DIRECT COMPOSITES

AND THEIR PROSTHODONTIC

APPLICATION

SUBMITTED BY: DR TAVLEEN KAUR

MDS I YEAR
DEPARTMENT OF PROSTHODONTICS
 CONTENTS
• INTRODUCTION
• EVOLUTION OF COMPOSITES
• COMPOSITION
• CURING OF COMPOSITES
• CLASSIFICATION AND TYPES OF COMPOSITES
• PROPERTIES OF COMPOSITES
• APPLICATION OF DIRECT COMPOSITES
• PROSTHODONTIC CLINICAL APPLICATION
• COMPOSITE RESIN VENEER
• PREFABRICATED COMPOSITE VENEER
• CORE BUILD UP MATERIAL
• COMPOSITES AS REPAIR MATERIAL
• COMPOSITE AS LUTING AGENT
• PROVISIONAL RESTORATION
• DIRECT INLAY
• FIBRE REINFORCED COMPOSITES
• FIXED FRC BRIDGES
• ENDODONTIC POSTS
• CONCLUSION
• REFERENCES
 INTRODUCTION
• Aesthetic and restorative dentistry aims to replace lost or damaged structures
with artificial materials that possess biological, physical, and functional
properties similar to natural teeth.
• Among these materials, composite resins occupy a paramount position because
they offer excellent esthetic potential and acceptable longevity ,allowing
minimally invasive preparation or sometimes no preparation at all.
• Because direct composite restorations are now a more integral part of
restorative procedures, to provide improved patient care dentists should have
an in-depth knowledge regarding the properties, indications of use, and
clinical performance of these materials.
 DEFINITION

• According to GPT 9 and philip’s dental materials:

Dental composite-a highly cross-linked polymeric material reinforced by

a dispersion of amorphous silica, glass, crystalline, or organic resin filler
particles and/or short fibers bonded to the matrix by a coupling agent.
 EVOLUTION
TIMELINE

• 1955: BUONOCORE – ACID ETCH TECHNIQUE

• 1956: DR.BOWEN FORMULATED BIS GMA
• 1962: SILANE COUPLING AGENTS
• 1970: FIRST PHOTO CURED COMPOSITES USING UV LIGHT
• 1972: VISIBLE LIGHT CURING UNIT WAS INTRODUCED
• 1976: MICRO FILLED COMPOSITES
• EARLY 1980’S : HYBRID COMPOSITE
• MID 1980’S: FIRST GENERATION INDIRECT COMPOSITES
• EARLY 1990’S: SECOND GENERATION INDIRECT COMPOSITES
• 1996: FLOWABLE COMPOSITES & CEROMER INDIRECT COMPOSITES WAS
INTRODUCED
• 1997: PACKABLE COMPOSITES
• 1998: ORMOCERS WAS DEVELOPED
• 2003: NANO FILLED COMPOSITES RESINS
• 2009: SELF ADHESIVE COMPOSITES
Bayne SC: Dental biomaterials: where are we going? J Dent Educ.2005 ;6(5):571−585
 COMPOSITION
•THERE ARE THREE STRUCTURAL COMPONENTS IN DENTAL RESIN-BASED
COMPOSITES:

MATRIX COUPLING
FILLER AGENT
• ADDITIONAL COMPONENTS ARE:

UV Activator
PIGMENTS ABSORBERS Initiator
System
 1)RESIN MATRIX(CONTINUOUS PHASE)
• METHACRYLATE MONOMERS
• 2,2-BIS[4(2-HYDROXY-3-METHACRYLOXY-PROPYLOXY)- PHENYL ] PROPANE (BIS-
GMA)
•URETHANE DIMETHACRYLATE (UDMA).
• DILUENTS:
• LOW MOLECULAR- WEIGHT COMPOUNDS WITH DIFUNCTIONAL DIMETHACRYLATE (TEGDMA)
• BIS-EMA6
• LOW-SHRINK METHACRYLATE MONOMERS
• DIMER ACIDS,
• INCORPORATION OF CYCLOALIPHATIC UNITS,
• PHOTOCLEAVABLE UNITS

• LOW-SHRINK SILORANE MONOMER

• A NEW MONOMER SYSTEM CALLED SILORANE HAS BEEN DEVELOPED TO REDUCE SHRINKAGE
AND INTERNAL STRESS BUILD-UP RESULTING FROM POLYMERIZATION.
 2.FILLER PARTICLES(DISPERSION PHASE)
FILLERS HAVE BEEN TRADITIONALLY OBTAINED BY GRINDING MINERALS SUCH AS QUARTZ, GLASSES, OR
SOL-GEL DERIVED CERAMICS. MOST GLASSES CONTAIN HEAVY-METAL OXIDES SUCH AS BARIUM OR ZINC SO
THAT THEY PROVIDE RADIOPACITY FOR VISUALIZATION WHEN EXPOSED TO X-RAYS

THE PROPERTIES OF DENTAL COMPOSITES ARE MAINLY IMPARTED BY THE FILLER PARTICLES:
(1) REINFORCEMENT OF THE MATRIX RESIN, RESULTING IN INCREASED HARDNESS, STRENGTH, AND
DECREASED WEAR;
(2) REDUCTION IN POLYMERIZATION SHRINKAGE;
(3) REDUCTION IN THERMAL EXPANSION AND CONTRACTION;
(4) IMPROVED WORKABILITY BY INCREASING VISCOSITY (LIQUID MONOMER PLUS FILLER YIELDS A PASTE
CONSISTENCY);
(5) REDUCTION IN WATER SORPTION, SOFTENING, AND STAINING;
(6) INCREASED RADIOPACITY AND DIAGNOSTIC SENSITIVITY THROUGH THE
INCORPORATION OF STRONTIUM (SR) AND BARIUM (BA) GLASS AND OTHER HEAVY METAL
COMPOUNDS THAT ABSORB X-RAYS.

7) CURING SHRINKAGE IS OFFSET IN PROPORTION TO THE VOLUME FRACTION (LOADING)

OF FILLER. ALTHOUGH SHRINKAGE VARIES FROM ONE COMPOSITE PRODUCT TO ANOTHER,
IT RANGES FROM 1 5 TO 4 VOL% WITHIN 24 HR AFTER CURING.

8) LESS WATER SORPTION AND LESS SOFTENING.

9) MECHANICAL PROPERTIES SUCH AS COMPRESSIVE STRENGTH, TENSILE STRENGTH, AND

MODULUS OF ELASTICITY (STIFFNESS) ARE INCREASED, AS IS ABRASION RESISTANCE.
 TYPES OF FILLERS BASED ON SIZE
Macrofill
20 to 30 μm

HYBRID Microhybrid
1) fine particles of 1)fine particles of a lower average particle size
2 to 4 μm
(0.04 to 1 μm)
(2) 5% to 15% of microfine particles
( silica)of
2)microfine silica
0.04 to 0.2 μm. (0.04 to 0.2μm)

NANOCOMPOSITES
NANOFILLS: nanometer sized particles (1-100 nm)
Nanohybrids:large particles (0.4 to 5 microns) with
added nanometer sized particles
Nanoclusters of silica
zirconia
 3.INTERFACIAL PHASE AND COUPLING AGENTS
THESE ARE ORGANO SILANE COMPOUNDS CALLED SILANE COUPLING AGENTS.
• A TYPICAL SILANE COUPLING AGENT IS 3-METHACRYLOXYPROPYLTRIMETHOXYSILANE (MPTS).
• IN THE LOW-SHRINK SILORANE COMPOSITE, AN EPOXY FUNCTIONALIZED COUPLING AGENT, 3
GLYCIDOXYPROPYLTRIMETHOXYSILANE.

