FAILURES OF COMPOSITE RESTORATIONS AND THEIR

MANAGEMENT
Causes of failure of a restoration:
i.

According to Wilson & Fuzzi

Failure

New Disease

Technical Failure

Caries & Tooth wear

Fractured restoration

Periodontal disease

Marginal breakdown

Pulpal problems

Tooth fracture

Trauma

Defective contours
Failure of retention

II. According to Jenderson & Roning

Failures of restorations can be characterized as

Secondary caries

Marginal deterioration

Tooth fractures

Loss of anatomy

Loss of aesthetics

Restoration fractures

III. According to Mount

Failure of tooth structure

Failure of restorative material

Failure of enamel margin

Failure of margins

Failure of dentin margin

Fracture or collapse of material

Bulk loss of tooth structure

Total loss of restoration

Split root

Loss of vitality

Composite resin placement is a very technique sensitive procedure and failure

to follow the protocol at any one step often produces compromised results. The
potential areas of error have been enumerated below:
1.

CASE SELECTION
Caries rate
Occlusal factors

2.

ISOLATION OF THE OPERATING SITE

3.

FACTORS RELATED TO TOOTH

Enamel quality
Dentin quality
Accessibility

4.

FACTORS RELATED TO CAVITY PREPARATION

Cavity depth
Cavity configuration
Extension of cavity on cementum
Retention features

5. FACTORS RELATED TO ETCHING

Type of etchant used
Application time
Quality of the substrate
Rinsing procedures
Contamination
6.

FACTORS RELATED TO BONDING

 Dry versus wet bonding

Evaporation of primer
Thickness of bonding agent
Application technique
Bond strength of adhesive
Compatibility of the adhesive with the resin
Contamination
7.

FACTORS RELATED TO MATERIAL ASPECT OF THE RESIN

Filler particle size
Type of composite selected
Viscosity of the material
Polymerization shrinkage
Wear of material
Depth of cure

8.

FACTORS RELATED TO SHADE SELECTION

Factors related to light
Factors related to eye
Factors related to shade guide

9.

FACTORS RELATED TO THE PLACEMENT OF THE RESIN

Whether mixing is required
Incremental technique or bulk placement

10. FACTORS RELATED TO THE LIGHT SOURCE

Intensity

 Distance between the tip and the resin

Curing steps
11. FACTORS RELATED TO CONTOURING AND FINISHING PROCEDURES
12. FACTORS RELATED TO PATIENT MAINTENANCE

FAILURES IN COMPOSITE RESTORATIONS MAY MANIFEST

AS:
1.

Marginal fracture

2.

Discoloration

3.

Secondary caries

4.

Postoperative sensitivity

5.

Weak or missing proximal contact

6.

Incorrect shade

7.

Poor retention

8.

Gap formation

9.

Wear

10. Voids
11. Bulk fracture of the restoration
12. Fracture of tooth
The above-mentioned manifestations are often coexistent and interlinked. These are
considered in detail subsequently.

MARGINAL FRACTURE
Marginal integrity of composites is very good under most circumstances.
Clinical appearance is affected by the nature of the margin. Butt joint margins
emphasize composite wear more than beveled margins. Butt joint margins of well-

bonded restorations wear more slowly and create a meniscus appearance against the
enamel. However, as beveled margins wear, thinner edges of material are produced
that are more prone to fracture. Microfracture of the enamel margins causes the
appearance of a white line or halo.

The following factors may be responsible for such a phenomenon:

Traumatic contouring or finishing.
All instruments should be used wet to contain the inevitable dust that can produce
an extremely bitter taste for the patient. The wet finishing also avoids the frictional
heat that may tend to pull up the margin. Continuing to polish dry after the margin
has opened sweeps the composite dust under the margins producing the white line.
The white line has also been proposed to result from relaxation of the
polymerization shrinkage stresses caused by the aggressive finishing techniques.
The initial cracking of a posterior composite resin is also thought to have been
caused by the contouring and finishing processes. Inappropriate sized finishing
instruments probably generate microcracks by the rapidly rotating blades of the
finishing instrument.
Inadequate etching and bonding of that area.
High- intensity light- curing resulting in excessive polymerization stresses.
Marginal ditching is a common finding in composite inlays and onlays. Because
resin cements tend not to be heavily filled, they wear more quickly than the adjacent
restorations or tooth structure. This is particularly true if the marginal fit is poor.
Potential solutions include:
Polymerization shrinkage coupled with technique sensitivity can lead to a risk of an
open margin. Incremental technique by adding 3-5 layers of material making sure
that the final layer is over the entire restoration is useful in combating
microfractures. This procedure will also avoid staining of the region.
Re- etching, priming and bonding of the area.
Conservative removal of the fault and re- restoring.

