CHANDRANI ADHIKARI

2ND YEAR PGT

DEPARTMENT OF CONSERVATIVE DENTISTRY AND
ENDODONTICS
GNIDSR
CONTENTS
 INTRODUCTION
 CLASSIFICATION & PROPERTIES OF COMPOSITE RESIN
 SELECTION OF MATERIAL
 FACTORS INFLUENCING COMPOSITE RESIN POLYMERIZATION
PROCESS
 POLYMERIZATION SHRINKAGE
 CUSPAL DEFLECTION
 ORIGIN OF POLYMERIZATION SHRINKAGE STRESS
 FACTORS AFFECTING POLYMERIZATION SHRINKAGE STRESS
 TECHNIQUE TO CONTROL POLYMERIZATION SHRINKAGE
 PLACEMENT OF COMPOSITE RESIN IN CLASS I, II, III, IV, V, VI
SITUATION
 SPECIAL CASES
 CURING LAMPS
 CONCLUSION
 REFERENCES
INTRODUCTION
Composite resins were first introduced in the 1960s
as a restorative material. Nowadays composite
restoration has become an essential part of everyday
dental practice with the improvement in dental adhesive
systems, the increase in patients’ demand for esthetics
and more emphasis on preservation of tooth structure.
The abrasion resistance and strength of dental
composites has continued to improve since their
introduction as dental restoratives, enabling expanded
use in posterior restorations with good longevity.
However, polymerization shrinkage and its associated
stress still remains a major drawback of dental
composite resin materials.
 CLASSIFICATION OF COMPOSITE RESIN AND INDICATION FOR USE
( PHILLIPS)

CLASS OF PARTICLE SIZE CLINICAL USE

COMPOSITE
Traditional 1-50 µm High stress areas

Hybrid (large particle) 1-20µm glass High stress areas requiring improved polishibility (Cl- I,
0.04 µm silica II, III, IV)
Hybrid ( midfiller) 0.1- 10 µm glass High stress areas required improved polishibility ( Cl- III,
0.04 µm silica IV)
Hybrid (minifiller/ SPF) 0.1 -2 µm glass Moderate stress areas requiring optimal polishibility (Cl-
0.04 µm silica III, IV)
Packable hybrid Midfiller/ minifiller Situations in which improved condensability is needed
hybrid, but with lower (Cl- I, II)
filler fraction
Flowable hybrid Midfiller hybrid, but Situation where improved flow is needed and /or where
with finer particle size access is difficult (class II)
distribution
Homogenous microfill 0.04 µm silica Low stress and subgingival areas that require a high
luster and polish.
Heterogenous microfill 0.04 µm silica Low stress and subgingival areas where reduced
Prepolymerized resin shrinkage is essential.
particle containing 0.04
µm silica.
TYPES OF RESTORATIONS AND RECOMMENDED
RESIN COMPOSITES (CRAIG’S)
TYPES OF RESTORATION RECOMMENDED RESIN COMPOSITE

CLASS I Multipurpose, nanocomposite, packable ,

CLASS II Multipurpose, nanocomposite, packable,

CLASS III Multipurpose,nanocomposite, microfilled, compomer

CLASS IV Multipurpose, nanocomposite

CLASS V Multipurpose, nanocomposite, microfilled, compomer

CLASS VI (MOD) Packable, nanocomposite

CERVICAL LESIONS Flowable, compomer

PEDIATRIC Flowable, compomer

RESTORATIONS
3 UNIT BRIDGE/ CROWN Laboratory (with fiber reinforcement)

ALLOY SUBSTRUCTURE Laboratory (bonded)

CORE BUILD UP Core

TEMPORARY Provisional
RESTORATION
 PROPERTIES OF COMPOSITE RESIN(PHILLIPS)
CHARACT UNFIL TRADITI HYBRID HYBRID MICROF FLOWA PACKABL ENAMEL DENTIN
ERISTIC LED ONAL ( SMALL (ALL ILLED BLE E HYBRID
PROPERT ACRYL PARTIC PURPO COMPO
IES IC LE) SE) SITE
Size(µm) -------- 8-12 0.5-3 0.4-1.0 0.04- 0.6-1.0 Fibrous --------- -----------
0.4
Inorganic 0 60-70 65-77 60-65 20-59 30-55 48-67
Filler
(vol%)
Inorganic 0 70-80 80-90 75-80 35-67 40-60 65-81
filler
(wt%)
Compres 70 250- 350- 300- 250- ------ -------- 384 297
sive 300 400 350 350
strength
(Mpa)

Tensile 24 50-65 75-90 40-50 30-50 --------- 40-45 10 52

strength
(Mpa)
 PROPERTIES OF COMPOSITE (cont.)
CHARACT UNFILL TRADITI HYBRID HYBRID MICROF FLOWABLE PACKABLE ENAMEL DENTIN
ERISTIC ED ONAL (SMALL (ALL ILLED COMPOSITE HYBRID
PROPERTI ACRYLI PARTIC PURPOS
ES C LE) E)

