Rena Vakay, DDS
Composite restorations were introduced in the mid-1950s.1Its evolution revolved mainly around the type and size of the filling.2Although, in general, the composite material performs well clinically, the potential for failure certainly exists. Annual composite failure rates in posterior teeth are 1% to 3%, and in anterior teeth failure rates are 1% to 5%.3Clinically, failure is mainly defined by recurrent caries or fracture of the restoration.4The causes of these failures are multifactorial. Volumetric shrinkage and microleakage are inherent in the material itself, and the lack of structural strength can be an issue in larger restorations. Factors such as the equipment used, operator training and technique, curing light ergonomics, patient habits and caries risk, location in the oral cavity and particle size are some of the variables that determine long-term success. .
This article will explore contemporary ways to reduce these risks and increase efficiency with composite restorations.
The technique used to place a composite material is fundamentally critical. Because each composite material has different physical and chemical properties, it is important for clinicians to follow the manufacturer's recommendations. Staying within the same resin system when placing restorations is also highly recommended as good practice.
To be mechanically retentive, traditional cavity preparations require greater sacrifice of tooth structure. The composite preparation lends itself to more conservative and minimally invasive preparations and the use of additive techniques. The conventional bonding technique involves laying the composite in incremental layers, which is time-consuming and labor-intensive. Composite layering is vulnerable to voids, seams, volumetric shrinkage, and cusp bending. These issues can contribute to the restore failing.
To reduce failures caused by composite layering, the block filling technique was introduced and has recently become more dominant in private practice.5for good reason. Efficiency is increased with the ability to place composites to depths of 4mm to 5mm.6The bulk-fill composite showed equal or improved qualities compared to the conventional technique, including less shrinkage, cusp deflection, polymerization stress and marginal gap, higher degree of conversion, and better flexural and fracture resistance.7
One of the most recent significant changes in technique is preheating the composite prior to placement. Preheating the material can increase the degree of monomer conversion and reduce the polymerization shrinkage force.7This creates a stronger compound and results in less polymerization stress. Preheating allows a more intimate adaptation of the composite to the preparation and facilitates the restoration of interproximal areas, traditionally difficult to adequately restore.
Many excellent bulk fill composites have been studied in the literature and are commercially available. Some of them include Tetric EvoCeram®Bulk Fill (Ivoclar Vivadent, ivoclarvivadent.com), SonicFill™(Kerr, kerrdental.com), e Filtek™Universal (3M Oral Care, 3m.com). Recently, a technique was perfected that incorporates the placement of block fill composites with a preheating technique to increase quality and efficiency.8This approach solves the ridge problem that can occur in interproximal areas and decreases composite placement time.
Other advancements aimed at simplifying the direct restorative process have involved composite technology that allows the clinician to limit shade choices without compromising esthetics (eg, Omnichroma, Tokuyama, tokuyama-us.com; Beautifil II Enamel Shades, Shofu, shofu.com ; admires Fusion x-tra, Voco, vocoamerica.com). Universal composites that are designed to match virtually any tooth color can reduce in-office shade selection time and also help dental practices reduce inventory and therefore overall costs, as fewer tooth colors need to be stocked. composites.9
When trying to restore tooth shape, the clinician is heavily dependent on an effective matrix system. The Tofflemire matrix system was introduced in 1946 and has been a popular system for amalgam and composite restorations for many years.10This system employs a screw-type retainer and thin stainless steel bands that are used with wedges of various sizes to space the teeth interproximally. This method allows for a tight contact area on the finished restoration.
Subsequently, various matrices have evolved to offer easier matrix placement, better light curing ergonomics, reduced chair time, and the ability to create improved restorative contours. Three types of matrices can be used: a matrix for interproximal surfaces, an occlusal surface matrix and a cervical matrix.