ITS FUNCTIONS ARE SUMMARIZED BELOW:

• IT FORMS AN INTERFACIAL BRIDGE.
• IT ENHANCES THE MECHANICAL PROPERTIES OF THE COMPOSITE AND MINIMIZES THE
PLUCKING OF THE FILLERS FROM THE MATRIX DURING CLINICAL WEAR.
• A MEDIUM FOR STRESS DISTRIBUTION BETWEEN ADJACENT PARTICLES AND THE POLYMER
MATRIX.
• IT PROVIDES A HYDROPHOBIC ENVIRONMENT
 ACTIVATOR-INITIATOR SYSTEM
Chemically Activated Resins:
Supplied as two pastes;
1)benzoyl peroxide (BP) initiator
2) an aromatic tertiary amine activator
(e.g., N, N-dimethyl-p-toluidine).
USE: for restorations and large foundation
structures (buildups) that are not readily
cured with a light source.
Also,only chemically cured materials can be
used with reliable results as a luting agent
under metallic restorations.
Light-Activated
Resins:T
The first light-activated systems were
formulated for UV light to initiate free
radicals.
Camphorquinone (CQ)( (0.2 %wt or
less ) is a commonly used photoinitiator
that absorbs blue light with wavelengths
between 400 and 500 nm.
A number of amine activators are
suitable for interaction with CQ, such as
dimethylaminoethyl methacrylate
(DMAEMA),( 0.15 %wt).
 INHIBITORS
• A typical inhibitor is butylated hydroxytoluene (BHT), which is used in
concentrations on the order of 0.01 wt%.
• Inhibitors are added to the resin systems to minimize or prevent spontaneous
or accidental polymerization of monomers. Inhibitors have a strong reactivity
potential with free radicals.

OPTICAL MODIFIERS
• To increase the opacity, the manufacturer adds titanium dioxide
and aluminum oxide to composites in only minute amounts ( 0. 001
to 0.007 wt%) because these oxides are highly effective
opacifiers.
•
CURING OF RESIN-BASED COMPOSITES
Light
Activation

Curing of
composites

Chemical Dual Cure

Activation Resins
 I. LIGHT ACTIVATION
ADVANTAGES:
• THEY DO NOT REQUIRE MIXING.
• AVOID THE POROSITY OF CHEMICALLY ACTIVATED RESINS
• WORKING TIME :LIGHT-CURED MATERIALS ALSO ALLOW THE OPERATOR TO COMPLETE INSERTION AND
CONTOURING BEFORE CURING IS INITIATED.
• THEY ARE NOT AS SENSITIVE TO OXYGEN INHIBITION AS ARE THE CHEMICALLY CURED SYSTEMS.
DISADVANTAGES:
• LIMITED DEPTH OF LIGHT PENETRATION. THUS LIGHT-CURED COMPOSITES CAN ACTUALLY REQUIRE MORE
TIME WHEN PRODUCING LARGE RESTORATIONS (E.G., IN CLASS II CAVITY PREPARATIONS).
• THE COST OF THE LIGHT-CURING UNIT

• SOME OF THE LIGHT CURE COMPOSITES: TE ECONOM (IVOCLAR VIVADENT),DENTSPLY SPECTRUM

COMPOSITE KIT,TETRIC N COLLECTION(IVOCLAR),PRIME DENT LIGHT CURE FLOWABLE.
 PHOTOCURING WITH VISIBLE (BLUE) LIGHT
ADVANTAGES
(1) MIXING IS NOT REQUIRED,
(2) ENHANCED COLOR STABILITY; AND
(3) COMMAND POLYMERIZATION ON EXPOSURE TO BLUE LIGHT, PROVIDING CONTROL OF
WORKING TIME.

DRAWBACKS:
( 1 ) LIMITED CURING DEPTH,
(2) RELATIVELY POOR ACCESSIBILITY IN CERTAIN POSTERIOR AND INTERPROXIMAL LOCATIONS;
(3) VARIABLE EXPOSURE TIMES BECAUSE OF SHADE (HUE, VALUE, AND CHROMA) DIFFERENCES,
RESULTING IN LONGER EXPOSURE TIMES FOR DARKER SHADES AND/OR INCREASED OPACITY; AND
(4) SENSITIVITY TO ROOM ILLUMINATION
 CURING LAMPS

1. LED LAMPS. 3. PAC LAMPS

2. QTH LAMPS. 4. ARGON LASER

 2. CHEMICAL CURE
ADVANTAGES:
• Convenience and simplicity.
• Hazard-free
• Long-term storage stability
• Manipulation of working/setting time by varying proportions
• Degree of cure equal throughout material if mixed properly.
• Marginal stress buildup during curing is much lower than for photocured resins owing to relatively
slower rates of cross-link formation.
Disadvantages:
• Incorporating air into the mix, thereby forming pores that weaken the structure and trap oxygen,
which inhibits polymerization during curing.
• No control over the working time after the two components have been mixed.

• Some examples of chemical cure :prime dent chemical cure, masterdent chemical cure
 3.DUAL-CURE RESINS
• Dual-cure resins consist of two light-curable pastes, one containing benzoyl
peroxide (BP) and the other containing an
Aromatic tertiary amine.
• When these two pastes are mixed and then exposed to light, light curing is
promoted by the amine/cq combination and chemical curing is promoted by
the amine/bp interaction
Advantages:
• “Command” setting (upon exposure to an intense blue light). This means that
working time is controlled, at will, by the clinician.
• Small increments of composite can be polymerized at a time allowing the
use of multiple shades within a single restoration and accommodating for
shrinkage within each increment as opposed to bulk shrinkage.
DISADVANTAGES:

•Limited cure depth: necessary to build up in layers of about 2 mm.

•Marginal stress buildup during curing is much higher than in self-cured resins..
•Mildly sensitive to normal room illumination (thus a crust will form when
exposed too long to an examination light).
•Special lamp is needed to photo initiate curing.
•Poor lamp accessibility in posterior and interproximal areas; requires extra
exposure time and care in placement and maintaining lamp tip angle and
distance for optimal results.
•Some examples are: variolink esthetic(ivoclar), compcure(premier), luxacore(dmg),
hyperfil(parkell), dual cure(dentex), fill up (coltene).
 DEGREE OF CONVERSION
Conversion of the monomer to polymer depends on several
factors:
• Resin composition,
• The transmission of light through the material, and
• The concentration of sensitizer, initiator and inhibitor
 REDUCTION OF RESIDUAL STRESSES
TWO GENERAL APPROACHES HAVE BEEN FOLLOWED IN SEEKING TO OVERCOME THE
PROBLEM OF STRESS CONCENTRATION AND MARGINAL FAILURE EXPERIENCED WITH LIGHT-
ACTIVATED RESINS:

reduction in volume contraction by altering the

chemistry and/or composition of the resin system

clinical techniques designed to offset the effects of

polymerization shrinkage
 CLINICAL TECHIQUES TO OFFSET POLYMERISATION
SHRINKAGE

• INCREMENTAL BUILDUP AND CAVITY CONFIGURATION

• SOFT-START, RAMPED CURING AND

DELAYED CURING

• HIGH-INTENSITY CURING

Malhotra N, Mala K.Light-Curing Considerations for Resin-Based Composite Materials: A Review Part I.Compendium of Continuing Education in
Dentistry.2010
 CLASSIFICATION OF RESIN-BASED COMPOSITES

• ANUSAVICE K.J. SHEN C & RAWLS H.R.PHILLIPS’S SCIENCE OF DENTAL MATERIALS.12TH EDITION.ELSEVIER; 2013
 TRADITIONAL/CONVENTIONAL /MACROFIILED
COMPOSITES
• Average size is 8 to 12 µm,.
• Filler loading generally is 70 to 80 wt% or 60 to 70 vol% exposed filler particles, some quite
large, are surrounded by appreciable amounts of the resin matrix.
• Developed during the 1970s. No longer used.
• The most commonly used filler for these materials is finely ground amorphous silica and
quartz.
DISADVANTAGE –
• Rough surface that develops during abrasive wear of the soft resin matrix, thus exposing the
more wear resistant filler particles, which protrude from the surface.
• Discoloration
 MICROFILLED COMPOSITE RESINS
• Introduced in the early 1980s.
• They are generally filled 35% to 50% by weight with
prepolymerized 0.02-µm to 0.04-µm silicon dioxide filler
particles.
• The main characteristics - high polish that can be achieved and
maintained over time and excellent enamel-like translucency.
• Indication: for the restoration of anterior teeth and cervical
abfraction lesions;
• Physical properties are inferior to those of hybrid composites
exception is their compressive strength, which can be relatively
high.
• Have higher coefficients of thermal expansion, greater water
sorption, greater polymerization shrinkage, lower module of
elasticity, lower tensile strength, and lower fracture toughness.
• Example: renamel microfill,heliomolar
 HYBRID COMPOSITE RESINS

• They contain a heterogeneous aggregate of filler particles.

