Microfilled Composite and Hybrid Composite

EVIDENCE-BASED DENTISTRY
JUCO, JENINA SHARMAINE

LOPEZ, AMADEO
MANALILI, SHANN
MANAOIS, REGINE
MICROFILLED COMPOSITE
and HYBRID COMPOSITE
TITLE: CONVENTIONAL, MICROFILLED AND HYBRID
COMPOSITE RESINS: LABORATORY AND CLINICAL
EVALUATIONS
AUTHOR: JAN W V VAN DIJKEN

Three groups of composites can be
identified according to their filler
content.
• Conventional composite resins
-The first generation of composites, contain
relatively large filler (macrofiller) particles such as
ground quartz, borosilicate glass or lithium
aluminium glass.
- Most particles range in size 20-50 pm, and the

total range is 0.1-150 pm.
CONVENTIONAL, MICROFILLED AND HYBRID COMPOSITE RESINS: LABORATORY AND CLINICAL EVALUATIONS
by: JAN W V VAN DIJKEN
Microfilled composite
• Microfilled composites
-Contain so called microfine filler particles of
pyrolytic silica (SiO^), in the range of 0.007-0.14
pm with a mean of 0.04 pm.
-They were developed in 1974 and were marketed
at the end of the 1970s.
Hybrid composites
• According to Websters dictionary a hybrid is
"anything of mixed origin".
• In dentistry the term hybrid composite is used
for resins containing a blend of macrofiller
particles and microfine pyrolitic silica particles.
• During the 1970s, microfillers were used as
reinforcing particles to obtain a more
polishable resin.
• At the end of the 1970s hybrid composite
resins were introduced which contained a blend
of macro- and microfiller particles, in an attempt
to combine the properties of the conventional
and the microfilled materials.
Filler Composition of Composites
• First microfilled composites had a filler load
in the range of 17-40 vol% (30-55 wt%).
• Most hybrid composite materials contained

a total of 75-85 wt% filler of which 7% was
pyrolitic silica. The inorganic filler of most
hybrid resins is a glass made radiopaque by
incorporation of barium or strontium.
Properties of Composite Resins
POLYMERIZATION SHRINKAGE
• One major drawback of polymeric materials is the
setting shrinkage which allows a gap to form between
the cavity wall and the restoration.
• This permits microleakage of oral fluids containing ions

and bacterial toxins, giving rise to pulpal reactions,
staining of restoration margins and recurrent caries.
• The incorporation of filler particles in the resins

reduced the level of shrinkage, but various composite
materials still exhibit shrinkage of 1.67 to 5.68 voi %
(Goldman 1983) CONVENTIONAL, MICROFILLED AND HYBRID COMPOSITE RESINS: LABORATORY AND CLINICAL EVALUATIONS
• Microfilled composite resins which contain
a relatively high percentage of organic matrix
exhibit a larger polymerization shrinkage than
the macrofilled composites. (Asmussen
1975).
• Water absorption
- All composite resins absorb water from the oral
environment and undergo hygroscopic
expansion (Asmussen & Jörgensen 1972, Bowen
et al 1982).
- Microfilled resins show higher levels of

water absorption than conventional
composites. (Söderholm 1984).
• Ameye et al (1981) reported that microfilled resins
showed a good color stability which was comparable or
sometimes superior to the conventional resins after 18
months. Marginal adaptation was, however, not satisfactory
in Class IV and V restorations.
• Loeys et al (1982) concluded that after 30 months

microfilled resins had a higher percentage of success than the
conventional composites.
• However, a high degree of marginal disintegration and chip

fractures of microfilled resins was reported by the same group
in another study (Lambrechts et al 1982).
SUMMARY
• Despite the improved qualities of the composites over the unfilled
resins, the conventional composites still revealed a number of
disadvantages which led to clinical problems. Polishing difficulties
and problems in obtaining lasting smooth surfaces led to rough
filling surfaces with large amounts of plaque formed, and to
gingivitis. Discoloration led to the need for rapid revisions of the
fillings. Porosities within the resin material led to increased wear,
water absorption and surface roughness.
SUMMARY
• A relatively high polymerization shrinkage led to
gap formation in the unetched parts of the
fillings and to internal stress in the composite
resin, enamel or material/enamel interface of
the acid-etched cavity margins. There is some
controversy about the reported frequency of
recurrent caries around composite resin fillings.
SUMMARY
• No consideration was taken in these studies to the potential caries
risk of the individuals. No studies have been published comparing
the conventional composite resins with the new microfilled- and
hybrid composites regarding the surface characteristics and
irritating effect on the gingival margin. No study has compared the
marginal adaptation and clinical behaviour of the three types of
composites either longitudinally or intraindividually.
RESULTS
Effect of finishing procedures on surface textures of some resin
restorations. A comparison between new and old types of
composite resins. Acta Odontol Scand 1980; 38: 293-301.
• The effects of twelve finishing procedures on the surface textures of two

