Professional Documents
Culture Documents
CONTENTS:
INTRODUCTION
HISTORY
BASIC COMPOSITION
CLASSIFICATION
INDICATIONS
MANIPULATION
PROPERTIES
TYPES
RECENT ADVANCES
REFERENCES
Dental resin composite
soft organic-resin matrix
polymer
Matrix
Polymerization
Fillers
inhibitors
Activator initiator
Plasticizers
system
A challenge for users of resins…
“Polymerization Shrinkage”
Solutions:
Incremental Curing: Allow for curing between layers
Use dentin bonding adhesives in prep site
INDICATIONS
Temporary Periodontal
Luting
restorations splinting.
CONTRAINDICATIONS
2) Excessive 3) Restorations
1) Inability to 4) Other
masticatory extending to the
isolate the site. operator errors.
forces. root surfaces.
ADVANTAGES
Esthetics
Alternative to amalgam
Repairable
DISADVANTAGES
Technique sensitivity
Polymerization shrinkage
marginal leakage
secondary caries
postoperative sensitivity
SiCl4 SiO2(Chains)
Increased r/o and diagnostic sensitivity through Sr and Ba glass and other heavy metal
compounds that absorbs X-rays
PROPERTIES OF FILLER
Size
Hardness Volume
Filler
R/O
distribution
Refractive
index
Types Of Fillers:
Based on chemistry
• Inorganic fillers – Quartz, Glass & Amorphous silica
Radio Opacity(R/O)
International standards r/o = 2mm Al
Air Abrasion
Erosion
Grinding / Milling
Precipitation
Ultrasonic Interaction
COUPLING AGENT
Bonding between filler and resin
examples: titanates and zirconates
organosilanes (gamma methacryloxypropyl trimethoxy silane)
Methoxy silanol
hydrolysis
Advantages:
Less opacifier → More light will be transmitted and less light will be
reflected; perceived as dark
More opacifier →Less light will be transmitted and more light will be
reflected; perceived as white
Radio-opacifiers
• Compounds used for increasing radiopacity
• eg: glass & ceramics that contain heavy metals such as Zr, Sr & Ba
UV Stabilizers
• Compounds which absorb electromagnetic radiation & improves
color stability
• eg: 2-hydroxy-4 methoxy benzophenone
CLASSIFICATION OF COMPOSITES
BASED ON CURING / POLYMERIZATION METHOD
Type 1: Polymer based materials suitable for restoration involving occlusal surfaces
Type 2: Other Polymer based materials
Class 1: Self cured materials
Class 2: Light cured materials
Group 1: Energy applied intra-orally
Group 2: Energy applied extra-orally
Class 3: Dual cured materials
LUTZ & PHILIPS CLASSIFICATION (1983)
Propagation
hundreds of monomer units
polymer network
50 – 60% degree of conversion
Termination
Examination, prognosis and treatment plan
Local Anesthesia
•While selecting, hold the entire shade guide near the teeth to
determine the general color.
•Then select and hold specific shade tab beside the area of the
tooth to be restored.
•Rubber dam
•Cotton rolls
Tooth preparation
Pulp Protection
•Calcium hydroxide
•GIC
•Resin Bonding agents
Matrix & Wedge Placement
•If both enamel and dentin have been etched the area must be left slightly moistened
•Significance:
increases surface energy which promotes wetting and adhesion
creates micropores for micromechanical retention.
Apply bonding agent to the dry & moist dentine.
Light cure.
Placement Of Composite
Curing Of Composite
A) Auto / Chemical / Self cure composites
B) Dual cure composite
C) Heat cure composite
D) U-V light cure composites
E) Visible light cure composite
Auto / Chemical / Self cure Light cure composite
Voids can be incorporated while Less number of voids
mixing
Bulk placement is possible Bulk placement is not possible
Polymerization proceeds from Polymerization proceeds from
periphery to centre centre to light source
Reduced working & setting time Adequate working time &
command setting
More staining due to aromatic Less staining due to aliphatic
initiator initiator
HEAT CATALYST
Chemical composites mix a base paste and a catalyst paste for self cure.
Cost
Camphoroquinone
Acenaphthene quinone
Benzyl
LIGHT CURING
Light curing can be accomplished with:-
1) Quartz-Tungsten-Halogen
2) Plasma Arc Curing
3) Light Emitting Diode
ADVANTAGES:
1. LED lamps
2. QTH lamps
Quartz bulb with tungsten filament
Must be filtered to remove heat and other wavelength than violet-blue range
3.PAC lamps
Plasma arc curing lamps use xenon gas that is ionized to produce plasma
QTH is cheaper,
LED and laser do not require filters
Polymerization is initiated when a critical concentration of free radical is
formed.