• They are usually filled 70% to 80% by weight with 0.04-µm silica and 1-µm to 5-µm
filler particles.
• The average particle size of hybrid composites is usually > 1 µm.
• This mixture of fillers accounts for their excellent physical properties with high
polishability when compared to the
earlier macrofilled composites.
• Problem with hybrid composite
Resins is their inability to maintain their gloss.
 MICROHYBRID COMPOSITE RESINS

• Was developed for a highly polishable composite resin with optimal physical properties.
• Reduced particle size, ranging from 0.04 µm to 1 µm .
• By incorporating smaller particles, microhybrid composites polish and handle better than their
hybrid counterparts.
• Microhybrid composites are stronger than most microfilled composites and can be used in both
anterior and posterior teeth.
• Therefore, microhybrid composites
Can be used as universal or
All-purpose composite resins.
• Majority of microhybrid composite resins present
Medium viscosity.
• Example herculite xrvtm
 HIGH-VISCOSITY COMPOSITE RESINS

• Also known as “condensable” or “heavy-body”), possess a

greater amount of load (above of 80% in volume), which makes
them more resistant and easier to apply because of their excellent
sculptability.
• Indication: for the reestablishment of the contour and proximal
contacts in class 2 restorations and for the precise definition of
occlusal anatomy features.
• Clinical performance of these composites is similar to that of
regular-viscosity microhybrid composites.
SOME AVAILABLE BRANDS INCLUDE
• P60 (3M ESPE),
• VIRTUOSO PACKABLE® (DEN-MAT),
• ALERT® CONDENSABLE COMPOSITE (PENTRON CLINICAL TECHNOLOGIES),
• TETRIC® CERAM HB (IVOCLAR VIVADENT, INC).
 LOW-VISCOSITY FLOWABLE COMPOSITE RESINS
• Midifilled hybrid with finer particle size distribution
• Present much less load (about 50% in volume), possess inferior mechanical properties, greater
degree of polymerization shrinkage.
Indications :
• In areas of difficult access and irregular cavity preparations because it favors the insertion and
adaptation of the subsequent increments.
• Restoration of highly conservative preparations such as placing preventive resin restorations,
• Repairing margins of existing composite resin restorations,
• Surfacing fiber splints,
• Repairing bis-acryl composite provisional restoration margins,
• Luting porcelain veneers.
SOME OF THE AVAILABLE MATERIALS INCLUDE:
• FLOW-IT® ALC™ (PENTRON CLINICAL TECHNOLOGIES),
• AELITE FLO® (BISCO, INC, SCHAUMBURG, IL),
• CLEARFIL MAJESTY™ FLOW (KURARAY AMERICA INC, NEW YORK, NY),
• PERMAFLO® (ULTRADENT PRODUCTS, INC).
SOME MANUFACTURERS HAVE DEVELOPED FLOWABLE COMPOSITES THAT ARE PART OF A
FAMILY OF COMPOSITES WITH THEIR ESTHETIC MICROHYBRID COMPOSITES. EXAMPLES
INCLUDE
• GRADIA® FLOWABLE (GC AMERICA)
• FILTEK™ SUPREME PLUS FLOWABLE (3M ESPE)
• POINT 4 FLOWABLE (KERR DENTAL);
• VIRTUOSO FLOWABLE® (DEN-MAT).
 NANOFILLED COMPOSITE RESINS

• Recently introduced .
• Consist of nanomers (5 nm to 75 nm particles) and
“nanocluster” agglomerates as the fillers.
• Nanoclusters are agglomerates (0.6 µm to 1.4 µm) of primary zirconia/silica nanoparticles (5 nm to
20 nm in size) fused together at points of contact, and the resulting porous structure is infiltrated with
silane.
• The nanofilled composites present similar mechanical and physical properties to those of microhybrid
composites, but when it comes to polish and gloss retention they perform significantly better.
• The main example of nanofilled composites is filtek™ supreme plus.
• Some “nanohybrid” composites examples are: premise (kerr dental), elite aesthetic enamel (bisco, inc),
clearfil majesty™ esthetic (kuraray america, inc), and artiste.
 • Working time and setting time
• Polymerization shrinkage

Physical •
•
•
Water sorption
Thermal properties
Solubility
• Colour Stability

• Strength

Mechanical •
•
Modulus of elasticity
Hardness
• Bond strength

• Depth of cure

Clinical •
•
Radiopacity
Wear rate
• Biocompatibility

Sakaguchi R & Powers J. M. Craig’s restorative dental materials .13th ed. Elsevier; 2012.
 PHYSICAL PROPERTIES
• WORKING AND SETTING TIME

• For light cured composites, about 75% of the polymerization takes place
during the first 10 minutes. The curing reaction continues for a period of 24
hours.
• Within 60 to 90 seconds after exposure to ambient light, the surface of the
composite may lose its capability to flow readily against tooth structure, and
further work with the material becomes difficult..
• The setting times for chemically activated composites range from 3 to 5
minutes. These short setting times have been accomplished by controlling the
concentration of initiator and accelerator.
 POLYMERIZATION SHRINKAGE
• Free volumetric polymerization shrinkage is a direct function of the amount of
oligomer and diluent,
• Micro hybrid composites shrink only 0.6% to 1.4%, compared with shrinkage
of microfilled composites of 2% to 3%.
• This shrinkage creates polymerization stresses as high as 13 mpa between
the composite and tooth structure.
• The net effect of polymerization shrinkage can be reduced by incrementally
adding a light cured composite and polymerizing each increment
independently, which allows for some contraction within each increment before
successive additions.
 THERMAL PROPERTIES

• The thermal expansion coefficient of composites ranges from 25 to 38 X 10-

6/°C for composites with fine particles to 55 to 68 x 10-6/° C for
composites with microfine particles.
• Thermal changes are also cyclic in nature, the cyclic effect can lead to
material fatigue and early bond failure. If a gap were formed, the
difference between the thermal coefficient of expansion of composites and
teeth could allow for the percolation of oral fluids.
 WATER SORPTION
• The water sorption of composites with fine particles (0.3 to 0.6 mg/cm2) is greater
than that of composites with micro fine particles (1.2 to 2.2 mg/cm2), because of the
lower volume fraction of polymer in the composite with fine particles.
• The quality and stability of the silane coupling agent are important in minimizing the
deterioration of the bond between the filler and polymer and the amount of water
sorption.
• It has been postulated that the corresponding expansion associated with the uptake
of water from oral fluids could relieve polymerization stresses.
Solubility
• The water solubility of composites varies from 0.01 to 0.06 mg/cm2. Adequate
exposure to the light source is critical in light cured composites. Inadequate
polymerization can readily occur at a depth from the surface if insufficient light
penetrates.
 COLOR AND COLOR STABILITY

• Change of color and loss of shade match with surrounding tooth structure are
reasons for replacing restorations.
• Stress cracks within the polymer matrix and partial debonding of the filler to
the resin as a result of hydrolysis tend to increase opacity and alter
appearance.
• Discoloration can also occur by oxidation and result from water exchange
within the polymer matrix and its interaction with unreacted polymer sites and
unused initiator or accelerator.
 MECHANICAL PROPERTIES
• Compressive strength is of importance because of the chewing forces.
• The flexural and compressive moduli of microfilled and flowable composites
are about 50% lower than values for multipurpose hybrids and packable
composites, which reflects the lower volume percent filler present in the
microfilled and flowable .
For comparison, the modulus of elasticity in compression is about
• 62 gpa for amalgam,
• 18-24 gpa for dentin,
• And 60-120 gpa for enamel.
 KNOOP HARDNESS
• Knoop hardness for composites (22 to 80 kg/ mm2) is lower than enamel (343
kg/mm2) or dental amalgam (110 kg/mm2).