10

 Using atraumatic finishing techniques (e.g. Light intermittent pressure)

Using slow- start polymerization technique.
Rebonding / glazing
This is an advisable procedure that involves re- etching the enamel margins of a
polished composite restoration and placing a coat of unfilled or lightly filled resin
with subsequent curing.
A 20 second re- polymerization of the restoration following final finish is reported
to provide a stronger and longer- lasting finish.
Ensure good marginal fit of composite inlays and onlays to reduce the marginal gap.

DISCOLORATION
Discoloration is a major failure of a direct tooth colored restorative material. It
results from
Surface staining
Marginal staining due to microleakage
Changes in surface morphology due to wear
Material deterioration over time
Diet and oral hygiene of patient
The quality of surface finish influences the esthetics and longevity of toothcolored restoratives. The presence of irregularities on the surface of the materials may
influence the appearance, staining, plaque retention, secondary caries risk and
gingival irritation. In addition, smoother restorations are also more easily maintained.
Although restorations against a matrix are not totally devoid of surface imperfections,
they represent the smoothest possible surface for most direct restorations. One
11

disadvantage of microfilled composite, as stated by Davidson and Kemp- Scholte, is

the tendency to undergo hygroscopic expansion which produces marginal
overhangs.in the less motivated patient, this may lead to excessive staining and
recurrent caries when microfilled composites are used to restore Class 5 cavities. Use
of some form of magnification may aid the restorative dentist in placing the desired
margins.

SECONDARY CARIES
Secondary caries is one of the leading causes of failure of the composite resin
restoration and also one of the major reasons for replacement of the same. Composite
resin material as such has no resistance at all to recurrent caries. As long as the
margins are well bonded and no marginal fractures occur, resistance to secondary
caries should be good. Although not well documented, most secondary caries seems to
occur along proximal and cervical margins where enamel is thin, less well oriented for
bonding, difficult to access during restorative procedure, and potentially subject to
flexural stresses as well. Only rarely is secondary caries observed along margins on
occlusal surfaces or noncervical aspects of other surfaces.
Recurrent caries may be due to:
Incomplete removal of primary caries- Failure to distinguish clinically between
affected and infected dentin may lead to some infected dentin remaining behind
ultimately leading to recurrence of the lesion.
Incorrect placement technique- the incidence of caries is quite variable,
depending largely on the degree of technical excellence during composite
placement. Clinical research studies indicate that for well- controlled insertion
techniques the incidence of secondary caries after 10 years can be as low as 3%.

12

Under these circumstances, the primary reason for failure is poor esthetics or
excessive wear. Cross- sectional studies of dental practices that did not conform to
recommended techniques indicate that caries levels as high as 25% to 30% have
been observed after 10 years for composites placed during the 1970 s and 1980s.
Errors during placement may occur due to
a) Poor isolation of the operating area
b) Voids
c) Improper technique
These have been considered separately.

Factors related to light curing- a study by Jain and Pershing

indicated that light curing of some high- intensity lights compared with halogen
lights may result in higher microleakage values.

Poor finishing and polishing techniques

Material aspects

The potential solutions to prevent the occurrence of secondary caries are:

Caries detector dyes may be used to ensure complete removal of the infected
dentin. However, they are not found to be totally reliable and are advised to be used
with caution.
Brannstrom indicated that residual bacteria in a cavity preparation could multiply
from within the smear layer, even in the presence of a good seal from the oral
cavity. He proposed the use of cavity disinfectants prior to placements of
restorations. In a study the use of Concepsis and Tublicid Red did not affect the
sealing ability of Clearfil SE Bond and Prompt L- Pop.

