FIXED PROSTHODONTICS
SECTION EDITORS
GORDON J, CHRISTENSEN SAMUEL
WILLIAM LEFKOWITZ WILLIAM
A classification and evaluation
resin systems
Felix Lutz, D.M.D., M.D., Ph.D.,*
Indiana University, School of Dentistry,
C omposite resins are subject to wear under oral
conditions and, in time, undergo other physical and
chemical alterations. Posterior stress-bearing restora-
tions ,produce fatigue and adhesion types of wear, later
enhanced by chemical disintegration. This produces an
unacceptable loss of substance that, to date, has pre-
vented their use as a substitute for dental amalgam. In
anterior restorations the esthetic appearance of a com-
posite resin may also change because of abrasion and
chemical disintegration, altering color and surface
texture.p2
Recently a direct correlation has been demonstrated
between changes induced by wear as related to both the
components of the composite resin and the type of
curing system.2 Thus, these appear to offer a scientific
basis for the classification of composite resins from
which conclusions may be drawn on the respective
clinical performance of a given system based on its
classification category. This article presents such clas-
sifications based on the current state of the art. In
addition, the advantages and disadvantages of the
currently available composite resins for anterior resto-
rations will be delineated. Hopefully, guidelines will be
provided for dentists in the selection and use of
commercial products.
COMPONENTS
Resin-based restorative materials are defined as
three-dimensional combinations of at least two chemi-
cally different materials with a distinct interface.3
Generally, a composite resin encompasses three phases:
(1) the organic phase (the matrix); (2) the interfacial
phase (the coupling agents); and (3) the dispersed
phase (the fillers). Each phase has the potential to
provide a basis for a classification. The respective
suitability of each for this purpose will be analyzed.
*Visiting Associate Professor of Dental Materials
sity of Zurich.
**Associate Dean for Research.
480
l OPERATIVE DENTISTRY
E. GUYER
F. P. MALONE ROBERT C. SPROULL
of composite
and Ralph W. Phillips, M.S., D.Sc.**
Indianapolis, Ind.
The organic phase
There is now evidence to substantiate that the degree
of polymerization is crucial to the clinical performance
of any resin system. The conversion percent of double
bonds and the network formation, and thus the degree
of polymerization, are affected by two major factors:
(1) the mode of curing used and (2) the type of resin
used in the organic matrix.2
An increasing degree of polymerization is achieved
generally in the order of chemical cure - light
cure - heat cure. For this reason the curing mode may
present one means of classifying composite resins.3,4
The most commonly used components in the organic
resin matrix are BIS-GMA, modified BIS-GMAs,
urethane diacrylates, TEG-DMA, and a number of
diluents.5-9 With chemically cured materials, the differ-
ences in the degree of polymerization resulting from
varying compositions of the organic matrix are in turn
reflected in the in vivo wear data derived from the
occlusal contact areas ofmesial-occlusal-distal restora-
tions as well as in in vitro wear rates from fresh and
aged composite resin specimens.* However, these dif-
ferences in wear performance were not seen either in
contact-free occlusal areas or with anterior restora-
tions. Thus, a classification of anterior composite resin
systems based on the compositions of their organic
matrices does not appear to be an accurate mode.
The interfacial phase
Bipolar molecules, mainly organosilanes, are usually
used as coupling agents to connect the inorganic fillers
and the organic matrix. With prepolymerized partially
organic filler particles, the bond is polymeric in
nature.0-2 Both these types of agents, and all current
versions of interface adhesion, are equally sensitive to
chemical disintegration. Hence, using coupling agents
as a basis for classification does not seem to be an
appropriate mechanism.* 3I3
The dispersed phase
from the Univer-
Under oral conditions the interfacial bonds deterio-
rate in time to reveal the dispersed phase. In current
OCTOBER 1983 VOLUME 50 NUMBER 4
COMPOSITE RESIN SYSTEMS

composite resin constructions, these exposed fillers MACRC!+lLLERS - MICROFILLERS - COMPLEXES: AVERAGE SIZE f AS I I SIZE DlSTRlRTlON , SD b

demonstrate distinct differences in properties. There-

fore, they may provide a basis for establishing a 1 nl * IO-6 In

,I 1-h
workable classification. Hence, the various types of A5: 2 8 I
MICROFILLERS .-I j 5ax
fillers will be discussed in some detail. so 0.1 - IW I