• The knoop hardness of composites with fine particles is somewhat greater than
values for composites with microfine particles because of the hardness and
volume fraction of the filler particles. These values indicate a moderate
resistance to indentation under functional stresses for more highly filled
composites, but this difference does not appear to be a major factor in
resisting functional wear.
 BOND STRENGTH TO DENTAL SUBSTRATES

• ENAMEL AND DENTIN

• BOND STRENGTH: 20 AND 30 MPA.
• MICROMECHANICAL RETENTION.
• A HYBRID LAYER OF BONDING RESIN AND COLLAGEN IS OFTEN FORMED, AND
THE BONDING ADHESIVE PENETRATES THE DENTINAL TUBULES

• OTHER SUBSTRATES
• COMPOSITE CAN BE BONDED TO EXISTING COMPOSITE RESTORATIONS, CERAMICS, AND
ALLOYS WHEN THE SUBSTRATE IS ROUGHENED AND APPROPRIATELY PRIMED . IN GENERAL, THE
SURFACE TO BE BONDED IS SANDBLASTED (MICROETCHED) WITH 50-ΜM ALUMINA AND THEN
TREATED WITH A RESIN-SILANE PRIMER FOR COMPOSITE, A SILANE PRIMER FOR SILICA-BASED
CERAMICS, AN ACIDIC PHOSPHATE MONOMER FOR ZIRCONIA, OR A SPECIAL ALLOY PRIMER.
BOND STRENGTHS TO TREATED SURFACES ARE TYPICALLY GREATER THAN 20 MPA.
 CLINICAL PROPERTIES

• DEPTH OF CURE (LIGHT-CURED COMPOSITES)

FACTORS THAT INFLUENCE THE DEGREE OF POLYMERIZATION:
1)THE CONCENTRATION OF PHOTO-INITIATOR OR LIGHT ABSORBER IN THE COMPOSITE
2)BOTH FILLER CONTENT AND PARTICLE SIZE ARE CRITICAL TO DISPERSION OF THE LIGHT
BEAM.
3)THE LIGHT INTENSITY AT THE RESIN SURFACE IS A CRITICAL FACTOR IN COMPLETENESS OF
CURE AT THE SURFACE AND WITHIN THE MATERIAL.
 RADIOPACITY

• MODERN COMPOSITES INCLUDE GLASSES HAVING ATOMS WITH HIGH ATOMIC NUMBERS, SUCH
AS BARIUM, STRONTIUM, AND ZIRCONIUM.
• SOME FILLERS, SUCH AS QUARTZ, LITHIUM-ALUMINUM GLASSES, AND SILICA, ARE NOT RADIOPAQUE
AND MUST BE BLENDED WITH OTHER FILLERS TO PRODUCE A RADIO OPAQUE COMPOSITE.
• THE MICROHYBRID COMPOSITES ACHIEVE SOME RADIOPACITY BY INCORPORATING VERY FINELY
DIVIDED HEAVY METAL GLASS PARTICLES. ALUMINUM IS USED AS A STANDARD REFERENCE FOR
RADIOPACITY.
• A 2 MM THICKNESS OF DENTIN IS EQUIVALENT IN RADIO OPACITY TO 2.5 MM OF ALUMINUM, AND
ENAMEL IS EQUIVALENT TO 4 MM OF ALUMINUM.
• TO BE EFFECTIVE, A COMPOSITE SHOULD EXCEED THE RADIO OPACITY OF ENAMEL, BUT
INTERNATIONAL STANDARDS ACCEPT RADIOPACITY EQUIVALENT TO 2 MM OF ALUMINUM.
• AMALGAM HAS A RADIOPACITY GREATER THAN 10 MM OF ALUMINUM, WHICH EXCEEDS ALL THE
COMPOSITE MATERIAL AVAILABLE.
 WEAR RATES
• LOSS OF SURFACE CONTOUR OF COMPOSITE RESTORATIONS IN THE MOUTH
• WEAR OF POSTERIOR COMPOSITE RESTORATIONS IS OBSERVED AT THE CONTACT AREA,
WHERE STRESSES ARE THE HIGHEST. INTERPROXIMAL WEAR HAS ALSO BEEN OBSERVED.
• DITCHING AT THE MARGINS WITHIN THE COMPOSITE IS OBSERVED FOR POSTERIOR
COMPOSITE.
• CURRENTLY ACCEPTED COMPOSITES FOR POSTERIOR APPLICATIONS REQUIRE CLINICAL
STUDIES THAT DEMONSTRATE, OVER A 5 YEAR PERIOD, A LOSS OF SURFACE CONTOUR
LESS THAN 250 ΜM OR AN AVERAGE OF 50 ΜM PER YEAR OF CLINICAL SERVICE.
 BIOCOMPATIBILITY OF COMPOSITES
1)inadequately cured composite materials  reservoir of diffusible components  induce long
term pulp inflammation.
2)second biological concern is associated with shrinkage of the composite during polymerization
and the subsequent marginal leakage.
The marginal leakage  bacterial in growth  cause secondary caries or pulp reactions.
3)bisphenol a, a precursor of bis-gma has been shown to be a xenoestrogen .Bpa and other
endocrine disrupting chemicals (edc’s) have been shown to cause reproductive anomalies
,especially in the developmental stages of fetal wildlife.
 Anterior restoration
(class 3,4,5)

Laminate veneer
systems

Posterior
restoration APPLICATION Luting Agent
OF DIRECT
COMPOSITES
IN DENTISTRY

Provisional
Crowns, inlays, Core Build-Up
and veneers restorations
Composites
PROSTHODONTIC APPLICATION OF DIRECT
COMPOSITES
 COMPOSITES FOR RESIN VENEERS
A VENEER IS A LAYER OF TOOTH-COLORED MATERIAL THAT IS APPLIED TO A TOOTH TO RESTORE
LOCALIZED OR GENERALIZED DEFECTS AND INTRINSIC DISCOLORATIONS.-STURDEVANT
INDICATIONS OF VENEERS :
TEETH WITH FACIAL SURFACES THAT ARE
• MALFORMED,
• DISCOLORED,
• ABRADED,
• ERODED,
• HAVE FAULTY RESTORATIONS .

• PARTIAL VENEERS: WHEN A SMALL NUMBER OF TEETH ARE INVOLVED OR WHEN THE ENTIRE FACIAL
SURFACE IS NOT FAULTY
• DIRECT-COMPOSITE FULL VENEERS :
• FOR CASES INVOLVING YOUNG CHILDREN,
• A SINGLE DISCOLORED TOOTH,
• WHEN ECONOMICS OR PATIENT TIME ARE LIMITED
 THREE TYPES OF VENEERS. A, FACIAL VIEW OF PARTIAL VENEER THAT DOES NOT EXTEND SUBGINGIVALLY OR INVOLVE INCISAL ANGLE.
B, FULL VENEER WITH WINDOW PREPARATION DESIGN THAT EXTENDS TO GINGIVAL CREST AND TERMINATES AT THE FACIOINCISAL ANGLE.
C, FULL VENEER WITH INCISAL-LAPPING PREPARATION DESIGN EXTENDING SUBGINGIVALLY
THAT INCLUDES ALL OF INCISAL SURFACE. (NOTE THAT SUBGINGIVAL EXTENSION IS ONLY INDICATED FOR PREPARATION OF DARKLY STAINED TEETH AND IS
NOT CONSIDERED ROUTINE.)
D TO F, CROSS-SECTIONS OF THE THREE TYPES OF VENEERS IN A THROUGH C.

ROBERSON T, HEYMANN H.O, SWIFT E.J. STURDEVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY.5TH EDI.MOSBY ELSEVIER.2012
ADVANTAGES INCLUDE
• EASE OF FABRICATION,
• PREDICTABLE INTRAORAL REPAIRABILITY,
• LESS WEAR OF OPPOSING TEETH OR RESTORATIONS.
DRAWBACKS
• LOW PROPORTIONAL LIMIT AND
• PRONOUNCED PLASTIC DEFORMATION THAT CONTRIBUTES TO DISTORTION ON
OCCLUSAL LOADING.
• SURFACE STAINING AND INTRINSIC DISCOLORATION TEND TO OCCUR WITH THESE
RESINS.
• SUSCEPTIBLE TO WEAR DURING TOOTH BRUSHING.
 DIRECT PARTIAL VENEERS
• SMALL LOCALIZED INTRINSIC DISCOLORATIONS OR DEFECTS THAT ARE SURROUNDED BY
HEALTHY ENAMEL ARE IDEALLY TREATED WITH DIRECT PARTIAL VENEERS.
• RESTORED IN ONE APPOINTMENT WITH A LIGHT-CURED COMPOSITE.
• IF THE ENTIRE DEFECT OR STAIN IS REMOVED, A MICROFILLED COMPOSITE IS
RECOMMENDED FOR RESTORING THE PREPARATION. NANOFILLED COMPOSITES ALSO
ARE EXCELLENT MATERIAL CHOICES FOR THIS TECHNIQUE.

