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Texts Authored by Harry Albers, DDS
Composites (Direct Resin Restoratives)
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These non-glass-containing composite materials have been used for over 20 years. Silicon dioxide powder is used as the inorganic filler in microfilled composites.
It is the ash (smoke particles) that remains after burning silicon (see figure). It is 0.4µ to 1µ (agglomerated) in size, which is smaller than the wavelength of light; hence the particles cannot be seen and the material maintains its smoothness over time.
Microfills maintain their surface smoothness better than any other composite and they are not affected by acids in the mouth that will roughen most glass-filled composites. However, they should not be used in stress-bearing areas since they fracture more under shear forces. Although these materials have been less popular in recent times, they are still the preferred material for the surface coating of a nonstress-bearing anterior restoration.
(Kulzer), which is filled 39% by volume and 52% by weight with fumed silica, is the standard to which all microfilled composites are compared. It has been on the market unchanged for nearly 20 years. It is a very predictable material.
is sold in Vita shades.
(Cosmedent) is almost identical to Durafill but is available in more shades. Discontinued products Silux Plus (3M) and Filtek A110 (3M ESPE) were filled 40% by volume and 56% by weight, and were very similar.
Agglomerated Microfilled Composites:
These materials, such as
(3MESPE), have medium strength with a high polish. They are good substitutes for regular microfills when additional strength is required. Heliomolar (Vivadent) is filled 64% by volume and 76.5% by weight; it is the most widely used and has been sold as a posterior composite. It is not recommended for use in molar teeth due to its reduced stiffness for cuspal support and because of fractures that occur after five years. It has worked well in premolar teeth when the occlusal stops are in enamel. Heliomolar, despite its name, is a good anterior restorative. It works well as a direct composite veneer and as the outer surface over more highly filled composites.
Almost all composites contain radiopaque glass that is ground down to make glass fillers for "macrofilled
(used to refer to nonmicrofilled composites). These glass particles are usually ground down to 0.6–10µ in size from radiopaque glass or quartz. Some products precipitate particles out of solution (as zirconium). Smaller particles increase polish and wear while higher loading increases strength. The remaining composites are glass filled and differ primarily in their particle size and loading. All composite matrixes are made of similar methacrylate resin monomers.
Submicron Composites (Minifilled Hybrid):
By definition, the largest filler particles in these composites are less than one micron in size. These materials have good esthetics since the filler particles are about the size of enamel prisms (0.5µ); they also have good strength and good polish. They are the closest materials in dentistry to a universal restorative material. The first of these materials was
(Kerr). It has a 0.6µ barium glass filler that is 74–78% by weight and just over 50% by volume, since barium glass is heavy. It contains the typical BisGMA/TEGDMA resin found in most composites. It has been used clinically for over 12 years. Over this time it has performed well as both an anterior and posterior restorative. Herculite is the composite restorative to which all composites are compared. Herculite XRV is available in enamel (20% less opaque), dentin, and incisal shades. The kit has one of the largest shade selections among direct restoratives. Other materials in this class are
(Caulk). These composites differ slightly in filler loading, shades, and handling properties. Charisma (0.7µ), Vitalescence, and Esthetix are very similar materials but in different shades. Prodigy is a non-tacky material with the same filler as Herculite but a different resin. It does not contain any BisGMA and therefore has slightly less fracture toughness. It comes in fewer shades.
by Kerr has a particle size of 0.4µ and is filled about about the same as Herculite. A filler of 0.4µ is unique and bridges the gap between microfilled and submicron hybrids. 4 Seasons (Vivadent) has sub-micron filler in its enamel shades.
(Kerr) contans prepolymerized resin fillers and has less polymerization shrinkage.
Micron Composites (Mid-filled Hybrid or Small Particle Hybrid):
By definition, the largest filler particles in these composites are generally 1 to 5µm. These materials have good esthetics, high strength, and moderate polish. They stain slightly more than the submicron composites in anterior applications. These materials have performed well in anterior and posterior areas for over 18 years. One of the first materials in this class was Prima. It was replaced by
Spectra (Caulk), which has a 1.2–2.0µm barium glass filler (76% by weight and 58% by volume). It is available in syringes and unidose tips.