13

 POSTOPERATIVE SENSITIVITY
A perplexing problem faced by most restorative dentists is tooth sensitivity
after placement of Class 1 and Class 2 resin restorations. According to Christensen,
the following factors should be considered when postoperative sensitivity occurs:
Hyperemic pulp tissue- the pulp condition should be normal as far as can be
determined before starting restorative procedures, especially Class 1 and Class 2
restorations.
Cracked teeth- sensitivity is often reported in teeth where cracks were detected in
the internal dentin surfaces.
Abusive cutting procedures- aggressive cutting procedures and inadequate water
lavage were found to increase the chances of postoperative sensitivity.
C- factor- the most commonly accepted theory for postoperative sensitivity with
resin restorations is polymerization shrinkage. Polymerization shrinkage leads to
gap formation, which allows bacterial penetration and fluid flow under the
restoration. Using bonded resin- modified glass ionomer cements or compomers to
fill undercuts or large defects in tooth preparation before placing restorative resin
helps to reduce the overall size of the restoration and reduce the damage.
Contraction stresses resulting from polymerization shrinkage and/ or expansion
from water sorption can cause flexure of the bonded cusps and produce pain.
Acid etching- According to Brannstrom, it is not the acid used while etching that is
harmful, but the post- restoration bacterial invasion that results from inadequately
sealed margins that causes sensitivity. Use of cavity disinfectants disinfectants
should be considered.
Hydration- the dentin should not be allowed to desiccate.

14

 Primer placement- inadequate primer placement may cause postoperative

sensitivity due to inadequate wetting.
Bonding agent- a nonuniform thickness may again lead to an inadequate hybrid
layer formation.
Curing light intensity- factors related to curing lights are discussed subsequently.
Increment size- the incremental placement technique has been largely
recommended to reduce the effect of polymerization contraction stress at the
bonding interface. When small increments are placed and light cured, the C- factor
is reduced. Some manufacturers of composite materials recently introduced in the
market, recommend bulk placements in increments of 5mm thickness (Pentron and
Caulk). However, studies have found lower hardness at the cervical surfaces when
compared to occlusal surfaces. This may be due to the fact that when light passes
through the material, it is dispersed and the efficacy of the polymerization in the
deepest layers is compromised. Composition of the resin material may also
influence the degree of polymerization in the deepest layers of a restoration- heavy
microfilled composite was the most affected. Darker shades also lead to lower
depths of penetration. However, studies have indicated that the opacity or
translucency of the material may be more important than the shade.
Coefficients of thermal expansion- composites have a coefficient of thermal
expansion 2-6 times that of the tooth. This means that the composite material
expands and contracts at a greater rate than does tooth structure in response to
changes in temperature, such as when hot coffee or ice- cream is consumed. This
mismatch contributes to loss of adhesion and increased microleakage leading to
postoperative sensitivity.

15

 Inadequate length of cure- after curing each increment for 30- 40 seconds as it is
placed, additional curing of 40- 60 seconds each on facial, occlusal and lingual
surfaces is suggested to ensure optimal care.
Voids on periphery of the restoration- this has been discussed separately.
Abusive finishing procedures- resin should be slightly overfilled at the margins
before curing, leaving only a small amount of resin to finish. Light finishing touches
with sharp burs are preferred. Some form of magnification may aid the operator in
preventing mutilation of the margins.
Occlusal evaluation- this is a prerequisite before placement of a resin restoration.
Postcure- after all the finishing and polishing has been completed, another minute
of curing should be accomplished on occlusal surface to ensure that the resin has
cured well and to reduce the resin wear during service.

WEAK OR MISSING PROXIMAL CONTACT

The causes of weak or missing proximal contacts in Class 2, Class 3 and Class 4
restorations are:

Inadequately contoured matrix band.

Inadequate wedging, both pre- operatively and during the composite insertion.

Matrix band movement during composite insertion, or matrix band not in

direct contact with the adjacent proximal surface.

A circumferential matrix band used when restoring only one contact.

Tacky composite pulling away from matrix contact area during insertion.

Matrix band too thick.

The potential solutions for the management of cases of weak proximal contacts are:

16

Proper contouring of the matrix band.

Matrix band should be in contact with the adjacent tooth.

Firm pre- operative and insertion wedging technique should be used.