Elastic 2.4 8-15 15-20 11-15 3-6 4-8 3-13 84 18

modulus
(Gpa)
Thermal 92.8 25-35 19-26 30-40 50-60 --------- ---------- -------- ---------
expansion
coefficient
(ppm/ºC)
Water 17 0.5-0.7 0.5-0.6 0.5-0.7 1.4-1.7 ---------- ----------- --------- ---------
sorption
(mg/cm²)
Knoop 15 55 50-60 50-60 25-35 ---------- ----------- 350-430 68
hardness
(KHN)
Curing 8-10 -------- 2-3 2-3 2-3 3-5 2-3 ---------- ---------
shrinkage
(vol%)
Radiopaci 0.1 2-3 2-3 2-4 0.5-2 1-4 2-3 2 1
ty (mm Al)
CHARACTERISTIC OF COMPOSITE RESIN (CRAIG’S)
TYPE OF SIZE OF FILLER VOLUME OF HANDLING CHARACTERISTICS AND
COMPOSITE PARTICLES (µm) INORGANIC PROPERTIES
FILLER (%)
ADVANTAGES DISADVANTAGES
Multipurpose 0.04, 0.2-3.0 60-70% High strength, high
modulus
Nanocomposite 0.002-0.075 78.5 High polishibility,
high strength, high
modulus
Microfilled 0.04 32-50 Best polish,best Higher shrinkage
esthetics
Packable 0.04, 0.2-20 59-80 Packable, less
shrinkage, lower
power
Flowable 0.04, 0.2-3.0 42-62 Syringeable, lower Higher wear
modulus
Laboratory 0.04, 0.2-3.0 60-70 Best anatomy and Lab cost, special
contacts, lower equipment,
wear. requires resin
cement
RELATION OF FILLER SIZE TO FILLER LOADING IN
VARIOUS CLASSES OF COMPOSITE RESIN

COMPOSITE RESIN FILLER PARTICLE LOADING BY

SIZE (µm) WEIGHT (%)
Microfilled 0.04 50-60
Submicron hybrid ≤1 50-75
Micron hybrid 1-5 60-78
Heavy filled Various sizes 80-87
Large particle 5-10 + > 80

(Tooth Colored Restoratives- ALBERS)

(Tooth Colored Restoratives- ALBERS)
 ANTERIOR TOOTH

POSTERIOR TOOTH
Relation between filler loading by volume and stiffness
Selection of material
 Class III restorations-
Submicron composites are recommended, because-
They are-
 Radioopaque
 Have a good finish
 Durable to occlusal forces
 Have favourable coefficient of thermal expansion that
helps to maintain a good marginal seal.
 Class IV restorations-
 Small class IV restorations are best treated with a
micron or submicron hybrid.
 Large restorations involving an occlusal contact point
are best treated with a heavy filled material.
 To improve esthetics, these can be coated with a micron
or submicron hybrid.
 Where esthetics is a primary concern, coating the
surface with a thin microfilled veneer is advisable.
 Class V restorations-
 In small restorations involving dentin, and for patients
highly susceptible to caries, a modified resin glass
ionomer cement is good choice.
 In large restorations, a submicron composite is
recommended.
 If the patient smokes or drinks a lot of coffee, placing a
flowable microfill veneer over a submicron composite
reduces surface staining.
 In small non stress bearing restorations entirely in
enamel, traditional microfills may be successful.
Factors that influence the composite resin
polymerization process.
 Curing time- It depends on: resin shade, light intensity, box deep, resin
thickness, curing through tooth structure.
 Shade of resin - Darker composite shades cure more slowly and less
deeply than lighter shades (60 seconds at a maximum depth of 0.5 mm).
 Temperature -Composite at room temperature cure more completely and
rapidly.
 Thickness of resin -Optimum thickness is 1-2 mm
 Type of filler –Micro fine composites are more difficult to cure than heavily
loaded composites.
 Distance between light and resin -Optimum distance < 1 mm, with the light
positioned 90 degrees from the composite surface.
 Light source quality - Wavelength between 400 to 500 nm. A power density
about 600 mW/cm2 is required to ensure that 400 mW/cm2 reaches the
first increment of composite in a posterior box.
 Polymerisation shrinkage -Depends on the amount of organic phase.
POLYMERIZATION SHRINKAGE
Polymerization shrinkage is one of the
primary concerns when placing direct
resin based composite restorations.
Polymerization of dimethacrylate based
composite is always accompanied by
substantial volumetric shrinkage in the
range of 2-6%. During polymerization the
conversion of monomer molecules into a
polymer network results in a closer
packing of the molecules leading to bulk
contraction. and resulting destructive
shrinkage stress. Only a thorough
understanding of the mechanisms that
cause shrinkage stress and the
techniques that may reduce its effect will
allow clinicians to gain a better use of
resin composites.
Shrinkage stress
Clinically composite strain is hindered by the confinement
of the material bonded to the tooth; as a result, shrinkage
manifests itself as stress. It is widely accepted this condition
often results in heavily pre stressed restorations which may
have adverse clinical consequences such as-
 Polymerization contraction stress is transferred to the tooth
and cause deformation. This tooth deformation may result in
enamel fracture, cracked cusps and cuspal movement.
 Initiate adhesive failure, such gap between the resin and
cavity walls may cause post operative sensitivity,
microleakage and secondary caries.
 Initiate microcracking of the restorative material.
 Depends on size of the restoration and thickness of cavity
wall.
CUSPAL DEFLECTION
 Linear displacement of cusps is known as cuspal
deflection.
 It is measured by digital micrometer.
 Degree of cuspal deflection ranges from- 6 to 47 µm.
It depends on-
 Size of the restoration
 Cavity design
 Stiffness and flow of composite
 Placement technique
ORIGIN OF POLYMERIZATION SHRINKAGE
STRESS
•ORGANIC MATRIX
•INORGANIC FILLER
COMPOSITE RESIN •COUPLING AGENTS
•INITIATOR/ ACCELERATOR
SYSTEM

