COMPOSITES IN PEDIATRIC DENTISTRY

ROLL NO. – 21277010001

Dr. Lopamoodra Das

Batch- 2018-2021
 CONTENTS
• INTRODUCTION
• COMPOSITION
• CLASSIFICATION
• PROPERTIES
• INDICATION AND CONTRAINDICATION
• ADVANTAGE AND DISADVANTAGE
• USES OF COMPOSITE
• TYPES OF COMPOSITE
• INNOVATIONS AND ADVANCES
• COMPOSITE AS SMART MATERIAL
 INTRODUCTION

Esthetic dentistry has shown much advancements in materials and technology since the last century .Over the
past two decades,there has been a substantial progress in the development and application of resin based
composites. Nowadays, composite resins are considered as an economical and esthetic alternative to other
direct and indirect restorative materials

According to Sturdevant :-
In material and science word composite refers to a solid
formed from two or more distinct phases that have been
combined to produce properties superior to or intermediate to
those of individual constituents.
Components Materials Functions

Resin matrix BisGMA,UDMA,TEGMA Highly viscous oligomers polymerize by cross-linking

and bind fillers

Filler Quartz ,colloidal silica Increase strength, decrease C.O.T.E and polymerization
shrinkages

Coupling agent Organosilanes Chemically binds filler particles and resin matrix

Polymerization inhibitors Butylated hydroxy toluene Increases shelf life and working time of chemically
cured resins
Initiators and accelerators i)initiator ;Benzoil peroxide Produces free radicals by depressing the dissociation
temperature, initiates polymerization
a. Chemical curing system ii)activator:N.N.DMPT
UVrays activate initiator and release free radical
   
Visible light rays activate initiator and release free
   
radicals
b.ultra-violet curing system i)initiator:benzoin methlyether
  ii)activator:UV;350nm
c.visible light curing system i)Initiator;camphoroquinone
ii)accelerator;DEA-EMA
III)Activator;Blue light of 468nm

UV absorbers Benzophenone Improve colour stability

 CLASSIFICATION OF COMPOSITES

According to Sturdevant
According to Skinners
Sturdevant made the classification according to the size of the
Based on filler particle size,
filler particles,
Traditional composites (Macrofilled) 8-12 µm
Megafill-1-2 nm
Small particle filled composite 1-5 µm
Macrofill – 10-100 µm
Microfilled composite 0.04 – 0.4 µm
Midfill – 1-10 µm
Hybrid composite 0.6– 1.0 µm
Minifill – 0.1-1 µm
Microfill – 0.01-0.1 µm
Nanofill – 0.005-0.01 µm

Based on method of curing,

Chemical Based On Consistency
Light Light Body- Flowable
U V Medium Body –Homogenous microfill, macrofill, midifill
 Visible Heavy Body- packable, minifill
Dual Cure
 Properties of composites
A) Linear Coefficient of Thermal Expansion (LCTE)
B) Water absorption.
C)Wear resistance Linear Coefficient of Thermal Expansion (LCTE)
D)Surface texture. Large differences between CTE of tooth and composite causes
expansion and contraction resulting in stress
E) Solubility.
F) Creep.
G)Configuration or C factor Creep
Surface texture progressive permanent deformation
H) Polymerisation shrinkage
Depends on the size & the composition of of a material under occlusal loading.
the filler particles. More is the content of resin matrix,
more is the creep.

Solubility
Inadequately polymerized composite resin has
greater water sorption and solubility ,which is Configuration or C factor
manifested clinically with early color It is the ratio of bonded surface of restoration to unbonded
instability. surfaces.Higher the C factor, more the polymerization shrinkage
Advantages:
Disadvantages:
1) Conservation of tooth structure
1) Increased cost and time.
2) Aesthetically acceptable
2) Technique sensitivity.
3) More precise control of contours and contacts.
3) Polymerization shrinkage
4) Biocompatibility and good tissue response.
4) Low wear resistance
5) Low thermal conductivity
5) High CTE and water sorption tendency
6) No galvanism