anterior conventional composites, two anterior microfilled resins and a
glass ionomer cement were investigated. The final evaluations based on the
SEM photomicrographs, showed that the microfilled composite resins are
superior in finishability to the resins loaded with larger filler particles. The
use of fine grit devices resulted in smooth surfaces. In contrast the
macrofilled composites showed rough surfaces with protruding filler
particles. Only the Sof-lex polishing system produced smooth surfaces on all
composite resins, whereas the use of a polishing paste led to very rough
surfaces on the macrofilled resins.
• CONCLUSION: Microfilled materials are superior to macrofilled

materials as regards the possibility of obtaining and retaining a smooth
surface. CONVENTIONAL, MICROFILLED AND HYBRID COMPOSITE RESINS: LABORATORY AND CLINICAL EVALUATIONS
SEM study of surface characteristics and marginal
adaptation of anterior resin restorations after 3-4
years. Scand J Dent Res 1985; 93: 453-62.
• A SEM replica technique was used to study the

surface roughness and marginal adaptation of
278 anterior resin fillings.
• The fillings were made of two conventional,
three microfilled and two hybrid
composite materials.
• After 3-4 years in vivo, replicas were made. The
surface roughness studied by SEM was graded
by using photomicrograph standards.
• The degradation of the bonding between the acid etched
enamel and the filling material was investigated in two
specified areas, one located on the incisal part and one on the
gingival part of the etched margin of each filling. The 3/4-
year-old composite restorations showed degradation of
surfaces and margins, with eroded areas and exposed filler
particles. Cohesive failures were seen as chip fractures and
marginal fractures parallel to cavity margins. Rough surface
characteristics increased in the following order:
1) light-cured microfilled,
2) chemically cured microfilled
3) hybrid and conventional composites. A light cured microfilled
resin showed the smoothest surface characteristics with less
surface degradation and porosity.
• Marginal defects were seen in about 50% of the
conventional and hybrid composite fillings.
• Defects occured in 66-88% of the chemically
cured microfilled resins but in only 44% of the
visible light-cured microfilled resin.
• Marginal defects were observed more frequently
in stress bearing fillings than in non-stress
bearing ones.
SEM study of surface characteristics and
marginal adaptation of anterior resin
restorations after 3-4 years. Scand J Dent Res
1985; 93: 453-62.
• CONCLUSION: The type of filler particle
seems to determine the final surface
characteristics.
A clinical evaluation of anterior conventional,
microfilled and hybrid composite resin fillings. A six-
year follow-up study. Acta Odontol Scand 1986; 44:
357-67
• The clinical behaviour and durability of 303 anterior

resin fillings of seven composite materials - 2
conventional, 3 microfilled and 2 hybrid - were evaluated
over a six year period. The restorations were placed in 27
patients including patients who experienced relatively
high levels of caries. Each patient received at least one
filling of each of the three composite resin types. Each
restoration was evaluated with respect to extrinsic
discoloration, color match, marginal discoloration,
marginal adaptation, surface roughness and the presence
and location of recurrent caries. A prediction of potential
caries activity was made for all patients.
A clinical evaluation of anterior conventional, microfilled and
hybrid composite resin fillings. A six-year follow-up study. Acta
Odontol Scand 1986; 44: 357-67
• The prediction, based on six caries risk factors, was compared to the
actual caries development during the six year period in each patient.
Unacceptable color match scores varied widely among the brands
(3.5-79.7%) after six years. Unacceptable marginal discoloration was
seen in 1.7% of the restorations, while unacceptable marginal
adaptation varied among the resins (13.7-37.3%). Recurrent caries
occurring at the margins of the composite fillings varied among the
materials (9.3% - 29.4%). During the experimental period between
14.8% and 55.1% of the fillings of each material were replaced per
patient. Recurrent caries was the major reason for replacement.
• CONCLUSION: There was a wide variation in clinical behaviour

and durability within each composite resin group. Recurrent caries
was the major reason for replacement. Patients with a high number
of caries risk factors showed a clearly higher increment of caries,
especially of recurrentCONVENTIONAL,
caries around composite fillings.
MICROFILLED AND HYBRID COMPOSITE RESINS: LABORATORY AND CLINICAL EVALUATIONS
COMPOSITE INLAY
TITLE : Clinical evaluation of a heat-treated resin
composite inlay: 3-year results
AUTHOR: Stanley Wendt

