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amalgamul

Amalgamul este un material utilizat de mai bine


de un secol. Amalgamul reprezinta o combinatie intre mercur cu o pulbere ce
contine procente variate de argint, staniu, cupru si zinc. Este durabil, usor de
utilizat, foarte rezistent la uzura mecanica si relativ ieftin. Avand in vedere culoarea
sa metalica se foloseste numai la dintii din spate, din considerente estetice. Desi
amalgamul dentar continua sa fie sigur si un material folosit pe scara larga, exista
numeroase avertizari legate de toxicitatea mercurului, dar acestea se elimina din
obturatie sub forma de vapori in cantitati minime.
Dezavantajele amalgamului: sensibilitate pe termen scurt la rece sau cald dupa
aplicarea obturatiei din amalgam. Aspectul metalic impiedica utilizarea sa in zona
vizibila a arcadelor dentare. Nu in ultimul rand, pentru plasarea unei obturatii din
amalgam, medicul dentist este nevoit sa indeparteze mai multa substanta dentara
pentru a crea retentivitati in scopul ancorarii obturatiei. In timp, amalgamul poate
colora tesutul dentar din jurul obturatiei.
Compozitele
Obturatiile din compozit sunt un amestec de
umplutura de sticla sau cuart cu un mediu rasinos. Aceste materiale asigura o buna
durabilitate si rezistenta la fractura in cazul utilizarii la obturatii cu dimensiuni mici
sau medii, expuse unor forte masticatorii moderate. edicul stomatolog nu este
nevoit sa creeze retentivitati suplimentare prin indepartarea unor cantitati
suplimentare din tesuturile dentare sanatoase pentru ancorarea obturatiei, ci se
poate limita la curatarea structurilor cariate. !unt disponibile sub forma de seturi,
ce cuprind mai multe nuante, pentru a putea adapta obturatia la culoarea dintilor
naturali ai pacientilor.
"osturile obturatiilor compozite sunt mai ridicate decat in cazul amalgamului, dar
depinde si de dimensiunea cavitatii preparate si de te#nica si materialele folosite.
Aplicarea obturatiilor din amalgam necesita si mai mult timp si mai multe etape de
lucru $demineralizarea peretilor cavitatii preparate cu acid, spalare, uscare,
aplicarea adezivului si doar apoi se introduce materialul de obturatie propriu%zis&. In
timp compozitul isi poate modifica nuanta initiala.
Ionomerii de sticla
Ionomerii de sticla sunt materiale translucente, de
culoarea dintelui, formate dintr%un amestec de acizi acrilici si pulbere fina de sticla.
!unt destinati utilizarii indeosebi la obturatiile pe radacina si zona gingivala a
coroanei dintelui. Ionomerii de sticla pot elibera cantitati reduse de fluoruri, cu efect
benefic asupra structurilor dentare adiacente. Nici in acest caz nu este nevoie de
indepartarea unei cantitati suplimentare de substanta dentara, intrucat materialul
adera c#imic de dinte.
Ionomerii de sticla sunt folositi in primul rnad in regiunile neexpuse fortelor
masticatorii puternice, intrucat preiznta o rezistenta mai mica la uzura si fractura.
Rasinile ionomerice
"ontin de asemenea umplutura de sticla, alaturi de acizi acrilici si rasini acrilice. !e
folosesc la obturatii mici, in zone lipsite de forte masticatorii semnificative $ex.
interdentar&, pe suporafetele radacinilor si prezinta o rezistenta moderata la
fractura.
Intrucat niciun material de obturatie nu este perfect si in timp obturatiile de pot
fisura, fractura, colora sau disloca, este recomandata verificarea integritatii
acestora cu ocazia fiecarui control stomatologic periodic $la intervale de cate ' luni&.
In cazul in care o obturatie se fractureaza sau se elimina complet din dinte, este
indicat sa va contactati imediat medicul stomatolog pentru a cere o programare in
vederea tratarii dintelui afectat.
TIPURI DE GLASS-IONOMERI UTILIZATI IN SIGILARI
ISTORIC
Glass-ionomerii au fost introdusi pentru prima data de Wilson si Kent in 1972, au aparut in
Europa in 1975,devenind disponibili in Statele Unite in 1977.rimul !lass-ionomer "omer"ial a
fost fa"ut de #e $re% &ompan% ,distribuit de 'mal!amated #ental &o in 'n!lia si de &aul( in
Statele Unite.
&unos"uti "a 'S') 'lumino-Sili"ate-ol%-'"r%late*, ei "onstand dintr-o pulbere de
fluoroaluminosili"at de "al"iu "u parti"ule de sti"la si o solutie apoasa a unui "opol%mer al
a"idului a"r%li". 'S' erau re"omandati atun"i pentru restaurarea "avitatilor de "lasa a +-a dar
le lipseau aspe"tul fi,ionomi" pla"ut si translu"iditatea.
Glass-ionomerii sunt -ibri,i re,ultati din "imenturi sili"ate si "imenturi poli"arb..ntentia era sa se
produ"a un "iment avand atat "ara"teristi"ile "imenturilor sili"ate) translu"iditate si eliberare de
fluor* "at si "ele ale "imenturilor poli"arbabilitatea de a se le!a "-imi" la stru"tura dintelui
neiritant pentru pulpa*.
COMPOZITIE
U/0E1E' #E S$.&/' - "ompo,itia apra sti"lei fluoroaluminosili"at de "al"iu , "are
repre,inta "omponenta de ba,a a pulberii "imentului !lasionomer.
'"este pulberi erau ameste"ate si topite )la temperaturi mai mari de 1233s& timp de 2 ore* "u un
flu4 de fluoruri "are serveau la redu"erea temperaturii de topire.Sti"la topita era apoi turnata intr-
o tava de otel.entru a o fra!menta ,masa era pusa in apa si fra!mentele re,ultate erau
,drobite,"ernute si transformate in pulbere. arti"ulele erau apoi tre"ute printr-o sita pentru a le
separa dupa marime.
5arimea parti"ulelor varia dupa produ"ator ,a"easta fiind de la 23 mi"roni pentru anumiti lineri
pana la 53 mi"roni pentru materiale restaurative.entru "imentare parti"ulele de sti"la au intre 12
si 19 mi"roni. ulberea "ontine fluoruri in "on"entratie de 136 pana la 226 re,ultate din fluoruri
de "al"iu, fluoruri de sodium si de aluminiu.7lu4ul de fluoruri "ontribuie de asemenea la
"on"entratia finala de fluor.
/.&8.#U/ 9 "ontine o solutie :3-"u 2;1 "opolimer a"id a"rili"- a"id ita"oni" in apa sau
"opolimer a"id malei"-a"id a"rili".7olosirea "opolimerilor imbunatateste pastrarea "ompusilor,in
"omparatie "u solutia apoasa de a"id polia"rili" folosita initial,solutie "e avea tendinta sa devina
vas"oasa relativ repede.
'"idul tartri" - se !aseste de asemenea in li"-id si este un "omponent foarte important al G.&s
"ontroland rea"tia de pri,a prin i,omerii opti"i a"tive.'"easta va stimula e4tra"tia de ionilor din
pulberea de sti"la , va mentine nes"-imbat timpul de lu"ru si va s"urta timpul de pri,a. ermite
de asemenea utili,area unei sti"le "u "ontinut s"a,ut de fluor, "are este mai
translu"ida) imbunatatind astfel proprietatile fi,ionomi"e ale "imentului*.
&imentul an-idru 9 <an-idru< este un termen impropriu, intru"at !lass-ionomerii sunt "imenturi a
"aror "omponenta de ba,a este apa. $otusi a"idul polia"rili" poate fi us"at prin vidare si
in"orporate in pulberea de sti"la , li"-idul fiind apa sau solutie apoasa diluata de a"id tartri". rin
ameste"area "elor doua "omponente re,ulta un "iment "u o vas"o,itate relative s"a,uta , indi"at
mai ales pentru "imentare sau "a obturatie de ba,a )lineri*.
&lasifi"area G.&s dupa modul de utili,are;
Tipul I 9 Glass-ionomeri de "imentare
indi"atii 9"imentarea "oroanelor, puntilor, in"rustatiilor, dispo,itivelor ortodonti"e
vite,a de pri,a- pri,a rapida
raport pulbere=li"-id- 1,5;1
!rosimea filmului 9 mai mi"a sau e!ala "u 23>
Tipul II - Glass-ionomeri de restaurare
Tip II.1.- 1estaurari fi,ionomi"e
indi"atii - restaurari fi,ionomi"e
vite,a de pri,a 9 autopolimeri,abil 9re,istenta s"a,uta la absorbtia si pierderea apei
"u adaos de rasini- pri,a rapida, re,istenta imediata la absorbtia apei
raport pulbere=li"-id 9 2;1 sau mai mare
radioopa"itate- ma?oritatea materialelor
Tip II.2.- 1estaurari armate
indi"atii 9 unde sunt ne"esare proprietati fi,i"e "res"ute iar fi,ionomia nu este importanta
vite,a de pri,a 9 pri,a rapida
raport pulbere=li"-id 9 2;1 sau mai mare
radioopa"itate 9 intotdeauna
Tipul III- /ineri sau obturatie de ba,a
- /ineri
indi"atii 9 in se"tiune subtire, "a i,olare termi"a sub restaurarile metali"e
vite,a de pri,a 9 pri,a rapida
raport pulbere=li"-id- 1,5;1
- @bturatie de ba,a
indi"atii 9 in "ombinatie "u rasini "omposite, in te-ni"a laminarii
vite,a de pri,a 9 pri,a rapida
raport pulbere=li"-id 9 2;1 sau mai mare
radioopa"itate 9 intotdeauna
Forme hiri!e re"e#$ i#$ro!u%e&
"imenturi !lass-ionomere)G.&s* 9 materiale "are "ontin parti"ule de sti"la "e se des"ompun sub