A matrix system that placed the band only around the proximal surface to be
restored should be used.

Specially designed, triangular light tips that help to hold the light tip against
the adjacent tooth while curing should be preferred.

A hand instrument should hold the matrix against the adjacent tooth while
curing the incremental placements of the composite resin.

Careful attention should be placed on the insertion technique.

INCORRECT SHADE
Incorrect shade selection is a commonly occurring problem especially for the
novice. Color matching not only depends on proper initial color match, but also on
the relative changes that occur with time. Both the restoration and tooth structure are
known to change in color with age.
Incorrect shade selection could occur due to:
Inappropriate color lighting while selecting the shade- commonly used
fluorescent light tubes emit light with a green tint that can distort color perception.
Selection of the shade when the tooth is dry- temporarily drying the tooth
structure makes it appear whiter and lighter in color because of dehydration of the
enamel. Presence of the rubber dam can also distort perception.
Shade tab not matching the actual composite shade- there may be a marked
difference, one noticeable to the eye, between the color shades and the resin samples

17

especially for the incisal shades and deep dark colors. Compounding the difficulty
in shade selection are, according to Makinson, color changes that develop during
curing. He found that, in general, all colors become lighter, with some becoming
more opaque and some transparent.

Color acuity and eye fatigue- staring at the tooth and shade tab for too long
causes colors to blend and results in a subsequent loss of acuity.

Color change with age- with time, chemical changes in the matrix polymer may
cause the composite to appear more yellow. This process is accelerated by exposure
to UV light, oxidation, and moisture. Anterior restorative materials with high matrix
contents that are self- cured are more likely to undergo yellowing. Even if a
composite is relatively color stable, tooth structure undergoes a change in its
appearance over time because of dentin darkening from aging. Aged tooth appears
more opaque and darker yellow.
Inadequate preparation of the cavosurface margin- an abrupt bevel results in
less surface area for a well- bonded margin and may lead to marginal leakage.
Marginal leakage leads to accumulation of subsurface interfacial staining that is
difficult or impossible to remove and creates a marked boundary for the restoration
appearance.
Wrong shade selection- in case of Class 5 lesions the shadow created by the lip
line tends to emphasize the gray shades. Therefore, gray and translucent shades are
to be avoided when restoring Class 5 defects and more opaque shades should be
selected for better blending.

Bleaching of teeth- bleaching of teeth complicates the process of trying to

establish and maintain good color match of an anterior restoration to adjacent tooth
structure.

18

Potential solutions to obtain an esthetic result are:

Natural light is preferred for shade selection. Color- corrected fluorescent tubes that
approximate natural daylight are recommended for dental operatories. If this light is
not available, color selection can be made near a window. However, even daylight
varies considerably from day to day. It is wise to use multiple light sources when the
shade is determined. When using the dental operating light, it should be moved
away to decrease the intensity, thus allowing the effect of shadows to be seen.
The shade should be selected while the tooth is moist before cavity preparation and
application of rubber dam.
If there is a dilemma while selecting the shade, especially in older teeth, it is better
to err on the barely perceptible darker side to allow for the age related darkening.

In choosing the correct shade, hold the entire shade guide near the teeth to
determine general color. Then select and hold the specific shade tab beside the area
of the tooth to be restored. The shade tab should be partly covered with the patients
lip or the operators thumb to create the natural effect of shadows. The cervical area
of the tooth is usually darker than the incisal area.

A cured try- in of the shade (s) that you have selected offers a good idea of the
color of the final restoration. Custom composite shade guides may somehow
improve shade matching. Appropriate structure of the tooth to be replaced should be
assessed and test shades should be placed in a mock- up to assure adequate opacity
and color density.

Newer systems that are visible light- cured, contain higher filler contents, and are
modified with UV absorbers and antioxidants are more resistant to color change.
They should therefore be preferred to self- cure resins for restorations in the esthetic
zones.

