10/14/08 1

Advantages of resin
composites
1- Superior esthetics;
 They have refractive index close to that of

enamel and dentin combined.

 The compositional filler scatters the incident

light producing excellent depth of

translucency.
 They are available in all possible tooth-

colors.

10/14/08 2
 Advantages of resin
composites
2- Composites have low thermal conductivity and
diffusivity. Therefore, they do not transmit thermal
shocks to underlying dentin and pulp.
3- Satisfactory physical and mechanical properties; that
are considered to be satisfactory for clinical
applications.
4- Easy to repair.
5- Strengthening of the remaining tooth structure via
bonding system.
6- Conservation of tooth structures.

10/14/08 3
 Disadvantages of resin
composites
 1- Questionable adaptation
a- High polymerization shrinkage. Composite resin
exhibits a clinically polymerization shrinkage of about
1.5-3 vol%, that causes the maturing resin to pull off
substrate enamel and dentin surfaces, with tensile
stresses of 17-20 MPa. The shrinkage gaps invite
leakage with ingress of oral environmental bacteria,
fluids, and stains causing acute clinical problems of
dentin hypersensitivity, adverse pulp reactions, and
recurrent caries. It is for this purpose that adhesive
systems are used.

10/14/08 4
 Disadvantages of
resin composites
 B- Poor wettability
It has low wettability, due to material high viscosity and
surface tension. This inhibits the spontaneous flow of
the material, and diffusibility into substrate enamel
surface ( with low surface energy) and substrate dentin
surface ( with low surface energy). Moreover, the
material is hydrophobic, and therefore is easily
displaced off substrate surface by compositional water.
Therefore, effective adhesive systems must be used to
promote resin wettability of substrate surface.

10/14/08 5
 Be aware
 Sufficient wetting of the adhesive will only occur if
its surface tension is less than the surface-free
energy of adherend ( substrate tooth substance ).
 High surface energy of adherend -----» able to
attract the atoms of adhesive.
 Low surface tension and low viscosity of adhesive
----» able to properly wet the adherend.

10/14/08 6
 Disadvantages of
resin composites
 C- High differential coefficient of thermal expansion
Composites have higher coefficient of thermal
expansion than that of the tooth. The closer the
coefficient of thermal expansion of the material is to
that of enamel, the less chance for creating opening at
the junction of the material and the tooth when
temperature changes occurs.
Bonding a composite to etched tooth structure reduces
the negative effects of a difference between coefficient
of thermal expansion of the tooth structure and the
material.

10/14/08 7
 Disadvantages of
resin composites
 2- Low wear resistance;
It leads to:
 Opening of interproximal contacts.

 Loss of anatomic form and of vertical

dimension.
 Makes the restoration vulnerable to surface

degradation by environmental fluids, food

chewing and plaque bacterial metabolic
activities.

10/14/08 8
 Disadvantages of
resin composites
 3- Hydrolytic instability.
Resin-based restorations are subjected in the
mouth to time-dependent structural, interfacial,
and surface deterioration by complex
mechanisms of hydrolysis ( by environmental
acids ), water sorption ( in oral environmental
fluid ) and marginal percolation with progressive
deterioration of marginal adaptation, wear and
loss of strength.
10/14/08 9
 Disadvantages of
resin composites
 4- Potentials for adverse pulp reactions.
Adverse pulp reactions are more frequent
under composite restorations. They were
believed to be due to residual
compositional constituents of composite
resin. Recent researches have confirmed
their bacterial etiology.

10/14/08 10
 Disadvantages of
resin composites
 5- Technique sensitivity.
It has potentials to exhibit significant variations
in properties, handling characteristic, and
clinical performance in response to deviations
from manufacturer instructions relative to
details of substrate surfaces pre-treatment
and application of composite.

10/14/08 11
 Disadvantages of
resin composites
 6- Lack of cariostatic potentials.
Anticariogenicity through incorporation of
fluorides has not been successful with
composite because its extremely low
solubility prevents sustained release of
sufficient amount of fluoride ions.

10/14/08 12
 Indications
 1- Carious defects:
Class I and II cavities that can be
isolated properly and where centric
contact (s) on tooth structure is
(are) present.
Class III, IV and V.