a"tiune a"ida si a"id solubil in apa "are fa"e pri,a printr-o rea"tie de neutrali,are "are poate
aparea si la intuneri") Keta"-7il, 7u?i .onomer $%pe ..*
rasini !lass-ionomer modifi"ate)15G.&s* 9 materiale "are au "omponentele de mai sus, dar
modifi"ate prin adaosul unei mi"i "antitati de rasina 9 8E5')-idrde pri,a este partial o rea"tie
a"id-ba,a si partial o polimeri,are foto"-imi"a. /a unele materiale polimeri,area rasinii poate
ne"esita o initiere "-imi"a.
E4ista diferente si intre 15G.&s si "onventionalul G.&s. 5odul de eliberare a fluorului din
materiale este "am a"elasi, "ea mai mare parte din fluor fiind eliberata in primele ,ile sau "-iar
saptamani,apoi nivelul s"a,and pentru un timp indelun!at. 15G.&s eliberea,a "am a"eeasi
"antitate de fluor "a si G.&s,dar ele sunt utili,ate in le,iunile "arioase re"urente.1e,istenta
15G.&s este mai mi"a "omparativ "u G.&s,probabil datorita diferentelor de stru"tura.'mbele
tipuri de materiale pre,inta o imbunatatire a re,istentei in timp,ba,ata pe rea"tiile a"id=ba,a ale
!lassinomerilor.#atorita proprietatilor fi,i"e -ota".7il este mai asemanator "u "imenturile
!lassionomere de"at 7u?i .. /& si +itremer.
rasini "omposite "u modifi"ari ale polia"idului)'5&1* - pot "ontine una sau mai multe
"omponente !lassionomere dar nu pot pre,enta o rea"tie a"id = ba,a. E4emple de astfel de rasini
sunt ; #%ra"t ', &ompo!lass 7 , 8%ta" 'plitip, 72333,Elan.
G.&s si 15G.&s se aseamana prin "apa"itatea lor de a "apta si a elibera fluorul mai tar,iu.
Aumai #%ra"t are o "apa"itate mai s"a,uta de "apturare si eliberare a fluorului.Un studiu re"ent
arata "a #%ra"t si &ompo!lass asi!ura o prote"tie anti"arie mai mi"a de"at G.&s.
diferente ; "aptare si eliberare fluor
G.&s B 15G.&s B '5&1s
re,istenta la u,ura
'5&1s B G.&sB 15G.&s
re,istenta
'5&s B 15G.&sB G.&s
usurinta in utili,are
'5&1s B 15G.&s B G.&s
finisare si esteti"a
'5&s B 15G.&s B G.&s
roprietatile "-imi"e si fi,i"e ale G.&s
&onstituienti ; "ompo,itia prafului si li"-idului varia,a de la produ"ator la produ"ator. Se
re"omanda "a pulberile si li"-idul sa nu se foloseas"a in alte "ombinatii.
1ea"tii "-imi"e ; rea"tia "adru este initiata in momentul ameste"arii pulberii "u li"-idul ,avand
trei etape "are se suprapun intre ele ;
fa,a . 9 "and pulberea si li"-idul sunt ameste"ate,se eliberea,a ioni de -idro!en prin ioni,area
a"idului polia"rili" in apa. '"esti ioni ata"a mar!inile parti"ulelor de sti"la "are stimulea,a
eliberarea ionilor de &a , aluminiu si fluor "u formarea unei ba,e -idro!el-sili"at in ?urul
parti"ulelor de sti"la.
fa,a .. 9 in fa,a a doua ionii de "al"iu si aluminiu mi!rea,a de la -idro!el sili"at in "imentul
moale, p8-ul "reste, si se pre"ipita inafara "a poli"arbiar "imentul se intareste. &al"iul poli"arbse
formea,a primul din mai multe motive; sunt eliberati intr-o "antitate mai mare sub a"tiunea
ionilor de -idro!en,deoare"e ata"ul asupra parti"ulelor de sti"la se produ"e la nivelul situsurilor
pentru "al"iu. &al"iul este bivalent si astfel poate mi!ra mai usor in fa,a de "iment moale.
&al"iul nu formea,a "omple4e stabile "u ionii de fluor asa "um fa"e "u "ei de aluminium, "eea "e
inseamna "a se lea!a imediat la polianioni. oli"arbde &a se formea,a in primele 5 min. in timp
"e poli"arbde 'l se formea,a in 2: de ore de"i, re,ulta "a "imentul are la in"eput "alitati fi,i"e
reduse. '"este "alitati se imbunatates" pe masura "e se formea,a aluminium poli"arb.onii de
fluor eliberati de parti"ulele de sti"la odata "u ionii de "al"iu si aluminiu nu iau parte la formarea
matri"ii dar raman in ea.
fa,a ...- se produ"e o -idratare lenta a ba,ei -idro!el-sili"at si poli"arb"are are "a re,ultat
imbunatatirea "alitatilor fi,i"e.'"easta fa,a poate dura "ateva luni.
#oua re,ultate "lini"e re,ultate din a"est lant de rea"tii sunt importante ;"a proprietatile fi,i"e ale
"imenturilor G. se formea,a intr-o perioada lun!a de timp datorita timpului de intarire si datorita
faptului "a a"este "imunturi sunt sensibile la "ontaminarea "u saliva si la desi"are pentru
parti"ulele !lass sunt a"operite "u -idro!el-sili"at.
roprietati fi,i"e ;
G.&s pot fi "onsiderate "a fiind materiale "u duritate medie,fra!ile,"u o putere de "ompre,ie
relativ mare,putin re,iste la fa"turi,putin fle4ibile si re,istente la u,ura,de a"eea nu sunt
re"omandate la restaurarea dintilor din ,onele "u forte mari de masti"atie.
roprietatile fi,i"e se de,volta in"et; de e4emplu forta de "ompre,ie a G.& .. "reste intr-o
perioada de un an,se dilata in mediu umed si se "ontra"ta in mediu us"at,si au o buna stabilitate
"oloristi"a.
&oefi"ientul termi" de dilatare este de 3,C iar "el de difu,ie termi"a este apra"elasi "u "el al
dentinei.G.&s pre,inta o re,istenta la u,ura de 13 ori mai mare de"at rasinile "ompo,ite.7ortele
de tensiune repre,inta 136 din fortele de "ompresie,dar sunt mai mari in "omparatie "u fortele
"imentului "u fosfat de ,in".Elasti"itatea repre,inta D din "ea a "imentului "u fosfat de ,in".
Eliberarea de fluor
G.&s "ontine fluor in proportie de 13 9 226,fluorul lo"ali,andu-se in prin"ipal in parti"ulele <
!lass< dar poate fi !asit si in matri"e .
7luorul este eliberat sub forma de fluorura de Aa "are nu parti"ipa la formarea matri"ii,dar
eliberarea nu du"e la redu"erea "alitatilor fi,i"e.Eliberarea este mare imediat dupa preparatie si
s"ade dupa o perioada de timp.Eliberarea este masiva in primele 2:-:C de ore dupa "are urmea,a
o s"adere rapida..nitial este eliberat fluorul de la suprafata,apoi "el din straturile profunde ale
materialului.
7luorul a fost !asit la 7,5 mm de mar!inea restauratiei "u G.& tip ...#upa 2 saptamani s-a
observat "a G.&s eliberea,a de 2,5 ori mai mult fluor in "omparatie "u "imentul sili"at.
&antitatea de fluor eliberata s"ade odata "u s"aderea p8-ului.
G.&s in saliva artifi"iala eliberea,a mai putin fluor de"at in apa neioni,ata.
Studiile au evidentiat "a G.&s fun"tionea,a "a un sistem eliberare-"aptare a fluorului..ntrodus <
in vitro < intr-un !el "u fluor,G.&s se in"ar"a "u o mare "antitate de fluor pe "are o eliberea,a
apoi fra!mentat. Eliberarea este mai mare la G.&s de tip .. de"at la "el de tip . datorita faptului
"a pulberea din ameste" este mai mare "antitativ la tip .. ,de"i "ontine o "antitate mai mare de
parti"ule de sti"la "are vor elibera o "antitate mai mare de fluor. 'meste"ul reali,at manual
eliberea,a mai putin fluor de"at "el reali,at me"ani".'pli"area unui si!ilant redu"e "antitatea de
fluor eliberata.
G.&s redu"e solubilitatea smaltului "u 526.
7luorul eliberat din G.& redu"e in"identa "ariei,dar e4ista dove,i "a ar a"tiona si in "ariile
se"undare.
Glasionomerii s-au dovedit a fi si!ilanti foarte efi"ienti pentru fisurile des"-ise, desi nu s-au
publi"at multe studii pe termen lun! referitoare la ei. +aloarea lor "onsta in ade,iunea la smalt
prin s"-imb ioni" si, in plus, in eliberarea "ontinua de fluor. 'u a"eleasi limite "a si rasinile,
intru"at nu "ur! din"olo de pun"tual unde fisura este mai in!usta de 233>m.
Pe#$ru o i#%er're "ore"$'( %upr')'$' !i#$elui $reuie "o#!i$io#'$' "u '"i! poli'"rili" 1*+
$imp !e 1* %e"u#!e( 'poi %p'l'$' i#e %i u%"'$' "u ,ri-'. A%$)el %e i#!ep'r$e'.' pl'"'
'"$eri'#' %i %e %"'!e $e#%iu#e' %uper)i"i'l' ' %m'l$ului( permi$'#!u-%e o u#' '!e.iu#e %i
o '!'p$'re "ore"$' ' m'$eri'lului. U# "ime#$ "u pri.' r'pi!' !e $ipul II re%$'ur'$i/(
'u$opolimeri.'il %'u "u '!io% !e r'%i#i( $reuie re'li.'$ "u u# r'por$ "re%"u$ !e pulere 0
li"hi! %i l'%'$ %' "ur,' i# )i%ur'. Se po'$e 'pli"' !e,e$ul 1i# m'#u%' %i u%or luri)i'$2 pe%$e
"ime#$ul 'u$opolimeri.'il pe#$ru ' '%i,ur' o '!'p$'re "omple$' i# pro)u#.ime' )i%urii. Se
$i#e !e,e$ul p'#' l' pri.' "ime#$ului %i 'poi %e mo!ele'.' "u '$e#$ie pe#$ru ' #u !e%hi!r'$'
"ime#$ul. U# ,l'%io#omer "u '!'o%!e r'%i#i e%$e m'i )lui! %i /' "ur,e m'i u%or i# )i%ur'(
)'r' pre%iu#e( '#'lo, r'%i#ilor.
.n timp, rasinile "omposite sau !lasionomerii ar putea fi indepartati "a re,ultat al stresului
o"lu,al dar, datorita "alitatilor "ementului , va ramane un re,iduu "are va elibera fluoruri,
si!iland fisura in"a multi ani. &-iar da"a pare pierduta, re,istenta la "arie va ramane in"a
semnifi"ativa.
Tipuri !e r'%i#i u$ili.'$e i# %i,il'ri