19

 The clinical challenge is to match the rate and type of color change of the
restoration with the tooth structure. A color mismatch that appears after several
years is difficult to avoid. Dentin is most likely to change color most rapidly during
middle age (35- 60 years old).
There should be a gradual transition between the restoration and the tooth to obtain
an esthetic result. Beveling the enamel tends to blend any color difference
associated with the margin over approximately 0.5 to 1mm (depending on the
preparation size and requirements for bevel width), rather than making it abrupt.
The shade selection should be made as rapidly as possible, since physiologic
limitations of the color receptors in the eye make it increasingly difficult to
distinguish between similar colors after approximately 30 seconds. If more time is
needed, looking at a blue ort violet object for a few seconds should rest the eyes.
Mixing resin composites- often shade selection from one single commercial brand
of composite does not meet the demanding needs of esthetic dentistry. In such a
case, the restorative dentist is faced with the dilemma of using more than one resin
systems to achieve an acceptable shade match. Contrary to some manufacturers
claims, different types and brands of composites can be used together. The two
common types of composites, bis- GMA and urethane dimethacrylate, are
polymerizable by a free radical system, and are capable of high cross- linking. Both
have identical reactive groups. It is probably best to use layering rather than mixing
to integrate shades, because mixing can incorporate air and cause voids in the
polymerized resin.
If bleaching occurs as a treatment of fixed duration, restorative procedures should
be postponed until after teeth have assumed a stable lighter shade (the
recommended period is at least 7 days). However, continual bleaching or on- and-

20

off bleaching (data bleaching or weekend bleaching) generally makes it

impossible for the restoration shade to perfectly match tooth color. Newer whitening
toothpastes and continual bleaching may have some effect on restoration surfaces as
well, but these are not known.

POOR RETENTION
The causes of poor retention include:
1. Failure to remove all debris from every surface of the tooth to be restoredthis may result in peeling off of the composite, especially interproximally.
2. Use of a prophylactic paste that contains glycerine and fluoride- these may act
as barriers to etching solutions.
3.

Inadequate preparation form

Incomplete excavation of caries.
Inappropriate cavity preparation.

4. Contamination of the operating area- Water or oil contamination from

handpiece or air- water syringes compromise the bond strength.
5. Poor etching and bonding techniques Inadequate etching may lead to incomplete resin tag formation. Etching times
should be altered according to the tooth to be treated. Longer etching times are
required for sclerosed teeth or teeth with fluorosis. If a patient has a high caries
activity, the enamel usually etches very easily. Freshly cut enamel etches faster
than unprepared enamel.
If an etchant gel is used and inadequate rinsing is performed, the cellulose
vehicle may act as a contaminant and reduce the bond strength of the subsequent
restoration. The recommended washing time for a gel etchant is a minimum of 5
21

seconds. Gwinnett advocates an extra 10 seconds of air/ water rinsing after use
of a gel etchant.
Drying the etched enamel surface with the three-way syringe is not advocated
due to the possibility of oil contamination or water contamination from
condensation in the airlines after the compressed air has been dried.
Over drying etched dentin surfaces compromises dentine bonding as a result of
the collapse of the collagen network in the etched dentin surfaces. This collapse
prevents optimal primer and adhesive penetration and compromises hybrid layer
formation. Thus, if both enamel and dentin have been etched, the area should be
left slightly moistened. If dentin walls have been dried, they may be re- wetted
with a water- saturated applicator tip.
The penetration of the dentine adhesive in sclerotic dentin may be limited.
Inadequate primer placement- this will result in incomplete wetting.
Incomplete evaporation of the solvent also leads to compromised bond
strengths.

Lack of uniform layer of bonding agent- pooling of bonding agent in line angles
and point angles may lead to the appearance of radiolucent spots on the
radiograph which are difficult to differentiate from secondary caries. This may
also interfere with the complete seating of a resin composite inlay or onlay. Air
thinning of bonding agent for a prolonged period is also known to compromise
the bond strengths.

6. Intermingling of bonding materials from different systems

7. Inadequate curing of the composite resin-

22

 A decrease in output over time may be attributed to lamp burnout, bulb

blackening or frosting and reflector degradation all of which mandate lamp
replacement at least every 6 months.