Curing Of Composite
C-factor
The light reaction occurs while light from the curing unit penetrates the composite.
The dark reaction, also called post-irradiation polymerization, begins immediately after the
curing light goes off and continues for up to 24 hours, even in total darkness, but most of it
occurs within 10 to 15 minutes post cure.
Components Of A Resin-dentine Bond
Source Of Light
Radiation & Need For Filter
Power Required
Need For Cooling Fan
Intensity & Exposure Time
Cost
Soft start curing - Ramped curing - Delayed curing
Degree of Conversion
Measure of the percentage of carbon-carbon double bonds that have been converted
to single bonds to form a polymeric resin.
Depth of Cure
Usually 2 – 3mm
FACTORS THAT AFFECT DEGREE OF CONVERSION & DEPTH OF
CURE
Air Inhibition
•Oxygen in the air competes with polymerization and inhibits setting of the resin.
•The extent of surface inhibition is inversely related to filler loading.
•The undercured layer can vary from 50 to 500 μm, depending on the reactivity of the
photointiators used.
•Unfilled resins should be cured, then covered with an air-inhibiting gel, such as a thin
layer of petroleum jelly, glycerin, and then re-cured.
Area Of Composite To Be Cured
•When the area of composite to be cured is larger than the diameter of the light tip,
composite sections must be overlapped at least 1 mm. Failure to properly overlap
during curing can result in poorly polymerized areas in the restoration.
•Curing time also must be increased to compensate for the increased area of resin.
Area Of Composite To Be Cured
.
•To avoid the time-consuming and tedious process of
overlapping, a number of wide-diameter attachments are
available for many visible light curing units. The attachments
are particularly useful in curing composite veneers.
•Generally, the more heavily loaded a composite is with larger inorganic fillers, the more
easily the resin cures.
•However, extremely high loading can make a composite opaque, which actually increases
the required duration of exposure.
Curing Through Tooth Structure
•It is possible to light-cure resin through enamel, but this technique is just one- to two-
thirds as effective as direct curing and is appropriate only when there is no alternative.
•When light-curing through tooth structure, porcelain veneers, and other barriers, it is
advisable to use a high-intensity light.
Distance
•A good rule of thumb is that the minimum power density output should never
drop below 300mW/cm2
•Intensity of light is inversely proportional to the distance from the fiber optic tip to
the composite surface.
•Ideally, the fiber optic tip should be adjacent to the surface being cured but this will
lead to tip contamination.
•Therefore, the tip should be within 2mm of
composite to be effective.
•Light transmitting wedges for
interproximal curing & light focusing tips
for access into proximal boxes are available.
•Intensity of the tip output falls off from the
centre to the edges. So bulk curing of the
composite produces bullet shaped curing
pattern
Heat Generated
•The heat given off by a curing light increases the rate of photochemical initiation and
polymerization reaction and increases the amount of resin cured.
•However, the heat generated in the tooth during light-curing results in higher
intrapulpal temperatures, which could be harmful.
•Deep layers of resin should be cured thoroughly; cooling with a dry air syringe may be
helpful.
Shade (Transmission of light through material)
•Darker composite shades cure more slowly and less deeply than lighter shades.
•At a depth of 1 mm, a dark composite shade achieves just two-thirds of optimum depth of
cure achieved in translucent shades.
•Hence, when esthetics is not critical, the lightest shade should be used.
Ocular Hazard
•The 468 to 480 nm wavelength of light that polymerizes composite resin is among the
ranges of light most damaging to the eyes.
•The best eye protection is to completely avoid looking at the curing light source. Covering
the curing site with a dark object would be ideal.
•Some clinicians cover the curing site with their hand. This may prove an unsafe practice.
In cell research, blue light is used to induce cancer growth; therefore, skin exposure is
highly discouraged.
•A simple yet effective way to provide shielding from curing lights is to cover
the curing field with the reflective side of a mouth mirror. This prevents
excess blue light from reflecting back against the restorative and improves
curing. If the mirror is not large enough, a folded patient napkin easily
covers most fields. A slight amount of brightness will show through the
napkin and shows if the light is on or off.
