization process). 1970: UV Photopolymerization. 1980: Visible Light Curing (VLC). Light-cured Resin Composites Camphoroquinon (CQ) is the photointiator. CQ absorbs light in the visible blue light portion of the electromagnetic spectrum. Light-cured Resin Composites Light activation of the resin composite. Polymerization Shrinkage Factors Affecting Photocuring 1. Exposure The minimum curing time for most resins under a continuous curing is 20 - 40s. 2. Intensity For well cured restoration Power Density should be more than 300 mW/cm. 3. Temperature Composites should be held at room temperature at least one hour prior to use. 4. Distance

Light-curing units 1. Quarts Tungsten Halogen Curing Lights (QTH): Relatively inexpensive. Good power density 600-1000 mW/cm. Broad spectrum. Different curing modes Fiber optic probes. Quarts Tungsten Halogen Curing Lights (QTH) Drawbacks: Main output is IR energy. Pulp and filter reliability. Limit effective lifetime of the halogen pulp is about 50 hours. 2. Laser Curing Units Argon laser Drawbacks: Expensive. Can not be made cordless. Require active cooling. Strict safety procedures. 3. Light Emitting Diodes (LED) Narrow wavelength (470 nm), no UV or IR. No filter, minimal heat generation. Can be cordless. Expected lifetime of several thousand hours of operation. Class III Restorations Originate on the proximal surfaces of anterior teeth ( incisors & canines) but do not involve the loss or removal of the incisal angle. Can be detected with explorer, radiographically or with transilluimination.

Preparation Approach and Instrumentation Class III Restorations Outline is determined by access and by the extension of caries. Outline should be as conservative as possible. Lingual approach unless the location indicated otherwise. High speed handpiece can be used for initial access through the marginal ridge. A large round bur on slow speed to excavate caries. Narrow bevel (0.5 mm) on accessible margins with tapered diamond bur. Class IV Restorations Involve the proximal surfaces of anterior teeth, and include the loss or removal of the incisal angle. More often as a result of traumatic fracture. Class IV Restorations For fracture, wide bevel of all enamel margins (1.0 to 1.5 mm). For carious lesion carious tooth structure and weak incisal enamel are removed then a wide bevel is placed. Shade or Color Selection Factors influencing Shade Selection: Proper lighting. Color acuity and eye fatigue. Achieving optimal color match. Matrices For Class III Restorations: Clear plastic matrix (celluloid strip). Wedge can prevent gingival overhangs. Wedge Seal the gingival margin. Separate the teeth. Protect interproximal gingiva.

 Push the gingival to open the embrasure. Ensure proximal contact. Matrices For Class IV Restorations: Clear plastic matrix (celluloid strip) with wedge. Clear plastic crowns.

Clinical Steps for Class III or Class IV Composite Restorations Select shade before initiation of dehydration. Place a rubber dam or proper isolation. Prewedge if difficulty in achieving proximal contact. Clinical Steps for Class III or Class IV Composite Restorations Make the cavity preparation with bevel. Apply acid etching (30% phosphoric acid for 15 seconds), protect adjacent tooth. Place the adhesive, light cure for 20 seconds. Place a clear matrix strip and wedge. Place the resin composite into the deep area (light cure for 40 seconds). Add composite and contour to proper shape and light cure again for 40 seconds. Remove the matrix and strip. Inspect for voids. Add composite if necessary. Remove gross excess composite with finishing diamond burs. Finishing disks and strips can be used for finishing and polishing. Impregnated rubber points and cups. Check occlusion. References: Chapter # 9 of Fundamentals of Operative Dentistry