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Tooth Colored Filling
By
Mohammed M. Nasser

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Ceramic inlay & onlay
Silicate cement
Acrylic resin
Glass Ionomer Restorations (GIR)
Composite
OUTLINE

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CERAMIC INLAYS AND ONLAYS
• Esthetics and durability.
• The physical and mechanical properties of ceramics are much closer
to the enamel than to the composite.
• Excellent wear resistance, and the coefficient of thermal expansion is
very close to that of the tooth.
• Fabricated outside the oral cavity (In Lab.).
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CERAMIC INLAYS AND ONLAYS
• Disadvantages:
1. More time + Temporary restoration. Except for clinics with CAD /
CAM System.
2. More expensive than composites.
3. Highly technic sensitive, restorations requiring high level of
operator skill.
4. Are brittle in nature ,if a preparation does not allow adequate
thickness to resist occlusal forces fracture.
5. Ceramics abrade opposing dentition and restorations
6. Repair is difficult.
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SILICATE CEMENT
• They was used extensively to restore the anterior teeth until 1965.
for restorations of anterior teeth in patients with high caries index in
the areas which are not subjected to masticatory forces.
• Now silicate cements have been replaced completely by composites,
as restorative materials.
• Silicate cement available as powder and liquid systems.
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SILICATE CEMENT
• Disadvantages:
1. Poor strength.
2. brittleness.
3. discoloration.
4. rough.
5. loss of contour.
6. irritation to pulp tissue.
Therefore, its use has been almost discontinued.
• Cavity Preparation: Should be of the conventional type.
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ACRYLIC RESINS (Unfilled Acrylic Resin)
• Now acrylic restorations are rarely used.
• Self curing or chemically curing.
• Restoration of anterior teeth.
• Introduced into dentistry in late 1940s.
• These materials are mostly available as powder and liquid systems.
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ACRYLIC RESINS (Unfilled Acrylic Resin)
• Disadvantages:
1. Poor activator system.
2. High polymerization shrinkage.
3. Weak (Poor strength and hardness).
4. Less wear resistance.
5. Poor marginal seal leading to microleakage.
6. Irritation and injury to pulp.
7. Color changes.
8. High coefficient of thermal expansion (CTE).
9. Dimensional instability.
10. No bonding to tooth structure.
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ACRYLIC RESINS (Unfilled Acrylic Resin)
• Advantages:
1. The tooth color matching ability, ease of manipulation.
2. It being cheaper in cost.
• Cavity Preparation:
Conventional or beveled conventional.
Adequate internal retention should be provided for the material.
• Indications: mainly used for making temporary filling (TF).
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GLAAS IONOMER RESTORATIONS
Conventional glass ionomers
Resin-modified glass ionomers (RMGI)
Compomers (Polyacid-Modified Composites)
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• Anticariogenic F release.
• Adhesion to dentin.
• Less wear resistance.
• lesser strength than composite and amalgam.
• Not used for posterior teeth.
• Indications:
- Root caries.
- Anterior teeth with high caries index.
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Conventional glass ionomers

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• GIC+ Resin.
• Improve physical properties for conventional one.
• Anticariogenic: sustained F release.
• Indications:
- CL V (adult high caries index).
- CL I,II for primary teeth (short term treatment).
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Resin-modified glass ionomers (RMGI)

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• Composites + GIC.
• Superior to the conventional GI & RMGI; but inferior to composites.
• Cariogenicity is questionable, not sustained F release.
• Indications: no indications in contemporary dentistry (limit clinical
use).
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Compomers (Polyacid-Modified
Composites)

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COMPOSITE
(Resin Based Composite / Composite Resin)
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History
Indications
Contraindications
Advantages
Disadvantages
Main components
Classification

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• Introduced to the profession in 1955 by Dr Raphael Bowen.
• Composite resin materials have evolved constantly over the past 50
years and contemporary composite resin materials are vastly superior
to the original material in both clinical performance and esthetic
potential.
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History

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I. Class I, II, III, IV, V and VI restorations.
II. Foundations and core buildups.
III. Sealants and preventive resin restorations (conservative composite restorations).
IV. Esthetic enhancement procedures:
A) Partial veneers.
B) Full veneers.
C) Tooth contour modifications.
D) Diastema closures.
V. Temporary or provisional restorations.
VI. Periodontal splinting.
VII. Luting of indirect esthetic restorations (when used in flowable form, or when heated to
increase flow).
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Indications