•If it is necessary to look at the light source for placement, eye protection is
warranted. Unfortunately, most optical glasses and plastic contact lenses
transmit blue light and near-UV light radiation with little attenuation.
•A number of colored plastic glasses and handheld shields are available. Some of these
plastics (usually red and orange) can block blue light. They can be cut and made into
custom shields. Over time, they may need to be replaced, since the organic dyes used to
color plastic fade with use.
•Colored protective lenses in glasses are another option. The drawback is that they
require a 2- to 6- minute recovery period before normal color perception returns. This
temporary distortion can interfere with the ability to judge shades.
Finishing & Polishing
Once a composite has been cured, it must be finished and polished to produce the final
surface.
During finishing (cutting) and polishing (smearing), the irregularities on the surface
are being removed. This step also removes the air-inhibited layer.
The irregularities are a function of the finishing burs, diamonds, or abrasive points
(grooving), particle size in the composite (because particles are ripped out during
finishing), and the particle size in finishing materials (abrasive particles in disks, strips,
pastes).
Proper finishing of restorations is desirable not only for esthetic considerations but
also for oral health.
Steps in finishing and polishing
The polish should be smooth enough to be tolerated well by gingival tissue. It has been
proven that rough surfaced restorations can create clinical problems such as plaque
retention, gingival irritation, staining, higher wear rates, and recurrent caries.
Tight margins should blend esthetically into the tooth’s natural contours.
Several factors can affect the final finish of a restoration: the matrix and fillers within
the material, finishing instruments, preparation design, curing, and post cure time.
A heavily filled material may require coarser instruments, whereas microfills require a
more delicate touch.
Chemical cured materials must be accurately timed to complete polymerization. It
has been suggested that before finishing the restoration it should be left undisturbed
for a minimum of 10 minutes to allow the resin to completely polymerize. This may aid
in reducing surface trauma from the finishing process.
Acid etching the dentin removes the smear layer and opens the dentinal tubules,
allowing a positive dentinal fluid flow and this leads to an increase in the wetness of the
dentin surface & subsequent marginal leakage occur.
It is therefore currently recommended that until reliable techniques and materials are
available for resin bonding to dentin, as a general rule.
•Dentine should not be etched in vital teeth
•Glass ionomer base should completely cover the dentin of all the cavity walls before
acid etching the enamel margins.
BIOCOMPATIBILITY
If acid etching the enamel did not come into contact with underlying dentin of the
involved Pulp - Dentin organ & when the:
•Effective - depth is less than 1.5 mm composite resins induce always destruction
of Pulp - Dentin organ.
BIOCOMPATIBILITY
BPA that leaches from dental composites (likely to be from hydrolysis of bis-DMA), can
act as a xeno-estrogen.
Maximum acceptable or "reference" dose for BPA of 0.05 mg/kg body weight/day.
The highest level of BPA reported in saliva from dental sealants is 50,000 times lower
than the LD50 values that have been reported for BPA.
Therefore, human exposure to BPA from dental resins is minimal and poses no known
health risk.
BIOCOMPATIBILTY
Incompletely cured resin, particularly in those materials with low filler content, appears
to be a tissue irritant.
BIOCOMPATIBILTY
HEMA is hydrophilic and also strongly allergenic. It has been shown that HEMA is able
to transverse dentinal tubules and appear in the pulpal tissue leading to allergic
responses.
Light activation units generating intense visible light have the potential to cause pulpal
injury. Temperature rise of 0.5-10°C have been reported through dentine measuring 1-
2mm in thickness this may lead to pulp damage.
BOND STRENGTH TO DENTAL SUBSTRATES
Bond strength of composites to acid etched enamel is in the range of 3500 lbs/in2
(24MPa) and the variation in the values reported is much smaller than for bond strength
to dentin.
Bond strength to dentin after removal of the smear layer from cavity preparation
(mainly collagen with hydroxyapatite particles) ranges from 700 lbs/in2 (5MPa) to 3500
lbs/in2 (24MPa) with many products reporting values from 2300 lbs/in2 (16MPa) to 2600
lb/in2 (15MPa).
Repair bond-strength is about 60% to 80% of the cohesive strength of the original
composite.
COLOR STABILITY
Change of color and loss of shade-match with surrounding tooth structure are reasons for
replacing restorations.
Composite resins may undergo discoloration, which may be either intrinsic or extrinsic.