Based on the manufacturing technique, the average

AS: 0.04 I i
size (Fig. l), and the chemical composition of the filler MICROFILLERS 7;; ;
so 0.03 - 0.8 *
particles, three categories can be characterized: (1) ,I :

traditional macrofillers, (2) microfillers (pyrogenic sili-

ca), and (3) microfiller-based complexes.
Traditional macrofillers. Traditional macrofillers
are mechanically prepared from larger pieces of the COMPLEXES: k ,,
15 - 103x
I
material by grinding and/or crushing. The particles SD: 1 - ,sOiXXI

are purely inorganic; usually splinter shaped; and are Fig. 1. Dispersed phase illustrating average size and
quartz, glass, borosilicate, or a ceramic. Heavy metal size distribution of inorganic fillers and microfiller-
glasses that provide adequate radiopacity are available. based complexes as well as lower and upper limit of
The ground chips fall into a size range of from 0.1 to wavelength of visible light. Arrows identify smallest
100 pm. The lower limit of the size distribution is particle size of each type.
established by the manufacturing method. At present
no mills provide particles smaller than 0.1 pm. On the
other hand, inorganic fillers larger than 100 pm would
present a diversity that would be highly visible if used
in a composite resin system.
In recent years there haI; been a definite trend to
smaller, softer, and more rounded macrofillers, with
mathematically calculated size distributions available.
I 1
With modern composite resin constructions containing 1 HOMCGENEWS
CCMpOSITf
MICROFILLED
RESIN I

this type of fille.r, the average particle size is generally

reduced from the original range of 5 to 30 pm to 1 to
5 pm.7*4
Microfillers. Microfillers are derived chemically by Fig. 2. Composite resin classification (right column)
w HETERWENWS
COMPOSITE
MICROFILLED
RESIN
I

hydrolysis and precipitation and consist of very finely
dispersed radiolucent glass spheres.* Originally, the
commonly used primary particles generally had an
average size of 0.04 km (Fig. 1).7,o,1,5,6 Recently, a inorganic loading. with microfillers. There are three
tendency to use larger average particle sizes, approxi-
mately 0.05 to 0.1 pm, has become apparent.
Pyrogenic silica has a strong thickening effect if
added directly to a liquid mixture. This effect on
viscosity of the paste has to date limited heavy inorgan-
ic loading of a resin matrix with microfillers. Such a
mix becomes extremely viscous and difficult to manip-
ulate. Therefore, alternative ways of admixing micro-
fillers to an organic matrix were needed to increase
the filler load without jeopardizing the handling
properties.
Microfiller-based complexes. Microfiller-based
complexes have been developed to attain maximum
*If the particle size ranges between 0.001 and 0.1 /.un, the dispersion
is colloidal. Hence, only microfillers smaller than 0.1 pm (Fig. 1)
can be colloidally dispersed.
based on types of fillers (left column) they contain.
Figure depicts construction of respective classes.
different types: (1) splintered prepolymerized micro-
filled complexes, (2) spherical polymer-based micro-
filled complexes, and (3) agglomerated microfiller
complexes.0-12~
Splintered prepolymerized microjlled complexes.
These are made by incorporating pyrogenic silica into a
resin matrix and then heat-curing the mixture. It is
then milled into particles that cover a rather large
range, from 1 to 200 pm (Fig. 1). Such particles
sometimes are erroneously labeled organic fillers. It is
true that the matrix of the particles is organic in
nature, but harbored within the resin is inorganic
silica. Consequently, they are more correctly termed
splintered prepolymerized particles., x z I6
Spherical polymer-based microfilled complexes.
These are commonly named spherical prepolymerized
particles and are manufactured by incorporating pyro-

