Dental composite in advanced restorative dentistry Flashcards
Advanced uses of resin composite
Polychromatic conformative restoration Altering morphology (veneering/bonding) Occlusal rehabilitation (reorganisation) Repairing failed composite and ceramic Tooth splinting and temporary bridges
Resin composite ideal properties
Perfect colour match High polishability and durable finish High wear resistance Low shrinkage and good radiopacity Compatible with all bonding agents Range of handling characteristics for different clinical situations
Restorative composite selection based on choice of
Shades and opacity Filler composition Physical properties Handling characteristics Cost
Greater complexity of composite selection =
Greater time and cost
Restorative composite classification
Classification by filler:
- macrofilled
- micro-hybrid
- continuum filled
- nanofilled
Macrofilled composite
Amorphous silica (35-63%)
Average particle size 0.04 µm
Examples: Heliomolar (vivadent)
Micro-hybrid composite
Glass particles and microfillers (>80%)
Average particle size 0.4-0.8 µm
Examples: EsthetX (Dentsply) or Point 4 (Kerr)
Continuum filled composite
Zirconia/ silica (87%)
Average particle size 0.01-3.5µm
Examples: Z100 and Z250 (3M ESPE)
Nanofilled composite
Zirconia/ silica nanofillers and clusters
Average particle size 5-20nm Zr/Si or 75nm Si
Examples: Filtek Supreme XT (3M ESPE) or Ceram.X Dentsply
Composite selection by complexity
Universal “Every day” composites Dual opacity composites Polychromatic layered composites Tints, opaquers, intensives and opalescents
Universal composites
“Every day” use for small cavities Limited shade sub micron hybrids -Spectrum TPH -Dentsply -Prodigy -Kerr -Z100 -3M ESPE -Charisma -Heraeus Kulzer
Dual opacity composites
Provide a range of dentines and enamels in “vita
classic” matched shades
Low cost introduction to layered multi colour
techniques
Excellent cosmetic results in selected cases
-Ceram.X Duo (Dentsply)
-Vanus (Heraeus Kulzer)
Layered composites examples
Multi-opacity systems
- Esthet-X
- Dentsply
- Premise & Herculite
- Kerr
- Miris
- Coltene
- Enamel HFO
- Micerium
- Filtek Supreme XT
- 3M ESPE
Layered composites
Kits are complex and costly Two or more levels of opacity Intensive and translucent shades Some shades may never be used! Training required to achieve best results Special instruments used for placement
Filtek Supreme XT (3M ESPE)
Four opacities in 34 vita based shades
Carefully refined shade matching
Mechanical properties of hybrid composites
Outstanding polishability similar to microfills with
good retention of surface finish
Excellent handling characteristics
Very high wear resistance
Multi shade approach
Supreme WE to form halo Supreme A2 Dentin n Supreme GT Supreme Body A2 Supreme YT
Enamel plus HFO
Dentine and enamel base shades Intensives and opalescent shades Slight “slumpy” handling Shade guides match optical properties of the resins Steep learning curve Training and practice needed for optimum results
Anterior layered build technique
Diagnosis - cosmetic trial and/or imaging Preoperative wax up or index Shade and characterisation assessment Tooth preparation Index build palatal, proximal and incisal enamel Multiple dentine shades and intensives Labial enamel, contour and polish Possible revision at review
Shade assessment (Vanini method)
- Base chroma (dentine shades)
- Value (enamel shades)
- Intensives (diffuse/opaque white)
- Opalescents (translucencies)
- Characterisations (Halos, cracks,
banding)
Finishing Systems
Fine Diamonds and TC finishers -finishing bur kits (Schottlander) Polishing discs -SofLex (3M ESPE) Smoothing and high gloss -enhance kit (Dentsply) Fast gloss polishing -occlubrush (Kerr)
Composite to composite repair
Bond strength dependent on adhesive and structure of aged composite* -prime and Bond NT (Dentsply) -optibond solo (Kerr) Clinical studies lacking on longevity Viable option for small fractures and margin failures in large restorations
Ceramic repair
Heterogeneous ceramics (leucite/ feldspathic) can be HF acid etched -reliable high strength bond with silane coupling and appropriate resins Low fusing homogenous ceramics: alumina and zirconia cores can not bonded If in doubt use CoJet silicoating and silane -highly successful with combined metal and ceramic exposures.
Single composite retained bridges
Composite and pin retained denture tooth
Resin bonded extracted natural tooth