Jordan has recommended that a minimum curing time of 40 seconds should be

used and the distance of the light tip to the composite should be as close as
possible to zero. Presence of contamination, such as composite material residue
on the light tip should also be checked for and eliminated.
Light absorption and scattering in resin composites reduces the power density
and degree of conversion exponentially with the depth of penetration. Intensity
can be reduced by a factor of 10 to 100 in a 2 mm- thick layer of composite.
This reduces monomer conversion to an unacceptable level at depths greater
than 2- 3mm.
For years, the standard photoinitiator used in restorative resins has been
camphoroquinone (CQ). This compound has an absorption maximum of 465nm,
and the absorption peak ranges from 450nm to 500nm. Because most handheld
Quartz-Tungsten-Halogen (QTH) sources have bandpass filters providing
continuous output between 400nm -500nm, abundant energy is delivered to the
tooth to result in cure. However, newer restorative materials are using other
types of photoinitiators, which have different energy requirements. These
compounds tend to absorb between 400nm and 450nm. Thus, if the filtering
system of the curing unit is not designed to pass this energy through to the
restoration, the material will not cure.

23

8. Incompatibilty of adhesives and self/ dual cure systems- growing scientific

evidence demonstrates that simplified acidic adhesive systems are incompatible
with self/ dual cured composites.
9. Incompatible temporary restoration- a zinc oxide eugenol based temporary
restoration given prior to a composite resin restoration will lead to poor retention
as eugenol inhibits the polymerization of the resin. Similarly, use of a varnish also
contributes to poor strength.
10. Water sorption- hydrolytic breakdown of the resin due to water sorption may
cause debonding of the restoration.
11. Aging bond strength between adhesive and tooth has been found to degrade
with aging both in vitro and in vivo.
Potential solutions for achieving good retention:
Thorough prophylaxis should be carried out, preferably some time before the resin
placement, to avoid crevicular weeping and hemorrhage that can undermine every
step of the bonding technique.
Cleaning of the teeth with pumice slurry reduces the surface tension of the tooth and
facilitates bonding procedure. Brockman has demonstrated that air abrasion prior to
etching a tooth creates an enhanced retentive effect.
Preparation of the tooth with appropriate bevels and flares and secondary retention
features when necessary. A 900 angle of exit is often used when maximum
conservation of tooth structure is desired. A chamfer in enamel also allows for a 90 0
angle of exit, which provides a more durable margin, but it is the least conservative
design and used only when maximum retention is necessary. The most commonly
used finish line, a 450 bevel on the enamel, also conserves tooth structure and
provides more exposure to the enamel rod ends.

24

 Keep area isolated when etching and bonding.

For drying, air from chip syringe should be used. Blowing air from the air syringe
onto a dry surface as a test procedure will demonstrate easily if water contamination
is present. Oil filters should be placed on the airlines after the air compressor and
before the syringe or handpiece. Filters must be changed frequently as suggested by
the manufacturer.
Pooling of the bonding agent especially at the line angles and point angles should be
avoided.
The manufacturers instructions should be followed explicitly.
Intensity of the lamp should be checked regularly.
Curing depth should be limited to 2-3 mm unless excessively long exposure times
are used, regardless of the lamp intensity.
When attempting to polymerize the resin through tooth structure, the exposure time
should be increased by a factor of 2-3 to compensate for the reduction in light
intensity.
Do not intermingle bonding materials from different systems.
High- intensity, short exposure times provide substantial savings in chair time but
there may be substantial residual stress buildup because insufficient time is allowed
for stress relaxation, even when used in combination with incremental buildup and
soft- start curing. At present, this aspect has not been well investigated and these
tradeoffs should be considered before investing in expensive types of curing lamps.
The clinician should ask for information on the emission spectrum of the curing
light which will enable him/ her to determine if the light will cure the composite
being used.

25

 To avoid problems related to incompatibility, clinicians are advised to use 3- step

total etch system or 2- step self- etching adhesives when fabricating cores with
chemical or dual- cure composites.

GAP FORMATION
Composite restorations that extend on the root surface may exhibit gap
formation at the junction of the composite and root. This contraction gap occurs
because the force of polymerization shrinkage of the composite is greater than the
initial bond strength of the composite to the root dentin (C- factor). The V- shaped gap
is composed of composite on the restoration side and hybridized dentin on the root
side. The long-term effects of such gaps are not known However, how long the
exposed hybridized resin layer on the root stays intact is unknown, and if it
deteriorates in a short time, the area is left at risk to caries. Use of a liner material may
reduce the effect of the gap formation.

