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Posterior Resin-Based Composite: Review of the Literature J.O

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Posterior Resin-Based Composite: Review of the Literature J.O Literature Review Posterior resin-based composite: review of the literature J.O. Burgess, DDS, MS Richard Walker, DDS, MEd J.M. Davidson, BS Dr. Burgess is professor and chairman, and Dr. Walker is associate professor, Department of Operative Dentistry and Biomaterials, LSUHSC- School of Dentistry, New Orleans, La; Mrs. Davidson is clinical research coordinator, LSUHSC-School of Dentistry, New Orleans, La. Correspond with Dr. Burgess at [email protected] Abstract The use of direct posterior resin-based composite has increased primarily due to patient esthetic desires and product improvements. Other factors (substantiated or not) con- tributing to increased use of resin-based composite are environmental and health concerns with dental amalgam.1 New visible light cured resin-based composite products are in- troduced yearly, as manufacturers continue to improve this tooth-colored restorative material. This paper will characterize current posterior resin-based composite materials (hybrid, microfill, flowable, and packable), review recent in vitro and clinical research, and recommend indications for these materials. In addition, the literature on compomers will be reviewed and recommendation made for their use. The data indicates that com- posite resin is a technique sensitive restorative material that can be used in large preparations if proper manipulation and isolation can be maintained. Compomers may also be used as an esthetic posterior restorative if proper isolation is provided.(Pediatr Dent. 2002;24:465-479) KEYWORDS: RESIN-BASED COMPOSITE, PEDIATRIC RESTORATIVE DENTISTRY, LITERATURE REVIEW ince the 1990s, resin-based composite (RBC) sales Minn) and Hytac (ESPE, Norristown, Pa) are composed have increased. The ability to mimic tooth structure primarily of bis-GMA, modified monomers and fluoride- Sgave RBC a distinct advantage for patients and den- releasing fillers.2-4 These single-component, light-cured tal professionals. As differences between amalgam and RBC materials contain no water. Water is sorbed into compomers properties narrowed, resin-based material was placed in after they contact saliva and produces the small acid-base larger preparations. Wear was an early concern with poste- setting reaction. The auxiliary setting reaction produces rior RBC restorations, but improvements in silane increasing strength and setting expansion of all compomers application, filler loading, and sizing improved wear. RBC as they age. All compomers require an adhesive bonding is available in different shades and opacities and various filler agent to bond to the tooth, reducing fluoride released5,6 from particle sizes using different polymerization methods, mul- the restoration into the prepared tooth. tiple viscosities, delivery systems, and ion leachability. The fluoride release and mechanical properties of compomers vary considerably.7,8 Hytac has low fluoride re- Compomers or polyacid lease and high mechanical properties similar to composite modified composite resins resin, whereas others (Compoglass, Dyract and F2000) have A compomer is a polyacid-modified, resin-based compos- properties more like resin-modified glass ionomers. Since ite with constituents derived from composite and glass Dyract and Compoglass were introduced earlier than F2000, ionomer. Compomers are derived from composite resin with or Hytac, more in vitro data are available on these products. glass ionomer components, the etchable glass fillers which According to the manufacturer, a hydrophilic monomer, provide fluoride release. The wear resistance and mechani- TCB, with 2 methacrylate and 2 carboxyl groups has been cal properties of compomers are less than composite resin, added to Dyract so that 50% of the reactive groups on each but the fluoride release and uptake are greater. Ease of han- molecule consists of carboxylic acid groups. These groups dling is a compomer’s greatest asset, which led to its are responsible for the bond of Dyract to the tooth. Al- popularity. though Dyract will bond to tooth structure without prior Materials classified as compomers have substantial dif- etching and without a bonding agent, this bond is too weak ferences. Compomers such as Dyract AP (LD Caulk); to be clinically useful. A single component bonding system, Compoglass (Ivoclar North America); F2000 (3M, St. Paul, Prime and Bond NT, is supplied with Dyract. Although Pediatric Dentistry – 24:5, 2002 Posterior resin-based composite Burgess et al. 465 early directions stated that this material did not require etch- bis-GMA, but more flexibile. UDMA may be used alone ing prior to placement, one clinical study has shown a low or in combination with other diacrylate monomers.11 