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Direct Placement =
directly into the cavity preparation
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Common materials for direct placement:
- Composite resin
- Glass ionomer cement
- Resin-modified glass ionomer cement-Hybrid ionomer
- Compomer
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Restorative Classification for Class I:
- Lingual/Occlusal

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Restorative Classification for Class II:
- Posterior interproximal

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Restorative Classification for Class III:
- Anterior interproximal

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Restorative Classification for Class IV:
- Anterior Incisal edge

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Restorative Classification for Class V:
- Cervical/gum line

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CuspRestorative Classification for Class VI:
- Cusp

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Composite Material Properties:
- Restorative material is tooth colored: may be in various shades or one universal shade.
- Some build-up materials come in colors like blue or gray.
- Material is usually a putty like consistency
- can be flowable
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Composite Benefits:
- Esthetics……looks great!
- Acid etching and bonding agents improve retention
- Less tooth structure is removed when making cavity preparation than with amalgam…..sometimes small enough to not need anesthetic
- More thermal insulation than with amalgam
- Less microleakage due to bonding
- No mercury
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Direct:
material packed (condensed) directly into a prepared cavity while in a plastic or putty-like consistency.
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Esthetic:
tooth colored to match, pleasing to the eye.
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Restoration:
Returning the tooth to original condition and function.
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FIVE Direct Esthetic Restorative Materials:
- 1.Unfilled Acrylic Resins
- 2.Composite Resins Most commonly used
- 3.Silicate (Porcelain)
- 4.Glass Ionomers
- 5.Compomers (hybrid of two dental materials: dental composites and glass ionomer cement and Fl2)
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How should composites be stored:
- need to be stored away from heat and away from light
- the refrigerator is best.
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What does “Filled” composites mean?
- “Filled” = Macrofilled / Microfilled / Nanocomposites
- Improvements: Filler particle size has decreased
- # of filler particles has increased
- Therefore shrinkage upon polymerization has decreased
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What does “Unfilled” composites mean?
- “Unfilled” = PF Sealants
- Flowable
- Low-viscosity
- Lightly filled
- ** materials that are lightly filled shrink more when polymerized, wear more readily, and are weaker
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Classification of Composites by Filler Size
Macrofilled composites:
- are the first generation of composite resin material.
- They are conventional composites containing the largest of the filler particles.
- Provide greater strength but have a duller, rougher surface, and they absorb stains more easily.

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Classification of Composites by Filler Size
Microfilled composites:
- were developed to overcome the problems that arose with the larger particle size.
- They contain much smaller particles, which makes them weaker; however, they polish to a glossy finish and do not absorb stain as easily.

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Classification of Composites by Filler Size
Hybrid composites:
- contain both large fillers and microfine fillers.
- They can be easily polished, have greater strength than the microfilled composites, and have a high wear resistance.
- Microhybrids use even smaller particles and contain a combination of small particles and microfine particles.
- Nanohybrids are microhybrids with nanosized particles added. The ability to add increased numbers of filler particles reduces the amount of resin, and they shrink less when polymerized.
Universal composites
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Classification of Composites by Filler Size
Nanocomposites:
- have filler particles that are about a thousand times smaller than conventional fillers.
- They have excellent polishability, wear resistance, and maintain their luster long-term.