Bis-GMA/ UDMA blended with

ORGANIC MATRIX TEGDMA
ORGANIC MATRIX C=C
crosslink

Polymer network
 Composite resin polymerizes by free radical
polymerization
MONOMER POLYMER + HEAT
POLYMER :
 Resin matrix changes from pregel state to viscous
solid
 Decrease in molecular vibration and intermolecular
distance
 GEL POINT
[ Inside Dentistry, September 2007, Volume-3, issue-8 ]
Free radical formation
 Generation of free radical is brought about in 4 different
ways.
 In heat activated system,
Benzoyl peroxide heat Free radical
 In chemically activated system
Benzoyl peroxide tertiary amine Free radical
 In UV light activated system
Benzoin methyl ether 365 nm uv light source Free radical
 In light cured system
camphoroquinone + tertiary amine 468 nm light source
Free radical
Free radical formation by camphoroquinone
PREGEL STATE: no stress is conducted to surrounding
tooth structure.
When curing begins:
materials flows from unbounded surface to accommodate
shrinkage.
At Gel point– composite resin becomes more rigid

Flow stops & composite resin transmits shrinkage stresses

generated to the surrounded tooth.
STRESS > Cohesive strength of composite resin
↓
Damage occur within composite resin
STRESS > Tensile strength of enamel → enamel fractures
[ Inside Dentistry, September 2007, Volume-3, issue-8 ]
 Factors that affect polymerization shrinkage stress

• Curing-light guide placement (how far away from the surface it is.
• Intensity and wavelength of the curing light.
• Curing mode of the composite resin (light-cure or self-cure).
• Flow of the composite—early compensation before development
of significant modulus of material;
• Water sorption of the composite—a mechanism for
compensating for shrinkage and giving improved marginal
adaptation;
• Composition - composites with low filler increases shrinkage
(flowable vs restorative composites);
• Shade and opacity of the composite resin;
• Type of composite resin—flowable vs highly filled.
[ Inside Dentistry, September 2007, Volume-3, issue-8 ]
With the increase of distance between
the light guide and composite, power
density at the surface reduces Schematic representation of a 50%
reduction in light intensity in deeper
areas of a preparation
Light intensity drops at composite depth
Darker composite cure more slowly
LIGHT CURE V/s SELF CURE
 Self cure composite has better marginal adaptation
and less micro leakage than light cure ones.
 They have different polymerization shrinkage due to 2
intrinsic factors-
 Velocity of polymerization
 Porosity
 Lower velocity results in a better adaptation of the
restoration to the cavity walls, velocity of
polymerization might affect the flow capacity of the
resin composite.
Schematic representation of changes in restoration size that occur as
a result of polymerization shrinkage and subsequent water absorption
Flowable composite
 Flowable composite is a low viscosity composite, it can
act as stress absorbing layer .
 When the bulk of the cavity are coated with an elastic
layer, the bulk contraction of the restoration can gain
some freedom of movement from the adhesive sides.
 It also helps in equal contribution of stress over the
adhesive interface.
FACTORS RESPONSIBLE FOR POLYMERIZATION
SHRINKAGE STRESS
 Filler content
 Degree of conversion
 Elastic modulus
 Water sorption
 C factor

(Journal of Contemporary Dental Practice; vol-7, no.-4, Sept- 1, 2006)

TECHNIQUE TO DECREASE THE ADVERSE EFFECTS
OF POLYMERIZATION SHRINKAGE
 Altered light curing cycles
 Three sited light curing technique
 Incremental curing of composites- layering techniques
 Intermediate elastic bonding concept
 Stress breaking liners under composites.

[JIADS VOL -2; Issue 2, April- June, 2011]

STRESS CAN BE CONTROLLED BY-

 Controlled stress reduction

 Stress relief by other phenomenon

[JIADS VOL -2; Issue 2, April- June, 2011]

CONTROLLED STRESS REDUCTION-
 Application of a thick elastic bonding resin (1st stress
breaker layer).
 Application of a “low elasticity module” base- lining (2nd
stress breaker layer).
 Use of a multilayer technique (optimizing the
configuration factor).

STRESS RELEASE BY OTHER PHENOMENON-

 Deformation of the composite at the free surfaces, so
called “flow”.
 Elastic deformation of the restorative material

 Water sorption ( Hydroscopic expansion).