WEAR
The principle concern for posterior for posterior composites has been that the
occlusal wear could occur at a high rate and continue over long periods of time,
exposing underlying dentin and leading to secondary caries or sensitivity. Composite
wear results from a combination of chemical damage to the surface of the material
and mechanical breakdown. The wear rate of composite materials to be used in
posterior restorations should be less than 50m/ year according to ADA and
Scandinavian Institute of Dental Materials. Excellent evidence from clinical research
studies for small to medium- width restorations now indicates that the rate of occlusal
26

wear tends to decrease over time, with total wear approaching an average limiting
value of approximately 250m over approximately 5 years. Wear resistant composites
still wear but take longer to reach that level of wear.
Wear of posterior composite resins has been compared to that of amalgam but
such comparison may be misleading. Occlusal amalgams do wear but the wear is
gradually compensated by continuing expansion of the restoration. Therefore the
amalgam restoration appears to have the same occlusal contour. Although this
expansion may be a functional advantage, the biologic effects of the wear of the
amalgam are known.
Finishing and polishing process can affect the wear characteristics of the
composite resin. A traumatic finishing technique or overheating can damage the
surface of a composite and result in accelerated wear characteristics. The finishing
technique may be one of the reasons that wear of the composite is often reported to be
greatest in the first 6- 12 months after placement.

VOIDS
Porosities in composite resins can be incorporated at many stages of packing
and placement. Porosities in a restoration contribute to reduced fatigue strength and
wear resistance and also increase the likelihood of microleakage. Some important
points to be considered are:
Self- curing composites generally have a porosity of 1- 2 %. In the case of visible
light cure composite materials, porosities may be minimized by vacuum loading of
the syringes.
Incidence of porosity is greater when the materials are placed with a hand
instrument than when the composite resin is injected directly.

27

 The presence of pins often proves a difficulty for the adaptation of a densely filled
composite resin.
Slumping, which is related to filler content and viscosity of the resin, appears to be a
crucial factor when incremental placement of the resin is considered. Provided that
the resin is given time to gloss over (a form of slumping at the microscopic level),
small defects should smooth out, leaving less opportunity for air incorporation if
another increment is placed over it.
Cavities with rounded angles and easy access for resin placement should be
employed. Occurrence of porosity at the line angle produced by the gingival floor of
a proximal box and the matrix band could increase the risk of microleakage and
recurrent caries in an area that is particularly vulnerable to such problems because
of inaccessibility.
Stickier resins are more susceptible to porosity from instrument handling.
Composite resins that require minimal handling during restoration should be used.
The use of Teflon- coated instrument is recommended.
If a void is detected immediately after insertion of the restoration but before
contouring is initiated, more composite can be added directly to the void area. These
materials will bond because the void area has an oxygen- inhibited surface layer that
permits composite additions. However, if any contouring has taken place, the
oxygen- inhibited layer may have been removed or altered and the area must be reetched and adhesive placed before adding the composite.

BULK FRACTURE OF COMPOSITE

Fracture through the main bulk of the restorative material is potentially
dangerous, particularly if a segment is retained within the cavity after becoming
28

mobile. Rapid caries will develop as a result of plaque being admitted under the
mobile segment, because it will be forced into the dentinal tubules by occlusal
pressure. It is preferable that the entire restoration be lost but the directly placed
plastic restorative materials are often retained because of the cavity design.
Bulk fracture of posterior composite restorations is rare. Although there has
been a persistent rumor that microfill composites are more subject to fracture at the
occlusal contact areas, there is no published evidence of that fact, except for a few
restorations. Whereas bulk fracture may be the most prevalent failure mechanism for
high- copper amalgam restorations, it is only rarely observed for intracoronal
composite restorations.

A glass ionomer base as a dentin- substitute under the

composite resin restoration has been advocated to reduce the further risk of caries.
Bulk fracture is a more common mode of failure with composite inlays and
onlays. It often occurs in areas of cuspal coverage, particularly if the restorative
material is thinner than 2.0mm. It may also occur at the isthmus adjacent to the
marginal ridges.

TOOTH FRACTURE
Tooth fracture is not a common occurrence with composite resin restoration. The
mode of fracture is often cohesive and the resin is reported to reinforce the tooth
structure.

29