Roberson T, Heymann H.O, Swift E.J. Sturdevant’s art and Science of Operative dentistry.5th
edi.Mosby Elsevier.2012
 DIRECT FULL VENEERS
• FULL VENEERS ARE INDICATED FOR THE RESTORATION OF GENERALIZED DEFECTS OR
AREAS OF INTRINSIC STAINING INVOLVING THE MAJORITY OF THE FACIAL SURFACE OF
THE TOOTH.
• (1)A WINDOW PREPARATION

Roberson T, Heymann H.O, Swift E.J. Sturdevant’s art and Science of Operative dentistry.5th edi.Mosby Elsevier.2012
 COMPONEERS
• COMPONEERS ARE PREFABRICATED COMPOSITE VENEER SYSTEM.
• THE COMPONEER IS AN EMERGING ESTHETIC SOLUTION FOR THE TREATMENT OF
DISCOLORED, FRACTURED, OR CONGENITALLY MALFORMED TEETH, WHICH ONCE
REQUIRED FULL COVERAGE RESTORATIONS.
• THESE COMPONEERS COMBINE THE SUPERIOR ESTHETIC OF CERAMIC VENEERS, AND THE
BONDABILITY TO TOOTH STRUCTURE, SUCH AS DIRECT COMPOSITE VENEERS.
• THE EXTREMELY THIN VENEER (0.3 MM) ALLOWS CONSERVATION OF TOOTH STRUCTURE.
INDICATIONS
1. SINGLE FACIAL RESTORATIONS
• LARGE RESTORATIONS/DECAYS WITH LOSS OF NATURAL TOOTH BUCCAL ANATOMY/COLOR
• NONVITAL, DISCOLORED TEETH
• TRAUMATIZED, DISCOLORED TEETH (WITHOUT ENDODONTIC TREATMENT)
• SEVERE/EXTENDED TOOTH FRACTURE
• EXTENDED TOOTH DYSPLASIA OR HYPOPLASIA.

2. FULL-SMILE REHABILITATION
• MODERATE TO SEVERE DISCOLORATIONS (i.e TETRACYCLINE STAINING AND FLUOROSIS)
• GENERALIZED ENAMEL HYPOPLASIA/DYSPLASIA (ie, AMELOGENESIS IMPERFECTA)
• LARGE SERIAL RESTORATIONS/DECAYS WITH LOSS OF NATURAL TOOTH BUCCAL ANATOMY/COLOR
• ATTRITION OF INCISAL EDGES (AFTER PROPER OCCLUSAL AND FUNCTIONAL MANAGEMENT)
• FINANCIAL LIMITATIONS.
• YOUNG PATIENTS WITH IMMATURE GINGIVAL PROFILES.
ADVANTAGES
• PRECONTOURED ENAMEL SHELLS WITH EXCELLENT COLOR STABILITY,
• NO LABORATORY PROCEDURE
• COST-EFFECTIVENESS
• EASE OF APPLICATION
• COMPONEERS ARE AS ATTRACTIVE AS PORCELAIN, ESPECIALLY AS IS EASY TO POLISH
• COMPONEERS USUALLY IS A ONE VISIT PROCEDURE
• TOOTH REDUCTION WITH COMPONEERS IS MINIMAL AND CONSERVATIVE THAN FOR PORCELAIN
• LESS LIKELY TO CHIP OFF .COMPONEERS CAN BE REFIXED AND REPAIRED AND ARE UNBREAKABLE

DISADVANTAGES
• ITS MECHANICAL STRENGTH IS MUCH LOWER THAN THAT OF PORCELAIN
• SURFACE HARDNESS IS LESSER THAN PORCELAIN
• LOW RESISTANCE TO WEAR
 USE OF COMPOSITES AS CORE BUILD UP MATERIAL
• Composites are commonly used in this application. Core composites are available as
selfcured ,light-cured, and dual-cured products.
• Core composites are usually tinted (blue, white, or opaque) to provide a contrasting color
with the tooth structure. Some products release fluoride.
• Composite cores have the following advantages as compared with amalgam:
• They can be bonded to dentin,
• Can be finished immediately,
• Are easy to contour,
• And can have a more natural color under ceramic restorations.

• Retention of the final restoration should not rely on the composite structure alone because
adhesion of the composite core to remaining dentin alone is insufficient to resist rotation and
dislodgement of the crown.
Advantages
• Directly placed into the cavity, they also show micromechanical bonding to the tooth structure
• rapid command set of the material
• Due to their high mechanical properties, including tensile and flexure strengths, their
acceptance as a core-buildup restorative material has increased tremendously.
Disadvantages
• Unfortunately, these materials are not easy to handle,,Displaying technique sensitivity
• More time consuming, due to their incremental placement technique,
• As well as inadequate degree of conversion (DC) and inherent polymerization shrinkage, with
a resulting breakdown at the interface and consequent gap formation with microleakage.
• The huge potential for water-uptake
• the high coefficient of thermal expansion
DUAL-CURE COMPOSITE CORE MATERIALS AS CORE BUILD UP
• Dispensed in either a dual-barreled bulk cartridge gun .
• Fitted with a spiral mixing tip to which a cannula can be attached for precise delivery to the cavity
form.
• These systems use a photocatalyst coupled with a catalyst/base redox reaction that permits "dark-
cure" auto-polymerization in deep preparations where access for adequate curing light intensity is
questionable.
• The flowable consistency of the dual-cure composite core systems allow for easy adaptation to
irregular preparations and endodontic posts

• Drawbacks of dual core composites:

• They can be difficult to manipulate and contain when
Crown-forms or band retainers are not used.
• Potential of trapping air while dispensing, which creates
Voids and limited working time.
• LIGHT-CURE-ONLY CORE MATERIALS
• MORE VISCOUS, NON-SLUMPING THAT CAN BE CONDENSED AND SCULPTED TO THE
DESIRED FORM WITH NEARLY UNLIMITED WORKING TIME, WHICH CAN REDUCE CROWN
PREPARATION TIME.
• THE PRIMARY CONCERN IS THE DEPTH OF CURE.
• DEDICATED LIGHT-CURE-ONLY COMPOSITE CORE MATERIALS SPECIFICALLY FORMULATED
FOR PLACEMENT IN LARGE INCREMENTS WITH SUFFICIENT DEPTH OF CURE AND IDEAL
PHYSICAL AND HANDLING PROPERTIES ARE USED.

• SOME BRAND NAMES OF CORE BUILD UP MATERIALS:

BUILD-IT® LIGHT CURE CORE MATERIAL, CORERESTORE2,
MULTICORE FLOW, FGM ALLCEM CORE DUAL CURE RESIN CEMENT,
DENTSPLY CORE FLOW
 REPAIR OF VENEERS
• FAILURES OF ESTHETIC VENEERS OCCUR BECAUSE OF
• BREAKAGE,
• DISCOLORATION, OR
• WEAR.