[JIADS VOL -2; Issue 2, April- June, 2011]
MANAGEMENT OF SHRINKAGE STRESS IN DIRECT
POSTERIOR RESTORATION
 Choice of materials
 Flowable composite
 Light curing and self curing
 Choice of restorative technique
 Facio lingual layering ( vertical)
 Gingivo occlusal layering ( horizontal)
 Three site technique
 Wedge shape layering (oblique)
 Successive cusp build up technique
 Bulk technique
 Centripetal technique
(Journal of Contemporary Dental Practice; vol-7, no.-4, Sept- 1, 2006)
Correlation between cuspal deflection and different
placement technique
 Youngchul Kwon et al (2012) done a clinical study in
order to see the effect of layering methods, flowable
composite liner on cuspal deflection and polymerization
shrinkage stress.
 GR I- Bulk filling with Z250
 GR II- Incremental filling with Z250
 GR III- Increment filling with flowable liner
 GR IV- Increment filling with silorane based composite P50
Dental Materials 28 (2012) ELSEVIER
RESULT-
 Cuspal deflection in incremental filling group was lower
than bulk filling group.
 The incremental filling group with flowable liner show
higher cuspal deflection than incremental group without
flowable liner.
 Silorane based composite showed less cuspal
deflection than other composites because they
polymerized with cationic ring opening mechanism
providing low shrinkage
CONTROL OF POLYMERIZATION SHRINKAGE
 ALTERED LIGHT CURING CYCLES
 Uniform continuous cure
 Step cure
 Ramp curing
 Delayed curing / Pulse delay cure
 HIGH INTENSITY CURING
 3 SITED LIGHT CURING TECHNIQUE
 C FCTORS
Relation between power density and diametral tensile strength
Plot of typical reduction in strain from curing in 2 separate
pulses over a 3 minute period
 C” Factors and polymerization contraction
 The configuration factor was introduced by Feilzer et al.
in 1987 and refers to the number of bonded surfaces to
the number of un-bonded surfaces in a dental restoration.
For example, for a class I preparation there would be 5
bonded surfaces and only 1 un-bonded surface; the net
result would be a c-factor of 5. With an increasing C factor
the developing curing contraction stresses of bonded
restorations (resin composites) increases too (Feilzer et
al. 1987).
 The developing curing contraction in a bonded restoration
generate stress on the bonded interface that are in
competition with the developing bond strength of the
setting restorative to the cavity surfaces, which may result
in (partial) debonding, marginal leakage and post-
operative pain (Davidson et al. 1984).
PLACEMENT OF COMPOSITE RESIN

BULK PLACEMENT OBLIQUE PLACEMENT CENTRIPETAL PLACEMENT

SPLIT HORIZONTAL INCREMENTAL

WEDGE SHAPE/ OBLIQUE PLACEMENT
Roopa R Nadig et al stated that-
 Microleakage is significantly decreases when placed in
increments than with bulk placement technique.
 Split horizontal technique showed least microleakage
followed by centripetal incremental technique and
oblique placement technique.
 At the gingival margin, there was no significant
difference in microleakage between centripetal
incremental and oblique placement techniques and
split horizontal technique showed least microleakage.
 Composite placed incrementally ensures more
complete curing. Incompletely cured composite
resins may release components into the oral
cavity that may be detrimental. The reason for
the reduced shrinkage with the bulk-curing
technique is obvious—uncured composite resin
does not shrink as much as completely cured
resin. A significant factor in the reduction of
curing effectiveness with a bulk-filling technique
is that, as previously discussed, light attenuates
while penetrating through the tooth structure.
As light passes through the tooth structure, it
drops dramatically from 500 mW/cm2 to 80
mW/cm2 when curing through 2.5 mm of tooth.
Eakle and Ito compared four incremental insertion
methods and noted that diagonal insertion was
best. Crim and Chapman reported that incremental
placement of composite resin was no more
effective than bulk placement in reducing leakage.
Coli and Brannstrom reported that in composite
resin restorations with bulk insertion, the number of
restorations with gaps was similar to a two-stage
insertion. Versluis and colleagues reported that
incremental filling techniques reduce cusp
movement in teeth with a well-established bond.
This brief and incomplete survey of the
investigations evaluating the bulk and incremental
insertion of composite resin reveals that neither
method consistently produces superior results.
Some report less leakage with the incremental
technique; others less with bulk placement.
Class V cavity and C factor

CLASS I CAVITY CLASS V CAVITY

PLACEMENT OF COMPOSITE
 The placement of composite is carried out
following the sequence as given below:
a) Shade selection
b) Cavity preparation
c) Pulp protection
d) Acid etching
e) Appling bonding agent
f) Placement of matrix
g) Restoration
h) Finishing
COMPOSITE RESTORATION MATERIALS
 Suitable liner
 Appropriate conditioning or etching liquids or gels
 Appropriate enamel and dentin primers with bonding
agents

EQUIPMENTS INCLUDES:
 Different types of burs
 Transparent wedges, matrix bands
 Small ball ended applicator
 Interproximal carver and condenser
 Finishing discs and cups
 Bard Parker No. 12 blade and handle.
Class I composite resin restoration
Class I composite resin restoration
Cont.
Hot dog technique
Class II composite resin restoration
1. Matrix application
a. Try- in the wedge and adjust as required
b. Remove the wedge.
c. Place the matrix band.
d. Place the wedge and firmly insert with the amalgam condenser.
e. Evaluate for proper seal with a sharp explorer.
f. Place the By Tine ring.
g. Burnish to form proper contours and contacts.
2. Etch the enamel for 20 seconds.
3. Thoroughly wash and air dry. Check for proper etch of the enamel as
indicated by the chalky white appearance of the enamel.
4. Etch the dentin for 5-10 seconds
5. Thoroughly wash and lightly air dry.
6. Blot away the excess moisture.
7. Apply the bonding agent and lightly air dry.
8. Light cure for 20 seconds.
9. Apply the light cured flowable compositeto the gingival, axial and
occlusal walls.The thickness of the flowable composite should no
exceed .5 mm.
Cont.
12. Light cure for 40 seconds.
13. Apply composite to form the proximal contact and occlusal
morphology. Remove the excess from the accessible margins.
14. Light cure for 40 seconds.
15. Remove the occlusal excess with the C375F finishing bur.
16. Remove the lingual gingival excess with the #12 blade.
17. Form the lingual and occlusal embrasures with the #12 blade.
18. Remove the facial gingival excess with the #12 blade.
19. Form the facial and gingival embrasures with the #12 blade.
20. Accentuate and smooth the occlusal morphology with the 7801
finishing bur.
21. Smooth and polish the occlusal surfaces with the medium and
fine Ultradent points.
22. Polish the occlusal with the polishing brush.
Class III Composite resin restoration

