FLOWABLE COMPOSITE

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TECHNOLOGY 

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RNSOlOGY OF ‏راخ‎ ‎Comoositas VERY WIDE RANGE OF MATERIALS SEALANTS MICROFILL FLOWABLE HYBRID & RELATED MATERIALS PACKABLE or CONDENSABLE ——WMCRECCIOE OIGCOECITY 

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RNSOlOGY OF ‏راخ‎ ‎Comoositas General idea) lower miller content= Ustially hytonid: ‏محر ماقرا محر‎ Silie, ‏20یلا‎ ۰۵ (3 Lone hy GniGinal Gaims (patent literature) recommended 101 61855 | ‏لا لا‎ ۱۸ late ۸ 22/2 Now eine recormmisrelsel for miley sooliceirions: (ag, isstire selling — cdiseussse fejrsr) 0/1 1 

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FLOWABLE COMPOSITE Robert W. Hasel D.D.S. Associate Professor Restorative Dentistry Midwestern University College of Dental Medicine Glendale, Arizona Composite History 1956 1960’s Dr. R.L. Bowen ‘bis-GMA’ “Adaptic” 1970’s Microfilled composite Light-initiated composite 1980’s 1990’s Posterior composite Hybrid composite Flowable, packable, etc. Nanocomposite Non-shrink composite ? 2000’s Development of Materials USA COMPOSITES UK GLASS-IONOMERS BRITISH DEVELOPMENTAMERICAN DEVELOPMENT VISIBLE LIGHT CURING RESIN-MODIFIED GLASS-IONOMERS Resin Composites & derived materials  Development     Dissatisfaction with silicates/acrylics Development of ‘Bowen’s resin’ – Bis-GMA Introduction of first materials – two paste systems Developments in filler content       Smaller particles Microfine particles Command setting – UV cure Single paste – VLC Change in viscosity – flowable/packable Nanocomposites? Low shrinkage materials? TECHNOLOGY Alter the Paradigm Dental composite Review Resin matrix Ceramic fillers Silane coupling agent Fillers Variations • Type SiO2 , barium glass, ZrO2 • Size macrofills (>10 m); midifills (1-10 m) minifills (0.1-1 m); microfills (0.04-0.1 m); nanofills (0.02-0.07 m) • Content 40% - 80+% by weight Note : vol % is 15-20 % lower Classification Based on filler size Lutz & Philips, 1983 • Traditional (‘macrofilled’) Glass particles ; size 1-15 m • Microfilled Amorphous silica ; size ~ 0.04 m • Hybrid Filler load ~ 80 wt% Glass particles (Avg size ~ 5 m) + microfillers Fillers Zirconia/silica • sol-gel process • spherical • polishability • continuum in sizes Z100, Z250, Palfique (3M ESPE) (Tokuyama) high packing density (85 wt %) Resin matrix (light-activated composite) Review Monomer : bis-GMA , bis-EMA, UDMA Diluent : TEGDMA Dimethacrylate Photoinitiator : camphorquinone Co-initiator : tertiary amine Reaction Amine coinitiator CQ Activated state + Free radical C=C C=C C=C C=C C=C C=C C=C C=C O2 C=C C=C C=C C=C C=C C=C C=C C=C Dimethacrylate monomer Resin matrix Polymerization shrinkage Current systems : 2-3 % vol shrinkage • Methacrylate-based monomers • Free radical, addition polymerization Products in development : ‘no shrinkage’ • Ring-opening reaction expand Resin matrix O2 inhibition layer = uncured monomer film at the surface • film thickness ~ 10 m • not biocompatible should be removed • ? between increments ? Biocompatibility ‘Most monomers have some biologic activity ……… but … biocompatible when reacted into polymer…’ Resin matrix Recommendations • Well cured • Remove O2 inhibition layer • Avoid contact with uncured resin • 5% of dental personel have contact allergy to methacrylates • Protective gloves are inadequate • Estrogenic effect • Adverse reaction: asthma, blister, rashes • Oral lichenoid lesions Wallenhammar et al, 2000 Olea et al, 1996 Hallstrom, 1993 Lind, 1998 FLOWABLE COMPOSITE Problems with Paste Composite         Difficult to use Difficult to manipulate Sticky, pull back Voids Porosities Unpolymerized areas Shrinkage Surface and Marginal integrity Problems with Paste Composite         Difficult to use Difficult to manipulate Sticky, pull back Voids Porosities Unpolymerized areas Shrinkage Surface and Marginal integrity         Easy Easy Stays put Eliminates Eliminates Less Minimizes (technique) Best Rheology  Definition   Rheology is the study of the flow and deformation of matter Dental importance  Important for any material placed in the mouth in a fluid state – examples:   Impression materials Directly-placed tooth