• THE MATERIAL MOST COMMONLY USED FOR MAKING REPAIRS IS LIGHT-CURED COMPOSITE.
FLOWABLE COMPOSITES ARE USED FOR REPAIRING PORCELAIN, OR FOR REPAIR OF
PROVISIONAL BIS ACRYL RESTORATIONS.
 REPAIR OF DIRECT COMPOSITE VENEERS AND
INDIRECT PROCESSED VENEERS
• SMALL CHIPPED AREAS ON VENEERS  CORRECTED BY RECONTOURING AND POLISHING.
• SIZABLE AREA IS BROKEN, IT CAN USUALLY BE REPAIRED IF THE REMAINING PORTION IS SOUND
PROCEDURE
• Clean the area, select the shade, roughen the damaged surface of the veneer or tooth or both
with a coarse, tapered, rounded end diamond instrument to form a chamfered cavosurface
margin.
• Roughening with micro etching (i.e., Sandblasting) is also effective. For more positive retention,
mechanical locks may be placed in the remaining composite material with a small, round bur .
• Acid etchant is applied to clean the prepared area and etch any exposed enamel that is then
rinsed and dried.
• Next, a resin bonding agent is applied to the preparation (i.E., Existing composite and enamel)
and polymerized. Composite is then added, cured, and finished in the usual manner
Roberson T, Heymann H.O, Swift E.J. Sturdevant’s art and Science of Operative dentistry.5th
edi.Mosby Elsevier.2012
Mopper B.Composite Repair.Cosmedent
 REPAIR OF PORCELAIN VENEERS
• A hydrofluoric acid gel,(10%) suitable for intraoral use (but only with a
rubber dam in place), must be used to etch the fractured porcelain. The
manufacturer’s instructions must be followed regarding application time for the
hydrofluoric acid gel to ensure optimal porcelain etching.
• A lightly frosted appearance, similar to that of etched enamel, should be
seen if the porcelain has been properly etched.
• A silane coupling agent may be applied to the etched porcelain surface
before the adhesive is applied. Silane coupling agents are organosilicone
compounds having two functional groups with different reactivity. One of the
two functional groups reacts with organic materials, and the other reacts with
inorganic materials.
• Sandblasting with aluminium particles is also among the famous
techniques that have been suggested for surface treatment of porcelain
before being silanated.
• Panavia f is a resin cement used to bond several materials such as
prostheses. The system is a self-etching, self-adhesive, dual-cure and
contains 2 photo initiators, providing a wider curing band width to be
used with any curing lights.
• Composite material is added, cured, and finished.
Fracture of incisal edge Air abraded with aluminium Ultradent Porcelain Etch (9% Silane application and
of porcelain veneer oxide HF acid) applied for 90 sec letting it dry

Bonding agent(ibond)
applied Composite layer applied and Fininshing with green, Final view
cured yellow,white polishing
burs.

• Brinker S P.How to repair porcelain restorations instead of replacing them.Heraeus dental.2015

 VENEERS IN METAL RESTORATIONS
• ESTHETIC INSERTS (I.E., PARTIAL OR FULL VENEERS) OF A TOOTHCOLORED MATERIAL CAN
BE PLACED ON THE FACIAL SURFACE OF A TOOTH PREVIOUSLY RESTORED WITH A METAL
RESTORATION.
• PROCEDURE

• A careful examination.
• Preliminary procedures consist of cleaning the area with pumice, selecting the
shade, and isolating the site with a cotton roll.
• A retraction cord is placed in the gingival crevice if required. Rubber dam
isolation may be required.
• A no. 2 carbide bur rotating at high speed with an airwater spray is used to
remove the metal.
• The preparation is made perpendicular to the surface (a minimum of
approximately 1 mm in depth), leaving a butt joint at the cavosurface
margins. The 1-mm depth and butt joint should be maintained as the
preparation is extended occlusally.
• All of the metal along the facial enamel is removed, and the preparation is
extended into the facial and occlusal embrasures just enough for the veneer
to hide the metal
• Preparation is extended gingivally approximately 1 mm past the mark
indicating the clinical level of the gingival tissue.
• Mechanical retention is placed in the gingival area with a no. '/,Carbide bur
0.25 mm deep along the gingivoaxial and linguoaxial angles.
• Retention and esthetics are enhanced by beveling the enamel
cavosurface margin (approximately 0.5 mm wide) with the coarse,
flame-shaped diamond instrument oriented at 45 degrees to the
external tooth surface
• After it is etched, rinsed, and dried, the preparation is complete .
• Adhesive resin liners containing 4-methyloxy ethyl trimellitic anhydride
(4-META), capable of bonding composite to metal, also may be used.
• Manufacturers' instructions should be followed explicitly to ensure
optimal results with these materials. The composite material is inserted
and finished in the usual manner.
 A, Mesiofacial portion of onlay is distracting to patient.
B, Model of tooth and preparation. Note 90-degree cavosurface
angle and retention prepared in gold and the cavosurface bevel
in enamel.
C, Clinical preparation ready for composite resin.
D, Completed restoration.
Roberson T, Heymann H.O, Swift E.J. Sturdevant’s art and Science of Operative dentistry.5th edi.Mosby Elsevier.2012
 RESIN LUTING AGENTS
• Resin cements are essentially flowable composites of low viscosity. Virtually insoluble and are much stronger
than conventional cements.
• High tensile strength- makes them useful for micromechanically bonding.
Indications:
• Luting crown or FPD having poor retention,
• For casts crowns,
• Metal ceramic crown, pressed,high leucite,ceramic, ceramic inlay, Ceramic veneers,
• Resin retained FPD,
• Cast post and cores.
Types
• Autopolymerizing resins -under light-blocking metallic PFM , thick ceramic restorations , resin bonded
bridges
• Photocured resins - thin ceramic veneers.
• Dual cured resins – bonding feldspathic ,pressed leucite, or cad/ cam –prepared leucite ceramic
restorations.
 COMPOSITION AND CHEMISTRY

• Similar to that of resin-based composite filling materials:

• A resin matrix with silane-treated inorganic fillers. The fillers are those used in
composites, that is, silica glass particles and/or colloidal silica used in
microfilled resins.
• The adhesive monomer incorporated in the bonding agent and the resin
cement includes hema, 4-meta, and an organophosphate, such as 10-
methacryloyloxydecamethylene phosphoric acid (MDP).
• Polymerization can be achieved by a
 Conventional chemical-cure system
 By light activation.
 Dualcure systems.
• LIKE DIRECT-COMPOSITE RESTORATIVE MATERIALS, MOST RESIN CEMENTS NEED TO BE USED
WITH BONDING SYSTEMS.

• THREE SUBTYPES:
 TOTAL-ETCH SYSTEMS,
 SELF ETCHING PRIMER SYSTEMS,
 SELF-ADHESIVE SYSTEMS.

• EXAMPLE:
• SPEED CEM- SELF ADHESIVE RESIN CEMENT
• MULTILINK AUTOMIX – SELF ETCHING, ADHESIVE RESIN
• VARIOLINK ESTHETIC – ADHESIVE CEMENTATION SYSTEM
(COMPATIBLE WITH ALL ETCHING TECHNIQUES).
• RELYX UNICEM SELF ADHESIVE CEMENT(NO ETCHING PRIMING)
• RELYX ULTIMATE ADHESIVE RESIN CEMENT .(FOR TOTAL ETCH,SELECTIVE ETCH,OR SELF ETCH)
• PANAVIA™ F 2.0- SELF ETCHING PRIMER SYSTEM
 MANIPULATION

• Resin cements are often designed for specific applications rather than general uses.The procedure
for the tooth surface remains the same for each system, but the treatment of the prostheses differs
depending on their composition
A)METALLIC PROSTHESES
B)BONDING OF RESIN-BASED VENEERS, INLAYS, ONLAYS, CROWNS, AND FIXEDPARTIAL
DENTURES
C)BONDING OF CERAMIC PROSTHESES
 PROVISIONAL COMPOSITE RESTORATION
• Provisional inlays, crowns, and fixed partial dentures are usually
fabricated from acrylic resins or composites.
• Provisional restorations fabricated from composites are generally
harder, stiffer, and more color stable than those made from
acrylics
COMPOSITE VENEERED ACRYLIC RESIN PROVISIONAL
RESTORATION
Restorations that are remade to improve esthetics, teeth with pronounced
gingival-to-incisal color contrast, or high-value translucent teeth can limit the
capability of shaded acrylic resin provisional restorations to satisfy the esthetic
demands of certain patients.
Improved optical properties of microfilled composite are combined with the
excellent marginal seal and contour of acrylic resin.
Precise control of color, translucency, and surface texture provide excellent
interim esthetics and a better guide for the definitive prosthesis
Provide excellent form, function, fit, and esthetics.
 Diagnostic wax up
Maxillary incisors showing Microfill composite on
diastema,abrasions and facial surface of matrix
worn incisal edges

Matrix after polymerisation Provisional restoration

with light in place
Sollow A.R. Composite veneered acrylic resin provisional restorations for complete veneer crowns. J Prosthet Dent
1999;82:515-7.
 USE OF COMPOSITE IN DIRECT INLAYS

Polymer-ceramic composite filling materials for use in posterior teeth.