1. Cavity is prepaped.
2. Shade for the restoration using shade tabs is selected.
3. Trial build- up is done with the selected composite materials
and get approval from the patient if the restoration is in an
esthetic area.
4. Build- up material is removed.
5. The rubber dam is placed.
6. Pumice, wash and dry teeth.
7. Protect Adjacent tooth with matrix band.
8. Etching solution to enamel and dentin for 20 sec is applied.
9. Wash for 10 sec and air dry. Check for chalky white
appearance to the etched enamel
10. Bonding agent with applicator is applied.
11. Gently air dry to remove the solvent.
Cont.
12. Light cure for 20 sec.
13.Composite is applied from facial or lingual surface (surface
with greatest access).
14. Remove excess and contour.
15. Pressure is applied to matrix band on lingual (facial) with
finger to form lingual (facial) contour of restoration and limit
excess.
16. Check to see excess material has been pushed toward
facial (lingual). Add material as needed and remove excess
and contour.
17. Matrix is wrapped around facial (lingual) surface.
18. Cure for 40 sec.
19. Matrix band is removed.
20. Examine from lingual, facial and incisal to verify that proper
contours have be established with a little excess to allow for
finishing. Add composite as needed.
Cont.
21. Remove excess and establish contour on lingual with
C379F (football shape) finishing bur.
22.Gingival excess is removed and establish correct
gingival and lingual embrasure form with #12 blade.
23. Gingival and incisal excess is removed and establish
correct gingival and facial embrasure form with #12
blade.
24. Excess is removed and establish contour on facia l
with medium Sof-Lex discs.
25. Wedge is placed to gain separation.
26. Smooth and polish proximal contact and embrasures
as needed with finishing strips going from course or
medium to X- fine.
27. The restoration is evaluated for proper contours,
surface finish and marginal integrity.
Cont.
 Modify as required to obtain proper margins and
contours. If minor surface defects appear they can
be corrected by following the following procedure.
a. Remove the defective area with a small (1/2 or 1) bur.
b. Clean by etching with acid.
c. Wash and dry.
d. Apply bonding agent.
e. Light cure.
f. Finish surface.
28. Remove rubber dam.
29. Check occlusion, both centric and excursive, with
articulating material and adjust as need with the
C379UF finishing bur.
Large Class III preparation requires at least
Correct use of proximal strip
3 layers of composite to minimize the
to finish class III restorations
polymerization shrinkage
Composite resin restoration in class III cavity

1 2 3

4 5
Cont.

6
7

8 9
Cont.

10 11

12
Class IV composite resin restoration
1.Select shade for the restoration using shade tabs.
2. Do a trial build- up with the selected composite materials and get
approval from the patient.
3. Remove build- up material.
4. Place the rubber dam.
5. Pumice, wash and dry teeth.
6. Protect adjacent tooth with matrix band.
7. Apply etching solution to enamel for 20 sec.
8. Wash for 10 sec and air dry.
9. Apply etching solution to dentin for 5-10 sec.
10. Wash for 10 sec., remove excessive water with air and vacuum
then dry with cotton pellet.
11. Apply bonding agent with applicator.
12. Light cure for 20 sec from lingual and facial.
13. Support matrix band on lingual with finger to form lingual
contour of restoration.
Cont.
13.Support matrix band on lingual with finger to form lingual contour of
restoration.
14. Place 1st increment of composite resin(usually dentin shade and
opaque) to form lingual wall.
15. Cure for 20 sec. from the facial and 20 sec. from the lingual.
16. Remove matrix band. Wedge may be replaced if separation is
required to help establish contact.
17. Place 2nd increment of composite (usually dentin shade) to
establish contact and internal bulk. Internal shades should be
established at this time.
18. Cure for 20 sec. from the facial and 20 sec. from the lingual.
19. Place 3rd increment of composite (usually enamel shade) to
establish facial form and incisal form. Incisal translucency would be
established as required.
20. Cure for 40 sec from the facial.
Cont.
21. Examine from lingual, facial and incisal to verify that proper
contours have be established with a little excess to allow for
finishing.
22. Remove excess and establish contour on facial and incisal with
courses Sof-Lex discs.
23. Refine the facial contours with the 7901 finishing bur. Remove
excess and establish contour on lingual with 9406 (football shape)
finishing bur.
25. Remove gingival excess and establish correct gingival, lingual,
facial and incisal embrasure form with #12 blade.
26. Evaluate for marginal excess and proper contours from facial,
lingual & incisal. Modify as required to obtain proper margins and
contours.
27. Separate from adjacent tooth, if bonded, with instrument like
binangle chisel by wedging and rotating the instrument. Warn
patient that they may hear a slight cracking sound and that it is not
the tooth or filling.
Cont.
28.Maintain slight separation with wedge.
29. Smooth and polish the proximal contact and embrasures
with finishing strips.Course to x-fine.
30. Smooth and finalize contours on the facial and incisal
surfaces with medium Sof-Lex discs.
31. Polish facial and incisal with the fine and x-fine Sof-Lex
discs.
Class IV composite resin restoration
Class IV composite resin restoration
Cont.
Cont.
Class V carious lesion
Class V composite resin restoration
1. Etch the enamel for 20 seconds.
2. Wash and thoroughly dry
3. Check the etched enamel to insure it is chalky white in
appearance.
4. Etch the dentin for 5-10 seconds.
5. Wash and lightly dry with air.
6. Remove the remaining water by blotting the area with a cotton
pellet until it is free of moisture.
7. Apply the bonding agent.
8. Gently air dry
9. Light cure for 20 seconds.
10. Apply the 1st increment of composite to cover the axial wall into
the gingival undercut and the incisal margins.
11. Light Cure for 40 seconds.
12. Apply the 2nd increment of composite to cover the gingival
margin and finalize the axial contours.
Cont.
 If it is a large restoration then 3 increments of composite should
be used.
 The 1st increment should cover the axial wall into the gingival
undercut and the incisal margin.
 The 2nd increment should cover the axial wall and create the
axial contours, but not extend over the gingival margin.
 The 3rd incurrent should cover and seal the gingival margin.
13. Light cure for 40 seconds.
14. Evaluate the restoration to insure it is slightly over-contoured so
that the final contours can be developed when finishing.
15. Contour and remove most of the excess from the marginal areas
with the 7901 finishing bur.
16. Remove the proximal and gingival excess with the #12 blade.
17. Finalize the contours and remove excess at the margins with the
course (green)Ultradent cup.
18. Smooth and polish with the Ultradent medium (yellow) and fine
(white) cups.
 Finished Finished preparation
preparation