Si!ilarea repre,inta o metoda de imuni,are a suprefetelor dure dentare impotriva
"ariei. 5aterialele utili,ate in si!ilarea santurilor si fosetelor sunt;
a. Glasionomeri "onventionali )G.&*
b. Glasionomeri modifi"ati "u rasini )15G.*
". 1asini "ompo,ite "u sau fara umplere )1&*
d. &ompomeri )5&1
,
s*

'. .onomeri de sti"la.
0. .onomeri de sti"la rein"ar"abili.
&. 1asini modifi"ate.
#. &ompomeri )ionomeri de sti"la -ibri,i*.
E. Suspensii de rasini-ionomer.
7. 1asini "ompo,ite.
A. Gl'%%io#omerii
&imenturile "onventionale din )G.* !lasionomei sunt al"atuite dintr-o sti"la esentiala
si un polimer a"id -idrosolubil, "are fa" pri,a printr-o rea"tie a"ido-ba,i"a in pre,enta apei.
Elesunt folosite "a a!enti de ade,iune, !arnituri, ba,e sau materiale restaurative. Sunt ori!inare
din Europa si nu au fost ni"iodata a""eptate in U.S. probabil din "au,a "a ne"esita noi te-ni"i
medi"ale pentru a putea fi folosite la nivel optim.Sunt mai putin re,istenti si mai putini esteti"i
de"at "ele mai noi rasini "ompo,ite "u ma"roumplutura si mi"roumplutura introduse in a"elasi
timp.
+e"-ile materiale "onventionale din !lassionomeri erau sensibile din pun"t de vedere
te-ni", pri,a era intar,iata, erau "onsiderabil opa"e dupa reali,area pri,ei si sensibile atat la
us"are "at si la ume,eala )-idratare* in timpul pri,ei. '"easta du"ea la pierderea pre"o"e de
material de pe suprafata.
$oate a"este probleme au fost evitate la noile materiale. 5aterialele moderne
reali,ea,a o pri,a mult mai rapida, sunt mai esteti"e si problemele de -idratare si sensitivitate au
fost mult reduse. @ri"um spre deosebire de "ompo,ite, ele nu er trebui folosite in restaurarile
as,pra "arora se e4er"ita un stres "res"ut.
&ara"teristi"i ale !lassionomerilor "onventionali;
7ormea,a o substanta dura pe pri,a
1ea"tie s"a,uta e4otermi"ade autovinde"are
Se resorb mai putin de"at rasinile polimeri,ate
&oefi"ient de dilatare termi"a similar "u stru"tura dentara.
'bsenta monomerilor liberi
Stabilitate dimensionala la umiditate "res"uta
/e!aturi "-imi"e de umplutura
1e,istente la mi"ros"ur!ei
0io"ompatibilitate
.nte!ritate mar!inala
'dera "-imi" la smalt si dentina in pre,enta ume,elii
Eliberarea de fluor in-iba infiltrarea mi"robiana
1e,istenta "res"uta la slefuire
Esteti"a obisnuita s"a,uta.
.ndi"atii de utili,are;
7i4area prote,elor unidentare si a puntilorE
@bturatii de ba,a )in !eneral*E
@bturatii de ba,a sub materiale "ompo,ite )sandFi"-*E
@bturarea dintilor temporariE
1efa"erea )reetansarea* in"-iderilor mar!inale a obturatiilor ve"-iE
1e"onstituirea le,iunilor odontale "oronare de "lasa a .., ..., +
)ero,iuni "ervi"ale, abra,ii*E
Si!ilarea santurilor si fosetelorE
Si!ilari lar!iteE
.n diferite te-ni"i de "ola? "are apelea,a la "omponente metali"eE
@bturarea "analelor radi"ulareE
@bturatii retro!rade in "-irur!ia parodontiului api"alE
.mobili,ari ade,iveE
&-irur!ia @.1./. )implante de "o-lee*E
&-irur!ia ortopedi"a )fi4area ?onturilor arti"ulatiilor*.

C.Gl'%%io#omeri mo!i)i"'$i "u r'%i#i 1RMGI2
15G.Gs se mai numes" rasini !lassionomere, dar a"easta denumire este te-ni"
in"ore"ta deoare"e ei au fost la ori!ine !lassionomeri si apoi au fost modifi"ati.
Glassionomeri modifi"ati "u rasini sunt materiale in "are o rasina polimeri,abila este
adau!ata la matri"ea !lassionomerului. .ntrodusi in 1991, ei repre,inta o in"er"are de a re,olva o
parte din problemele pe "are le provoa"au !lassionemerii. '"este materiale au imbunatatit
esteti"a, proprietatile fi,i"e, au imbunatatit pri,a si au mai putine probleme de us"are si -idratare.
&um materialele !lassionomere nu reali,ea,a ade,iunea 15G. au o mai mare putere de ade,iune
la stru"tura dintelui "and apli"area este pre"edata de !ravarea a"ida. e lan!a asta rasina poate
forma o le!atura "-imi"a "u stru"tura dintelui. Au este "unos"ut da"a a"est lu"ru are vreo
importanta "lini"a.
'"este materiale -ibride fa" pri,a in parte printr-o re"tie a"ido-ba,i"a a G.& si o
polimeri,are a "omponentei rasinoase a matri"ei.
&omponentele rasinoase pot fi supuse tratamentului "u lumina sau tratamentului
"-imi". ri,area se reali,ea,a prin adau!area unei rasini-monomer -idrosolubile, "um ar fi
8E5', in li"-idului -idrosolubil al a"idului polia"rili". Un initiator "-imi" si sau fotoinitiator
determina rea"tia prin "are se reali,ea,a pri,a.
$ermenul light-cured sau dual-cured nu inseamna "a intrea!a rea"tie de pri,are este
fotoinitiala. @ portiune a pro"esului de pri,are poate impli"a de asemenea pro"esul tipi" a"ido-
ba,i" intre materialul de umplutura si matri"ea polia"ida.

C. Compomeri
&ompomerii sunt mai "ore"t numiti rasini "ompo,ite a"ide polia"rili"e modifi"ate sau
5&1Gs. a"este materiale sunt moi, nelipi"ioase, nu ne"esita ameste"are si sunt usor de folosit.
Sunt o in"er"are dea "ombina "ele mai bune proprietati ale !lassionomerilor si a rasinilor
"ompo,ite. .ntroduse in 1992, ele repre,inta a"um 156 din totalitatea materialelor dentare
vandute in intrea!a lume. 7olosirea lor in U.S. este mai s"a,uta.Sunt usor de introdus intr-o
"avitate, usor de modelat, rapid de tratat, pot fi !ravate si lustruite. Ele inlo"uies" rasinile
"ompo,ite in restaurarile anterioare pro4imalesi !lassionomerii in restaurarile "ervi"ale. .n
aproape toate "elelalte arii, "ompo,itele si !lassionomeriisunt preferati.
&ompomerii au ade,iune buna la stru"tura dintelui. Sunt fa"uti dintr-o rasina
dimeta"rilata a"ida "are poate intra intr-o rea"tie a"ido-ba,i"a "u o pudra de !lassionomer "are
poate fi ameste"ata "u un "ompo,it "onventional. 7un"tionea,a prin absorbtia apei "are mareste
in timp restaurarea. '"easta apa absorbita poate "au,a apoi o rea"tie a"ido-ba,i"a intre lanturile
"are repre,inta apro4imativ 236 dun "antitatea eliberata de un !lassionomer "onventional.
Spre deosebire de !lassionomeri proprietatile fi,i"e ale "ompomerilor s"ad pe masura
"e apa se absoarbe. /a unele materiale a"esta s"adere poate fi de 536 fata de un material inferior
in "eea "e priveste puterea.
&u "at "ompomerul "ontine mai multe !rupari a"ide "arbo4il, "u atat matri"ea devine
mai -idrofila si ioni"a, "eea "e du"e la "resterea absorbtiei apei. Spre deosebire de 15G., "and
un "ompomer absoarbe apa, proprietatile lui fi,i"e s"ad. .n unele "a,uri s"ad "-iar "u 23-536.

&ompomeri. 'vanta?e.
0io"ompatibilitateE
Efe"t "ariostati", redu"e aparitia "ariilor sa"undareE
'pli"are e"onomi"a si rapidaE
Etape de apli"are reduse prin indepartarea !rava?ului )optional*E
re,inta proprietati -idrofili"eE
Au ne"esita i,olare perfe"ta prin apli"area de di!aE
Au adera de instrumente. Se manipulea,a si se modelea,a usorE
'de,iune performanta la S si #- asi!ura inte!ritatea mar!inala a obturatieiE
)me"anism de ade,iune me"ani"a si "-imi"a*
rin prelu"rare- suprafata neteda- redu"e retentia de 0E
1e,istenta la abra,ie buna )pre,inta parti"ule mi"i*E
&ontra"tii de pri,a mai mi"i de"at la "ompo,ite.
.ndi"atii de utili,are;
/ineri ai "avitatilorE
@bturatii de ba,aE
1estaurarea le,iunilor odontale "oronare din ,ona anterioara si
posterioara a ar"adelor dentare "lasa ., .., ..., +, ero,iuni radi"ulare,
defe"te "uneiformeE
Si!ilarea fisurilor molarilot temporariE
Si!ilarea santurilor si fosetelor ,onelor "are nu sunt supuse stresului
o"lu,al.

F. R'%i#i "ompo.i$e.
'"este materiale se !ases" in medi"ina dentara de mult timp si proprietatile si
"ara"teristi"ile lor sunt bine "unos"ute si apre"iat. .n ultimii ani a"este materiale au fost
imbo!atite prin utili,area unor parti"ule de umplere mai mi"i. '"este materialesunt durabile,
foarte esteti"e, pot fi foarte mult lustruite, slefuite, "uloarea lor este stabila, sunt usor de modelat,
re,istente la u,ura, la rupere si dusponibile in anumite nuante. roprietatile lor de manipulare
sunt "ele mai elasti"e dintre toate sistemele restaurative.
'u si de,avanta?e "are "onstau in faptul "a se mi"sorea,a "a volum atun"i "and se
stabili,ea,a si trebuie ase,ate in straturi atun"i "andsunt folosite "a materiale restaurative. #in
a"est motiv plasarea lor este sensibila din pun"t de vedere te-ni". .n ori"e "a,, ma?oritatea
pra"ti"ienilor au invatat sa lu"re,e "u a"este materiale si a"um pot fi utili,ate "u usurinta.
erformanta "lini"a a rasinilor "ompo,ite a fost e4"elenta, mai ales da"a o "omparam
"u sistemele restaurative pre"edente. .n "eea "e priveste ade,iunea la smalt, este "eea "e poate
medi"ina dentara sa ofere "el mai bun. 'de,iunea la dentina este repre,entata de "on"eptul Htotul
sau nimi"I. #a"a "avitatea nu este bine in"-isa sau este sparta poate aparea rapid "aria re"urenta
din moment "e a"este materiale nu au proprietati de in-ibare a aparitiei "ariilor.
&-iar da"a in"-iderea dentinei poate sa se reali,e,e "u su""es in laborator, in
utili,area "lini"a multi fa"tori ne"ontrolabili pot du"e la apritia unor re,ultate mai putin optime.
#in "au,a a"estor limitari ale "ompo,itelor s-au fa"ut multe eforturi pentru a de,volta
sisteme alternative "are au efe"te benefi"e bioterapeuti"e si anti"arie.
7olosirea "ombinata a G.&, drept "aptuseala ti ba,a sub rasinile "ompo,ite a fost
indelun! utili,ata pentru a re,olva probleme "lini"e. #esi "ombinatia a fost mult timp utila, a"um
este depasita iar "erintele te-ni"e sunt mai mari.