Posterior interproximal matrix systems are moving away from traditional Tofflemire-style stainless steel bands and retainers. Newer rear retainers are clip-shaped and can support a very thin or clear metal band. palodient®The BiTine ring (Dentsply Sirona, dentsplysirona.com) was one of the first of its kind, featuring a spring action that gently separates the teeth to provide the space needed to achieve proper contours. Garrison Dental Solutions (garrisondental.com) would soon follow with Composi-Tight®Sectional array system comprised of a natural contoured band and easy-to-use retention system. The company now offers several ring systems and sectional dies. A more recent entry, Waterpik®ClearView (Water Pik, Inc., waterpik.com), features an hourglass matrix system designed to increase visibility and access.
One of the newer matrix systems has transparent interproximal matrices for anterior and posterior restorations (Bioclear, bioclearmatrix.com). The anterior matrices are ideal for closing "black triangles" that can appear after orthodontic treatment or certain periodontal surgeries. Along with preheating the flowable and pasty composite, these matrices use injection molding to avoid interproximal bulges that can occur with the use of straight mylar strips.11
An occlusal matrix or stamp made of clear polyvinyl can be used to record the occlusal surface of the tooth prior to preparation.12This matrix is used near the end of completing a bulk fill restoration to help reduce procedure time and increase efficiency. A cervical matrix can be constructed in the same way and used to restore the cervical portion of the tooth.
Perhaps the most crucial step to the long-term success of a composite restoration, and perhaps the one that clinicians take for granted, is proper curing. Just as it is essential to follow the manufacturer's instructions in handling the composite, it is also essential with regard to light curing.
The characteristics of the composite material affect the time required for complete cure. Particle size, opacity due to color, photoinitiators and depth of preparation all influence the speed of cure. Light performance also depends on light maintenance. The tip of the light should be kept clear of debris and the performance of the light should be routinely validated by the clinician. One study found that when curing light performance and operator technique effects were considered, 30% of curing light/composite combinations failed to deliver even half the energy dose required by the light curing composite resin.13
To ensure the light is working properly, it should be tested regularly. Radiometers cannot accurately measure curing lights as radiometers only provide relative information.14A spectrometer is the recommended instrument for accurately measuring the output of a light source.15This instrument can be quite expensive and an economical alternative for doctors is to use a device like a check.™(BlueLight Analytics, bluelightanalytics.com). Through an application and a small device connected to a smartphone, a report is built with information on the intensity of light and the specific materials used.sixteen
Proper ergonomics are required to fully cure the composite. The restoration must receive direct light emission for the correct time as recommended by the manufacturer.
Clinicians can take simple steps to increase the success of composite restorations, such as knowing and following the manufacturer's recommendations for composite material and selecting the correct lumen and matrix. Perhaps most important is ensuring that the curing light is properly maintained and calibrated for proper output. These new techniques and products presented in this article support the goals of preserving tooth structure, increasing efficiency and providing superior patient outcomes.
About the author
Rena Vakay, DDS
Clinical Instructor, Kois Center, Seattle, Washington; Member of the American Academy of Restorative Dentistry; Member in Accreditation, American Academy of Cosmetic Dentistry; Editor of Restorative Section, Compendium of Continuing Education in Dentistry; Private Practice, Centreville, Virginia
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What is conservative and restorative dentistry? ›
Conservative restorative dentistry refers to management and treatments that maintain your teeth functional and healthy. These procedures include placing dental implants, fillings, crowns, and dentures. This type of dentistry is not exclusive to one area.What are the advances of composite? ›
Composite restorative materials are successful in modern biomaterials research, since they replace biological tissue in both appearance and function. The advantages of resin based restorative materials include tooth-like appearance, simplistic material manipulation and relative insolubility in oral fluids.What is the most widely accepted restorative material in dentistry today? ›
Direct dental restorative materials can be placed directly into a tooth cavity within one office visit. Amalgam remains the gold standard for durable restorations, although resin composites have shown reasonably long survival rates.What are the properties of composite dental restorative materials? ›
Composite resins are filled resin and have high compressive strength, abrasion resistance, ease of application, and high translucency.Why is conservative dentistry recommended? ›
A conservative dentist uses a different approach. They are more likely to recommend less invasive treatments like fillings or partial crowns. Restoring a tooth with fillings does not require altering its healthy structures, and it helps prevent further decay.What are the four basic types of advanced composites? ›
The advanced composites are replacing metal components in many uses, particularly in the aerospace industry. Composites are classified as per their matrix phase. These classifications are polymer matrix composites - PMCs, ceramic matrix composites - CMCs, and metal matrix composites - MMCs.What are 3 advantages of using composite materials? ›
- Composites have a high strength-to-weight ratio. Perhaps the biggest advantage of composites is their high strength-to-weight ratio. ...