Single layer Single layer pre cure

pre cure

Single layer Single layer post cure

post cure

Contraction gap not Contraction gap not desirable

desirable but acceptable but not acceptable
Placement of retentive groove just inside
the cavosurface margin of a class V
preparation
CLASS VI CAVITY
Anterior restorative treatment
Diastema closure
Bond strength of composite resin to enamel, dentin and
cementum
 Shear bond strength of composite resin (Scotchbond
Multipurpose) to enamel = 26.8 ± 5.2 Mpa.
 Shear bond strength of composite resin (Scotch bond
Multipurpose) to dentin = 25.5 ± 7.5 Mpa.
 Tensile bond strength of composite resin after 30 sec of acid
etching = 17.8 ± 8.2 Mpa.
 Micro shear bond strength of composite resin to cementum =
23.4 ± 7.2 Mpa.
Richard B. Price et al (2000) : Effect of composite
thickness on shear bond strength to dentin.
The study compared the 24 hour in vitro shear bond
strength of 2mm and 5mm increments of 2 condensable
(Alert and Predigy) composite and 1 conventional
composite (Z100) resin when bonded to dentin.
Result-
 Shear bond strength to dentin of Z100, Alert, Predigy
composites tested were much more lower when cured in
a 5 mm increment than when cured in 2mm increment
of composite.
 Condensable composite did not have a greater bond
strength to dentin than the conventional composite
when polymerized in a 5 mm bulk increment.
( J Can Dent Assoc 2000; 66: 35-9)
Mario Fernando et al (2008) : Micro tensile bond strength
of adhesive systems to dentin with or without application
of an intermediate flowable resin layer.
Scotchbond Multipurpose, Single bond, Adper Prompt,
Clearfil SE Bond used.
RESULT:
The effect of a low viscosity, flowable resin layer
application on micro tensile bond strength was material
dependent and increased the adhesion of all materials
but only Clearfil SE Bond was significantly increased.

(Braz Dent J (2008) ; 19 (1) : 51-56)

CURING OF COMPOSITES
After discontinuation of chemically cured composites,
various types of lights has been used to cure composites.
Light allowed ‘cure on demand’ feature, which is not
available with self cure composites. A light curing unit with a
minimal light output of 550 lux is considered appropriate for
dental use.
FACTORS THAT AFFECT LIGHT CURING
COMPOSITE
 Lamp output intensity
 Exposure time
 Distance from light source to material
 Thickness of resin
 Curing through the tooth structure
 Temperature
 Angle and path of light
 Shade of the resin
 Type of filler
 Amount of photoinitiator
DEPTH OF CURE
 Light intensity and scattering in resin composite
reduces the power density and degree of
conversion (DC) exponentially with the depth of
penetration.
 As light passes through the tooth structure, it drops
dramatically from 500 mW/cm2 to 80 mW/cm2 when
curing through 2.5 mm of tooth.
 Curing depth is 2-3mm.
 Light attenuation vary considerably from one type
of composite to another. It depends on-
 Opacity
 Filler size
 Filler concentration
 Pigment shade
Light is absorbed and scattered as it passes through tooth
structure, especially dentin thereby causing incomplete
curing in such critical areas as proximal boxes. When
attempting to polymerize the resin through tooth
structure, the exposure time should be increased by a
factor of 2-3 to compensate for reduction in light
intensity.
DEGREE OF CONVERSION
 DC is a measure of the percentage of carbon
carbon double bonds that have been converted to
single bonds to form a polymeric resin.
 Higher the DC, better the strength, wear
resistance.
Conversion of monomer to polymer depends
upon-
 Resin composition
 The transmission of light through the material
 The concentration of sensitizer
 Initiator and inhibitor
LIGHT CURE UNITS
Various modalities of light and light curing
units are-

 Ultraviolet Light Cure Units

 Quartz Tungsten Halogen (QTH)
 Light emitting diode (LED)
 Plasma arc curing (PAC)
 Argon laser
Ultraviolet Light Cure Unit
 It utilizes the polymerization process accomplished by
the energy derived from the ultraviolet light in the
range of 365 nm.
 Benzoin ether type compounds were as photoinitiator.