.ndi"atii de utili,are;
1e"onstituiri "oronare ale !rupului frontal si lateralE
Si!ilarea santurilor si fosetelorE
&onfe"tionarea fatetelor vestibulare si in"rustatiilorE
1efa"erea "omponentei fi,ionomi"e a prote,elorE
7i4area puntilor ade,ive, inla%-uri si fatete vestibulare din "erami"a si
"ompo,it, bra"(ets-urilorE
rote,e fi4e peovi,oriiE
'de,ivi amelo-dentinariE
1e"onstituirea bonturilorE
@bturatii provi,oriiE
.mobili,ari ade,ive.
&on"lu,ii; nu este posibil sa fa"i re"omandari !enerale pentru folosirea uneia dintre
"lasele de materiale in defavoarea alteia in toate "a,urile. 7ie"are are utilitatea ei.
Co')'-ul !ire"$ pulp'r o pro"e!ur3 re"om'#!'il3
&oafa?ul dire"t se pra"ti"J in s"opul "onservJrii vitalitJtii pulpare si "onstJ in apli"area pe pulpa
e4pusJ a unui pansament repre,entat de -idro4idul de "al"iu, material dovedit a fi efi"ient in
timp. $e-ni"a "e foloseste deminerali,area totalJ )total et"-* este mult mai re"entJ dar, si
a"easta, "u re,ultate satisfJ"Jtoare pe termen lun!.
entru su""esul "oafa?ului pulpar este ne"esar "a dintele impli"at sJ fie asimptomati" sau "u
simptomatolo!ie minimJ. #e asemenea, -emosta,a este absolut ne"esarJ.
8emosta,a
re"ede "oafa?ul pulpar, fiind obli!atorie. #upJ iri!area pulpei "u ser fi,iolo!i" steril, se usu"J
"u bulete de vatJ. Sunt re"unos"ute trei metode de -emosta,J; apli"area de bulete de vatJ
imbibate in apJ o4i!enatJ 26 sau -ipo"lorit de sodiu 2,56 sau folosirea de a!enti -emostati"i "a
trombina.
.n "a,ul in "are san!erarea "ontinuJ se va "onsidera tratamentul endodonti" al dintelui.
8idro4idul de "al"iu
Se apli"J pe podeaua us"atJ a "amerei pulpare, uniform si in "onta"t dire"t "u tesutul pulpar
e4pus )printre alte produse, se pot folosi; #%"al, /ife sau Ultradent &al"ium 8%dro4ide*.
este stratul de -idro4id de "al"iu se apli"J obturatia de ba,J "u !lass-ionomer "e "ontine o
rJsinJ iar obturatia provi,orie se poate reali,a fie "u eu!enat de ,in" )o4id de ,in"-eu!enol*, fie
"u a?utorul unui ade,iv dentinar )dentin bondin!*.
#a"J dintele rJmane asimptomati" si isi mentine vitalitatea, peste trei luni se poate apli"a
obturatia definitivJ.

RESTAURAREA PRE4ENTI4A CU RASINI
1estaurarea preventiva "u rasini 9 11- se adresea,a le,iunilor "arioase in"ipiente,dar si
situatiilor de dia!nosti" in"ert de "arie.#e,voltarea "ontinua a materialelor bioade,ive fa"ilitea,a
indeplinirea obie"tivelor a"estui tip de tratament in "aria dentara;
1. reali,area unor preparatii minime ,"u sa"rifi"iu dentar redus 9
1ES$'U1'1E K1
2. .nlo"uirea e4tensiei preventive me"ani"e "u "ea "-imi"a,neinva,iva 9
1E+EA$.+' K
2. .muni,area suprafetelor o"lu,ale "u a?utorul rasinilor si!ilante 9 1'S.A. K1
'bordarea le,iunilor "arioase in maniera preventiva) si!ilari * sau "onservativ 9"urativa
)11 .,..,...* va fi apli"ata dupa stabilirea "ertitudinii dia!nosti"ului de"arie.&oroborarea datelor
de dia!nosti" ; "lini" ) e4aminare, inspe"tie, palpare*, para"lini" )radiolo!i"; bite-Fin!, raper,
transluminare, masurarea re,istentei ele"tri"e,"ariodete"tia "u laser* si spe"iale,va trebui sa
redu"a sau "el putin sa minimali,e,e erorile dedia!nosti".
Stomatolo!ii ,"er"etatorii din domeniul biomaterialelor si to4i"olo!ii au "onsiderat "a
materialele de restaurare in le,iunile in"ipiente trebuie sa pre,inte urmatoarele "alitati;
ade,ivitate pentru o preparatie minima,"onservativaE
re,istenta la abra,ie asemanatoare smaltuluiE
blo"area deminerali,arii si favori,area reminerali,arii ) eliberarea de fluor*E
stabilitatea in timp ) fara "ontra"tii de pri,a si absorbtie de apa* si sub stresul
o"lu,al) re,istenta la presiune*E
bio"ompatibilitate
radioopa"itate mai mare "a smaltul
usurinta in manipulare,inserareE
finisare pre"isa,fara alterarea stru"turii dentare restanteE
"uloare asemanatoare dintelui
5aterialele e4istente,privite individual nu au putut raspunde e4i!entelor impuse de
"lini"a le,iunilor in"ipiente de a"eea modifi"area "ontinua a rasinilor "ompo,ite,in"ear"a sa
depaseas"a ese"urile le!ate de "ompo,itia a"estora.'stfel se e4pli"a ne"esitatea "orelarii stri"te
intre; dia!nosti"ul "lini","ompo,itia materialului si modul de utili,are,dupa indi"atiile
produ"atorului,"u toate "omponentele sistemului; a"i,i,ade,ivi,primeri,lampa de
fotopolimeri,are,pene,instrumentar de finisare.
#atorita duritatii "res"ute,radioopa"itatii,"ompo,itele -ibride ) umplutura anor!ani"a
ultrafina "u diametrul de 3,7mm* sunt preferate pentru restaurarile posterioare) 11 .,..* in lo"ul
"elor "onventionale.arti"ulele ultrafine mares" !radul de finisare si prelu"rare,de maniera
similara "ompo,itelor mi"rofilled.&er"etarile a"tuale se a4ea,a asupra "ompo,itelor "u
nanoparti"ole ) nano"ompo,ite * si parti"ule noi de umplutura,pentru mi"sorarea "ontra"tiei de
polimeri,are.
@ des"operire revolutionara ar fi introdu"erea monomerilor e4pandabili,fara "ontra"tie de
pri,a.&ompo,itele "u fluor redu" semnifi"ativ deminerali,area smaltului fata de "ele
nefluorurate.
Gl'%%io#omerii sunt o "ate!orie relativ noua de materiale,"u apli"abilitate si in
stomatolo!ia preventiva.roprietatile "imenturilor G.. difera in fun"tie de utili,are
) "imentare,restaurare,ba,a* si depind de raportul pulbere-li"-id si timpul s"urs de la prepararea
materialului.#a"a G.. "onventionali pre,entau in"-idere mar!inala buna,dar re,istenta me"ani"a
s"a,uta) "u utilitate limitata in ,onele ferite de stres o"lu,al*,modifi"area "ompo,itiei a
determinat impli"it si modifi"area me"anismelor de pri,a si a "alitatilor.roprietatile me"ani"e
ale materialelor -ibride) PAMR sau RMGI* sunt imbunatatite "onsiderabil fata de G..
"onventionali,in dauna eliberarii de fluor , "are este mult mai redusa.
entru a nu limita utili,area G.. in 11 ..,... se apli"a peste G.. un si!ilant,ne"esitatea
apli"arii si!ilantului fiind ?ustifi"ata de poro,itatea "res"uta a materialului) asemanatoare "u a
"ompo,itelor "onventionale* si mi"rofisurile "are apar datorita tensiunilor interne in momentul
pri,ei.1aportul pulbere li"-id "onditionea,a aspe"tul suprafetei.
Ceme#$urile G.I 'rm'$e ) G.. &E15E$;Keta"-silver,&-elon-Silver* prin proprietatile
me"ani"e,superioare fata de "elelate G...,re,ista la abra,iune,duritate,pot fi utili,ate in "a,urile in
"are G... "onventionale nu au reusit sa se impuna sau au dat re,ultate mai slabe )11 ...- le,iuni
multiple,separate prin punti de smalt sanatos*.#upa intarire si prelu"arae suprafetele "ermet au
aspe"t metali",fara a atin!e lu"iul a"estora,insa mai apropiat de aspe"tul smaltului fata de
amal!am.
RMGI 1 ,'l%%io#omeri 5r'%i#i mo!i)i"'$e* sunt "ementuri G... "arora li s-a adau!at o
rasina "are permite usurarea apli"ariiEutili,and lumina sau un "atali,ator "-imi",se initia,a rea"tia
a"id-ba,a a !lassionomerului.'stfel,a"este materiale se vor apli"a "u usurinta si fara a modifi"a
proprietatile esentiale ale !lassionomerului.
PAMR1r'%i#i "ompo.i$e poli'"i! mo!i)i"'$e* au un "ontinut mai mare de rasina si
rea"tia a"id-ba,a a !lassionomerului nu mai are lo".#esi a"este materiale sunt usor de
utili,at) sunt predo,ate in "apsule*,e4ista nelamuriri in "eea "e pre,inta benefi"iile in
timp,"omparativ "u rasinile "ompo,ite "onventionale.
@rmo"erii respre,inta o "lasa noua de materiale,"are vor trebui sa anule,e de,avanta?ele
"elor e4istente,apropiindu-se de de,ideratele materialului ideal..n. laborator ormo"erii se pot
"ompara "u sili"atii si polimerii or!ani"i.E4perimentele arata "a pre,inta o u,ura mai mi"a "a la
"ompo,ite si lipsa to4i"itatii.Sub forma de pasta,usor de manipulat,polimeri,area va fi indusa
termi") auto* sau foto"-imi".1e,istenta la u,ura,lipsa to4i"itatii si proprietatile reolo!i"e) de
"ur!ere* vor ?ustifi"a indi"atiile a"estor materiale in si!ilari lar!ite) fisuri in palnie* si 11 .. si
...
roprietatile fi,i"e si me"ani"e impun stabilirea unor noi prin"ipii de tratament;
forma de a""es; trebuie sa fie mult mai "onservativa,se abordea,a fie"are
le,iune in parte si se pastrea,a puntile de smalt inte!re.
mana!ementul le,iunii; se indepartea,a numai dentina ramolita
forma de ade,iune; "ara"teristi"i "are asi!ura
ade,iunea,etanseitatea,re,istenta la dislo"are
"uratirea "avitatii ) me"ani"a si "-imi"a*; me"ani", "u instrumentar rotativ si
"-imi",prin sisteme primer si "onditioner spe"ifi"e.Ea"estea indepartea,a
debriurile re,ultate in urna preparatiei,impreuna "u smear-la%erul si
biofilmele in"lu,and mi"roor!anismele re,iduale.
'titudinea "ore"ta in "eea "e priveste restaurarile preventive este data de "orelatia dintre
situatia "lini"a si dotarea materiala de "are dispunem.&ompromisule sau e4tinderea ne?ustifi"ata
in utili,area a"estor te-ni"i vor afe"ta prin"ipiul preventiv in sine.