10/14/08 13
 Indications
 2- Non-carious lesions:
 Hypoplasia.
 Hypocalcification that is esthetically
objectionable or is cavitated.
 Abrasion and erosive lesions.
 Class VI cavities ( faulty pit on selected occlusal
cusps ).
 Abfraction lesion, ( cervical induced cavities
owing to the flexure of teeth during function as a
result of the presence of an occlusal
interference ).
10/14/08 14
 Indications
Non-carious lesions

Enamel hypoplasia
Abfraction
10/14/08 15
 Indications
 2- Non-carious lesions:
 Veneer for metal restorations.
 Repair of fractured areas.
 Core build-up.
 Cementation of orthodontic brackets.
 Luting purposes.
 Splinting of mobile teeth.
 Restoration of a weakened tooth that can be
strengthened by a bonded restorations.

10/14/08 16
 Contraindications
 When the occlusal contacts will be on
the composite material.
 Heavy occlusal stresses due to
unfavorable occlusion.
 Deep subgingival areas that are difficult
to prepare or restore.
 Poor oral hygiene.
 Wherever provision of dry field is not
possible.
 Bruxing patients.
10/14/08 17
 Designs of cavity
preparation:
A- Modified cavity design:
The introduction of adhesive practice i.e.
bonding to enamel and dentin, has modified
the classic cavity preparation in to what is
known as the adhesive or conservative cavity
design. These cavities are characterized by:
 A- Minimum extensions.
 B- Beveled cavo-surface angle.

10/14/08 18
 A- Minimum extensions:
 The objective of modified design is to remove the
fault as conservatively as possible. The design
have neither specified cavity wall configuration
nor specified pulpal depth and have enamel
margins.
 N.B Axial walls may be composed partially or
completely of enamel, because no extension for
retention in dentin is required.

10/14/08 19
 B- Beveled cavo – surface angle:
The cavo-surface angle is beveled
to a 45 degree angle and for a width of 0.5mm.

10/14/08 20
 Advantages of beveling:
1- Improved peripheral seal and attachment, with
improved adaptation and micromechanical
retention as a result of:
 The increase in surface area of enamel available
for bonding.
 Exposing the ends, rather than the sides, of
enamel rods provides for more effective acid
etching with creation of more numerous
micro – and macro – pores.
10/14/08 21
 Ends of enamel rods (A) are more effectively
etched, producing deeper microundercuts than
when only sides of enamel rods are etched

10/14/08 22
 Advantages of beveling:
2- Improved esthetics:
Bevel useful in gaining a gradual optical transition
from composite to enamel.
Contraindication for beveling of cavo–surface angle:
 Enamel walls that are located at high stress bearing
areas, such as those of occlusal cavities and lingual
cavities in upper anterior, to avoid marginal chipping
of composite. (because of its brittleness)
 Cementum or thin enamel. (instead, gingival grooves,
are incorporated and/or a glass ionomer cement liner
is placed for retention and improved adaptation.

10/14/08 23
 B- Bevelled
conventional
design
 This design is indicated:
 When composite restoration is being used to
replace an existing restoration exhibiting a
conventional cavity preparation with enamel
margin.
 When restoring a large carious lesion where
the need for increased retention form is
anticipated.

10/14/08 24
 Manipulation:
 Selection of composite, type and shade
 Field isolation
 Pulp protection
 Matricing and wedging.
 Pre-treatment of the substrate surface.
 Packing.
 Carving.
 Polymerization.
 Finishing and polishing.

10/14/08 25
 Selection of
composite:
 The multipurpose system incorporating whole etchant,
universal bonding agent and hybrid type composite
are the preferable system.
 Composite are supplied in different shades and with a
shade guide. The shade selection should be
accomplished before the restorative procedure is
initiated.
 Therefore, selection is made while the tooth is moist,
before the cavity preparation, and before the rubber
dam is placed. Desiccation of the tooth causes
significant lightening of the shade, and the presence
of a rubber dam can distort color perception

10/14/08 26
 The selected shade can be confirmed with
a small amount of composite (test shade)
placed directly on or adjacent to the tooth
and cured. This procedure should be
performed on an unetched tooth surface
to make removal easy after shade
verification.

10/14/08 27
 Selection of
composite:
 For class 4 restorations and others in
which no tooth structure is remaining
lingual to the composite, the test shade
should be placed in the approximate
thickness of the tooth structure to be
replaced to assure adequate opacity or
color density.