DISADVANTAGES:
 Prolonged exposure time (90 seconds)
 Harmful effects of UV radiation to human eyes.
QUARTZ TUNGSTEN HALOGEN (QTH)
 QTH devices are the most widely used light curing unit.
 Contain a quartz bulb with a tungsten filament in a halogen
environment.
 The units irradiate both UV and white light that must be filtered to
remove heat and transmit light only in the violet blue region of the
spectrum that matches the photo absorption range of
Camphoroquinone.
 Less than 0.5% of the total light produced in a QTH is suitable for
curing, and most is converted to heat .
 To minimize the heating, UV and infrared band pass filters are
inserted just before the fiber optic system.
 Orange filters are widely used because they are complementary to
blue and adsorb blue radiation.
 Usually, filters degrade with time due to the heating and cooling
cycles. QTH curing light work at wave lengths of 400 nm -500nm
with out put ranging from 400 mW/ cm² to 800 mW/ cm².
 Halogen bulb usually last for 50 hours and had to be replaced.
ADVANTAGES-
 Easy to install
 Relatively inexpensive

DISADVANTAGES
 Slower curing time (40-60 sec)
 Units are relatively large and cumbersome
 Lights(bulbs) decreases in output with time and thus
need frequent replacement.
 Have low energy performance and generate high
temperatures.
 Require filter and ventilating fan.
LIGHT EMITTING DIODE
 Solid state light emitting diodes (LEDs) use junctions of
doped semiconductors (p-n junctions) based on gallium
nitride to emit blue light.
 The spectral output of blue LEDs falls between 450-490
nm, so these units are effective for curing materials with
camphoroquinone photo initiators.
 They donot require filters because they can emit light at
a specific wavelength within the range of 400-500nm..
 All the emitted light is useful, resulting in high energy
performance of the curing light.
 The spectral output falls between falls between 410nm
and 490nm
ADVANTAGE-
 These units shows a constant effectiveness without any drop
in intensity with time because the diodes donot require
frequent replacement.
 Cooling fan is not required.
 Depth of curing with LED units is higher than QTH.
 LED unit has no bulb or filter that require maintainance.
 It has the potential lifetime of 10000 hour.
 Some units have integrated microprocessor to control the
light intensity which remain constant at all times, irrespective
of whether the battery is freshly charged or already running
down.
DISADVANTAGES-
 Battery must be recharged.
 Cost more than conventional halogen light.
 Curing time is slower than that of plasma arc curing lights.
PLASMA ARC
 High intensity light curing units(900mW/ cm²).
 Have more intense light sources (fluorescent bulb-containing
plasma), allowing for shorter exposure times.
 Light is obtained from an electrically conductive gas (xenon)
called plasma that forms between two tungsten electrodes
under pressure.
 The light spectrum provided by plasma is limited. The wave
length of high intensity light emitted is determined by the
bulb-coating material and filtered out to minimize
transmission of infrared and UV energy and to allow emission
of blue light. This also helps remove the heat from the
system.
 High intensity light is available at lower wavelengths, these
units are able to cure composites with photoinitiators other
than camphoroquinone.
 An exposure of 10 sec of PAC = 40 sec from QTH
 Work at wavelengths between 370nm - 450nm
ADVANTAGES
 These units have high energy output and short curing
time.
 Higher conversion rate and depth of cure than QTH.

DISADVANTAGES-
 Heat production must be controlled.
 Expensive.
 Lamp replacement is costly.
 Devices are large, heavy, bulky
 Low energy performance.
 Filters and ventilating fans are required.
ARGON LASER
 Emitted wavelength of laser depends on the material
used. (Argon produces blue light having the highest
intensity 800mW /cm² and wavelength of 490 nm.)
 Donot require filters, requires short exposure time for
curing composites.
 Generate little infrared output, not much heat is
produced.
 As laser is a narrow beam of coherent light, no loss of
power over distance occurs as in seen in QTH units,
therefore Argon laser is unit of choice for inaccessible
areas.
 The intensity of laser required for curing is 250± 50mW.
ADVANTAGES-
 Curing time is very short.
 Polymerization is uniform and is not affected by the
distance between the material and light source.
 Uniform depth of cure.
 Degree of conversion of materials of all the shades is
higher when cured by lasers as compared to the
conventional halogen light.