THE JOURNAL OF PROSTHETIC DENTISTRY 481

 LUTZ AND PHILLIPS

genie silica into partially cured polymer spheres that Table I. Composite resins and manufacturers
have an average diameter of 20 to 30 pm. Again, a
a B-21 Bayer AG, Leverkusen,
sophisticated size distribution permits an extremely West Germany
dense Racking.2 B-23
Agglomerated microfiller complexes. Agglomerated Superfil H. J. Bosworth Co.,
microfiller complexes consist of artificially agglomer- Skokie, Ill:
ated microfillers in the range of 1 to 25 pm. In contrast b Superfil Light (VLA)
C Ful-Fil (VLA) L. D. Caulk Co., Milford,
to the above-mentioned types of complexes, these Del.
particles are purely inorganic. Prisma-Fil
Based on the present state of polymer and filler Nuva-Fil
technology, of the three phases of the composite resin, Vytol
Finesse
the composition, chemical properties, size and size
Uvio-Visio-Dispers Espe GmbH,
distribution. of the dispersed phase or filler particles Seefeld/Oberbayern,
appear to provide the best information for determining West Germany
the potential in vivo performance of a restorative d Nimetic-Dispers
composite resin. Therefore, the following classification d Visio-Dispers (VLA)
e Miradapt Johnson & Johnson, East
is focused principally on the fillers they contain.
Windsor, N:J.
CLASSIFICATION AND CLINICAL Adaptic
Answer
PERFORMANCES Aurafil
The three types of fillers previously described repre- Smile Kerr Mfg. Co., Romulus,
sent the backbone of the classification. Fig. 2 depicts Mich.
Simulate
how traditional macrofillers, microfillers, and micro- Command
filled complexes are organized into four major systems. Command Ultrafine
The schematic diagrams of each type of composite Estic Microfill Kulzer & Co., GmbH,
resin, (which will be discussed next), are shown in Friederichsdorf, West
Germany
Figs. 3 to 8, The materials and manufacturers are
g Estilux Posterior, Rx
listed in Table I. (UVLA-VLA)
g Durafill (VLA)
Traditional composite resins Smile
g
A schematic presentation of the structure of a h Clear81 Kuraray I? Co.,
traditional composite resin can be seen in Fig. 3. Kurashiki, Okayama,
Japan
Representative products of this type, the average parti- Concise 3M Co., St. Paul, Minn.
cle size of the filler, and the advantages and disadvan- P-10
tages of that system are presented in Table II. P-30 (VLA)
The differences in hardness of the two bulky phases Silar
Silux (VLA)
and the high visibility of the rather large macrofillers,
Phaseafill Phasealloy Inc., El Cajon,
which in general are larger than the wavelength of the Calif.
visible light, make it difficult to finish the resin to a k Lite (VLA)
smooth surface. Therefore, trimmed restorations soon I Profile S. S. White, Philadelphia,
become rough and prone to stain and plaque accumu- Pa.
m Isopast Vivadent AG, Schaan,
lation as hydrolysis of the interfacial bond and the fast
Liechtenstein
&ear of the organic matrix facilitate protrusion and/or m Heliosit (VLA)
dislodgment (plucking out) of the macrofillers. For that m G-2
reason, the rather poor wear properties .observed in m M-18
both stress-bearing and contact-free situations are not m Iso-Ex
surprising.8, 18,9 VLA = Visible light activated; UVLA = ultraviolet light activated.
As mentioned previously, the modern, traditional
composite resins contain smaller, more rounded, softer a higher inorganic filler load; (2) shelf life; (3) iian-
macrofillers, coupled with an appropriate size distribu- dling characteristics of the freshly mixed resin; (4)
tion. Furthermore, these fillers are frequently radi- wear resistance, particularly with single-paste light-
opaque. In this manner, several properties can be curing formulations; (5) radiopacity; and (6) a. poten-
improved: (1) packing of the organic matrix to provide tial to be finished to a smoother surface. Nonetheless,