10/14/08 28
 Field isolation
 Composite is highly sensitive to moisture
contamination which causes deterioration of its
physical properties. In addition bonding to
enamel and dentin is severely affected by
moisture. Field isolation is best obtained using
rubber dam which prevents moisture
contamination and protects gingival tissues.
 In case of inability to establish a moisture free
field, indirect rather than direct restorations are
indicated

10/14/08 29
 Field isolation

10/14/08 30
 Pulpal protection
 Protection against oral environmental irritants
may be provided by:
 effective peripheral sealing with elimination of
leakage
 sealing of tubular orifices by adhesives or cavity
liners and bases (specially if they are
antibacterial)

10/14/08 31
 Pulpal protection
 If used, calcium hydroxide should be
limited to those areas of the preparation in
which there is the potential for pulpal
exposure. Placement of a CaoH liner over
an extensive area of dentin decreases the
surface area for adhesion, and dissolution
of the liner during acid etching can
interfere with a sound bond to enamel and
dentin.

10/14/08 32
 Pulpal protection
 Although CaoH offers good protection, yet it dissolves
under clinical restorations with gap formation (that
can fill with tissue fluid and become secondarily
infected under leaking restorations). If the preparation
is conservative in size, no liner in addition to adhesive
agent is required. In deeper preparations and those
that approach or extend beyond the cemento-enamel
junction, a glass-ionomer liner or base may be
considered.

10/14/08 33
 Pulpal protection
 Glass-ionomer bounds to both tooth structure and
composite.
 It releases fluoride into adjacent tooth structure.
 Use of a glass-ionomer liner has been demonstrated to
improve marginal integrity and decrease marginal
leakage. Less bulk of composite is required to fill the
preparation, reducing the amount of polymerization
shrinkage and improving marginal adaptation.
 Glass-ionomer liners also reduce the rise in pulpal
temperature associated with application of the curing light
during incremental insertion procedures.

10/14/08 34
 Pulpal protection
 However, with improvements in dentin adhesives,
the use of glass-ionomer under composite
restorations has been greatly reduced in recent
years.
 Be aware:
 Enamel walls
Should be kept
 Retentive grooves free of the liner
 Peripheral portion of gingival-dentin
walls

10/14/08 35
 Matricing and
wedging:
 Application of matrix may be essential especially with
chemically-curable composites, in order to:
 Protect the adjacent tooth against accidental acid etching.
 Establish proper contour.
 Prevent marginal overhangs that may cause gingival
irritation.
 Increase density and adaptation of the restoration by
pressure application on composite during its
polymerization that eliminate internal voids.

10/14/08 36
 Matricing and wedging:
 Prevent air-inhibited polymerization at the significant
surface areas by protection coverage of the
maturing resin.( When curing bonding layers or
composites, the outermost layer will remain
unpolymerized due to the inhibiting effect of oxygen
in the adjacent air (air-inhibited layer). This 3-20
micron thick layer will cure as soon as oxygen is
excluded. After adding all the increments, the outer
most layer will remain sticky due to this air inhibition.
This sticky layer is eliminated during finishing and
polishing operations).
 Improve surface texture of composites and leave
smooth as set surface that requires less finishing.
10/14/08 37
 Matricing and
wedging:
Different types of matrices are available including:
 The Mylar matrix strip.

 Celluloid crown form.

 The compound-supported and wedged dead-soft

metal matrix (suitable for compound cavities).

 The Howe circumferential plastic strip,

ready-made (suitable for large compound

preparations).

10/14/08 38
 Matricing and
wedging:
 Usually a wedge (wood wedge for chemically
curable composites, or a light-transmitting
plastic wedge for VLC composite) is placed
just gingival to this margin of proximal cavities
to:
 Hold the strip in position.
 Prevent a gingival overhang of the material.

10/14/08 39
 Matricing and
wedging

10/14/08 40
 Matricing and
wedging:
 Provide slight separation of the teeth
(pre-wedging):
Resin composite does not have the condensability
that permits amalgam to deform a matrix band and
maintain close adaptation to an adjacent tooth.
Placement of an interproximal wedge at the start
of the procedure is recommended to open the
contact with the adjacent tooth and compensate
for the thickness of the matrix band.
10/14/08 41