restorative materials Rheology of Resin Composites VERY WIDE RANGE OF MATERIALS SEALANTS MICROFILL FLOWABLE HYBRID & RELATED MATERIALS PACKABLE or CONDENSABLE INCREASING VISCOSITY Viscosity A has highest viscosity C is the most fluid B is intermediate A B C HIGH FLUIDITY LOW VISCOSITY LOW FLUIDITY dkjdfjkl HIGH VISCOSITY Rheology of Resin Composites     General idea - lower filler content - usually hybrid filler. Includes fumed silica, claimed to give thixotropy* Original claims (patent literature) - recommended for Class I, II, III, IV and V cavities Now being recommended for many applications (e.g. fissure sealing – discussed later) *What is thixotropy? Rheology of Resin Composites     Thixotropy is a reversible structural breakdown of a material that occurs when the material is stressed Flowable composites were designed to be thixotropic This means that when the material is being syringed, the high stress from syringing breaks down some of the structure (e.g. hydrogen bonding), so the material flows But when the material is placed into the cavity, it will not flow (‘non-drip’) because the hydrogen bonding structure quickly recovers Flowable Composites THERE ARE SIGNIFICANT ‘FLOW’ PROPERTY DIFFERENCES BETWEEN DIFFERENT PRODUCTS VERY FLUID; VIRTUALLY NEWTONIAN: NO “THIXOTROPY” APPARENT VISCOSITY [Pa.s] HENRY SCHEIN FL OWABL E 302 300 298 296 294 292 290 0 0.1 0.2 0.3 SHEAR RATE [1/s] 0.4 0.5 -- contrast with ... Flowable Composites THERE ARE SIGNIFICANT ‘FLOW’ PROPERTY DIFFERENCES BETWEEN DIFFERENT PRODUCTS APPARENT VISCOSITY [Pa.s] REVOL UTION 4000 3500 3000 2500 2000 1500 1000 500 0 0 0.2 0.4 0.6 0.8 SHEAR RATE [1/s] 1 1.2 …contrast HIGHER VISCOSITY; SHOWS “SHEAR THINNING” DIFFERENT TECHNIQUE AND APPLICATIONS? Flowable Composites THERE ARE SIGNIFANT COMPOSITIONAL DIFFERENCES BETWEEN DIFFERENT PRODUCTS Material Filler content (mass %) Henry Schein 41 Starflow 61 Revolution 60 Florestore 50 Flowable Composites  SOME MATERIALS (at least 34!) – examples     Florestore (Den-Mat) Flowable composite (Henry Schein) Revolution – Formula 2 (Kerr) Starflow (Danville Materials) Flowable Composites    There is no such thing as a standard flowable material 34 brands (some identical); many with different formulations, handling characteristics, properties and applications Confusion because of untested materials no track record of clinical success 1. Philosophy      1. Dental materials do not naturally belong in the mouth! 2. All synthetic materials evoke a host response 3. Synthetic materials not as good as health tooth substance 4. Best treatment is the least treatment 5. Best treatment is the most durable treatment THEREFORE – there is an obligation to prevent dental disease, and where treatment is necessary, to choose the best materials, and manipulate them in such a way that optimum properties are obtained. Principles of Selection         (i) Evidence from laboratory data (ii) Clinical performance (iii) Esthetic considerations (iv) Clinical needs (v) Patient’s preferences (vi) Operator’s preferences (vii) Cost effectiveness (viii) Environmental considerations Filler contents have Caught up Filler content (wt %) Flowable composites 75 80 68 56 53 higher shrinkage  compromised mechanical properties Wear (m) 28 28 26 flowable 21 22 hybrid Fracture toughness  flowable hybrid 2.051.90 1.36 1.24 flowable hybrid Conclusion   The criteria for choice of a material include not only factors such as physical and mechanical properties, but also include ease of manipulation. Note that there are no standard specifications for these materials, and that they differ considerably in their flow properties. Need improvements? B Biocompatibility I Interfacial properties C Chemical properties cured vs uncured adhesive system Biodegradation C=C C-O esterase O M Mechanical & physical properties E Esthetic consideration P Practical questions & Polishability Flowable / Packable Failure Zone    Biofilm Improper Etching Thick Layers       Unpolymerized areas Porosities Voids in the body Marginal Integrity Surface Integrity Shrinkage FAILURE ZONE     Biofilm Improper Etching Improper Curing Thick Layers   Unpolymerized areas Porosities     Voids in the body Marginal Integrity Surface Integrity Shrinkage