482 OCTOBER 1983 VOLUME 50 NUMBER 4

COMPOSITE RESIN SYSTEMS
Fig. 3. Traditional composite resins. Schematic draw-
ing shows components: organic matrix plus traditional
macrofillers. Representative products are listed in
Table II.
Fig. 4. Hybrid composite resins. Schematic drawing
shows components: organic matrix plus traditional
macrofillers plus microfillers. Representative products
are listed in Table III.
the improved smoothness is still only short lived as the
macrofillers become dislodged. Is,20,
Hybrid composite resins
It is now common practice to reinforce the organic
matrix with microfillers to reduce the differences in
properties between the inorganic macrofillers and the
unfilled organic matrix. In addition, the microfillers
provide better control of the viscosity and improve wear
resistance. That technology is used even with the
leading traditi0na.l composite resins of the 197Os, such
as Adaptic and Concise. Hence, the purely traditional
types of composite resins have become rare.2,22
A typical hybrid composite resin is depicted in Fig.
4; and again, representative products, classified accord-
ing to the size of the macrofillers they contain, are
presented in Table III. These materials contain inor-
ganic macrofillers of an optimized traditional type of
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 5. Homogeneous microfilled composite resins.
Schematic drawing shows components: organic matrix
plus microfillers. Representative products are G-2,
M-18, and Iso-Ex.
Fig. 6. Heterogeneous microfilled composite resins
with splintered prepolymerized particles. Schematic
drawing shows components: organic matrix plus
microfillers plus splintered prepolymerized micro-
filled complexes. Representative products are listed in
Table IV.
composite resin plus pyrogenic silica. Hybrids still do
not make ideal anterior restorations because of their
surface properties. Even if acceptable smoothness can
be achieved by means of an optimal finishing tech-
nique, it is short lived because of the wear pattern
inherent in a resin system that contains traditional
macrofillers. Nevertheless, the surface morphology of
a hybrid composite resin is superior to that of the
traditional type. A further improvement can be antici-
pated with the use of even smaller macrofillers, which
would have an average size of approximately 1 pm.
The basic characteristics of the currently available
hybrids are seen in Table III.
Apart from the common hybrid type of composite
resin, there are some rather rare constructions of this
kind that combine the elements present in a hybrid
483
 LUTZ AND PHILLIPS

Fig. 7. Heterogeneous microfilled composite resins Fig. 8. Heterogeneous microfilled composite resins
with spherical prepolymerized particles. Schematic with agglomerated microfiller complexes. Schematic
drawing shows components: organic matrix plus drawing shows components: organic matrix plus
macrofillers plus spherical polymer-based mi- microfillers plus agglomerated microfiller complexes.
crofilled complexes. Representative products are Representative products are Answer, Nimetic Dis-
B-21 and B-23. persd, and Visio-Dispersd.

Table II. Traditional composite resins Table III. Hybrid composite resins
Average particle size Average particle size
(rtm) (urn)
Adaptice (1970s) Adapt2 (1980s) > 10
ClearfiP > 10 Concise (1980s)
Concise (1970s)
Aurafil
Command (VLA) Estilux Posterior, Rx+
Estilux Posterior, Rx-8 (UVLA/VLA)
(UVLAWLA) Ful-Fil (VLA) < 10
Nuva-Fil (UVLA) Miradapt
Profile < 10 P-10 >3
Simulate P-30 (VLA)
Smile Vytol

Prisma-FilC (VLA) <5 Command Ultrafine <3

UVLA = Ultraviolet light activated; VLA = visible light activated. UVLA = Ultraviolet light activated; VLA = visible light activated.
Advantages Disadvantages Advantages Disadvantages
Favorable optical properties Lack of polishability Favorable optical properties Surface morphology inferior
Favorable physical properties Surface roughness Favorable physical properties to that of microfilled
Long clinical observation period Plaque accumulation and Improved wear resistance composites
Radiopacity achievable stain in time Surface morphology superior to Increased surface roughness
that of traditional composites with time
Radiopacity achievable Short clinical observation
with microfilled complexes. Representative of this type period
are Finesse and Uvio-Visio-Dispersd. Because these
two products do not demonstrate superior properties containing inorganic fillers, which are smaller than the
when compared to their microfilled equivalents, they wavelength of visible light, visually appears homoge-
will not be discussed further. neous. Consequently, this results in a high degree of
surface polishability. In addition, even if the microfill-
Homogeneous microfilled composite resins ers are mechanically or chemically dislodged because of
Homogeneous microfilled composite resins are com- in vivo wear, the polished surface retains its enamel-
binations of an organic matrix and directly admixed like luster because the induced surface irregularities
microfillers, as shown in Fig. 5. cannot be detected optically. Second, the homogeneity
They are considered optimal with regard to at least and the extremely small particle size provide only a
two properties. First, a composite resin exclusively minimal working surface for wear plucking-out pro-