COLOR STABILITY
Extrinsic discoloration: It is the most common type and can occur marginally or
on surface.
A) Marginal discoloration:
may be due to dissolution of varnish, micro leakage, recurrent decay
B) Surface discoloration:
mainly due to surface roughness or irregularities that increase
stainability or possibility of plaque accumulation on the surface. It may also be
a continuation of intrinsic discoloration.
Discoloration can also occur by oxidation and water exchange within the polymer
matrix and its interaction with unreacted polymer sites and unused initiator or
accelerator.
Stress cracks within the polymer matrix and partial debonding of the filler to the resin
as a result of hydrolysis tend to increase opacity and alter appearance.
In the long term, light activated composites are relatively colouring stable, provided
that the resin in adequately cured.
ELASTIC MODULUS / STIFFNESS
More heavily loaded composites have higher values & have almost same stiffness as that
of dentine (18.5 Gpa) but substantially less rigid than enamel (82.5 Gpa).
Flexible restorations (Low Elastic modulus) would be clinically more retentive because of
improved accommodation to flexural forces. The opposite requirement would be true for
large MOD restorations. Composites in those cases should be very rigid and thus minimize
tooth flexure of remaining cusps.
FRACTURE TOUGHNESS
More heavily loaded composites and those with coarser particles have greater
fracture toughness.
Tends to reduce overtime in the oral environment because of water sorption and
degradation.
LINEAR COEFFICIENT OF THERMAL EXPANSION
Coefficient of thermal expansion compared to natural tooth structure & amalgam is high.
Constant thermal cycling can lead to material fatigue and early bond failure.
During extreme intraoral temperature changes and times, significant stresses may
be generated at the tooth/restoration interfaces where composites are
micromechanically bonded, causing microleakage, unaesthetic staining, pulpal
sensitivity, pulpal irritation due to diffusion of bacterial endotoxins, and/or
predisposition toward recurrent caries.
OPTICAL PROPERTIES
Transparency - chiefly controlled by absence / presence of and type of filler. That is why
unfilled resins have high transparency.
Translucency - depends mainly on nature & type of unreacted particles of the original
powder material or its filler. Composite have the most appropriate translucency to that of
tooth enamel.
Reflectiveness - mainly the product of surface texture. Smoother the surface, more rays
are reflected. Saliva will impart certain reflectiveness on the surface of the tooth and
material, that is why in choosing a shade the tooth should be covered with saliva.
Hue, Value and Chroma are products of the inherent coloration of the material and the
nature of incorporated pigments. Inorganic pigments seem to produce the most stable
and predictable coloration and shading.
POLYMERIZATION SHRINKAGE
One of the main factors that determine the longevity of composite restorations.
Residual stresses of 2.8 to 7.3 MPa have been reported for composite resin
(Davidson and Degee 1984).
POLYMERIZATION SHRINKAGE
Residual stresses are less than the tensile strength of enamel, which is
about 20-40 MPa (Hegdahl and Gjerdet 1977).
To offset contraction stresses, the resin to tooth bond should be atleast
17Mpa
•Autocure resins
For a composite used for class II filling, must be radiopaque for the following reasons
(Roulet, 1988).
•Diagnosis of secondary caries:
•Diagnosis of Over hanging margins.
Taria et al, 1993 - use of Zr –Si fillers (ZrO2-SiO2) have much better radiopacity then
silica alone.
RHEOLOGICAL PROPERTIES
Composites are rather viscous, sometimes sticky and cannot be condensed to create a firm
interproximal contact area.
Friction between the filler particle surfaces and the monomer is a principal factor controlling
the fluidity.
Jacobsen and Ferrcane et al reported that the composites are pseudoplastic and the fluidity is
strongly dependent on the resin phase.
Lee et al (2005) reported that resin matrices were Newtonian fluids and all experimental
composites exhibited pseudoplasticity.
WATER SORPTION / ABSORPTION
Water sorption is accompanied by the swelling of composite but this has not been as
effective way to counteract polymerization shrinkage .
2nd most frequent clinical problem apart from polymerization shrinkage of composite is
occlusal wear.
Wear classification
I. According to Anusavice
Two body wear causes significant wear of composite rather than three body wear.
ADA guidelines for posterior composites include that mean maximum wear should
not exceed 50 μm when measured over the 1-year period from 6 to 18 month (2001).
Of posterior composite is 0.1 to 0.2 mm/year more than that of enamel.