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I. Inability to obtain adequate isolation.
II. Occlusal considerations related to wear and fracture of the
composite material.
III. Extension of the restoration on root surface.
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Contraindications

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I. Esthetics.
II. Conservative tooth preparation (less extension, minimum depth,
mechanical retention usually not necessary).
III. Low thermal conductivity.
IV. Universal use.
V. Adhesion to the tooth.
VI. Repairability.
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Advantages

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I. May have poor marginal and internal cavity adaptation, as a result of
polymerization shrinkage stresses or improper insertion of the
composite.
II. May exhibit marginal deterioration over time in areas where no
marginal enamel is available for bonding.
III. Are more difficult and time consuming and more costly.
IV. Are more technique sensitive {good isolation, incremental
placement technique and proper adhesive technique is absolutely
mandatory}.
V. May exhibit greater occlusal wear.
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Disadvantages

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I. Resin matrix
(Polymeric Matrix
phase).
II. Filler particles
(Dispersed phase
inorganic).
III. Silane coupling
agents (Coupling
phase).
IV. Initiators and
Other components
{Pigments, Viscosity
diluents, and Cross-
linking agents}.
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Main components

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Main components
I. Resin matrix (Polymeric Matrix phase)
• Bis-GMA (Bisphenol-glycidyl methacrylate).
• Urethane dimethacrylate (UDM).
II. Filler particles (Dispersed phase inorganic)
• Macro-filler (quartz or glass), Micro-filler (silica), and hybrid (composed from
both).
• Improvement physical properties (increases the strength, reduces the
amount of polymerization shrinkage).

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Main components
III. Silane coupling agents (Coupling phase)
• Complex, bifunctional molecules that have two different end groups {one
bonds to the filler particle & the other bonds to the matrix}.
• Stronger bonding of the filler to the matrix, which improves wear resistance,
and also permits the incorporation of more filler.
IV. Initiators and Other components
• Initiators: Most current composites are polymerized with the help of light.
• Other components: Pigments, Viscosity diluents, amd Cross-linking agents.

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Main components
I. Resin matrix
(Polymeric Matrix
phase)
• Bis-GMA
(Bisphenol-
glycidyl
methacrylate).
• Urethane
dimethacrylate
(UDM).
II. Filler particles
(Dispersed phase
inorganic)
• Macro-filler (quartz
or glass), Micro-filler
(silica), and hybrid
(composed from both).
• Improvement
physical properties
(increases the
strength, reduces the
amount of
polymerization
shrinkage).
III. Silane coupling
agents (Coupling phase)
• Complex, bifunctional
molecules that have two
different end groups {one
bonds to the filler
particle & the other
bonds to the matrix}.
• Stronger bonding of the
filler to the matrix, which
improves wear
resistance, and also
permits the incorporation
of more filler.
IV. Initiators and Other
components
• Initiators: Most
current composites
are polymerized
with the help of
light.
• Other
components:
- Pigments.
- Viscosity diluents.
- Cross-linking
agents.
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I. Based on polymerization method:
1. Light cured composites
2. Chemical cure composites
3. Dual cure composites
II. Based on filler particle type:
1. Macro filler composites
2. Micro filler composites
3. Hybrid composites
4. Microhybrid, Nanohybrid, and
Nanofill composite
III. Based on viscosity:
1. Packable composites
2. Flowable composites
IV. Recently introduced composites:
1. Low shrinkage composite
2. Silorane composites
2. Bulk- fill composite {Flowable base
& Full-body}
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Classification

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Classification
I. Based on
polymerization
method
1. Light cured
composites
2. Chemical
cure
composites
3. Dual cure
composites
II. Based on filler
particle type
1. Macro filler composites
2. Micro filler composites
3. Hybrid composites
4. Microhybrid,
Nanohybrid, and Nanofill
composite
III. Based on viscosity
1. Packable
composites
2. Flowable
composites
IV. Recently
introduced
composites
1. Low shrinkage
composite
2. Silorane composites
2. Bulk- fill composite
{Flowable base & Full-
body}
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I. According to Polymerization Reaction Initiation
A. Chemical Cure (auto-cure / self-cure): Initial composite resin materials were chemically
initiated.
B. Light Cure: Ultraviolet light (UV light) or Visible light (V light).
C. Dual Cure: Both chemical cure and light cure technologies.
The setting reaction is initiated by exposure to visible light (V light) but the reaction will
slowly continue over time in the absence of light.
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Classification