- Composites are durable. ...
- Composites open up new design options. ...
- Composites are now easier to produce.
R The most common advanced composites are Polymer Matrix Composites .What is the strongest dental restoration? ›
The strongest material currently in use for dental restorations is zirconia. Zirconia is a white ceramic, so it's passable when it comes to restorations, but it's opaque, not translucent like your natural tooth enamel.Is one of the most common dental materials used for a restoration is a composite resin? ›
Dental composite resin is a tooth-colored restorative material used to replace a decayed portion of tooth structure. Its esthetic appearance is the main advantage over the conventional dental amalgam.
What is the most frequently used device in restorative dentistry? ›
Handpieces are the most frequently used device in restorative dentistry, but there can be a huge variation in quality, price, longevity and after-sales support depending on the supplier, brand and model of handpiece you choose.What are the advantages of composite restoration? ›
They require very little tooth preparation.
With the development of stronger bonding materials, composite resins can restore even many large defects in teeth caused by decay or trauma with little structural removal and still remain durable.
Composite resins are a class of dental restorative materials that are a mixture of organic and inorganic components. The three primary organic components are the resin, the coupling agent, and the initiator, with the primary inorganic component being the filler.What is the disadvantage of using composites as restorative material? ›
The Disadvantages of Composite Resin Fillings
They're more labor intensive for your dentist to place on your tooth. You may experience some brief tooth sensitivity following the procedure. They tend to wear out sooner than metal fillings, especially if you have heavy wear from grinding and chewing.
- Order of treatment. Operative treatment generally proceeds from the most to the least involved teeth. ...
- Treatment plan sequencing. It is the process of scheduling the needed procedures into a time frame. ...
- Urgent phase. ...
- Control phase. ...
- Re-Evaluation phase. ...
- Definitive phase. ...
- Maintenance phase.
One-third of Americans indicate that a person's smile is the first thing that they notice when them for the first time. Here's an interesting fact: adults with straight teeth are 57% more likely to get a date and are judged as being: Healthier. Happier.What is conservative approach of cavity preparation? ›
A conservative cavity is prepared by minimally removing hard tooth structure with maximum preservation of its strength and anatomy followed by its restoration for maximum longevity.What is conservative restoration? ›
The traditional restoration employs extensive surgical removal of enamel and dentine about the cavity to eliminate potential risk of further caries development, while conservative method #1 removes significantly less enamel and infected dentine, and conservative method #2 only restores the overhanging enamel above the ...What is the full name of conservative dentistry? ›
Conservative Dentistry, also known as operative dentistry or crown and bridge dentistry, is the area of dentistry that focuses on dental crowns and bridges.What is conservative filling? ›
A branch of dentistry which aimed at the early treatment of the caries which is developed in the enamel or dentin layers to save the pulp of the tooth. Many kind of fillin material are employed in this sector to restore the function of the tooth such as composite and Amalgam.