$e-ni"a de deminerali,are totalJ )total et"-*
#upJ reali,area -emosta,ei, se apli"J pe podeaua "amerei pulpare o pastJ pe ba,J de -idro4id de
"al"iu "are nu se intJreste )de e4. ulpdent* si se "ontinuJ prepararea "avitJtii.
#upJ de,infe"tarea a"esteia se pro"edea,J la deminerali,area smaltului si a dentinei )total et"-*
"u a?utorul a"idului fosfori" 226 "are se mentine timp de 15 se"unde. 'poi, "avitatea se spalJ si
se usu"J "u aer.
Se apli"J ade,ivul dentinar; "ateva straturi su""esive de primer -idrofil urmate de
fotopolimeri,area in douJ straturi a ade,ivului apli"at pe tesutul pulpar e4pus )pentru a preveni
intru,ia materialului de obturatie*, dentinJ si smalt. .n "ontinuare, se apli"J obturatia de ba,J "u
!lass-ionomer iar obturatia provi,orie se reali,ea,J prin metodele "lasi"e a""eptate.
.n "a,urile in "are metoda de "onservare a vitalitJtii pulpare prin "oafa? esuea,J, rJspunderea
apartine medi"ului stomatolo!; "ontaminare mi"robianJ, resturi de dentinJ pe suprafata e4pusJ a
pulpei, si!ilarea neade"vatJ a dentinei, et".
'mbele te-ni"i folosite pentru "oafa?ul dire"t al pulpei sunt efi"iente, desi e4perienta "u -idro4id
de "al"iu este mai indelun!atJ.
&oafa?ul pulpar va fi mai efi"ient in "a,urile de e4punere me"ani"J a pulpei )des"-idere
a""identalJ* de"at in "a,urile de e4punere prin evolutia pro"eselor "arioase.
Semnifi"atia "lini"J
ro"entul de su""es prin metoda de "oafa? dire"t pulpar este foarte ridi"at, ambele te-ni"i
)-idro4id de "al"iu sau total et"-* avand a"elasi pro!nosti" favorabil.
S.o"6$o# L7& 4i$'l pulp "'ppi#,& ' 8or$h8hile pro"e!ure.
9 C'# De#$ A%%o" :;& <2=( 1>>>
Dental Composites (an overview)
A composite is any material that is composed of hard, pebble-like filler particles similar
to sand or pebbles, surrounded by a hard matrix of a second material which binds the
filler particles together. The filler particles can be any coarseness varying from large
rocks to microscopically fine powder or virtually any shape varying from spherical
through fibers to flakes. The matrix material generally starts out as a paste or liquid and
begins to harden when it is activated, either by adding a catalyst (which may be mixed
with the filler particles, or by adding water or another solvent to allow chemical
reactions to take place.
!efore it hardens, it can be pressed into a mold, or stuffed into a hole. The most
commonly understood composite material is concrete, or "#ortland cement". $t is
composed of sand, sometimes mixed with pebbles, bound together by a matrix of lime,
alumina and $ron. This material can be formed into bricks, poured into molds, or used
to "cement" iron rods into the ground. %omposites are an increasingly important part of
everyday life, from wooden particle board to %orianL countertops.
The image on the right shows the
microscopic structure of a typical
composite material. The filler particles are
the darker, irregular granules. The matrix
is the lighter
material that
surrounds
them. This
particular
composite is
not highly
"filled", which
means that
there is a low density of filler particles
compared to the amount of matrix material. %ompare that with the micrograph on the
left. This shows another composite material with differently shaped filler particles
which are much more closely packed together. This is a " highly filled" composite.
!ecause the characteristics and relative volumes of both the matrix materials and the
various filler particles can be manipulated by the manufacturer of the composite, it is
obvious that these materials show an almost infinite range of physical properties.
In dentistry, The material commonly called "composite" is made of an
acrylic matrix called BIS-!" mixed with a finely #ro$nd #lass
particle filler% The acrylic will harden with the addition of a catalyst, similar to
the way fiber-glass hardens. $n the case of light cured composites, the catalyst is
already mixed into the paste, but does not become active until illuminated with a
strong light. To ensure bonding between the filler and the matrix, the filler
particles are coated with a silane-coupling agent that contain a methacrylic group
able to co-polymeri&e with the matrix-forming dimethacrylate monomers and
functional groups able to interact with the filler.
Dental amal#am is also a composite, although it is not customary to refer to
it as such. $t is made up of finely ground silver'tin metal powder mixed with
mercury. The mercury dissolves the outside layers of the metal powder particles
to form a matrix of silver-tin-mercury which hardens around the unreacted metal
powder particles to form the finished amalgam composite. (or much more on
dental amalgam, please click here.
)ental cements are all composite materials made from different powders mixed
with different liquids. The liquid partially dissolves the powder particles and
forms a matrix which becomes hard enough to act as a "glue" and is used to
cement %rowns and #osts. "ll non metallic composite fillin# materials
are really &$st more hi#hly filled versions of their respective cements.
'orcelain is not generally thought of as a composite material, but it is in fact
composed of a glass matrix filled with crystalline particles. *hile ceramics are an
extremely important part of dentistry, very few dental professionals really
understand them. (or this reason, $ have written a Be#inners co$rse in
dental ceramics to help fill this void.
*hat is !onding, and how is it done+
#rior to the age of bonding, dental
restorations (fillings, crowns, onlays
etc. had to be attached to teeth
mechanically. This is still done in the
case of most fillings by the use of
$nderc$ts placed inside the cavity
preparation (the "hole" in the tooth. The filling material is
condensed into the cavity preparation so that it flows into the
undercuts. *hen hardened, the filling will not be able to
dislodge because it is larger at the bottom of the hole than it
is at the top. *hen placing a cast restoration such as a crown
or an inlay, there can be no undercuts. ,therwise, the casting would not be able to seat.
The vertical walls of the preparation are made nearly parallel, usually slightly tapered.
The space between the restoration and the tooth is filled with a waterproof cement such
as &inc phosphate which hardens and "locks" the restoration onto or into the tooth. The
cement flows into the tiny imperfections in the sides of both the preparation and the
restoration and acts as a "lock and key" to keep the restoration from sliding out or
!onding is a different process entirely. -estorations that are bonded "stick" to the tooth
without the aid of undercuts or "lock and key" cementation. There are four types of
bonding used in dentistry today.
"cid etch enamel conditionin#
$n this technique, a ./0 solution of phosphoric acid is
placed on the enamel portions of the tooth and left in place
for fifteen seconds. *hen it is washed off, the formerly
shiny enamel surface now looks like it is chalky, or frosted.
1nder a microscope, the surface looks like a ragged
landscape of 2agged mountains and valleys (see
micrograph to the right. These microscopic irregularities
are then filled with a liquid acrylic plastic which hardens in
place. 3ince the filling material is composed of the same
sort of plastic, mixed with glass particles (see filled resins
below it will bond onto the plastic which becomes mechanically adhered to the
conditioned enamel. %lick the image to learn more about the structure of enamel
Dentinal (ondin#
The micrograph on the left shows what dentin looks
like when it is sliced perpendicularly to the dentinal
tubules. The tubule openings are clearly visible, but
the hard material between them is still fairly smooth
and will not bond to a layer of liquid plastic in the
same way as it does to etched enamel. 4tching the
dentin dissolves a small amount of the hard dentin material around the tubules
allowing the strands of collagen that permeate the dentin to pro2ect beyond the
cut surface, and partially opening up the the
tubules (image to the right. An aqueous
solution of 5-hydroxyethyl methacrylate
(647A--a hydophylic (water soluble polymer
(plastic--is applied to the conditioned dentin.
This material flows into the tubules and
between the exposed collagen fibers. This acts
as a bridge between the otherwise hydophylic
collagen fibers and a subsequent layer of
hydrophobic (water insoluble resin, allowing the resin to thoroughly infiltrate
between the collagen fibers. ,nce the resin hardens, it serves as the basis of
dentinal bonding. %lick either image to learn more about the structure of dentin.

Chemical adhesion
%ertain materials such as 8lass $onomer, and polycarboxylate cements may be
applied directly to unconditioned enamel and dentin. They are applied in a liquid
form, and this liquid is fairly acidic. 7etallic polyalkenoate salts combine with
the hydroxyapatite by replacing phosphate ions. The carboxylic groups of the
polyalkenoic chains can chelate (chemically combine with the calcium of the
hydroxyapatite to bond the cement to both dentin and enamel. This cross linking
of restorative material and tooth structure gives excellent chemical bonding
strength.

"mal#am (ondin#
The bonding of a dental amalgam to a tooth involves any or all three of the above
mechanisms to bond a filled resin cement to the tooth structure and a mechanical
mechanism to bind the amalgam to the resin. The enamel and dentin are
conditioned with ./0 phosphoric acid, 647A is applied to the dentin for
dentinal bonding, and a layer of very loose filled resin is applied over the tooth
structure. )ental amalgam is condensed into the tooth while the resin is still
unset. This causes tags of amalgam and filled resin to intermingle at the
interface, and when both materials set, they are securely mechanically locked
together. Thus the amalgam is locked to the resin, and the resin is bonded to the
tooth.
)ental %ements and the composite restorations derived
from them
$nterestingly, all dental cements, and all tooth colored filling materials are made of
combinations of only two different powders ( top row, and four different liquids (left
column . $n most cases, the chemical combination of the various powders with the
various liquids creates a material which begins as a paste and "sets" as a hard cement.
7ost of these materials are water soluble during the setting phase, but become
waterproof after they become hard.
)i*$id +, 'owder--- .inc /xide powder lass powder
'hosphoric "cid .inc 'hosphate cement
Silicate Cement and fillin#
material
'olyacrylic acid 'olycar(oxylate Cement
lass Ionomer Cement
and fillin# material
BIS-!" "crylic
0esin Composite Cement
and fillin# material
1$#enol (oil of clove)
./1 (.inc oxide and
1$#enol cement and
fillin# material)