Clinical evaluation of a heat-treated
resin composite inlay: 3-year results
• The study evaluated a resin composite inlay system

in clinical trials involving human subject. 60
restorations were inserted equally in class 1 and 2
preparation and in premolars and molars. A glass
ionomer cement liner was applied to the dentin.
Light cured direct inlays were fabricated in oral
environment. Thirty inlays were heat – treated for
7.5 minutes at 125 degree Celsius in a dre heat oven.
Enamel margins of the preparations were etched
with 37% phosphoric acid gel.
• All inlays were cemented with light – cured enamel
bonding resin. Restorations were evaluated using the
USPHS system and M-L indirect scale. Six, 12, 24 and 36
months recalls were compared to baseline; Interfacial
staining, secondary caries and wear were unchanged
from baseline for all restorations. Marginal integrity and
surface texture show a differential change from baseline
and with respect to restorations type. Indirect wear was
not significantly different between restoration types.
Wear resistance was not significantly improved with heat
treatment, but marginal integrity and surface
characteristics showed marked improvement in the heat-
treated group at 24 and months recall .
• Compared to light cured composite inlays and
direct placement composite restorations,
marginal integrity and interfacial staining
characteristics were superior in heat – treated
composite inlays. Post operative sensitivity and
secondary caries for the 3 years period were
nonexisted. Wear resistance depends upon the
type of composite used and not upon heat -
treatment
CERAMIC INLAY
TITLE : Long-term clinical results of chairside
Cerec CAD/CAM inlays and onlays: a
case series
AUTHOR: Otto, T; Schneider, D

Long-term clinical results of chairside Cerec
CAD/CAM inlays and onlays: a case series
• The study examined the performance of Cerec inlays and
onlays, all of which were placed by the same clinician, in
terms of clinical quality over a functional period of 15
years.
• The materials used of 200 Cerec inlays and onlays placed
consecutively in a private practice by one of the authors
(TO) between 1989 and early 1991, 187 were closely
monitored over a period of 15 years.
• All ceramic inlays and onlays had been placed chairside
using the Cerec 1 method and had been luted with a
bonding composite. Up to 17 years after their placement,
a follow-up assessment was conducted, and the
restorations were classified using modified United States
Public Health Service criteria.
Long-term clinical results of chairside Cerec
CAD/CAM inlays and onlays: a case series
• RESULTS: According to Kaplan-Meier analysis, the
success rate of Cerec inlays and onlays was 88.7% after
17 years. A total of 21 failures (11%) were found in 17
patients. Of these failures, 76% were attributed to
ceramic fractures (62%) or tooth fractures (14%). The
reasons for the remaining failures were caries (19%) and
endodontic problems (5%). Restorations of premolars
presented a lower failure risk than those of molars.
• CONCLUSION: The survival rate probability of 88.7%

after up to 17 years of clinical service for Cerec
computer-aided design/computer-assisted machining
restorations made of Vita Mk I feldspathic ceramic is
regarded as a very respectable clinical outcome.
NANOFILLED COMPOSITES
TITLE : Clinical Evaluation of a Nanofilled Composite in
Posterior Teeth: 12-month Results
AUTHORS:
W Dresch • S Volpato • JC Gomes
NR Ribeiro • A Reis • AD Loguercio
Clinical evaluation of a nanofilled composite in
posterior teeth: 12 month results
AUTHOR: W Dresch et. al.
• Nanofilled composites is a new developed category of composite.

Nanofilled composites claimed that it has a high translucency, high
polished while maintaining physical properties and wear equivalent
to several hybrid cimposites.
• This article evaluate the nanofilled composite in posterior teeth for
12 months. The nanofilled composite was tested to the patient with
at least five class 1 or class 2 restorations with complete and normal
occlusion.
• Results: Nanofilled composites showed a good performance in
posterior teeth that can compared to other microhybrid and
packable composites. In terms of color matching some researcher
claims that this type of composite has a higher percentage of color
mismatching within 12 to 24 months. As a whole nanofilled
composites shows an excellent clinical performance for 1 year same
as the other types of composite materials.
FLOWABLE COMPOSITES
TITLE : Flowable Resin Composites: A Systematic Review
and Clinical Considerations
AUTHORS:
Kusai Baroudi and Jean C. Rodrigues
Flowable Resin Composites: A Systematic
Review and Clinical Considerations
• Flowable resin-based composites are conventional
composites with the filler loading reduced to 37%-
53% (volume) compared to 50%-70% (volume) for
conventional minifilled hybrids. This altered filler
loading modifies the viscosity of these materials.
• Most manufacturers package flowable composites in
small syringes that allow for easy dispensing with
very small gauge needles.
• This makes them ideal for use in small preparations
that would be difficult to fill otherwise.
Baroudi et.al., 2015. Flowable Resin Composites: A Systematic Review and Clinical Considerations.
Flowable Resin Composites: A Systematic
Review and Clinical Considerations
• Little is known about flowable composite