484 OCTOBER 1983 VOLUME 50 NUMBER 4

COMPOSITE RESIN SYSTEMS

cesses.This has raised expectations for superior wear Table IV. Heterogeneous microfilled
properties. composite resins with splintered
However, the inorganic loading with such small prepoiymerized particles
particles, approximately 0.04 to 0.2 pm, is still limited
Estic MicrofiW Durafillg (VLA)
because of the viscosity effect resulting from the large Isopast Heliosit (VLA)
surface area they present.16 Hence, a homogeneous Phaseafill Lite (VLA)
microfilled composite resin has not as yet been mar- Silar Silux (VLA)
keted as an anterior restorative material. Therefore, SuperfiP Superfil Lightb (VLA)
other technologies were required to incorporate the VLA = Visible light activated.
microfillers in a higher concentration without effecting Advantages Disadvantages
viscosity, as noted earlier. Polishahility Technique sensitivity
Permanent surface smoothness Radiolucent
Heterogeneous microfilled composite resins Excellent esthetics Short clinical observation
Good wear resistance period
Heterogeneous microfilled composite resins are com- Alteration in certain physical
binations of an organic matrix, directly admixed properties
microfillers, and microfiller-based complexes. Different optical properties
Heterogeneous microfilled composite resins fall into
three different subclasses: (1) those with splintered pre- strength is strong enough to resist wear in non-
polymerized particles, (2) those with spherical prepoly- stress-bearing situations, as in anterior restorations and
merized particles, and (3) those with agglomerated in contact-free occlusal areas in posterior restora-
microfiller complexes. tions.2
Heterogeneous microfiled composite resins with However, this lack of a perfect polymeric interfacial
splintered prepolymerized particles. The admixture bond is the main reason for the technique sensitivity
of splintered, prepolymerized complexes to a microfill- seen with microfilled composite resins. Improper fin-
er-reinforced organic matrix, as previously described, ishing techniques can readily cause damage. Green and
is one of three methods that are technically feasible for white stones or tungsten carbide burs, especially when
augmenting the inorganic loading and volumetric filler used dry, can fracture the prepolymerized particles and
content without further increasing the viscosity and form fissures along the interfacial surface phase. Con-
jeopardizing the handling characteristics of the com- sequently, when such restorations are incorrectly fin-
posite resin. Such a system can be labeled as a ished, they do not demonstrate the same lusterlike
heterogeneous microfilled composite resin with splint- surface finish possible when finished with kinder
ered prepolymerized particles and is shown schemati- flexible disks @of-Lex disks, grit 150, 360, 600, 1200,
cally in Fig. 6. Representative products based on this 3M Co., St. Paul, Minn.) or specially developed
type of formulation are listed in Table IV. superfine finishing diamond burs (Composhape-Set
Such a resin will be comparable in characteristics to [made by Intensiv], W. Hubschmid Sohn, Switzerland;
a homogeneous microfilled composite resin that has U.S. distributor: Teledyne, Denver, Co10.).~~
excellent polishability, a permanent surface smooth- Apart from their sensitivity to the finishing tech-
ness, excellent esthetics, and good wear resistance, nique, heterogeneous microfilled resin systems also
provided that two crucial conditions are fulfilled: (1) demand additional modifications of other clinical pro-
the concentration of the dispersed silica microfillers cedures. As they have a somewhat greater polymeriza-
must be equal in the prepolymerized particles and in tion shrinkage, they should be used in combination
the polymerizable organic matrix in order to provide a with long-beveled cavity preparations, the enamel-etch
uniform distribution throughout the composite resin technique, and bonding agents. This will safeguard an
following polymerization and (2) the bond between the excellent marginal adaptation and provide superior
reinforced organic matrix and the partially organic esthetic results.24,25Furthermore, as their optical prop-
complexes should be as str0n.g as the cohesive forces erties differ from those of traditional or hybrid compos-
within the phases. ite resins and the surface texture does not interfere with
With regard to the dispersion of the inorganic phase, the esthetic appearance of a restoration, the dentist may
current products (Table IV) are in general more or less have to relearn selection of shades.
homogeneous. However, the polymeric interfacial bond At present, the heterogeneous microfilled composite
is not adequate under certain circumstances and may resin with splintered prepolymerized particles is the
occasionally contribute to failure.16,23 The bond most common type of microfilled composite resin. The