By direct technique:
• The fabrication process for direct composite inlays first requires the application of a
separating medium (agar solution or glycerin) to the prepared tooth .
• The restorative resin pattern is then formed, light-cured, and removed from the preparation.
• The rough inlay is then exposed to additional light for approximately 4 to 6 min or heat-
activated at approximately 100" c for 7 min, after which the preparation is etched, the inlay
is cemented into place with a dual-cure resin, and it is then polished.
• Composites available for inlay production are:
• Microfilled resins.
• Fine/coarse particle size blended filler or hybrid type materials
 FIBRE REINFORCED COMPOSITES
• The FRC material is a combination of fibers and a resinous matrix.
• Different types of FRC materials exhibiting a wide variety of mechanical flexural properties
are commercially available.
• The mechanical properties of FRC materials are primarily dependent upon fiber type (glass,
carbon, or polyethylene), quantity of fibers in the matrix resin (maximum is 15x103 in a
bundle), fiber architecture (unidirectional, woven, or braided), and quality of impregnation of
fiber with resin.
• Hand impregnation by the technician or the dentist, e.g. Ribbond, glas span, and construct.
• Machine impregnated with resin by the manufacturer, e.g. Everstick, fiberkor, and vectris.
These machine-impregnated materials are also known as pre-impregnated FRC materials
• CHAIRSIDE PROSTHESES:
• The properties of FRC include high flexural strength, desirable aesthetic results, ease in use,
adaptability to various shapes, and capability for direct bonding to tooth structure.
• Among the many direct intraoral applications of this technique are splinting of mobile teeth,
replacement of missing teeth, and fabrication of endodontic posts.
• One of the most potentially useful applications of pre-impregnated FRC technology is its use
in replacing missing teeth in a timely and cost-effective manner.
Potential clinical applications for chairside-fabricated FRC prostheses include :
• In place of a provisional removable prosthesis immediately after anterior implant placement
but before loading.
• Immediate fixed-tooth replacement after extraction, after traumatic loss of a tooth, or for
space maintenance in pediatric or adolescent patients.
• The recurrent fractures of removable dentures can be eliminated by the use of FRC as
reinforcement.
• CHAIRSIDE TOOTH REPLACEMENT USING FRC

SELECTION CRITERIA:

• A patient who desires an immediate minimally invasive approach

• A patient who requires extraction in esthetic area and desires immediate
replacement
• Abutment teeth with questionable long term prognosis
• Anterior disarticulation during mandibular protrusive movements
• A nonbruxing patient
• Cost consideration
PROCEDURE
• Initial visit: A shade is selected for denture tooth, alginate impression taken for diagnostic cast.
• Denture tooth modification
• The tooth is modified as 1)proximal preparation are placed on mesial and distal surfaces to
tack the tooth interproximally to the abutment teeth . 2) an occlusal groove atleast 2mm wide
and deep is prepared
• Alternate technique: using extracted tooth
• Fabrication of intraoral occlusal-incisal pontic index: the denture tooth is positioned on the
diagnostic cast and index is fabricated from vinyl polysiloxane putty.
• Chairside insertion:
• Abutment teeth are anaesthetized, denture teeth is tried to verify fit ,shade and contour
and a rubber dam is placed.
• Grooves are prepared in the abutment teeth,2mm wide and deep. The occlusal /lingual
groove in the denture tooth is sandblasted with 50սm aluminum oxide.The putty index can be
removed as the tooth is tacked in place.

• The occlusal groove of the abutment teeth are etched and treated using dentin bonding
agent. The denture teeth is placed in the putty index and positioned in the mouth. A flowable
composite is placed and light cured.

• Composite resin is syringed into the occlusal grooves and proper length of frc is added into
the particulate composite based groove.

• 3/more pieces of frc is condensed and light cured. A less viscous flowable composite is used
to fill the remaining of the groove and light cured. The rubber dam is removed and occlusal
adjustments are made with composite finishing bur.
 ENDODONTIC FRC POSTS
• FRC posts offer greater flexural strength , modulus of elasticity close to dentin, ability to form
single bonded complex within the root canal for a unified root post complex and improved
esthetics with all ceramic or FRC crowns. It reinforces a compromised root and distributes stress
more uniformly on loading to prevent root fracture. The post will yield prior to the
catastrophic root failure better than the custom made cast metal posts.
• Two categories are available: CHAIR SIDE FABRICATED AND PREFABRICATED.
• Chairside use custom designed polyethylene non preimpregnated woven
fibres(ribbond,connect) or glass fibres (glasspan) to hold a composite core.
• Prefabricated posts: carbon fibres embedded in epoxy matrix(c- post, aestheti- post) and s
type glass fibres embedded in a filled resin matrix (fibrekor post).

POST SELECTION AND PLACEMENT

• Teeth that can have margin placed below composite core on sound tooth structure to allow
ferule effect.
• Teeth with large, flared canals where composite luting resin frc combination creates a
reinforced bonded root.
PROCEDURE FOR PREFABRICATED FRC POST AND CORE
• Using a rubber dam and gingival retraction clamp or floss ligation, isolate the tooth
• Using either heat /peeso reamer, remove the GP from the canal to 4-5mm of apex.
• Using proper drills, select the size of prefabricated post to fit within the canal
And select the proper size preparation drills and post hole preparation.
• Using a diamond disk /bur cut the selected fitted post to the correct height.
• Etch and rinse root canal chamber and the remaining tooth structure
And apply chemical cure dentin primer and adhesive.
• Coat the FRC with primer and place a dual cure /chemical cure composite resin luting
cement into the canal and on apical third of the post and insert the post into the canal.
• Add composite resin core material to the remaining chamber and crown and the core is
prepared for a crown.
• PROCEDURE FOR FABRICATING FRC POST AND CORE
1. Using a rubber dam and gingival retraction clamp or floss ligation, isolate the tooth
2. Using either heat /peeso reamer, remove the GP from the canal to 4-5mm of apex
3. Do not enlarge or shape the existing canal space but cut strips of polyethylene woven ribbon in
excess of twice the post space.
4. Etch, rinse and apply chemical cure dentin bonding agent system to the canal space , pulp
chamber and remaining tooth structure.
5. Apply dual cure /chemical cure composite resin luting cement into the canal
6..Saturate the polyethylene woven ribbon with resin ,form it into v shape and place it into the canal,
leaving the excess as an ear out into the chamber. Place as many pieces of polyethylene woven
ribbon as will fit in the canal.
7. Apply composite resin core material to the polyethylene woven ribbon coronal extensions to create
a core and prepare a crown preparation of the core tooth complex.
CLINICAL PROBLEMS WITH FRC PROSTHESES:
• Problems associated with FRC prostheses can be grouped under the following categories:
• Gray/ metal shadow due to metal posts and cores or amalgam cores on abutment teeth;
• Loss of surface shining on the particulate veneering composite;
• Excessive translucency in pontic areas;
• Fracture or chipping of the particulate composite veneer and debonding of the retainer
• The amount of plaque accumulation on the surface of FRC materials depends on the type of
fibers used.
• Polyethylene FRC has the roughest material with promoted plaque accumulation significantly
more than the other smoother materials.Glass FRC and restorative composite showed very similar
plaque accumulation properties.
 CONCLUSION

• The evolution in the development and improvements with composite resins has changed the way
dentists practice restorative dentistry.
• Currently, the new generations of composite resins offer excellent performance materials for
anterior and posterior direct placement restorations.
• When selecting composite resins, the criteria should include highly esthetic shade matching,
translucency, and fluorescence; high polishability; excellent mechanical properties that contribute to
restoration durability; good handling properties; excellent wear resistance; radiopacity; low
polymerization shrinkage; and biocompatibility.
• The criteria for future development and introduction of new composite resins point to the
progression to one universal composite. This is a difficult challenge to manufacturer and clinician
alike. To date, in general, the microhybrid and nanofilled composites offer an alternative to
microfilled composites in their ability to be highly polishable with toothlike translucency. This class
of composites would be considered universal-use composite resins.
 REFERENCES
• 1.ANUSAVICE K.J. SHEN C & RAWLS H.R.PHILLIPS’S SCIENCE OF DENTAL MATERIALS.12TH EDITION.ELSEVIER; 2013

• 2.COMBE E.C.NOTES ON DENTAL MATERIALS.6TH EDI.CHURCHILL LIVINGSTONE;1992

• 3. ROBERSON T, HEYMANN H.O, SWIFT E.J. STURDEVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY.5TH EDI.MOSBY ELSEVIER.2012

• 4. SAKAGUCHI R & POWERS J. M. CRAIG’S RESTORATIVE DENTAL MATERIALS .13TH ED. ELSEVIER; 2012.