retention rate when no etchant was used.9 Other base monomers are utilized besides bis-GMA and The filler in the original Dyract compomer is a 2.5 µm urethane dimethacrylate, however, none has proven to be strontium-aluminum-fluoro-silicate glass filler which pro- clinically superior; and these 2 monomers still predominate. vides fluoride release. Dyract AP has a reduced filler size of The first improvement in the resin matrix was developed 0.8 µm, which improves fluoride release and polish com- 30 years after the original Bowen formula. In 1998, the first pared to Dyract. RBC was introduced based on the ormocer chemistry Compoglass is a single-component, light-cured fluoride- (Definate, Degussa, Germany).12 releasing compomer composed of silanized barium Multifunctional urethane and thioether(meth)acrylate fluorosilicate glass and ytterbium trifluoride fillers. With a alkoxysilanes as sol-gel precursors have been developed for mean filler particle size of 1.6 µm, Compoglass is 56% filled the synthesis of inorganic-organic copolymer ormocer com- by volume and 79% filled by weight. Compoglass releases posites.13 fluoride from the ytterbium trifluoride and barium alumi- Ormocers (organically modified ceramics) have inor- num fluorosilicate glass fillers. It is supplied with a single ganic-organic copolymers in the blend that allow the RBC component bonding material. to be manipulated like any other RBC. This material seems Although classified by the manufacturer as a compomer, promising in that mechanical properties were similar to Hytac has physical and mechanical properties like fluoride- Tetric Ceram (Ivoclar/Vivadent) and the wear was signifi- releasing composites and should be classified as a cantly better.13 fluoride-releasing composite resin. Hytac contains The initiator/catalyst system for direct RBC may be bismethacrylate and acid-modified bismethacrylate resins chemically activated, light activated, or both. With chemi- and is 81% filled by weight (66% is glass filler and 15% is cally activated polymerization, benzoyl peroxide is the ytterbium trifluoride, a radiopaquing and fluoride-releasing initiator (or sulfinic acid may be used as the initiator), and agent), with a mean filler particle size of 5 µm. The glass a tertiary amine (eg, dihydroxyethylparatoludine— filler is zinc-calcium-aluminum-fluoro-silicate glass, a typical DHEPT) is the activator.14 Once the 2-paste, chemically- glass ionomer glass and provides an additional source of fluo- cured RBC is mixed, the initiator and activator contact and ride release. polymerization begins. After a few minutes, the polymer- F2000 is the most recent addition to the family of ization produces a gel (solid) where the polymer is compomers and has a mean fluoro-aluminosilicate glass filler cross-linked enough to form a cohesive mass which may be particle size of 3 µm (maximum of 10 µm) and added col- finished and polished. In the 1980s, visible light-cured loidal silica to produce filler loading of 84% by weight. (VLC), resin-based composites were introduced to the den- F2000 has an acidic primer/adhesive system based on the tal profession. These resin systems became very popular and Vitremer (3M, St. Paul, Minn) primer and maleic acid. are now the dominant, directly-placed esthetic material. Visible light-cured RBCs are single-paste materials po- Resin-based composite lymerized with visible light energy. VLC RBCs allow the composition and improvement operator to control setting time, require no mixing, and have Resin-based composite consists mainly of a resin matrix fewer voids, greater strength, greater fracture toughness, surrounding inorganic filler particles. The primary constitu- better shade selection, better color stability and higher sur- ents of the resin matrix are resin monomers and an initiator/ face polymerization conversion rates than chemically catalyst system for polymerization. The first dental RBC activated RBC. VLC RBC polymerizes by free radical po- monomer developed in the 1960s is still used today. Based lymerization and has a photoinitiator and accelerator/ on the reaction product of bisphenol-A and glycidyl meth- catalyst system. The photoinitiator absorbs light energy acrylate (bis-GMA), it is a bulky monomer with (photons) emitted from the curing light and directly or in- methacrylate groups at each end of the molecule directly initiates polymerization. Photoinitiators are (dimethacrylate). Polymerization occurs through a free radi- diketones, such as camphoroquinone, activated by visible cal addition reaction. The double-bonded carbons of the light, in the presence of an amine accelerator/catalyst (eg, methacrylate groups at each end of the active site on the dimethylamino ethylmethacrylate— DMAEM). The acti- monomer cross-links during the polymerization process, vated diketone/amine complex initiates the polymerization
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