What are the 3 main categories of composite materials? ›
Organic, polymeric or Reinforced-Plastics matrix composite materials.What are the properties of advanced composite materials? ›
Advanced composites exhibit desirable physical and chemical properties that include light weight coupled with high stiffness (elasticity), and strength along the direction of the reinforcing fiber, dimensional stability, temperature and chemical resistance, flex performance, and relatively easy processing.What are the three 3 classification of composite materials? ›
Composites are usually classified by the type of material used for the matrix. The four pri- mary categories of composites are polymer matrix composites (PMCs), metal matrix compos- ites (MMCs), ceramic matrix composites (CMCs), and carbon matrix composites (CAMCs).What are 4 advantages of using composite materials? ›
Composites offer many benefits. Key among them are strength, light weight, corrosion resistance, design flexibility and durability.What are the advantages and disadvantages of composite material? ›
Part count gets reduced. Minimized production costs since composites production is done through a broad array of processes. Composite materials don't rust or corrode readily. Metal fatigue doesn't cause them to crack, and they can last for long periods in structural flexing environments.What are the importance of composite materials? ›
Why use composites? The greatest advantage of composite materials is strength and stiffness combined with lightness. By choosing an appropriate combination of reinforcement and matrix material, manufacturers can produce properties that exactly fit the requirements for a particular structure for a particular purpose.What are major drawbacks of advanced composite materials? ›
Composites are more brittle than wrought metals and thus are more easily damaged. Cast metals also tend to be brittle. 2. Repair introduces new problems, for the following reasons: Materials require refrigerated transport and storage and have limited shelf lives.What are the applications of advanced composite? ›
- Composited conjugated materials and their applications.
- Nanomaterial preparation technology and properties.
- Nanomaterial self-assembly technology.
- Composited materials used in electronics.
- Optical, electrical, and magnetic materials, components and systems in the nanoscale.
What is the most difficult tooth to extract? Impacted wisdom teeth are wisdom teeth that have failed to erupt properly. They are generally considered to be the most difficult teeth to extract. The higher the degree of impaction, the more difficult the extraction.What is the most painful dental work? ›
Root canals have a long history of being viewed as the most painful and negative dental procedure. Inaccurate information or fear-mongering over others' experiences may have given them a bad reputation. Here are some facts and myths about root canals to ease your fears.
What is the most painful dental condition? ›
#1 Abscess Tooth:
Every tooth has a root protected by soft-tissue and that tissue can get an infection. For most people and abscess tooth comes with a considerable amount of pain.
Conventional glass polyalkenoate (ionomer) restorative cement (GIC) is the material of choice that has been used for ART and ITR. This is because of its fluoride release properties, including its ability to bond to enamel and dentine, its pulpal biocompatibility, and its ease of manipulation.Which material is the most commonly used dental material for a Class III restoration? ›
The class III restoration is nominally a “one-surface” restoration on the proximal contacting surface of the tooth. It is generally formed with composite resin or ionomer cement.What are the different types of composite materials in dentistry? ›
Different types of composite used since its introduction include macrofill composites (also called conventional composites), microfill composites, hybrid composites (including traditional hybrid, microhybrid, and nanohybrid composites), and nanofill composites.What are the 4 types of restorative hand instrument categories? ›
Restorative dental hand instruments include the amalgam carrier, burnisher, condensers, composite placement instruments, carvers, and Woodsen.
Direct restorative dental materials are essentially safe for patients and the dental team when used correctly, although a low risk of adverse reaction remains, primarily to unpolymerised resin components that come into contact with human tissues.What can be used under all types of restorative materials? ›
Calcium hydroxide is a frequently selected cavity liner because of its unique characteristics. It helps protect the pulp from chemical irritation, it has the ability to stimulate reparative dentin, and it is compatible with all types of restorative materials (Figure 20-5). Figure 20-5 Placement of a liner.What are the advantages of composite in dentistry? ›
Advantages of Composite
They look practically invisible since they are color-matched to blend in with your natural teeth. They can be used to fill small to moderate cavities in the front or back teeth. The resin compound bonds very well to tooth enamel, making fillings less likely to pop loose.
The overall goal of a composite restoration is to improve the tooth's function and give it a natural-looking appearance. Composite fillings, also known as white fillings, are a popular treatment option for decayed teeth.What are the two reasons for using composite structures? ›
The dual properties make the structure resistant to the various loads like wind, seismic, etc., from various directions, thus increasing the durability of the structure. Moreover, composite structures provide high resistance to impact loads like blast from explosions, making buildings safer for the residents.