THE JOURNAL OF PROSTHETIC DENTISTRY 485

 LUTZ AND PHILLIPS

Table V. Polishability (according to five-point Heterogeneous microfilled composite resins with

rating system) agglomerated microfiller complexes. Agglomerated
Homogeneous microfilled composite resin Ic * * *
microfiller complexes are similar to traditional macro-
Heterogeneous microfilled composite resin*** fillers in size and chemistry, but not in structure.
Traditional and hybrid composite resin (< 5 Mm)*** Further, they allow a substantial increase in the
Traditional and hybrid composite resin (< IO pm)** microfiller content when admixed to a microfiller-
Traditional and hybrid composite resin (> 10 pm)* reinforced organic matrix. Such a restorative resin is
schematically depicted in Fig. 8. It can be termed a
Table VI. Permanence of surface smoothness heterogeneous m&o$lled com>osite resin with agglom-
(according to five-point rating system) erated microfiller complexes. Such a composite resin
demonstrates excellent finishing and perfect surface
Homogeneous microfilled composite resin*****
qualities. 25 Unfortunately, however, not much is
Heterogeneous microfilled composite resin****
Traditional and hybrid composite resin (< 5 Fm)*** known about the in vivo performance of that filler type
Traditional and hybrid composite resin (< 10 pm)** and consequently of these resins. Those essential clini-
Traditional and hybrid composite resin (> 10 pm) cal studies are not available.

COMPARISON OF SYSTEMS
Table VII. Esthetics (assuming use of
New materials are often troublesome, even if they
adequate technique) (according to five-point
are deemed progressive, because they may be associated
rating system)
with a reevaluation of the established techniques of use.
Homogeneous microfilled composite resin* * * * l Furthermore, there is an unavoidable time lag in
Heterogeneous microfilled composite resin* + l * establishing the precise relationship of properties to
Hybrid composite resin***
clinical performance. Thus, the introduction of micro-
Traditional composite resin*
filled resin systems has led to considerable controversy,
both from the standpoint of the dentist and within the
Table VIII. Technique sensitivity (according scientific community. However, it is possible to evalu-
to five-point rating system) ate the four main composite resins classes that have
been shown in Fig. 2 and were then described. This has
Traditional composite resin*****
Hybrid composite resin * * * been done in Tables V through IX by use of an
Homogeneous microfilled composite resin** arbitrary five-point rating system. An assignment of
Heterogeneous microfilled composite resin** one asterisk indicates the lowest rating, while five
designates the best rating in that category. The respec-
tivecomparisons cover the features iha; have clinical
Table IX. Clinical observation time (according
relevance, namely, polishability, permanence of surface
to five-point rating system)
smoothness, esthetics, technique sensitivity, and in vivo
Traditional composite resin l * * * l observation time.
Hybrid composite resin * l As the filler particle size is reduced, the polishability,
Heterogeneous microfilled composite resin***
permanence of surface smoothness, and esthetics
Homogeneous microfilled composite resin*
improve. As would be anticipated, the hybrid, and
especially the microfilled, composite resins are marked-
general advantages and disadvantages of such a system ly superior to the traditional composite resins. For that
are summarized in Table IV. reason, the original macrofilled systems are now almost
Heterogeneous microfilled composite resins with obsolete. In the same vein, the profession has hailed the
spherical prepolymerized particles. Spheres with a microfilled resins for the superior esthetic results that
specific size distribution allow dense packing. There- are possible, if an operative technique is used that
fore, the so-called heterogeneous microfilled composite incorporates the cavity design and finishing procedures
resins with spherical prepolymerized particles, sche- previously stated. Certainly, they do have a greater
matically shown in Fig. 7, can be filled to a high technique sensitivity, which in turn can influence the
volume percent, which is reflected in a reduced poly- clinical performance.
merization shrinkage. Experimental versions of that However, it is fair to note that the older macrofilled
type of composite resin have shown promising results.2 composite resins do have the edge in terms of the
However, such a heterogeneous microfilled composite clinical observation period, simply because they have
resin has not been marketed to date. been in use for a longer period of time. Therefore, a

