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What Is a “Compomer”?

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What Is a “Compomer”? C LINICAL P RACTICE What Is a “Compomer”? • N. Dorin Ruse, M.Sc., PhD, MCIC • Abstract “Compomers” are recently introduced products marketed as a new class of dental materials. These materials are said to provide the combined benefits of composites (the “comp” in their name) and glass ionomers (“omer”). Based on an critical review of the literature, the author argues that “compomers” do not represent a new class of dental materials but are merely a marketing name given to a dental composite. MeSH Key Words: composite resins; dental cements; glass ionomer cements. © J Can Dent Assoc 1999; 65:500-4 This article has been peer reviewed. ental materials science, to paraphrase a definition of a proposal for the classification of dental composites.3 Metals, materials science,1 is primarily concerned with the ceramics and polymers can form either the matrix or the filler. D search for basic knowledge about internal structure, Pigments, antioxidants, inhibitors, preservatives and anti- properties and processing of dental materials. The aim of this microbials are some other possible minor constituents of paper is to analyze from a dental materials science point of composites. view a recently introduced dental material marketed as “com- Dental composites are polymer-ceramic materials in which pomer”. To facilitate the discussion, a brief review of dental methacrylate and dimethacrylate monomers polymerize to composites and polyalkenoate cements, in particular glass- form the matrix and glasses, ceramics or glass-ceramics are polyalkenoate cements or glass ionomer cements (GICs), is incorporated as spherical fillers. Among the most commonly necessary. used dimethacrylate monomers are 2,2-bis[4-(2-hydroxy-3- methacryloyloxypropoxy)phenyl]propane (BIS-GMA), 1,6-bis Dental Composites (urethane-ethyglycol-methacrylate)2,4,4-trimethylhexane A composite is “a material system composed of a mixture or (UEDMA) and triethyleneglycol dimethacrylate (TEGDMA). combination of two or more micro- or macro-constituents To ensure bonding between the filler and the matrix, the filler that differ in form and chemical composition and [that] are particles are coated with silane-coupling agents that contain a essentially insoluble in each other.”1 To generalize and sim- plify, composites have two main constituents: the matrix and the filler. The matrix forms a network that provides the struc- Ec/Em tural skeleton of the composite, and the filler imparts its mechanical properties onto those of the composite. 6 The filler has to be intimately bonded to the matrix to ful- 5 fil its role. Based on their dominant dimension (length, width, 4 thickness), fillers can be classified as spherical (no dominant dimension), fibres (length is dominant) or flakes (length and 3 width are dominant). The percentage of volume occupied by 2 the filler (Vf [volume fraction filler]), the orientation of fibre- 1 type fillers and the aspect ratio of flake-type fillers are crucial in determining the properties of a composite. The effect of Vf 0809010 20 30 40 50 60 70 % Vf of spherical fillers on the modulus, for instance, follows an exponential curve, which becomes significant beyond 60% Figure 1: The effect of volume fraction filler (Vf) on the modulus of 2 elasticity of composite (Ec) in relation to the modulus of elasticity of (Figure 1). This relationship has been used as the rationale in the unfilled resin matrix (Em). 500 October 1999, Vol. 65, No. 9 Journal of the Canadian Dental Association What Is a “Compomer”? methacrylic group able to co-polymerize with the matrix- Ca Al Ca forming dimethacrylate monomers and functional groups able Al Al CH - COO CH - COO to interact with the filler. The quality and extent of the silane 2 2 Ca COO COO COO coating significantly affect the properties of composites.4 COO The best available hybrid composites have mechanical COO COO COO COO COO properties that are far from ideal for a restorative material. An COO COO COO COO COO ideal restorative material should have properties that match Al Ca COO Al those of the hard tissue that it is supposed to replace. From a Ca Al Al Al Ca Al structural point of view, matching the modulus of elasticity is Ca Ca Al Ca Al the most important consideration. Matching the compressive CH - COO CH - COO 2 2 COO strength, fracture toughness, coefficient of thermal expansion COO COO and other properties are secondary considerations. The modu- COO COO lus of dentin is approximately 18 GPa and that of enamel is COO COO COO COO COO COO COO approximately 80 GPa; the modulus of hybrid and posterior COO COO Al Ca COO composites (including laboratory-processed ones) ranges from Al Ca Al 15 to 25 GPa. Hybrid and posterior composites have adequate Al Al Ca Al stiffness to replace dentin but are far from approaching the stiffness required to replace enamel. The stiffest dental com- Figure 3: Schematic structure of set