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Composite Resins
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Question #1: How many types of composite restorative do I need to provide my patients with the optimum care?

Answer: A minimum of three: a minifilled, a heavy-filled hybrid, and a microfill.

Question #2: I'm confused and don't understand the chemical way that these materials (Macrofill, Microfill, and Hybrid) are related. How could I explain this to my assistant or patient?
Answer: Perhaps an analogy would be useful. Lets consider the everyday concrete used for driveways which is a composite of rock, sand, and mortar. A microfill would be similar to mortar mixed only with sand. Its smooth but not very strong. A macrofill would be similar to large rock mixed with mortar. This is strong by not very smooth. A hybrid would be similiar to mixing mortar with rock and sand. This is much stronger and the smoothness would be related to the maximum size rock used in the final concrete. Depending on the size of wall or repair being made one or all of these materials may be indicated for optimum results.

Question #3: Can all brands of composites be added to each other?

Answer: In theory, yes. However best results are obtained when similar resins are used. 3M, Kerr, Kulzer, and other Bis-GMA products mix well. Espe composites (which use a tricyclic resin) and Vivadent composites (which use a urethane resin) work best when used by themselves. However, since these are all dimethracylates the differences will probable not have any clinical success.

Question #4: How many shades of composite restorative do I need to provide the best esthetics?

Answer: Generally, a few light or universal shades of heavy filled is adequate since this material is used internally. If the minifill will be covered with a thin layer of microfill about 6 shades are required. If the minifill is to be used as the final surface a dozen or more shades will be necessary.
With microfills, since they are generally used as a final surface layer on anterior teeth, you can use many shades. Avoid microfilled opaque shades since they do not perform well as an outer surface layer.

Question #5: Are layering techniques really necessary or can I use one composite for all my restorations?

Answer: If all your composite use is in nonstress bearing molars and small to moderate sized anteriors, a minifilled composite will work as a general-use material. However, larger stress bearing restorations can benefit from the stiffer composite core of a heavy filled hybrid. In addition, some patients can benefit from the higher luster of a microfilled composite.

Question #6: Why are there so many composites on the market? Do we really need them all?

Answer: Direct composites are attractive to manufacturers since they are relatively inexpensive to make (made from petroleum products and glass) and they sell for a relatively high price. Making a composite is relatively easy for most manufacturers.
But making a high quality, consistent product well loaded with smaller filler particles is a formidable challenge. The number of excellent products is limited. Also because many manufacturers make composites for other distributors, there are many more composite brand names than there are different composites.

Question #7: Do light cured composites have a shelf life?

Answer: Yes, but composites differ in their shelf life. Light-cured materials at room temperature are usaully good for 4 or more years after the their date of manufacture if they are sealed well and kept at room temperature, much longer if kept refrigerated. Auto-set composites have an optimal shelf life of about 1 year and always should be kept refrigerated. Although auto set materials will generally set after this time, their physical properties may be compromised.

Question #8: What is the difference between the "enamel" and "dentin" versions of a composite resin? Is one better than the other?

Answer: Generally, dentin shades are more opaque.(about 20%) They are helpful when used behind enamel shades to reduce "shine-through" with Class III and IV restorations. Some manufacturers place an "O" behind the letter of a shade to distinguish it from a nonopaque shade. "For example YO" is the opaque shade of "Y". Usually enamel or nonopaque shades should be used whenever possible since they appear more tooth like and have better vitality than dentin or opaque shades. Opaque or dentin shades are generally used below the surface of nonopaque and enamel shades.

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