What are the newer materials in restorative dentistry? ›
Restorative materials such as smart composites, smart ceramics, compomers, resin-modified glass ionomer, amorphous calcium phosphate (ACP)-releasing pit and fissure sealants, and other smart burs and orthodontic shape memory alloys have all benefited from the usage of smart materials in dentistry.What are the five direct restorative materials used in the clinical dental practice? ›
Direct restorative dental materials include amalgam, resin-based composite, glass ionomer, resin modified glass ionomer and acrylic.What are the common problems of composite restoration? ›
The most common reasons for restoration failure are caries development and fracture in posterior teeth, with secondary caries as the main cause of composite restoration failures in high caries-risk patients (5,6). This has wide-reaching implications for the longevity of affected teeth and health expenditure.Why do composite restorations fail? ›
The main cause of failure, for most dental resin composites, is the breakdown of the resin matrix and or the interface between the filler and the resin matrix.What is restorative dentistry? ›
Restorative dentistry focuses on repairing or replacing damaged or missing teeth. These procedures help improve oral health and function. Common dental restorations include crowns, bridges and implants.What does the term restorative dentistry mean? ›
To put it simply, restorative dentistry involves any dental process which focuses on repairing or restoring damaged oral structures. This can include procedures such as fillings, bridges, and implants among many other services.What does it mean when treatment is conservative? ›
Conservative treatment is a type of medical treatment defined by the avoidance of invasive measures such as surgery, usually with the intent to preserve function.What is advanced restorative dentistry? ›
Cosmetic dentistry is focused on enhancing the look of your smile and the appearance of your teeth, gums and mouth. In contrast, advanced restorative dentistry is focussed on improving the function of your teeth and fixing structural problems such as badly damaged, decayed or missing teeth.What is another name for restorative dentistry? ›
SUMMARY. Restorative or operative dentistry is a major portion of dentistry, because dental caries (decay) has been the most common oral disease. However, most people are not aware of the numerous alternatives for restoring (filling) teeth.What are major restorative dental procedures? ›
What does this mean? Major dental care refers to services that are more extensive than fillings or root canals. These types of services can include treatments such as dental crowns, dental bridges, and dentures – services that replace damaged or missing teeth.
Are crowns considered restorative? ›
Restorative dentistry is what your dentist does procedure wise to keep your mouth healthy and fully functioning. This includes a number of procedures, for example, if you get any dental fillings, dental implants, dentures or crowns.What is the difference between restorative dentistry and cosmetic dentistry? ›
The purpose of restorative dentistry is to restore function, while the purpose of cosmetic dentistry is to improve visual appearance. Restorative dental treatments focus on restoring decayed, damaged, or missing teeth in order to maintain proper function and oral health.What are examples of conservative ideas? ›
- Individual Freedom. The birth of our great nation was inspired by the bold declaration that our individual,God-given liberties should be preserved against government intrusion. ...
- Limited Government. ...
- The Rule of Law. ...
- Peace through Strength. ...
- Fiscal Responsibility. ...
- Free Markets. ...
- Human Dignity.
Conservatism is a cultural, social, and political philosophy that seeks to promote and to preserve traditional institutions, practices, and values.What does conservative view mean? ›
Conservatism in the United States is a political and social philosophy based on a belief in limited government, individualism, traditionalism, republicanism, and limited federal governmental power in relation to U.S. states.What are the types of conservative treatments? ›
- Aspirin for mild pain.
- Muscle relaxants.
- NSAIDS (non-steroidal anti-inflammatory drugs) to reduce inflammation.
- Non-narcotic prescription drugs for treatment of moderate or chronic pain.
- Narcotic pain medication for the treatment of acute or severe pain.
Failure of conservative treatment was defined as the persistence or aggravation of symptoms and signs, increasing aneurysmal dilation, or new appearance of a dissecting aneurysm after treatment.What are conservative back pain treatments? ›
Conservative treatments do not require surgery. Conservative treatments for back pain may include medications, injections or physical therapy. Non- surgical treatments require less downtime from everyday life and are considered by many patients to be a more practical pain management technique.