GICs. posite has the ability to “flex” three times more than enamel, a fact that clearly contradicts the arguments of those who the calcium of the hydroxyapatite to bond the cement to min- advocate the use of more flexible composites. eralized hard-tooth tissues.9,10 The ability to bond to mineral- ized hard-tooth tissues represents a major benefit of both Polyalkenoate Cements ZPCC and GICs. The developments of zinc polycarboxylate cement (ZPCC) The acid-base reaction that leads to the setting of GICs by Smith5 and of GICs by Wilson and Kent6 are considered results in calcium, aluminium, sodium, fluoride and silicate important milestones in the history of dental materials. ZPCC ions being released from the acid-soluble glass. A silicagel layer and GICs have two common features: (1) they set via an acid- rich in fluoride surrounds the unreacted glass particles. Water base reaction in an aqueous environment, thereby complying sorption-desorption facilitates an ion exchange between with the general definition of dental cements; and (2) the acid hydroxyl (OH-) and fluoride (F-) ions — ions that have simi- component is an alkenoic acids polymer (Figure 2). The ratio lar radii. As a result of this exchange, fluoride can be released of carboxylic groups to backbone carbon atoms is approxi- from a set GIC into the surrounding environment. It has been mately 1.5:2. The “base” in ZPCC is zinc oxide, and in GICs suggested that the release of fluoride from GICs has beneficial it is an ion-leachable (sodium) calcium fluoroaluminosilicate effects in overall caries control,11 but this suggestion is still glass. Zinc crosslinks the poly(acrylic acid) chains leading to under debate.12 Nevertheless, the release of fluoride is consid- the setting of ZPCC. Calcium and aluminium from the ion- ered to be the second major benefit associated with GICs. leachable glass crosslink the acrylic-maleic-itaconic co- From a structural point of view, a set GIC is a composite in polymer chains (Figure 3), leading to the setting of GICs.7,8 which the unreacted glass particles are the filler and the The carboxylic groups of the polyalkenoic chains can chelate calcium-aluminium crosslinked polyalkenoate chains form the matrix. The reaction products surrounding the glass particles mediate an intimate bonding between the filler and the CH - COOH 2 matrix. Ionic bonds are responsible for the crosslinking of the H C = CH H C = C HC = polymeric chains and the setting of the cement; however, a 2 2 large number of secondary bonds are present and play a sig- COOH COOH HOOC COOH nificant role in determining the mechanical properties of the acrylic itaconic maleic cements. GICs are brittle, have a low modulus of elasticity, are weak in tension and have low fracture toughness. Their rela- CH - COOH CH - COOH tively poor mechanical properties limit their usage as a restora- 2 2 COOH 13 COOH COOH tive material. A significant effort has been made over the COOH years to improve the mechanical properties of GICs while COOH COOHCOOH COOH COOH maintaining their two major benefits: adhesion to hard-tooth COOH COOH COOH COOH COOH tissues and fluoride release. These efforts have followed two COOH approaches, one focused on the filler and the other focused on the matrix. For every 2 carbons in the chain there are ~1.5 COOH There have been two major attempts to improve the Figure 2: Three alkenoic acid monomers and a schematic represen- mechanical properties of GICs by modifying the filler (ion- tation of a polyalkenoic acid present in GICs. leachable glass). One approach was to substitute some of the Journal of the Canadian Dental Association October 1999, Vol. 65, No. 9 501 Ruse glass with silver-tin-copper amalgam-alloy particles14 under H2C = CH CH = H2C the erroneous hypothesis that the presence of metal filler COO - H2C - H2C - H2C - H2C CH - CH - CH - CH - OOC would impart some of its properties onto the set material. Both 2 2 2 2 HC —CH in vitro and in vivo results were disappointing, and the approach was abandoned. A second approach was to change HOOC COOH the properties of the acid-soluble glass by incorporating in its HOOC COOH structure a metal constituent (silver), thus creating a “cermet” HOOC COOH (ceramic-metal) filler.15 Cermet-ionomer cements are still on the market, although their usage is limited to just a few appli- COOH cations. This approach has proven more successful than the HOOC one previously described; however, the resulting slight improvements in some mechanical properties were offset by For every 8 carbons in the chain there is ~1 COOH decreases in others,16 by the release of silver ions and by a decreased release of fluoride.17,18 Figure 4: Schematic structure of a dicarboxylic monomer used in “compomers”. Resin-Modified GICs reaction between sparse carboxylic groups and areas of filler The second approach to improving the mechanical proper- not contaminated by the silane coupling agents is speculative47 ties of GICs focused on the matrix.
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