Studies:
•Condon and Ferracane (1997) - wear of composites depend on degree of cure, filler
level, and silanation. The wear depths did reflect cure values. Greater wear was
correlated with lower filler levels, significantly increasing below 48 vol%. Wear
increased linearly as the percent of Silane-treated fillers was reduced.
Macroprotection
Microprotection
Incandescent lighting - incandescent lights are low in blue light and provide
the longest composite working time.
Fluorescent lighting - in general, fluorescent lighting has the shortest working
time for light-cured composites, because it emits a large amount of blue light.
1. Place the operatory light further from the working field. Generally, doubling
the distance of the operatory light from the patient greatly increases the working time
while still providing adequate light for composite placement.
For light cured about 75% of the polymerization takes place during the
first 10 minutes. The curing reaction continues for a period of 24 hours.
TYPES AND RECENT ADVANCES OF
COMPOSITE RESINS
CONVENTIONAL COMPOSITES: (1970’S)
• Nanofills
• nanometer-sized particles throughout matrix
• Nanohybrids
• nanometer-sized particles combined with more
conventional filler technology
NANOCOMPOSITES
Contains nanofillers that range in size from 0.005 to 0.01 μm, which is below the
wavelength range for visible light (0.02 to 2 μm).
Potential advantages:
•Nanofillers are so small that they fit between several polymer chains. These
characteristics permit the opportunity to achieve very high filler loading levels in
composites while still maintaining workable consistency.
•Nano-sized filler particles allow the polish and polish retention typical of a
microfill in addition to good handling, strength and wear properties.
PACKABLE/CONDENSABLE COMPOSITES
Introduced in 1996
Limited acid base reactions are believed to occur after the material with
hydrophilic monomers absorb H2O from tooth and the oral environment. –
which contribute to fluoride release
CEROMER (CERamic Optimized polyMER)
Resins that expand slightly during polymerization are highly desirable as these
would facilitate bulk placement of the material, and reduce post operative sensitivity.
Epoxy resins contract approx 3.4% and SOCs expand approx 3.6%, there fore
combining these two will achieve a net polymerization expansion.
ENA HRi flow
No bubbles formulation
• HRi features breakthrough technology - a light refractive index (1.62) that is
identical to natural enamel, with optical properties that can't be found in any
other composite.
• The ENA HRi Flow formulation eliminates air bubbles, resulting in superior
physical properties.
GINGIVAL MASKING COMPOSITES
Releases fluoride, hydroxyl and calcium ions as the ph drops in the area
immediately adjacent to the restorative material.
Paste consists of Ba, Al and F silicate glass filler (1 mm) with ytterbium trifluoride,
silicon dioxide and alkaline calcium silicate glass in dimethacrylate monomers.
Introduced as the product Ariston in 1998
• The inserts are surrounded by light cured composite, which bonds to the insert via a
silane coupling agent. The inserts are produced in a variety of shapes and sizes to fit most
cavity preps.
•.
When fitted into the cavity, they minimize the volume of shrinking composite and reduce
curing contraction (George and Richards, 1993). The integration of inserts reduces the
polymerization shrinkage stress and lowers the overall coefficient of thermal expansion
AVAILABLE INSERT SYSTEMS:
Beta Quartz: Glass Ceramic Inserts:
• Beta quartz inserts are manufactured of a cast glass ceramic based upon a lithium
aluminium silicate with the addition of iron, sulphur. The surface of inserts is presilanized.
Beta quartz silane liquid is available for the chairside resilanization of contaminated inserts.
Metacryloyloxydodicylpyridinum bromide
MDPB was found to be effective against important species in plaque
formation like actinomyces, Neisseria and veilonella
Silver has also been added in the composites to make it antibacterial - ‘oligodynamic
action’
Use for fabrication of veneers, onlays, inlays & crowns are polymerized outside the oral
environment, which are luted to the tooth with a compatible resin cement.
Artglass (kulzer), belleglass hp (kerr), clearfil cr inlay (kuraray co., Ltd.), Coltene inlay
system, cristobal (dentsply ceramco, inc.), Targis vectris (ivoclar), sculpture-fibrekor (jeneric
pentron)
Potential advantage
•Higher degree of polymerization is attained
•Not as abrasive to opposing tooth structure as ceramic inlays.
•Polymerization shrinkage does not occur in the prepared teeth
•Repairable in the mouth
ORMOCER (ORganically MOdified CERamic)
Dr. Herbert Wolters from Fraunhofer Institute for Silicate Research introduced this
class of material in 1994.