DISADVANTAGES-
 Curing tip is small, more time is required to cure
composite.
 Narrow spectral output.
 Expensive
 Size and weight of these units are very large.
RADIOMETER
 The light intensity and output of a light
curing unit can be monitored using a
portable or chairside buildin
radiometer. A radiometer measures
the number of photons, per unit area,
and unit time through a standard 11
mm diameter window. Usually a
minimal output higher than 300 mW/
cm² is recommended.
 It also measures all light energies and
cannot discriminate the light energy of
the photoinitiator, limiting the
measurement of the real value.
 Polymerization is initiated when a critical concentration
of free radicals is formed. This requires that a particular
number of photons be absorbed by the initiator system,
which is directly related to the wave length, intensity and
the time of exposure. QTH lamps emit a radiant power
density that ranges from approximately 300-1200
milliwatts/ cm² (Mw / cm²) in the violet blue region.
 For maximum curing, which is about 50%- 60%
monomer conversion, a radiant energy influx of
approximately 16000 millijoules /cm²(16 joules /cm²) is
required for 2 mm thick layer of resin. This can be
delivered by a 40 sec exposure to a lamp emitting 400
mW/ cm² .
 Thus increasing the power density of the lamp increases
the rate and degree of cure.
 Hofmann N et al (2002) conducted a study comparing
commercially available light-emitting diode (LED) lights with
a quartz tungsten halogen (QTH) unit for photo-activating
resin-based composites (RBC). Shrinkage strain kinetics and
temperature within the RBC were measured simultaneously
using the 'deflecting disc technique' and a thermocouple.
Surface hardness (Knoop) at the bottom of 1.5-mm thick
RBC specimens was measured 24 h after irradiation to
indicate degree of cure. Irradiation was performed for 40 s
using either the continuous or the ramp-curing mode of a
QTH and a LED light (800 mW cm(-2) and 320 mW cm(-2),
respectively) or the continuous mode of a lower intensity
LED light (160 mW cm(-2)).
RESULT-
Definite (containing an additional photo-activator
absorbing at lower wavelength) lower hardness was
observed after LED irradiation. The temperature rise during
polymerization and heating from radiation were lower with
LED compared to QTH curing. The fastest increase of
polymerization contraction was observed after QTH
continuous irradiation, followed by the stronger and the
weaker LED light in the continuous mode. Ramp curing
decreased contraction speed even more. Shrinkage strain
after 60 min was greater following QTH irradiation compared
with both LED units (Herculite, Definite) or with the weaker
LED light (Z250).

( Eur J Oral Sci. 2002 Dec;110(6):471-9)

LIGHT CURING TECHNIQUE
 Soft Start
 High intensity
 Soft Start-
Low intensity curing is utilized initially followed by a
high intensity curing. Various light curing units
automatically provide one or more soft start exposure
sequences. Some produce a 100 mW /cm² output for
10 secs followed by an immediate increase to 600 mW/
cm² output for 30 secs.
 Soft Start polymerization is divided into 3 techniques-
 Stepped
 Ramped
 Pulse Delay
 High intensity-
High intensity curing allows for shorter exposure
times for a given depth of cure. A depth of 2.0 mm can
be cured in 10 secs. With a PAC light and 5 secs with
Argon laser curing light, as compared with 40 secs by a
QTH lamp. A high intensity curing initiates a multitude of
growth centers during an initial irradiation period along
with final polymer with higher cross link density.
DISADVANTAGES-
 Greater shrinkage stress
 Heat
 Result more cytotoxicity than a longer curing time with
lower intensity.
EXTRA ORAL CURING-
It is used for the fabrication of indirect composite
restorations that are processed in the laboratory. These
light curing units work with various combinations of light,
heat, pressure and vacuum to increase the degree of
polymerization and wear resistance of composites. It is
reported that laboratory units, which provide light curing
in conjunction with heat and nitrogen pressure, result in
a significant increase in hardness and tensile strength of
composites.
Ocular Hazards of Curing lamps
 The blue light used to polymerize composite is not well
tolerated by the human eye. All light cured polymerization
systems use light that is harmful to vision.
 A number of studies show that blue light is damaging to
retina.
 Blue light forms free radicals in the eye, just as it does in
composite resins. However, in the retina, these free radicals
react with the water content of cells, causing peroxides to
form in the visual cells. These peroxides are reactive and
denature the delicate photoreceptors of the eye.
 Researchers estimate that blue light is 33 times more
damaging to the photoreceptors of the retina than is UV
light.
Eye protection
 Cover the curing site with the hand of clinicians.
 Covering the curing field with the reflective side of a
mouth mirror
 Coloured plastic glasses and handheld shields are
available, usually red and orange, as they can block
blue light.
 Any protective eyewear should transmit less than 1%
of wave lengths below 500 nm.
CONCLUSION
The use of composite restoration is increasing
because of the benefits accrued from adhesive
bonding to tooth structure, esthetic qualities and most
universal clinical usage. When done properly, a
composite restoration can provide excellent service for
many years. However, composite restorations are
more difficult and technique sensitive to operative
ability than amalgam restorations. Judicial selection
and use of composite resin, careful control of
polymerization shrinkage and effective placement
techniques can be used to create more predictable and
esthetic direct resin based composite restorations.
REFERENCES
 Inside Dentistry; Sept 2007, vol-3 , issue-8
 Dental materials; Elsevier, 2004
 Dental materials; Elsevier, 2012
 JIADS; Vol-2, issue-2, April- June 2011
 Med Oral Patol Oral Cir Bucal 2006; 11
 Tooth Coloured Restoratives- ALBERS
 Text Book of Operative Dentistry- Vimal K Sikri
 Craig’s Restorative Dental Materials 12th edition
 Dental Materials- Phillips 11th edition
 Operative Dentistry : Sturdevant, 4th edition