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Self-cure composite
resins
Dual-cure composite
resins
Light-cure composite
resins

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II. Based on filler particle type:
1. Macrofilled (Conventional) composite.
2. Microfilled composite.
3. Hybrid composite.
4. Microhybrid, Nanohybrid, and Nanofill composite.
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Classification

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Properties Macrofilled
(conventional)
Microfilled Hybrid Microhybrid, Nanohybrid, and
Nanofill
Filler % 75 - 80 % 35 - 60 % 75 - 85 % Microhybrids are 56 to 66% by
volume.
Filler size 8–12 um 0.01 to 0.04 um 0.4 – 1 μm Microhybrids : 0.4 to 0.8 μm.
Nanofill and nanohybrid: less
than that of microfilled.
Surface
texture
Relatively large size
 Rough surface
texture
Small particle size 
smooth, luster, polished
surface
Patina-like Polished surface

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Properties Macrofilled
(conventional)
Microfilled Hybrid Microhybrid, Nanohybrid, and
Nanofill
Advantage Physical and mechanical
performance is better
than unfilled acrylic
resins
- Resistant to plaque, debris
and stains
- Highly polishable.
- Good esthetic.
Mixture of fillers 
physical properties
similar to those of
conventional
composites with the
advantage of smooth
surface texture
-Highly polishable, Tooth-like
translucency with excellent esthetic,
Optimal mechanical properties, Good
handling characteristics, Good color
stability, Stain resistance, High wear
resistance
Disadvantages
Rough surface finish,
Poor polishability, More
wear, Discoloration and
plaque accumulation
take place quickly than
other types of
composites.
Poor mechanical properties,
Poor color stability, Low wear
resistance, Less modulus of
elasticity and tensile strength,
More water absorption, High
coefficient of thermal
expansion.
Not appropriate for
heavy stress bearing
areas, and loss of gloss
occurs when exposed to
tooth brushing with
abrasive toothpaste
Indication
Not present now - Restoration of anterior
teeth.
- Cervical lesions/ Abfraction.
Especially indicated in
anterior restorations,
but can also be used in
posterior restorations
Can be used for both anterior and
posterior restorations and for splinting
teeth with fiber ribbons

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III. According to handling (According to Viscosity):
1. Flowable composites:
They can be flowed into the deep pit and fissure, very small class I, class III, class V and class
VII, marginal defects and as a base under hybrid or condensable composites.
Features:
A. Low Filler content (less than 30 %): Inferior physical properties like poor strength and wear
resistance. Increased polymerization shrinkage. Viscosity is reduced and flow is increased.
B. It sticks to the instrument, hence difficult to smoothen the surface.
C. High stress areas should not be restored with it.
D. At one time it can be used only up to a thickness of 6 mm.
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Classification

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Uses: is used for the following conditions:
A. Very small cavities in low stress or stress-free areas.
B. Repair of leaking and defective margins, filling in deep pit and fissure.
C. In tunnel cavities
D. Core building
E. Repairing and cementing porcelain restorations.
F. For laminations and veneering
G. Resurfacing of worn out composite.
* Flowable composites are contraindicated in large class I, class II, class IV and class VI
cavities.
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Classification

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III. According to handling (According to Viscosity):
2. Condensable (packable) composites:
* Possess handling characteristics similar to amalgam.
Advantage: More viscous, Feel like amalgam, Good proximal contact.
Disadvantage: No optimal marginal adaptation, [to compensate add flowable along margin].
Uses: In cavity that involve proximal wall, such CL II & Large class I, class II, class IV and class
VI cavities.
Clinical notes: Each increment is condensed similar to silver amalgam. The cavity is slightly
over filled. The excess is removed with a carver. The restorations is light cured for 30 to 40
seconds and finished and polished.
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Classification

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