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Unfilled Acrylic Resins:
- Not used any more for restorations
- Expansion and Contraction = Recurrent decay
- Powder is called polymer
- Liquid is monomer
- Polymerization or Curing
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Composite Resins:
- *most commonly used*Bulk-Fill [mixture of two or more materials]Available in two consistencies:Flowable and Viscous nanohybrids
- Joined together by a silane coupling agent
- Do NOT use liners/base with eugenol
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Eugenol:
oil extracted from cloves. (Most people associate smell with a dental office).
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Composite Resins uses:
- Restorative material for class III, IV, and V restorations (anterior fillings)
- Restorations in class I and II cavities (posterior)
- ‘Direct veneers’ (not as long lasting as indirect porcelain veneers)
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Composite Resins (Packable):
- Highly viscous microhybrids
- High volume of filler particles
- Posterior teeth restoration
- The high volume of filler particles gives this material a stiff consistency.
- ▪Packable = no longer popular but are still available on the market.
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Core Buildup Composite Resins:
- replace missing tooth structure
- bonded to tooth structure
- minimize bacterial leakage
- increase retention
- Heavily filled composites
- Can be:Light-cured, Self-cured,Dual-cured
- Cementation
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Physical Properties of Composites:
- Biocompatibility
- Strength
- Wear
- Polymerization shrinkage
- Degree of conversion
- Thermal conductivity
- Coefficient of thermal expansion (CTE)
- Elastic modulus
- Water sorption
- Radiopacity
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Strength:
Most of the composites used today are similar in compressive strength
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Wear:
Composites wear faster than amalgams
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Polymerization shrinkage:
matrix, when cured, usually shrinks away from the cavity walls. Curing in small increments (1 to 2 mm) decreases shrinkage
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Thermal conductivity:
close to natural tooth structure
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CTE:
is greater=undergo a greater change resulting in debonding and leakage
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Water sorption:
The greater the resin content, the more water is absorbed. Water softens the resin matrix, which gradually degrades the material.
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Elastic modulus (Young’s modulus):
The greater the volume of the filler, the stiffer (higher elastic modulus) and more wear resistant the restoration.
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Radiopacity:
Metals such as lithium, barium, or strontium are added to the filler to make the restoration more opaque
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Shade Guides:
- Color tabs used in shade selection
- Natural light source
- Drying out of teeth (desiccation)
- Mixing shades
- Shades should be selected while the teeth are wet
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Components of Composite Resins:
- Mixture of two or more materials
- Tooth-colored restorative materials
- Composition:
- Organic resin matrix
- Inorganic filler particles:▪glass, quartz, silica, and ceramic
- Silane coupling agent = adheres the particles to the matrix
- Initiators and accelerators =cause the material to set
- Pigments
- Resins are thick liquids made up of two or more types of organic molecules called oligomers
- Filler particles added to:
- produce strength
- reduce shrinkage
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Organic Resin Matrix?
- bis-GMA (bisphenol-A-glycidyl dimethacrylate) *most common
- UDMA (Urethane Dimethacrylate)
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Silane the Bonding Agent:
- Reacts with the inorganic filler and organic matrix to:
- Allow the two to adhere to each other=Good adhesion
- Has low viscosity (flows easily) and can wet the etched tooth
- Purpose is to improve retention
- Self-cured or Light-cured
- Surface is tacky, don’t wipe it off
- Supplied with the composite kit
- Applied AFTER acid etching
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Factors affecting Light-Curing?
- Short curing times
- Inadequate light output
- Wrong wavelength of light
- Incorrectly positioned light guide
Light-cured composite resins must receive the correct amount of radiant energy at the right exposure time and the right wavelength in order for them to polymerize correctly.
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Incremental Placement:
- Used in moderately sized or large cavity preparations
- Placed in small increments(no larger than 2 mm thick)
- Minimizes polymerization shrinkage
- Permits adequate curing(light might not penetrate if increments are too thick)
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Other Factors of Clinical Handling of Composites:
- Shelf life (2 to 3 years ) / refrigerator / covered in a light-protected container
- Dispensing and cross-contamination
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before placing composite restorations:
- Clean tooth with non-fluoride and oil free paste
- Isolate area to avoid contamination from water, saliva, or blood
- No oil in air syringe
- Do NOT use cavity liners with Eugenol….inhibits polymerization
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How do you Repair a Composite ?
- Small fractures in a composite can be repaired
- Repair of a new composite is optimum
- New composite repairs better than old composite:
- New composites have a like chemical union
- Finishing and polishing
- Surface sealers:
- unfilled resins
- reseal margins that might have opened
- by polymerization shrinkage happens to fill small voids
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Indirect-Placement Composite Resins:
- Laboratory-processed composites
- Materials for indirect composites:
- Conventional composite
- Fiber-reinforced composite
- Particle-reinforced composite
- Indirect chairside technique:
- CAD/CAM technology
- replica (die) or form of a digital impression
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Glass Ionomers:
- Use for cervically (Cl. V) eroded areas
- Fluoride releasing
- Chemically bonds with tooth
- Packaging:
- Hand-mixed powder and liquid
- Encapsulated powder and liquid
- Two-paste systems
- Sensitive to moisture uptake or loss during the first 24 hours of placement
- Not wear resistant watch polishing
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Glass Ionomer Restorations uses?
- For cementation of metal restorations and direct bonding of ortho brackets
- for class III and V restorations:
- as a liner and for dentin bonding; post and core and build-ups
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Glass Ionomer Restorations Advantages?
- Chemically bonds to tooth (chemical adhesion)
- May have fluoride in the powder (anticariogenic)
- Can be placed in moist environments.
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Hybrid (Resin-Modified) Ionomers:
- Hybrid of two dental materials: dental composites and glass ionomer cement
- Improved physical properties
- Dual cure materials
- Stronger than regular glass ionomers
- Easier to polish
- More wear resistant
- Fluoride release
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Nano-ionomers:
- Improved esthetics
- Increased wear resistance
- Improved polishability
- Fluoride release
- Nanoparticle technology has been applied to the hybrid glass ionomer cements to improve their physical properties
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Compomers:
- Are composite resins that have been modified with polyacid:
- The good qualities of the composite have been married with the fluoride release of the glass ionomer
- Fluoride release
- Light-activation chemicals included
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Giomers the Next Generation:
- New hybrid restorative materials
- Fluoride release at a slower and lower release than glass ionomers
- Can be recharged with fluoride toothpaste or mouth rinse to act as a fluoride reservoir
- Packaged as single paste syringes or flowables
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