• 5.FRIELICH MA, MEIERS JC.FIBRE REINFORCED COMPOSITES IN CLINICAL DENTISTRY.QUINTESSENCE PUBLISHING CO.2000

• 6.SENSI LG, STRASSLER HE, WEBLEY W. DIRECT COMPOSITE RESINS. INSIDE DENTISTRY. 2007;3(7):76

• 7.KUGEL G, PERRY R. DIRECT COMPOSITE RESINS: AN UPDATE. COMPEND CONTIN EDUC DENT. 2002;23(7):593-608.

• 8. BAYNE SC: DENTAL BIOMATERIALS: WHERE ARE WE AND WHERE ARE WE GOING? J DENT EDUC.2005 ;6(5):571−585.

• 9. DIETSCHI, DIDIER & DEVIGUS, ALESSANDRO. PREFABRICATED COMPOSITE VENEERS: HISTORICAL PERSPECTIVES, INDICATIONS AND CLINICAL APPLICATION. THE
EUROPEAN JOURNAL OF ESTHETIC DENTISTRY : OFFICIAL JOURNAL OF THE EUROPEAN ACADEMY OF ESTHETIC DENTISTRY. 2011;6:178-87.

• 10. PUCKETT, A. D., FITCHIE, J. G., KIRK, P. C., & GAMBLIN, J. DIRECT COMPOSITE RESTORATIVE MATERIALS. DENTAL CLINICS OF NORTH AMERICA.2007; 51(3): 659–
675.

• 11. SOLLOW A.R. COMPOSITE VENEERED ACRYLIC RESIN PROVISIONAL RESTORATIONS FOR COMPLETE VENEER CROWNS. J PROSTHET DENT 1999;82:515-7

• 12. CHANDRAMOULI MK. COMPONEERS. INT J PREV CLIN DENT RES 2017;4(3):232-234.

• 13. BLANK, JT. RESTORING SEVERELY COMPROMISED TEETH WITH A CORE BUILD-UP. THE ADVANTAGES OF USING A DIRECT, LIGHT-CURED ONLY COMPOSITE CORE
MATERIAL. INSIDE DENTISTRY. NOVEMBER/DECEMBER 2010; 6(10):108-112.
Sol gel derived ceramic
 COMPOSITE INSTRUMENTS

TITANIUM COATED/GOLD TITANIUM/BLUE

TITANIUM COATED/ Titanium nitride coated
 INCREMENTAL BUILD UP TECHNIQUE

Chandershekar V.Incremental techniques in direct composite restoration. J Conserv Dent. 2017 Nov-Dec; 20(6):
386–391
SEPARATE DENTINE AND ENAMEL BUILDUP
• Here, sloping increments are again applied to cavity walls [figure 9] (and cured in turn) but only
to the level of the amelodentinal junction. Final “enamel” increments are then applied. Prudent
control of the final layer will again reduce the finishing stage. Some operators (if agreeable to the
patient) place composite pit and fissure stain before placement of the final layer. An alternative
method of achieving a more natural appearance is to use a dark (e.G., A4) shade of composite for
the bulk of the restoration and a translucent or light shade for the “enamel” increment
Dual-shade layering technique
• Basic practitioners are recommended to establish confidence in layering techniques by beginning
with two material shades as this simplified technique is reported to deliver an acceptable color
match in a large number of clinical situations. Following etching and adhesive application, an
opaque dentine material is applied, shaped, and light cured. Most dentine restorative materials are
in the shade group A and selection of the correct chroma is a key to success. Palatal, proximal,
and labial enamel increments are then layered, freehand over the opacious central core at
approximately half the thickness of residual enamel
Polychromatic layering technique
• When esthetic demands are high, the widely accepted stratification technique proposed by
lorenzo vanini is recommended.the fundamental principle of polychromatic layering technique is
to use different composite shades to replicate the layers seen in natural teeth which can be
described in layers as palatal enamel layer, dentine layer, special features, opalescents,
characterizations, and intensives.
 FINISHING AND POLISHING OF COMPOSITES
• STEP 1: MATERIAL SELECTION
As a reference, diamond impregnated polishers should be used, followed by an
aluminum-oxide polishing paste when polishing nanofill and microhybrid composites.
When polishing microfill composites, aluminum-oxide polishers should be used, followed
by an aluminum-oxide polishing paste
• Either multi-fluted carbides or fine diamonds for gross contouring can be used to
begin finishing the restoration. Brush strokes and air coolant is used. Lingual areas
are contoured with light intermittent pressure with oval carbide bur at medium
speed with air coolant

• Discs can be used for the contouring of all tooth surfaces as well as bulk reduction of
excess material. Discs will help contour and finish curved surfaces such as labial
proximal line angles, lingual marginal ridges, cervical areas, incisal edges, shaping
and finishing of incisal corners, plus finishing and polishing of labial surfaces. They
are also excellent for contouring and finishing of posterior marginal ridge areas,
and for lingual and buccal surfaces.

Mopper W.Contouring, Finishing, and Polishing Anterior Composites.Inside Dentistry.2011;7(3)

• To provide maximum control for the operator, composite
finishing should be done under low-speed/high-torque (speed
from 0 rpm to 30,000 rpms). A constant shifting motion is
used.
• Coarse—the coarse grit is the stiffest of all the discs. This grit
is used in conjunction with multi-fluted finishing burs for gross
contouring and shaping. When used with pressure, the coarse
disc makes it easy to blend the composite into the tooth surface,
eliminating the white line and raised margins.
• Medium—the medium grit should be used to continue
smoothing the restoration surface. Medium grits remove any
remaining imperfections and marks.
• Fine—this part of the grit sequence is where polish really starts
to shine through. The fine grit helps remove the smallest
imperfections while adding a nice luster to the restoration.
• Superfine—the superfine grit further refines the surface
smoothness attainable to create a highly polished restoration.
• Diamond strips help start the inter- proximal finishing process
while maintaining the integrity of the interproximal contact. A
larger-grit (45-µm strip) should be used for interproximal
stripping of natural teeth or for gross removal of material, and
smaller grits (15 µm and 30 µm) should be used to start
interproximal polishing. They should not be used in sawing
motion. It should be curved over the restoration
• Aluminum-oxide cups should be used to polish gingival margins,
achieve labial characterization and anatomy, and effectively reach
areas such as the gingival third and the gingival margins of
anterior teeth. Aluminum-oxide points should be used to create
labial grooves in veneers, to finish and polish occlusal surfaces of
posterior teeth, and on lingual surfaces of anterior teeth.
• An aluminum-oxide polishing paste should be used as the last
step in the finishing and polishing process. Polishing paste with
felt discs and points can be used to bring out the final beautiful
polish of composites, metals, porcelain, or natural dentition after
prophylaxis
 • Finishing and polishing should be achieved with a
low-speed, high-torque handpiece, typically
anywhere from 7,000 rpm to 30,000 rpm. A high-
speed handpiece may be used to pre-contour, but
using anything over 30,000 rpm during finishing
and polishing is too high. Low-speed, high-torque is
preferable, because it gives the operator complete Aluminium oxide paste polishing
control.

Step 2: Conceptualization
Before finishing and polishing, the dentist must
conceptualize the desired end result

Step 3: Action
A realistic tooth form should be developed before the pre-
contouring phase begins. Now it is time to apply the
correct technique during the final phases of the
restoration. Felt flexi point for lingual
surface
• MECHANISM OF ETCHING AND ETCH PATTERNS • ACID ETCHING CONVERTS SMOOTH ENAMEL
INTO A VERY IRREGULAR SURFACE WITH HIGH SURFACE ENERGY. • IT REMOVES 10ΜM OF
SURFACE ENAMEL AND CREATES A MICROPOROUS LAYER WHICH IS 5 TO 50ΜM DEEP. •
OPTIMUM CONCENTRATIONS OF ACID PRODUCES MONOCALCIUM PHOSPHATE
MONOHYDRATE PRECIPITATE WHICH CAN BE EASILY RINSED OFF.

• WHEN PRIMER AND BONDING RESINS ARE APPLIED TO ETCHED DENTIN, THEY PENETRATE THE
INTERTUBULAR DENTIN, FORMING A RESIN-DENTIN INTERDIFFUSION ZONE, OR ‘HYBRID LAYER