Types of 2on metal Composite material
.inc phosphate cement
9inc phosphate cement is one of the oldest and most reliable dental materials. $t has
been used for at least two hundred years. $t is still used for cementing cast metal crowns
and onlays. $t is made by mixing a strong solution (:;0 of phosphoric acid with &inc
oxide powder. The &inc oxide powder partially dissolves in the acid creating &inc
phosphate which when dry is a very hard, waterproof matrix which bonds unreacted
&inc oxide particles together. 7ixing and cementing with this material is something of
an art since it must be mixed slowly or else it will harden too quickly, and the work must
be kept dry until the cement is set or else it will dissolve in saliva or water. ,nce set, it is
still one of the most reliable and most durable cements for luting (cementing cast metal
crowns and onlays on teeth. $t is also used to cement posts in teeth and was used until
quite recently as a base under amalgam fillings. (A base is a layer of material placed
under a filling to protect the nerve from hot and cold while the overlying filling is in
service. 3ome bases can also be useful as a method of desensiti&ing the nerve.
9inc oxide has an added benefit since the acidity of the phosphoric acid etches the
enamel on the tooth creating the irregular surface seen in the micrograph above. The
cement flows into these irregularities to create a tight mechanical seal with the tooth
itself. $t also flows into irregularities in the structure of the casting to form a "lock and
key" type of bond between the tooth and casting thus locking it in place. *ith the
advent of newer cements with a quicker working time and less demanding technique,
&inc phosphate is used less and less today. <ote that &inc oxide is an opaque white
powder. *hile it can be manufactured to be any color, the set material remains
perfectly opaque. (or this reason, and the fact that it lacks wear resistance, &inc oxide is
not esthetic or tough enough to be used as a "tooth colored" filling restorative.
'olycar(oxylate cement
#olycarboxylate cement is a newer innovation than &inc phosphate cement. $n this case,
&inc oxide powder is mixed with polyacrylic acid. 3ometimes the polyacrylic acid is
free&e dried into a powder and mixed with the &inc oxide powder, in which case the
powder is mixed with distilled water. As with &inc phosphate, the &inc oxide dissolves
and creates a matrix which eventually becomes quite waterproof, and though not nearly
as strong a cement as &inc phosphate, it is much easier to work with, sets much more
quickly and is less irritating to the nerve of the tooth. As with &inc phosphate, the &inc
oxide remains opaque and the color of this material is not easily controlled. $t is rarely
used as a restorative filling material. =ike &inc phosphate, this cement is somewhat
technique sensitive in that it too must be kept dry until it is completely set.
Silicate and lass Ionomer Cements
3ilicate cement was probably the very first tooth colored filling material (if you discount
whalebone. 8lass $onomer restoratives came later. 6owever, in order to understand
silicate cement, and, indeed, in order to understand the characteristics of most modern
composites, it is very important to understand the composition and chemistry of the
#lass powder that gives them their special characteristics.
lass is composed of silica (silicon dioxide which is essentially quart&. 3ilica is the
chief component in ordinary sand. The melting temperature of quart& is very high, but
it was discovered early in human civili&ation that the addition of certain metallic oxides
could serve to lower the melting point of the glass quite a bit. These additional
components, when added to sand in order to lower the melting temperature are called
"fl$xes". *hen the glass mixture melts, it becomes a liquid with the consistency of
syrup on a very cold day. 8lass does not have a specific melting temperature, and when
it cools, it remains a "s$percooled" li*$id (think of a hard candy, like a lollipop,
however contrary to mythology, it does not continue to flow at normal temperatures. A
third component of glass is a sta(ili3er. 3tabili&ers make the glass strong and water
resistant. %alcium carbonate, (limestone is a stabili&er. *ithout a stabili&er, water and
humidity attack and dissolve glass. 8lass lacking a stabili&er is often called "waterglass"
since it can dissolve in water.
*hen lead is used as the stabili&er, the resulting glass has superior clarity and
durability, and will ring like a bell when tapped. $t is also fairly insoluble, even in
acidic solutions. =ead is <,T used in dental glass. The ()A (13 food and drug
administration has recommended that lead modified glass not be used to store
liquids as small amounts of lead have been known to leach out of the glass and
into the liquid. 6istorically, lead "crystal" has been used for years in the
manufacture of fine tableware including drinking glasses and wine canisters
(-eference *aterford crystal. =ead is not used to flux or stabili&e any dental
glass manufactured in <orth America or 4urope.
Boron oxide is, like silica, a glass former. *hen added to silicon based glass at
a minimum of >0 by weight, the glass becomes a (orosilicate. 8lass fortified in
this way is resistant to mechanical and thermal shock and is used to make baking
pans (#yrex, laboratory ware and sealed beam headlights.
"l$mina (aluminum oxide is found combined with silicon in naturally
occurring glasses called feldspars. $t is used in molecular form to toughen the
glass and and is also used as a crystalline structure dispersed throughout the
glass that acts as a sort of framework or skeleton. This "framework" stiffens the
glass during firing and makes it less likely to slump. The inclusion of crystalline
structures transforms the glass into porcelain which is much tougher and less
prone to fracture than the same glass without such a matrix. Alumina is a ma2or
component in ordinary clay and is present in nearly all the ceramic products you
buy such as the plates and cups in your dinnerware and your mother?s bone
china. $t is generally added to dental porcelain in the form of aluminum oxide.
The addition of trace metals can give color to the glass. %obalt imparts a blue
color, while gold imparts red and copper a green color. (These metals are added
as oxides, and they generally have fluxing qualities, but they are added in such
small amounts that they are not considered fluxes for purposes of calculating
glass formulas.
The addition of 3irconi$m and titani$m oxides add opacity to the glass. These
oxides form a crystalline structure within the otherwise translucent glass, and
this diffuses light as it penetrates, creating a milky or pure white appearance
depending on the amount of &irconium or titanium oxides used.
4l$xes are oxides of alkaline metals such as sodium, potassium, lithium, boron
and lead. They serve to dissolve the silica, a bit like water dissolves sugar. This is
important, since glass is composed of silicon dioxide which has a very high
melting temperature. ( #ure quart& melts at .;.: degreed centigrade. The
addition of 5> 0 sodium oxide can lower the melting temperature to ;@: degrees
centigrade. The most common fluxes used in ceramics are sodium and
potassium oxides, but there is a long list of fluxes, each one with its own set of
characteristics and uses.
"l$mino-4l$oro-Silicate #lass
The glass powder that is used in the production of both 3ilicate cement and 8lass
$onomer cement is made from a glass made with Sodi$m 4l$oride and stabili&ed with
minimal al$mina% $t is technically known as "l$mino-4l$oro-Silicate #lass. This
glass is ground into a very fine powder. *hile this glass is stabili&ed to make it insoluble
in water, it is formulated to remain partially soluble in very highly acidic solutions. ($t is
not soluble in saliva or in any food or liquid that can be consumed by mouth. !y the
use of various trace metals, &irconium, and other components, the glass can be
fabricated to match the various colors and opacities of tooth structure. The ma2or
characteristic of this type of glass, however is its ability to partially dissolve and form a
hard, waterproof matrix when mixed with either of the two types of acids shown in the
table above. *hen the powder to liquid ratio is varied correctly, a stiff paste results.
This paste can then be used to fill cavities, and the paste will set in time to form a very
hard and insoluble solid. The hardness, durability and appearance of the resulting
restoration is largely dependent on the nature of the chemistry of the matrix formed
when the glass particles begin to dissolve in the acidic solution.
-estorations and cements made with alumino-fluoro-silicate glass have a number of
advantages and disadvantagesA
Alumino-fluoro-silicate glass cements and restorations bond chemically with
both enamel and dentin (and also metalic structures.
o This means that they can be applied directly to clean tooth structure
without etching or bonding or even cutting retentive undercuts.
o These materials will also chemically bond to metallic substructures such as
gold and base metal crowns and bridges, so they can be used to anchor
esthetic facings made of resin composite to these structures.
Alumino-fluoro-silicate glass cements will slowly release fluoride into the
ad2acent tooth structure. This converts hydroxyapatite into fluoroapetite, thus
strengthening the tooth structure and making it more resistant to decay.
The ma2or disadvantages of restorations and cements made from unmodified
alumino-fluoro-silicate glass areA
o The materials are very water soluble during the setting phases, and if they
are allowed to get wet during placement, they can leach out allowing the
final restoration to leak.
o They are also not especially resistant to abrasion, and are not suitable as
restorations on occlusal or stress bearing areas.
Silicate Cement
3ilicate cement is made by mixing a powder made of "l$mino-4l$oro-Silicate #lass
with a :;0 solution of phosphoric acid. The acid partially dissolves the #lass,
chemically com(inin# with it, th$s creatin# a very hard and (rittle matrix%
A fluid mixture of this cement can serve the same purpose as the &inc phosphate cement
described above, however, its main use in dentistry has been as a tooth colored filling
material. *hile the matrix is very hard, its brittleness and lack of wear resistance limits
its use as a restorative in stress bearing areas. 1ntil the advent of resin composites,
silicates were the only tooth colored filling material available, and the only alternative to
silver amalgam as a simple (non gold permanent filling material. $ts use was limited to
front teeth, or areas of decay on non stress bearing surfaces of back teeth.
$ts largest single advantage, other than its color, is that the fluoride from the glass,
(which is also a component of the matrix material due to the chemical reactions involved
in mixing the powder with the liquid, tended to prevent further decay around the
margins of the filling. (In fact, it is a characteristic of all the form$lations $sin#
an "l-4l-Si #lass,acid com(ination that the finished restoration contin$es
to leach small amo$nts of fl$oride into the s$rro$ndin# tooth str$ct$re
thro$#ho$t its life% This is tr$e of #lass ionomer restorations as well% $ts
ma2or disadvantage is its appearance. -eal teeth are somewhat translucent. 3ilicate
cements tend to be lacking in this characteristic. $n addition, the glass particles are
prone to dislodging from the surface of the filling leaving a rough surface which is prone
to staining. The brittleness of the matrix is another esthetic difficulty since it causes
surface cra&ing and marginal chipping as the restoration ages and creating more
potential places for stains to lodge.
lass Ionomer (polyal5enoate cement)
8lass $onomer cements and restoratives (filling materials are a fairly recent advent in
dentistry. *hile 3ilicate cements have been around for years, 8lass $onomer had to
await the invention of poly-acrylic acid. The mixture of poly-acrylic acid with
"l$mino-4l$oro-Silicate #lass causes a partial dissolving of the glass particles. The
poly-acrylic acid chemically combines with the dissolved glass components and
produces a hard matrix material similar to that in silicate cement. (This is essentially an
acid-base reaction resulting in the formation of a "metallic polyalkenoate salt" which
precipitates and begins to gel until the cement sets hard. The characteristics of this
matrix material, however, are strikingly different than the characteristics of the matrix
found in silicate cements. 1nlike silicates, the matrix is reasonably translucent allowing
the color of the glass particles to dominate the esthetics. $t is also much less brittle than
the matrix of 3ilicate cement making it a bit less prone to fracturing over time. 3ince the
filler is a glass, its esthetics can be precisely controlled. The less brittle matrix means
that the margins and surface of the restoration are less prone to chipping and cra&ing so
there is much less staining with 8lass $onomer restorations than there is with silicates.
As a restorative, glass ionomers can be used in all esthetically sensitive areas with no
reservations. ,f all the composite restoratives, glass ionomers are some of the prettiest
restorations available.
,n the plus side, these restorations not only look good, but they (ond to tooth structure
quite well. !onding between the cement and dental hard tissues is achieved through an
ionic exchange at the interface. #olyalkenoate chains enter the molecular surface of
enamel and dentin, replacing phosphate ions. %alcium ions are displaced equally with
the phosphate ions so as to maintain electrical equilibrium. This leads to the
development of an ion-enriched layer of cement that is firmly attached to the tooth.
8lass ionomer restorations, like silicates also leach fluoride into the tooth structure
throughout the life of the restoration and thus tend to reduce the likelihood of recurrent
decay around the margins. (or an excellent detailed technical explanation of the
chemistry of glass ionomer, click on this link to the %anadian )ental Association review
of glass ionomers.
,n the negative side, the matrix material is much less hard than the matrix of silicate
cement, so the restorations wear faster than silicates. They also lack fracture resistance.
8lass $onomers are excellent fillings on the front surfaces of front teeth, but should not
be used to rebuild top edges of these teeth due to their inherent weakness. They are also
used extensively in dentistry as luting agents ("dental glue" for cementing crowns. The
material is very sensitive to water contamination during placement, and poor technique
on the part of the dentist (or poor cooperation on the part of the patient can shorten the
lifespan of the resulting restoration considerably. 7ost dentists have switched to using
a version of glass ionomer mixed with acrylic resin known as a resin modified glass
ionomer for cementing cast metal restorations. The ma2or uses of glass ionomer
cements today are as bases under resin composite restorations and as luting agents for
cementing crowns and bridges which have metallic substructures.
0esin-#lass composites (filled resins)
The most widely used tooth colored filling materials in use today are the resin (plastic-
glass reinforced composites. These restoratives, like the composites discussed above,
are composed of
A powdered filler material (in this case glass (quart& particles
A hard plastic matrix which binds them together. The plastic is a form of acrylic
known as bisphenol A glycidyl methacrylate, most commonly refered to as !$3-
87A. This material is in a viscous liquid form until it is cured either by the
addition of a peroxide catalyst or by applying a light source to a pre-cataly&ed
form of !$3-87A.
6nli5e the #lass ionomer and silicate restoratives disc$ssed a(ove the
composition of the hard, plastic matrix does not depend $pon a
chemical reaction (etween an acid and the #lass particles% This
means that the #lass $sed in resin (ased composites are not
form$lated to (e sol$(le in acidic sol$tions% =ike everything else, this has
some advantages, and a few disadvantages.
The glass particles are pre-mixed with the acrylic liquid into a paste. *hen the dentist
is ready to place the restoration in the tooth, he or she mixes a catalyst into the paste
and this causes the acrylic to harden around the glass particles. Thus the material
resembles a refined version of fiber glass or auto body putty. As an alternative, the
catalyst may already be mixed into the paste, but it is not activated until the dentist
shines a very bright light on it, causing it to harden. This procedure is known as li#ht
c$rin#.
The acrylic resin has certain characteristics which make it unsuitable as a restorative
material if used by itself without the glass filler particles. The unfilled resin is prone to
abrasive wear, but its ma2or disadvantage is that the material tends to shrink while it is
setting. This would create large spaces between the filling and the walls of the cavity
preparation in the tooth, or in combination with the bonding process, would cause
intolerable stresses on the tooth and could possibly even break the tooth. The addition
of substantial amounts of rigid glass filler prevents most of the shrinkage associated
with the resin. The glass particles are also much more wear resistant than unfilled resin,
and if the particles are of irregular shape, they are less likely to dislodge from the resin
matrix under stress. Thus the glass filler solves the durability problem as well.
The fact that the glass particles do not have to react with the matrix allows the
manufacturer a great deal of leeway in the manufacture the glass powder. 6e can flux
and stabili&e the glass with materials that give it characteristics like better wear,
workability and esthetic qualities than he could achieve if he were constrained by the
need to manufacture the glass according to solubility specifications. The glass can be
formulated with virtually unlimited variations for esthetics. 3pecial formulations allow
for particles of differing si&e for different restorative situations. The particles may also
have different shapes which allow for an attachment between ad2acent particles thus
strengthening the material. #article si&e and shape may be varied to allow for differing
consistencies without compromising strength or wear characteristics. 6e can also vary
the qualities of the acrylic matrix independently of the filler particles.
,ne disadvantage to standard resin systems is that unlike with Al-(l-3i glass'acid
mixtures, there is no mechanism for fluoride fluxed into the glass to enter the resin
matrix, and thus no way for fluoride to leach into the tooth structure offering a measure
of decay resistance to the margins of the cavity preparation. This problem has been
overcome to a certain extent with the introduction of the compomers, and also by
advances in the composition of the unfilled resin matrix itself.
A second disadvantage is that resin composites do not bond to tooth structure unless the
tooth is acid-etched and a layer of thin plastic bonding resin is placed on the prepared
surface first. Al-(l-3i glass'acid mixtures chemically bond with tooth structure without
the need for etching or special resin bonding agents.
4ven with these disadvantages, however, the advantages of resin composites are
impressive. !y decoupling the chemical link between the glass filler particles and the
surrounding matrix, the resulting flexibility has created huge developmental
possibilities for manufacturers. The evolution of dental composites is so advanced, that
the industry is now working on a sixth generation of materials, and resin'glass
composites have even begun to replace the ever popular silver amalgam as the
inexpensive restoration of choice for back teeth.
Types of resin composites
Traditional (!acrofill) Composites---This was the first type of resin
composite marketed for filling front teeth. As the name implies, the particles in a
macrofill are fairly large. %rystalline quart& was ground into a fine powder
containing particles B to .5 microns in diameter. As mentioned above, the
acrylic matrix in a composite tends to shrink on setting. 4xcessive shrinkage in a
filling material is undesirable because it would either leave a gap between the
tooth surface and the filling material, or, if well bonded, would cause cracks in
the tooth structure as the filling contracts during setting. The inclusion of glass
particles reduces this problem because they reduce the volume of acrylic, and act
as a mechanical "skeletal structure" within the composite to help maintain the
original volume of the filling. The advantage of large particle si&e is that more of
them can be incorporated into the mixture without making it too stiff to work
with. 7acrofills are ;/0 to B/0 glass by weight, C/0 toC>0 by volume.
1nfortunately, macrofill composites have two undesirable qualitiesA

