(Editor's note: This article was updated as of Jan. 31, 2018.)
Previously, we compared three different composites. You can review these dental composite comparison articles on Spear Digest in which we compare use, handling, and other properties.
Even if you’re happy with what you’re using, it always benefits us to know what the trends are and what’s available “out there.” The ultimate goal of your composite material is to replace the biological, functional and esthetic properties of healthy tooth structure.
Here are a few recommendations of what to look for when evaluating a new dental composite product.
Types of composites available today
What are macrofills? Macrofills were the first composites introduced to the market. Macrofills have particles ranging in size from 10 to 50 micrometers. These large particles provide excellent strength, but poor esthetics. They are difficult to finish and polish. The polishing issue with these was due to the large particle-filler size as these particles, some of which are large enough to see with the naked eye, were “flaking” out of the resin matrix. While there are no widely used macrofill composites today, you may see still see some old restorations that were done with them come into your office.
What are microfills? We first saw these in the late 1970s following the surge of macrofills. Particles are under 100 nm. While microfills increase the polishability and overall esthetics that macrofills lack, they were weak. Microfills aren’t strong enough to withstand the compressive forces in the posterior. Two examples of microfill on the market today are the various versions of Heliomolar from Ivoclar Vivadent and Renamel from Cosmedent.
What are hybrids, microhybrids and nanohybrids? These are the composites that brought together the strength of macrofills and the polishability of microfills. They contain a mixture of particles between 10 and 50 micrometers as well as 40 nm particles. Examples of nano-hybrids on the market today would be Tetric EvoCeram and IPS Empress Direct from Ivoclar Vivadent along with Herculite Ultra from Kerr. When it comes to microhybrids, Herculite XRV from Kerr is just one example.
What are nanocomposites? The newest generation of composites were patented by 3M ESPE. Filtek Supreme Ultra Universal is a nanocomposite containing particles of 20 nm. What’s unique about nanocomposites is that the particles group together to form nanoclusters. This allows smaller particles to come together and function as larger particles, resulting in increased strength, wear resistance and polishability.
Factors for long-term success of composite restorations
Compressive strength: The resistance of a material to breaking under compression. This is especially important in posterior restorations.
Adaptation and handling: How well will it adapt to the walls of the preparation? Seeing your final results on a radiograph helps indicate how well you’re doing with this. Handling is related to personal preference; how well are you able to work with the material to achieve your desired results?
Translucency: As bulk fill materials flood the market, you’ll see higher translucency in your restorations. Bulk fills have to be translucent in order to cure in one layer to greater depths. This can necessitate opaquers and liners to block stains and mimic the natural tooth. Depending on the esthetic demands and the location in the mouth, this can affect material choice.
Flowability: How easily can the material flow to the walls of the preparation and the pulpal floor?
Shrinkage: The limiting factor in the long-term effectiveness and prognosis of a composite is shrinkage during polymerization. Shrinkage leads to poor marginal seal, higher potential for recurrent caries, and marginal staining.
Polishability: Microfilled composites offer high polishability. Hybrid composites also have high polishability. The newer nanofilled composites have even greater polishability than hybrids. You want a material that will polish well and maintain its luster over time.
Top dental composite picks
If you had to pick one and only one composite to have in your office, your best bet would be a hybrid like Venus Diamond. You can see a comparison of Venus Diamond and Estelite Omega here. If you want creamier feel, another great choice is Venus Pearl. Needless to say there are a lot of other choices out there, so if Venus Diamond or Venus Pearl are not the right fit for you, try some others. It is hard to go too wrong as long as you stick with a major manufacturer.
If you are to the point that you would like to add to your arsenal, then your next addition would come down to either a bulk fill or a composite for high esthetics. In the bulk fill category, SonicFill 2 from Kerr is a really great choice. (Check out this article for facts and tips on SonicFill 2.) The only real drawback is that you have to purchase their proprietary handpieces in order to use it.
Want a bulk fill without the need for special handpieces? Then give Tetric EvoCeram bulk fill a look. Now if, on the other hand, you would rather add a composite for high esthetics, then give Estelite Omega a try as you will likely be amazed at what you can achieve with it. Are there other highly esthetic composites out there? Sure, but hands down our pick would be Estelite Omega.
Needless to say you could end up with a host of composites and – dare we say it? – it is easy to go overboard and have too many in your office. This could result in increased overhead and waste due to expiration of materials not used very often as well as increased stress due to too many choices.
That being said, while you could have just one hybrid composite and a flowable in your office, it is likely you would benefit from adding a bulk fill and highly esthetic composite to your arsenal, as we have discussed.
The reality of composites is that there are a lot of excellent material choices. There may not be one magic bullet, but there are a plethora of choices that will meet your functional and esthetic demands. Find what works in your hands.
We’ve come so far in this area of restorative dentistry that there’s no reason composite can’t be your go-to material for function and esthetics!
Courtney Lavigne, D.M.D., Spear Visiting Faculty and Contributing Author - http://www.courtneylavigne.com
John R. Carson, D.D.S., P.C., Spear Visiting Faculty and Contributing Author - www.johncarsondds.com