materials. Most literature mentions
conventional composite materials at large, giving
minimal emphasis to flowables in particular.
• This paper briefly gives an in depth insight to the
multiple facets of this versatile material.
Major Indications of Fowable Composite:
Preventive Resin Restorations (for
minimally invasive occlusal Class I):
• According to a survey conducted by Savage et
al., flowable composites are one of the most
widely used restorative materials for PRR’s with
more than 30% of paediatric dentists using a
flowable composite or a combination of flowable
and packable composite.
Pit and Fissure Sealants
• Jafarzadeh et al., compared the retention of
flowable composites with conventional resin based
sealants and concluded that flowable composites
had better retention when used as pit and fissure
sealants
• Dukic et al., concluded that flowable composite
resins should be used in combination with dentine
bonding agents as they can improve the strength of
the adhesive bonding to enamel in fissures and
reduce marginal microleakage and improve
retention rate
Cavity Liners
• Payne et al., concluded that flowable
composites are a good choice as cavity liners .
They adapt well to the microstructural
irregularities of the cavity preparation prior to
restorative composite placement.
• Rainer et al., evaluated the use of flowable
composite liners in large extended class I
restorations and concluded that large Class I
restorations without dentin support showed high
amount of marginal enamel fractures,
Minimally invasive Class II restorations and inner layer
for Class II posterior composite resin placement in
sealing the gingival margin to avoid deficiencies:
• Leevailoj et al., evaluated packable composite

resin placement with and without a flowable
composite and found that there was significantly
less microleakage in teeth restored with the
flowable composite resin as the first increment
in the proximal box
Class V abfraction lesions
• These are small angular Class V lesions
attributed to the forces of tooth flexure. When
restored with a stiff hybrid composite resin, the
clinical success rate was only 70% (McCoy,
2015). The high failure rate was attributed to the
stiffness of the composite used.
• Thus, using a flowable composite resin with a
lower biaxial flexural strength than traditional
hybrid composites was assumed to improve the
clinical success of these restorations.
CONCLUSION
• Flowable composites form an inhomogeneous group
of materials. They exhibit a wide variety in their
composition and consequently a variety in
mechanical and physical properties. Clinicians must
be aware of this variability, thus selecting the most
appropriate material based on a particular clinical
situation.
• Flowables are relatively newer members to the
family of conventional composites and clinical
studies still do not provide conclusive results of their
performance in the oral environment, suggesting
that long term clinical trials are necessary.
CONCLUSION
• Within the limitations of this review, the authors
would like to conclude that flowable composites,
once thought to be a passing fad, have become a
versatile workhorse in various aesthetic dental
procedures. They surely do claim to be a
promising material for the future

Microfilled Composite and Hybrid Composite

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EVIDENCE-BASED DENTISTRY

JUCO, JENINA SHARMAINE

AUTHOR: JAN W V VAN DIJKEN

- Most particles range in size 20-50 pm, and the

• Most hybrid composite materials contained

• This permits microleakage of oral fluids containing ions

• The incorporation of filler particles in the resins

- Microfilled resins show higher levels of

• Loeys et al (1982) concluded that after 30 months

• However, a high degree of marginal disintegration and chip

• The effects of twelve finishing procedures on the surface textures of two

• CONCLUSION: Microfilled materials are superior to macrofilled

• A SEM replica technique was used to study the

• The clinical behaviour and durability of 303 anterior

• CONCLUSION: There was a wide variation in clinical behaviour

AUTHOR: Stanley Wendt

• The study evaluated a resin composite inlay system

AUTHOR: Otto, T; Schneider, D

• CONCLUSION: The survival rate probability of 88.7%

• Nanofilled composites is a new developed category of composite.

• Little is known about flowable composite

• Leevailoj et al., evaluated packable composite

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