o )ue to large particle si&e, macrofills are not very polishable. (urthermore,
they feel rough and are prone to accumulation of plaque. The relatively
soft acrylic polymer tends to wear below the level of the glass particles,
which constantly pop out of the surface leaving holes in their place. This
leads to a surface which, on a microscopic level, looks like a series of
craters interspersed with boulders.
o =arge particles are relatively easily dislodged from the surface of the
restoration during function exposing the relatively soft acrylic polymer
which wears away exposing more filler particles which again pop out ad
infinitum. This tendency to abrade away makes macrofils unsuitable for
posterior restorations.
The first macrofill appeared on the market in the mid .@C/?s. 7ost older dentists
affectionately remember it by its brand name, Adaptic. Adaptic had the
additional disadvantage of containing no radiopaque materials which made it
hard to distinguish from decay on x-rays.
!icrofilled and 2anofilled composites---$n dentistry, microfillers are
particles that are smaller than . micron, while nanofillers are particles that are
smaller than /.. micron. $n reality, most microfill composites use particles that
vary between ./D and .5 microns, while nanofill composites are those that contain
filler particles no larger than /.. micron. Thus nanofill composites are
technically 2ust a category of microfill composites, although the term "nano" has
come to imply the newer agglomerated microfill composites (defined below.
The smallest nano particles are in a form called a colloidal silica, which is
produced by "burning" silica compounds such as 3i%lD in an oxygen atmosphere
to form macromolecular structures which fall into this si&e range. 7icrofilled
composites were originally invented to overcome the esthetic liabilities of the
macrofills. 7icrofilled composites polish beautifully and can be formulated to be
quite translucent. 6owever, the tiny particle si&es affect many more of the
fundamental properties of composites than 2ust the ability to maintain a high
polish.
,lder macrofill composites were formulated from a simple mixture of a light-
cured acrylic matrix and standard quart& particles. These composites contained
;/0 to B/0 by weight of quart& particles (C/0-C>0 by volume to avoid the
problem of curing shrinkage, and also to avoid excessive wear from the opposing
dentition. The resin matrix, by itself, is not a suitable filling material. To
reiterate, it shrinks as much as ./0 during curing and would leave large gaps
between the filling and the tooth structure if no bonding techniques were used.
$f bonding techniques are used, the resin, upon setting, would draw the edges of
the cavity preparation together placing great stresses on the tooth structure, most
likely causing fractures. (urthermore, any filling made from resin alone would
wear very rapidly in service.
8lass (quart& particles, on the other hand, resist both wear and shrinkage. A
high density of glass particles displaces the resin and reduces its volume thus
mitigating much of the shrinkage that happens as the composite cures. These
particles also form a sort of rigid skeleton which mechanically counteracts much
of the remaining shrinkage. (inally, the glass particles themselves do not wear in
service. A composite restoration wears exclusively because the glass particles are
slowly dislodged from the surface. $f there were a way to keep them in place
forever, the restoration would never wear down. $n theory, the less acrylic and
the more glass a composite contains, the better. An ideal composite filling would
contain only glass, and no acrylic at all. This, of course, is impossible, since the
resin is the material used to glue the silica particles together. $t is also the
component that gives the unpolymeri&ed material the handling characteristics
that allow the dentist to work with it in the first place.
=arge macrofill particles have the unfortunate property of popping out of the
surface of the finished restoration. This exposes the resin matrix around it to
wear. This property makes older macrofilled composites unsuitable for posterior
restorations, since the occlusal (top surfaces of the back teeth receive a lot of
abrasive challenges. Any filling that wears excessively would allow the bite to
change, and the teeth will move over time. $n persons who brux (grind their
teeth, this could cause a collapsed bite and contribute to Temperomandibular
Eoint )ysfunction (T7E, or T7).
" smaller particle has a relatively #reater s$rface area in relationship
to its vol$me than a (i##er one. This gives micro particles a ma2or
advantage over macro particles. The greater surface area, combined with the
smaller volume of micro si&ed particles, makes them more difficult to dislodge
from the plastic matrix. The more microsi&ed particles the composite contains,
the more resistant the finished composite is to wear in the mouth.
1nfortunately, micro particle si&es have one ma2or disadvantage when compared
to macro particles. Since friction is a f$nction of involved s$rface area,
the increased s$rface area of micro particles also increases internal
friction and ma5es the composite so stiff that it (ecomes very diffic$lt
for the dentist to manip$late% According to #hillips 3cience of )ental
7aterials, "%olloidal silica particles, because of their extremely small si&e, have
extremely large surface areas ranging from >/ to D// square meters per gram."
7acrofilled composites are much easier for the dentist to handle than micros.
These dueling facts bring us back to square one. 7acro composites are easy for
the dentist to work with, have minimal shrinkage, reasonable esthetics and are
fine for anterior teeth, but they do not wear or polish well. %ertainly, they are
unsuitable for posterior applications. 6ighly filled micro filled composites would
not only look great and resist shrinkage, but they would wear very well in any
area of the mouth. 1nfortunately, any composite that contains a very high
percentage of micro and nano si&ed quart& particles would be so stiff that it would
be impossible for the dentist to handle. *hen first formulated in the late .@;/?s,
microfilled composites were filled to a maximum of :B0 by weight, 5>0 by
volume. They were used mostly to veneer over larger macrofill restorations in
anterior teeth to make them more polishable. (urthermore, even though the
particles are smaller and thus retain better in the plastic matrix, the low density
of glass particles in the micros made them wear almost as badly as the macros, so
they were not suitable for posterior restorations.
7anufacturers came up with a
solution to this problem by pre-
polymeri3in# the micro filled
composite before putting it into the
paste form distributed to dentists.
This pre-polymeri&ed composite can
be fabricated to ;/-B/0 by weight
of glass using industrial machines.
The composite is allowed to
polymeri&e and is then milled into a
fine powder with particle si&es between ./ and 5/ microns. This composite
powder (called a##lomerated microfiller is then mixed with resin to make
the composite paste that is sold to the dentist. The final composite contains
between >/0 to C/0 glass particles by weight, :50 to >/0 by volume.
$n other words, the dentist is supplied with a composite that handles a bit like a
macrofil due to the larger si&e of the agglomerated particles, but has most of the
properties of a microfill due to the microstructure of the agglomerated particles
themselves. (urthermore, since the glass particles in the agglomerated
microfiller are so small, they are not easily dislodged from the surface of the
restoration during service. This means that modern microfills (now generally
called nanofills to differentiate them from the older, less filled microfills wear
quite well and are suitable for restorations in the occlusal (top surfaces of the
posterior teeth.
The agglomerated microfiller particles do not give the final composite paste quite
the same handling characteristics found in traditional macrofills. 4ach
agglomerated particle is, after all, coated with the same plastic that is found in
the liquid resin. This changes the flow characteristics of the paste making it more
difficult to work with than macrofilled or microhybrid composites. The ma2or
problem with microfilled composites is that they tend to be sticky, and to slump
while the dentist places them. Their main advantages are their superior esthetics
and their ability to resist wear during service. The viscosity of these nano
composites can be ad2usted by varying the si&e and density of the agglomerated
microfiller particles.