486 OCTOBER 1983 VOLUME 50 NUMBER 4

COMPOSITE RESIN SYSTEMS

time lag does exist for the newer hybrid composite Table X. Visible light cure versus chemical cure
resins and particularly the microfilled systems. Such
Advantages
clinical data are essential to determine the precise Single-paste formulation
performance of the microfilled composite resins over No mixing
the same time frame as the established macrofilled Less porosity
materials. This is of special importance in view of the Adequate working time
Suitable for incremental technique if desired
alterations in certain physical properties between the
Restoration color, opacity, translucency, and
two basic constructions. To date, the maximum clinical morphology can be optimized
observation time is only 7 years. However, the clinical Improved margin adaptation
reports on microfilled composite resins during the last 3 Faster cure
years have consistently been favorable.8,2s-27 More complete surface cure
Optimal physical properties
VISIBLE LIGHT CURE Wear resistance somewhat improved
Instant finishing possible
All the above-mentioned systems can be formulated
Disadvantages
to polymerize either chemically or by light. It is not the
Technique sensitivity
purpose of this article to discuss at length the differ- Polymerization starts under operating light; thus, not
ences between the two curing mechanisms; however, unlimited working time
light cure does provide a higher degree of polymeriza- Limited depth of cure
tion than chemical cure. For that reason photocured Additional equipment necessary

restorative resins do have some definite advantages, as

is shown in Table X.3,4 This is particularly true with
microfilled composite resins. The single-paste formula-
tions do not require mixing; consequently, there is
much less porosity in the restoration. Thus, with
light-cured microfilled composite resins, perfectly
smooth enamel-like surfaces that are free of irregular-
ities can be achieved. Furthermore, such a system
allows sufficient working time for a more precise
insertion of the material. Thus, these systems are
particularly suitable for an incremental technique,
which provides an improved margin adaptation. In
addition, it facilitates an optimal match to the sur-
rounding natural tooth structure with regard to color,
opacity, translucency, and morphology. Finally, the
faster and more Icomplete cure is of great importance in
the feather-edged margins of freshly inserted restora-
tions. In contrast, the degree of polymerization of
chemically cured resins is, among other factors, mass
dependent. Therefore, the thin and frail marginal areas
of a restoration may be insufficiently cured. With
light-cured systems, an immediate finishing is possible
without jeopardizing the excellent initial margin adap-
tation.
As seen in Table X, there are some disadvantages to
be encountered with light-curing systems. Of course, it
is necessary to purchase a light generator. Further-
more, some precautions must be noted with light-cured
resins. The depth of cure may not be as great as is often
stated. Even with a curing time of 40 seconds, the depth
of cure may be in the order of 3 mm with the lighter or
universal shades and only 2 mm with the darker ones.
In addition, the working time is actually not unlimited
since polymerization does sta.rt on exposure of the
resins to the operating light. Therefore, the resin
should be shielded from light until a few seconds before
it is to be inserted.
All factors considered, the potential to achieve virtu-
ally undetectable anterior restorations by use of a
combination of a microfilled composite resin and the
visible light cure is certainly attractive.
CONCLUSION
Hybrid composite resins can be considered an opti-
mal combination of the well-tried traditional and the
new microfiller composite resin technology. The most
promising anterior types, especially with regard to
esthetics, consist of an extremely small (1 to 2 rm),
rather soft, traditional macrofiller with a sophisticated
size distribution placed into a reinforced organic
matrix. Such a resin system demonstrates all the
favorable properties seen with modern, traditional
composite resins but has a somewhat superior wear
resistance. Furthermore, the surface smoothness is
definitely better, even though not ideal. Overall, use of
hybrid composite resins means remaining on the safe
side. Good, but not perfect, restorations can be
inserted.
If esthetics is the primary concern and virtually
undetectable restorations are in demand, then micro-
filled resin systems, particularly light-cured versions,
are the materials of choice. At present, these are the
heterogeneous microfilled composite resins with splint-
ered prepolymerized particles. However, in order to
achieve restorations of consistently outstanding quality,
attention to technique sensitivity should be maintained,
and certain modifications have to be made in the

THE JOURNAL OF PROSTHETIC DE:NTISTRY 487

 LUTZ AND PHILLIPS

clinical procedures that are used with traditional 15. Gross, A.: Kunststoffe in der Zahnmedizin. Chemie unserer
Zeit 13:142, 1979.
composite resins. Cavity preparation and insertion and
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488 OCTOBER 1983 VOLUME 50 NUMBER 4