7) Extended working time

Indications:
Restoration of class I, II, III, IV, V, VI cavities Contraindications:
Esthetic enhancements Laminates,Veneers,Diastema
closure ,Tooth discolourations,Hypoplastic defects
1) Patient who do not maintain oral hygiene.
Foundations or core build-ups
2) Difficult moisture control.
Pit & fissure sealants 3) Teeth that experience heavy occlusal forces like
in bruxism and clenching.
Preventive Resin restoration
4) Teeth in which outline form includes marked
Resin Infiltration technique undercuts.
5) Teeth that show excess wear.
As cements
6) Teeth in which there are deep gingival margins
Misc-bonding of orthodontic brackets,splinting that have insufficient enamel for bonding

 
 Resin infiltration technique
It is a microinvasive novel approach
Pit and fissure sealants to prevent the progession of non
cavitated active carious lesions by
• Caries potential is directly related to shape and occluding the pores within the body
of the lesion which act as diffusion
depth of the pit and pathways for the acids and bacteria
fissures.
• The cariostatic properties of sealants are
attributed to the physical
obstruction of the pit and grooves.
• Sealants are the effective caries protective agents
and their
effectiveness should justify their routine use
as a preventive measure.
• Age range for sealant application-
3-4 years – primary molars
6-7years - 1st permanent molar
 Preventive resin restoration
 The preventive resin restoration(PRR) is an
alternative procedure for restoring
young permanent teeth that requires
only minimal tooth preparation for caries
removal but also have adjacent susceptible
fissures.
 PRR utilizes the invasive and non
invasive treatment of borderline or questionable caries.

 Light-curing composite or resin-modified glass ionomer

Preventive resin restoration

is particularly applicable
for young patients with
recently erupted teeth and
minimally carious pits and
fissure
 CLINICAL STEPS
Initial Clinical Procedures- complete examination , diagnosis, and
treatment plan be finalized before patient is scheduled for operative
procedures.. Review of medical complications and evaluation of radiographs
should precede each restorative procedures.
Acid etching & Dentin Bonding
Agent application
Preparation of the operative site – Cleaning the operating site with a
slurry of pumice to remove plaque, pellicle, and superficial stains.
Calculus removal if needed.
Insertion of composite material in
increments <=2 mm and light curing
Natural light is preffered for shade selection

Finishing of the restoration after 15

minutes and final polishing after 24 hours
Isolation by Rubber Dam ,cotton rolls with or without retraction cord

Tooth Preparation
 TYPES OF COMPOSITE
 Packable composites
Flowable composites
 Based on the newly introduced
Low Viscosity, flow readily, spread
uniformly, and intimately adapt to cavity concept, called PRIMM(Polymer
form, to provide desired dental anatomy. Rigid Inorganic Matrix Material).
Drawbacks:-  May allow more convenient
1) Decrease filler cause increase placement in posterior sites and easy
occlusal wear and shrinkage. establishment of contact points
 Less stickiness or stiffer viscosity
2) Mechanical properties inferior
than conventional composites, which
than Hybrid composites.
allow them to be placed in a manner
3) Sticks to the instruments. that somewhat resembles amalgam
placement.
 Promoted as amalgam alternatives

Ormocers
 Organically modified nonmetallic inorganic composite material
 Thermal coefficient of expansion similar to tooth.
 Low shrinkage,High abrasion resistance, Biocompatibility, Excellent
Esthetics.
 Compomers
 A polyacrylic-/polycarboxylic acid-modified composite.
 This glass acts as radio opaque substance and is also able to react with
carboxylic groups of dimethacrylate monomers and an acid base reaction
occurs similar to GIC
Silorane based composite  Composed of an ion-leachable glass embedded in a polymeric matrix.
 Silorane ring-opening monomers provided low 1) Less strength than composites but more than GIC
polymerization shrinkage. 2) Poorer esthetics than composites
 Silorane is used with self etching primer and
adhesive.
 Silorane based composite resin is based on the
silorane chemistry and does not contain
methacrylates.
Nano –filled composites
 Produced with nanofiller technology and formulated with
nanomers and nanocluster filler particles.
 The nanofilled composites present similar mechanical and
physical properties to those of microhybrid composites, but
when it comes to translucency, polish and gloss retention
they perform significantly better
 Giomer