(Coltene/Whaledent) is filled with 0.6–2.5µm barium glass (74% by weight).
(Vivadent) has a 2µm filler (76% by weight).
(3MESPE) is filled with 2.0µm quartz (80% by weight) and comes in a unique Aplitip dispenser. Quartz is the most insoluble and durable of composite fillers.
(Cosmedent) is also in this class. 4 Seasons (Vivadent) has mid-micron filler in its dentin shades.
Heavily Filled Composites (Macrofilled Hybrid):
These composite materials have the highest strength. They usually have a larger distribution of particles sizes, which results in a higher filler loading (over 80% by weight) and more stiffness. However, the use of larger particles results in lower polish.
was the first of these materials to be introduced. It had a large quartz fill, was radiolucent, and would wear the opposing teeth. It was replaced by
, and then
. This series of composites has performed well in posterior teeth.
(3M) used a new 1–2µm zirconia/silica filler (66% volume and 85% weight). The material has gone through some growing pains and has higher than normal polymerization shrinkage. Nevertheless, it has done well in terms of wear in posterior teeth.
is an improved version of Z-100 with less shrinkage, better handling, and an improved polish.
(Bisco) have a 4µm strontium glass (73% volume and 80% weight),
(3MESPE) is filled with 2.0µm quartz (80% by weight).
(Kuraray/J Morita) has a 3µm barium glass filler (70% volume and 88.8 weight). Other composites filled over 80% are available.
Nanofiller Macrofiller Hybrids:
These are materials that contain many sizes of filler and are added to the composite resin in silinated complexes. Their advantage is good stiffness and good polish since these complexes are polishable. Filtek Supreme (3MESPE) was one of the first materials in this class. They behave like submicron hybrids clinically, but have improved physical properties. These materials are new but seem promising.
Packable Composites (Macrofilled Hybrids):
These composites are firm and can be packed into a preparation. They are also called "condensable" composites although they cannot be condensed (volume is not reduced during placement). Because of their high viscosity they are more difficult to sculpt and voids are more common. They are most commonly used for posterior composites and crown buildups. They can provide excellent proximal contacts in posteriors. All, except the
(Kerr), contain larger filler particles to improve packing qualities. The first packable composite was
(Pentron). It contains very large fibers and does not finish well.
(Kulzer) has poorer wear properties due to its larger particles (1 to 20µm);
(Caulk) has some larger particles and comes in tubs.
Composite Buildup Materials:
Composite buildup materials are highly filled composites that are handmixed (autoset) for bulk placement. These materials include
, (Kerr), and
, (Bisco). Any composite can be used as a buildup. However, more heavily filled materials are preferred because of their strength. Light-cured materials can be used if they are layered.The major advantage of a buildup composite is that it can be placed in bulk. However, polymerization shrinkage concerns makes these composites less desirable than light-cured materials that are layered. When layering, it is important that each layers not exceed 2 mm.
These are diluted composites (with low filler loading) sold under a new name. They are the same resin materials as porcelain veneer luting agents and filled sealants. The only difference is that some of them come in more shades. These products represent a very successful marketing scheme. Flowables should never be substituted for conventional composite restoratives. A porcelain luting agent or filled sealant would fill the need for a more fluid material. Any fluid composite can also be used for repairs, porcelain luting, or as a filled sealant. Some of these fluid materials are
(Kulzer) are microfills and useful for coating veneers and temporaries.
(Kerr), Filtek Flow (3M), Aelite Flow (Bisco), and most others are glass filled.
(Caulk), and many others.
(3M ESPE) has a color changing sealant than goes from pink to opaque when cured. Most flowable composites are usable as sealants.
Resin Glazes or Surface Sealants:
These materials are composite resins that have little or no filler. They have a low air inhibition layer because they contain highly reactive initiators that can overcome competition with oxygen and start polymerization.
(Bisco) was the first. One study showed that its use as a glaze after finishing a posterior composite reduced wear. Actually, any fluid resin (especially a fluid material as a sealant) placed over a composite that has been etched will fill in voids, cracks, and marginal openings and repair the surface. Similar resins (used for filling minor surface defects) are now becoming available as part of many composite kits.
(Kerr) in the Prodigy kit,
(3MESPE) are among those available.
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