New dental
Advancements
Advancements restorative
in bonding
in resins (COMPOBOND
agents
S)
• Compobonds exploit the benefits of SE DBAs and nanofilled resins, eliminating the
precursory bonding stage necessary to adhere a resin to tooth substrate, and are
termed Self-adhering Composites.
TRADE NAME :- VERTISE FLOW
• Light curing reaction also halts the etching process of the SE agent
• Increasing its pH from approximately 2 to 7
• So that continual acidity does not erode the dentine bond.
SELF-REPAIRING COMPOSITES:
• One of the first self-repairing synthetic materials reported, interestingly shows some
similarities to resin-based dental materials , since it is resin based.
• This was 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 and release the resin.
• The resin subsequently fills the crack and reacts with a Grubbs catalyst dispersed in
the epoxy composite , resulting in a polymerization of the resin and repair of the
crack.
WHISKER REINFORCED COMPOSITE
Silica glass particles are fused onto high-strength fine sized ceramic crystalline whiskers
(Mean diameter– 0.4 μm & Length - 5 μm) at high temp.These whiskers were then
silanized and incorporated into dental resin.
The resulting composites possess strength and toughness values similar to those of
currently available resin composites.
However, when nano-sized silica particles were thermally fused onto the surfaces of
whiskers, the strength and toughness of the composites doubled.
REPAIR OF COMPOSITES
Composites may be repaired by adding new material over the old composite.
Procedure for adding the new material differs , depending on whether the
restoration is a freshly polymerized or aged.
Freshly polymerized restoration:
•An oxygen inhibited layer of resin on the surface
•More than 50% of unreacted methacrylate groups
Aged restoration :
•Fewer unreacted methacrylate groups
•Filler particles free from silane
•Greater cross-linking
Strength of the bond between the original material and the new resin
decreases in direct proportion to the time.
van Noort R, Davis LG. A prospective study of the survival of chemically activated anterior resin composite restorations in
general dental practice: 5-year results. J Dent. 1993 Aug;21(4):209-15.
at 5 years 91.7%
Survival rate of posterior
composite resin
restorations
at 10 years 82.2%
Opdam NJ, Bronkhorst EM, Roeters JM, Loomans BA. A retrospective clinical study on longevity of posterior composite
and amalgam restorations. Dent Mater. 2007 Jan;23(1):2-8.
When clinically
unacceptable restorations
were not included into the 11.0 years
Median survival failure
times of composite When clinically
resin restorations unacceptable restorations
9.7 years
were included into the
failure
Kim KL, Namgung C, Cho BH. The effect of clinical performance on the survival estimates of direct restorations. Restor
Dent Endod. 2013 Feb;38(1):11-20
Annual failure
2%
Median survival rate
times of composite
resin restorations Cumulative 84.3% at 8
survival rate years
Pallesen U, van Dijken JW, Halken J, Hallonsten AL, Höigaard R. Longevity of posterior resin composite
restorations in permanent teeth in Public Dental Health Service: a prospective 8 years follow up. J Dent.
2013 Apr;41(4):297-306.
Longevity of resin composite restorations in Class I and II cavities of posterior teeth - 5.0
years
Rho YJ, Namgung C, Jin BH, Lim BS, Cho BH. Longevity of direct restorations in stress-
bearing posterior cavities: a retrospective study. Oper Dent. 2013 Nov-Dec;38(6):572-82.
CONCLUSION
References:
• Phillip’s Science of Dental Materials - Kenneth J. Anusavice
• Kim KL, Namgung C, Cho BH. The effect of clinical performance on the survival estimates of direct restorations.
Restor Dent Endod. 2013 Feb;38(1):11-20
• Pallesen U, van Dijken JW, Halken J, Hallonsten AL, Höigaard R. Longevity of posterior resin composite restorations
in permanent teeth in Public Dental Health Service: a prospective 8 years follow up. J Dent. 2013 Apr;41(4):297-306.
• van Noort R, Davis LG. A prospective study of the survival of chemically activated anterior resin composite
restorations in general dental practice: 5-year results. J Dent. 1993 Aug;21(4):209-15.
• Opdam NJ, Bronkhorst EM, Roeters JM, Loomans BA. A retrospective clinical study on longevity of posterior
composite and amalgam restorations. Dent Mater. 2007 Jan;23(1):2-8.