Hybrids of glass ionomers and composites

Contains pre-reacted glass-ionomer (PRG) particles i.e,
Fluoro aluminosilicate glass reacted with polyalkenoic acid
Incorporated into silica filled urethane resin.
Light activated, require a bonding agent.
Antibacterial Composite Indications:-
1) Class I, II, III, IV and V restorations
• Chlorhexidine has been tried in an attempt to reduce plaque 2) Repair of fractured composite restorations
accumulation on the surface of filling materials. 3) Primary tooth restorations.
• Deterioration of physical and mechanical properties of the
materials.
• Imazato et al (1994) added newly synthesized monomer,
MDPB with antibacterial properties into the resin composite.
Silver has also been added in the composites to make it
antibacterial - ‘oligodynamic action’

Expanding matrix resin for composites

Spiro ortho carbonates added to combat the

polymerization shrinkage
 Coloured Composites
Gingiva-colored composite provides dental practitioners with
a versatile material that can be used to directly restore cervical
defects caused by gingival recession.

This, thus corrects the appearance of the gingival anatomy.

Fibre reinforced composites
It offers a treatment option that may increase patient
Fibre reinforced composites consist of fibre satisfaction through the provision of a cost-effective, minimally
material held together by a resinous matrix. invasive solution with highly esthetic results.
Due to translucent appearance of these materials no
masking materials are needed, which allows a thin
layer(0.5mm) of composite to be placed,which is
esthetic.
Improved mechanical properties
 Innovations and Advancements
COMPOSITE AS SMART MATERIAL

SELF HEALING COMPOSITES

SMART COMPOSITES The first self‑healing resin‑based synthetic
material has been developed byWhite et al.
 Light activated alkaline.
 Nano-filled glass restorative material
 Releases calcium, fluoride and hydroxyl ions when
intraoral pH values drop below the critical pH of 5.5 and counteract the
demineralization of the tooth surface and help in
Remineralization
 Class I and class II lesions in both primary and permanent teeth
 Excellent biocompatibility
 This response of ACP containing composites to pH can be described
as smart.
Bulk fill posterior composites
CENTION-N
 The materials can be applied in increments upto 4
mm in thickness.
 The bulk-fill resin composites are curable up to 4 •Cention N is an “alkasite” restorative. Alkasite
mm thickness, thus skipping the time-consuming refers to a new category of filling material,
layering process. which like compomer or ormocer materials is
 Good bond strengths regardless of the filling essentially a subgroup of the composite
technique and the cavity configuration are material class.
reported
 Improved self-leveling ability, decreased • This new category utilizes an alkaline filler,
polymerization shrinkage stress, reduced cusp capable of releasing acid-neutralizing ions.
deflection in standardized class II cavities •Cention N is a tooth-coloured, basic filling
material for direct restorations.
•It is self-curing with optional additional light-
curing.
 Ivocerin

•Like others, Ivoclar Vivadent searched for alternative photoinitiators and

succeeded in developing tailor-made visible light initiators based on germanium
compounds.
• Apart from demonstrating a more rapid polymerization process, composites
containing Ivocerin exhibit excellent bleaching behaviour and require a
considerably lower photoinitiator concentration to achieve comparable mechanical
properties

Ivoclar Vivadent AG, Report No. 19 Research and Development of Ivoclar Vivadent AG,
Ivocerin® – a milestone in composite technology, 2013
 CONCLUSION
“There is nothing permanent except change”
Heralictus

 Vastly improved bonding system and enhanced formulations of resin composites has resulted in
their increased durability and reliability in a wide spectrum of restorative procedures.

 Major emphasis for research on new reins for composites has been in the area of reduced
polymerization shrinkage and shrinkage stress.

 The future use of polymers in dentistry will undoubtedly expand, by the investigations of dental
manufacturers and researchers

Pediatric dentists should be aware of these innovative materials to enable their use and
utilize their optimal properties in day‑to‑day practice to provide quality and effective
holistic treatment.