Dental Composites Buying Guide
The popularity of dental composite fillings shows no sign of slowing as patients continue to demand teeth-coloured restoratives to retain that all-white smile.
Personal preference will always be the key factor behind selecting which dental composite brands to use in your practice, but there are many variables that should be considered to help you in finding your favourites.
With more choice of dental composites available on the market than ever before, our guide aims to help you in your search to find the perfect materials to suit your requirements.
What is a dental composite?
Dental composites, or resin-based composites, are synthetic, hydrophobic materials that combine polymeric matrix with a dispersion of glass, mineral, or resin filler particles and/or short fibres.
They are used to restore tooth structure lost through trauma, caries or other diseases. Composites can also be used as cements to cement crowns, bridges and other prosthetics. Composites can be classified as chemically activated (self-cure) resins and photochemically activated (light-cure) resins.
Distinguishing between dental composites
Before jumping into which particulars you should look out for when browsing dental composites, below is a quick reminder of the key differentiators.
Classification of Dental Composites
Microfilled Composites: Microfilled composites contain very small particles of filler. This allows good polishability and fine aesthetics. They are not very strong or durable and are not recommended for the restoration of posterior teeth
Macrofilled Composites: Macrofilled composites contain large particles which makes the material very strong and durable. This composition does not lend itself well to finishing and polishing, leaving an unaesthetic finishing that is undesired for anterior teeth.
Hybrids (Universal) Composites: Hybrids contain a mixture of particle sizes that combine the strength of macrofilled composites with the aesthetics of microfilled composites, thus making it suitable for both anterior and posterior teeth.
Nanocomposites: Made up of particles less than 100nm in size, nanocomposites typically have nanosized particles which can be clustered to form larger filler. These clusters provide the appropriate strength and opacity, combined with excellent polish and polish retention. Nanocomposites are the composite type used in most of today’s restorations. This popularity is owed to being able to tick all the boxes when it comes to aesthetics and wear resistance, and be easily shaped in anterior teeth, yet also strong enough for the posteriors.
Handling properties of dental composites
Perhaps the most important consideration for most dentists when choosing a composite is how it handles. Being comfortable working with a material is crucial to the overall outcome of a restoration.
Bulk Fills
Bulk fills are light-cured dental composites that require fewer layers than conventional composites.
Bulk fill composites have seen a rapid rise in popularity over the years as new formulations have made the material translucent enough to allow curing lights to reliably penetrate material as thick as 5mm.
This results in a reduction in time of material placement and polymerization, while many dentists prefer using fewer layers to reduce risk of air pockets and voids.
Bulk-fill composites are mostly indicated for Class I and II posterior restorations.
Flowables
Coming pre-packed in a syringe for quick use, flowable composites are known for their excellent handling properties as they are made up of a lower filler content therefore lower viscosity.
This increased fluidity allows flowables to be used in tight or small indications as the material flows into the small recesses of a preparation more easily than a thicker composite would.
To negate some of the disadvantages of flowable composites, such as the greater likelihood of polymerization shrinkage, a lot of flowables are now formed with higher filler content for added strength.
Universal/Conventional Composites
The oldest subtype of resin composite, universal composite is associated with being versatile enough to cover most restoration types, both anterior and posterior.
This adaptable material is designed for both indirect and direct restorations, and is applied in incremental layers. Though not as quick to apply as bulk-fills, conventional composites remain extremely popular due to their well-documented clinical performance.
Indications include the restoration of class I, II and III and IV.
Finding the perfect composite shades
Aside from ease of handling and reducing patient time, delivering a satisfactory aesthetic finish may be the most important requirement of a composite for dentists.
To mimic the true shade of the restoration and surrounding teeth, many dental practices stock a flexible range of composite shades. Many brands make this easy by offering a range of 20+ variety of shades of enamel and dentine as either full kits or individuals in accordance with their own shade guides or the Vita classical A1-D4 shade guide.
The there are also outstanding composites that offer dual shading, such as the DEHP Nanohybrid Composite, which is perfect for dentists who want consistent results without having to store too many variants.
Reducing shrinkage
Polymerizations contract, or shrinkage as its more commonly known, is an inevitable part of restorations and can lead to staining, microleakage and secondary caries among other problems.
Though it’s impossible to completely remove any chances of this happening, this does not mean different composite materials and techniques can and should be carefully selected to reduce any likelihood.
Bulk fills, such as SDR Flow+ from Dentsply, which uses technology to enable a more relaxed polymerization process, is a favourite of dentists when it comes to trying to minimize shrinkage.
Composite bonding and radiopacity
When it comes to composite bonding, manufacturers often prefer dentists to use the same brand of composite and adhesive. However, if you can find a bonding agent that is compatible and easy to use, there’s no reason it cannot be used more flexibly.
3M Scotchbond Universal Plus is a prime example of such an adhesive as it can bond to all composite fillings and is suitable for adhesion to all dental substrates without the need for a separate primer, silane or activator.
Radiopacity is also an important factor to also look out for when deciding which composites to stock.
Using a dental composite that is radiopaque, such as Venus Pearl and Charisma ABC, allows x-rays to distinguish between composite and natural tooth more easily, thus aiding the diagnosis of defects like fractures, voids, marginal problems, secondary caries and over-contouring.
Compressive strength
Perhaps the most important mechanical property of a composite is its compressive strength. This is certainly the case with stress-bearing posterior restorations where the strength of the composite needs to be high enough to withstand the masticatory forces.
Restoratives with lower compressive strength are more likely to fail, fracture and lead to loss of tooth structure.
Nanocomposites have been proven to have the mechanical properties necessary to tolerate these masticatory forces, while offering the aesthetics properties lacking in macrofilled composites.
Other important factors to consider
Polishability
To get that much desired glossy and smooth finish to your restorations, you will want your dental composites to be ones that polish well. Nanocomposites offer the highest polishability followed by hybrids.
As well as improved aesthetics, a highly polished composite will also prevent plaque retention and bio-film.
There is no longer a need for separate polishing systems for different composites and using nanocomposites with excellent polishing retention makes the whole process quicker and more systematic.
Wear Resistance
With the amount mechanical forces and chemical affects that occur in patients mouths, the wear resistance of a composite is central to long-term performance.
Posterior restorations are for more likely to show noticeable wear, so it’s important to make sure the composite being used has a similar or lesser wear resistance than teeth.
While some research has shown there to be little difference between conventional and nanofilled composites, some has reported superior resistance to wear for nanofilled composites.
Durability
Any high-quality composite intended for anterior and posterior restorations should be able to demonstrate how its fairs against other brands in terms of hardness, compression strength and shrinkage volume.
Picking a durable dental composite that has the clinical evidence to show its durability, such as SDR Flow+, should be strongly considered and will make up for any potential outlay with less failed restorations down the line.
Selecting the right LED curing light should not be underestimated in this process and is crucial for improved longevity of a restoration.
Translucency
The translucency of a composite is a vital part of delivering an aesthetic restoration that mimics the properties of natural tooth structures.
Translucency varies across different composite brands and shades. The colour of the composite resins will have a significant effect on its translucency which is why it’s important to have accurate knowledge regarding the translucency and colour of different composite materials.
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