!icrohy(rid composites---
7icrohybrids contain a range of
particle si&es ranging from /.D to .
micron. )eveloped in the late
.@B/?s, these composites achieve
between ;/ to ;> percent by weight
of filler particles. The first
generation hybrids achieved
excellent wear characteristics which
made them acceptable as posterior
filling materials. Their main advantages were good polishability and excellent
handling characteristics. The second generation of hybrids achieved greater
polishability and superior color optics by using uniformly cut small filler particles
between the larger particles, as well as resin hardeners which help to maintain a
surface polish during prolonged function. 7icrohybrids also have unique color
reflecting characteristics which gives them a chameleon-like appearance. They
are now used primarily in anterior restorations. Their larger particle si&es gives
them better handling characteristics than the micros, and their superior esthetics
make them especially useful for anterior restorations. 3everal microhybrids are
marketed as posterior filling materials, however they wear much faster than the
agglomerated microfill (nano composites.
4lowa(le composites---(lowable composite restorative is formulated with a
range of particle si&es about the same as hybrid composites. The amount of filler
is reduced and the amount of unfilled resin matrix material is increased. This
makes for a very loose mix. $t is delivered into a cavity using a syringe. $t flows
freely over the inside surface of the cavity preparation. This material has made it
possible to fill small cavities in the tops of teeth without a shot since the area of
decay is often small enough to be removed with little or no sensation in the tooth,
and the flowable composite will bond even if there are no undercuts in the cavity
preparation. (lowable composites are often used to seal the dentin of a tooth
prior to placing the filling material. )ue to the low level of filler particles,
flowable composites are more prone to shrinkage, so they are generally not used
in bulk to fill large cavities.

0esin (Composite) Cements---*hen formulated as loose, sticky, chemically
cured substances (i.e. with a separate catalyst that is manually mixed into the
base at the time of use, filled resins make remarkably strong cements for crowns,
veneers, onlays, posts, 7aryland bridges, orthodontic brackets and other bonded
appliances. 3ince both porcelain and tooth structure can be etched with acids, the
resin component can flow into the microscopic irregularities in the appliances to
be cemented as well as the irregularities etched into the tooth structure. This
etched bond is, by itself, quite strong, however the presence of the filler particles
adds a second "lock and key" type of mechanism to help cement the appliance as
well.
0esin modified #lass ionomers
-esin modified glass ionomers are glass ionomer cements that contain a small quantity
of a polymeri&able resin component. These materials have most of the advantages of
glass ionomer materials with the added advantage of water insolubility while setting.
These materials are always dispensed in two component systems and begin hardening
only when both components are mixed together. The resins included in some systems
have dual curing capability, which means that they will cure chemically once the pastes
are mixed, but the curing can be accelerated by the use of high intensity light. The
ability to light cure the excess material reduces chair time.
0esin modified #lass ionomer cements
o These are a real success story in dentistry. -esin modified glass ionomer
cements have become the standard material used to cement metal and
&irconia based crowns and bridges onto prepared teeth. They reduce post
operative sensitivity and reduce the likelihood of cement washout. They
chemically bond to both the metal and the tooth structure. They have
much less shrinkage on setting than resin based composites. They are also
easy to use and simple to mix, unlike &inc phosphate cement which was the
industry standard up until the introduction of these cements.
0esin modified #lass ionomer restoratives
o These are used mostly as bases under composite resin restorations. They
lack the ability to resist occlusal wear, but their ma2or virtue is that they
shrink very little while setting and thus reduce post operative sensitivity
while reducing compressive stresses on the tooth. They also release
fluoride into the tooth structure. They are also useful for filling cavities
around the gum line. $n this capacity they leach fluoride into the tooth
throughout their service life thus reducing the likelihood of recurrent
decay.
The Compomers (polyacid-modified resin composites)
A compomer is really a modified composite resin. These materials have two main
constituentsA A resin modified with dimethacrylate monomer(s with two carboxylic
groups present in their structure, and a filler that is similar to the ion-leachable glass
present in glass ionomer cements. The filler particles are only partially silanated to help
the adhesion of the resin to the glass particles, while at the same time allowing some of
the soluble fluoride in the glass to leach out into the tooth structure. *hen first
marketed, it was claimed that the carboxylic groups in the resin would allow adhesion to
tooth structure without the acid etch bonding technique, similar to glass ionomer
cements. This turned out to be a false assertion. 4ven so, compomers are still popular
with dentists for filling deciduous (baby teeth, and, due to their high degree of
translucency, they are highly esthetic when used for the repair of cervical (gum line
caries. They confer a degree of fluoride release into the tooth, although less than that
found in glass ionomer cements. Thus, at least in the short term, they prevent recurrent
decay while allaying parents? concern about the presence of mercury in standard
amalgam fillings. They do not have the surface durability of standard composite resins,
but will wear quite well for the life of a deciduous tooth. 1nlike glass ionomer
restorations, they do <,T adhere to tooth structure without an acid etch bonding
technique. They are esthetically pleasing and seem to resist recurrent decay for several
months after placement when used to fill cavities near the gum line.
'aste compomer restorative (fillin#) materialF These materials are
excellent tooth colored filling materials when used on front teeth in non stress
bearing areas, such as for filling cavities at the gum line, or in larger restorations
if they are fully supported by natural tooth structure and do not involve incisal or
occlusal surfaces. They are especially good on the buccal or labial (front surfaces
of teeth where esthetics is extra important. They are often used to cover exposed,
sensitive root structure on both front and back teeth.
$n spite of the fact that they are less wear resistant than regular composites, some
dentists use light activated compomers to fill (a(y teeth due to their extended fluoride
release, and also to allay parents? fears about the mercury in amalgam fillings. The baby
teeth generally exfoliate (fall out before the wear becomes a problem. %ompomers are
also useful in geriatric dentistry since oral hygiene is often poor in elderly patients, and
they frequently suffer xerostomia (dry mouth. The combination of poor oral hygiene
and dry mouth causes rampant decay in these patients, and the constant release of
fluoride at the tooth'restorative 2unction can be helpful to prevent recurrent decay.
4lowa(le compomersF These are like the paste compomer restorative, but they
contain much more of the unfilled resin. They are used in the same fashion as
flowable composites, except they are rarely used in stress bearing areas such as
the occlusal surfaces of adult teeth.
A note on radiopacity of dental materials
G-rays are an essential part of dental diagnosis, and it is very important that any
material that remains implanted in any part of the patient?s body, including his teeth, be
radiographically distinguishable from natural structures or disease processes. $n other
words, any material or device implanted in teeth or in any other part of the body must
be visible on an x-ray. 7aterials like amalgam, gold and titanium (for implants or
posts are made of metal and are naturally radiopaque (ie. they block x-rays and cast a
white shadow on s-ray film.
7aterials like restorative composites, porcelain, or various dental cements are not
inherently radiopaque and without modification of their composition, would not be
visible on an x-ray film except as a dark spot if deposited in bone or tooth structure.
1nfortunately, decay in teeth shows up as a dark area on an x-ray film, and in the early
days of composite technology, before the addition of radiopacifiers, it was often difficult
to distinguish between a composite filling or an area of decay in a tooth when looking at
an x-ray. The addition of &irconium dioxide, barium oxide or Htterbium oxide to any
radiolucent (the oposite of radiopaque material will impart the property of radiopacity.
These three oxides are chosen for their compatibility with the chemistry of composites.
<ote that !arium 3ulfate is used as a "milkshake" or enema when taking medical x-rays
for the observation of the gastro-intestinal tract.
The addition of radiopacifiers is especially important in the production of dental
cements used to lute crowns and bridges. 4ven though the cement will spend its
lifetime under the crown, excess cement will be forced out from between the crown and
the tooth during placement, and often end up between the teeth or under the gums
where it cannot be seen by direct observation. *hen this happens, it can cause
inflammation of the gums and even eventual loss of the tooth. As long as the cement is
visible on the x-ray, it will reveal the presence of the cement so that it can be removed.