Unique properties of compomer filling materials

Compomer materials are used for restoration and filling of chewing and anterior teeth. Compomers are composite reflective materials for filling, for the manufacture of which glass ionomers and composites are used. Such glaciosites include an organic base in the form of carboxyl modified groups and methacrylate resin. Aluminosilicate glass is used as a filler for mixtures.

Types of cements

Dental cements and other filling compounds are used in the treatment of permanent and primary teeth in the form of fillings, linings, obturation materials and sealants.
They are classified according to their basis, and can be of the following types:

• Mineral cements. They are made on the basis of phosphoric acid, which is why they are called “phosphates”. These include zinc phosphate, silicate and silicophosphate compounds.
• Polymer cements. They use organic acid as a base, usually polyacrylic acid. This group includes polycarboxylate and glass ionomer cements.
• Oil-based formulations. The main material of this group is zinc oxide-eugenol cement.
• Water-based materials (water-based dentin).

Phosphates

Phosphates in pediatric dentistry are used as a permanent filling material or to form insulating linings.

The powder consists of 70-90% zinc oxide. It requires liquid to mix it.

The mixture hardens in 3-9 minutes at room temperature, but this time can be increased if you use a cooled plate when kneading.

The substance has the following advantages:

• fast hardening;
• good strength characteristics;
• plastic;
• low level of shrinkage.

However, such a substance has low aesthetic appeal, wears off quickly and can break, and irritates the pulp. The product does not provide an antibacterial effect, although many manufacturers have begun to add silver to the composition.

Phenolates

Zinc oxide eugenol cement is produced in the form of a white powder containing oxides of magnesium and zinc.

To mix the solution, a liquid containing eugenol with cottonseed oil (or olive) is required. Depending on the type of material, it takes 5 minutes or about 24 hours to harden.

The advantages are:

• acceptable level of acidity (pH 6.6-8.0);
• no impact on the pulp;
• antiseptic and bactericidal properties;
• slight anesthetic effect;
• good ductility and ease of use;
• radiopacity.

Disadvantages include solubility under the influence of saliva, insufficient mechanical strength, and the ability to disrupt the polymerization of composites, therefore it is not used as a base.

Polycarboxylates

Polycarboxylate cement is a powder containing calcium salts, magnesium and zinc oxide. It also sometimes contains colored pigments.

The substance is used for filling both temporary and permanent teeth. The main characteristic is good adhesion to enamel and dentin.

At room temperature, the mixture hardens in 2-3 minutes, at 37 degrees this time increases to 6-9 minutes.

The product has the following advantages:

• high adhesion to dentin and tooth enamel;
• practically does not irritate the pulp;
• complete biological compatibility with tissues;
• antibacterial effect;
• radiopacity.

However, this product has disadvantages. It is not durable enough, there are difficulties in use due to the short working time. Aesthetic unattractiveness and the presence of shrinkage are also noted.

There is also difficulty in removing excess cement. If the procedure is carried out too late, the composition will be difficult to separate from the enamel. Cleaning too early will damage the edge seal.

Acrylates

Such cement compositions are two-component. They are presented in the form of liquid and powder, two pastes. The powder contains quartz or borosilicate glass.

The mass hardens in 6-7 minutes, and the total working time is 10-11 minutes. This cement is characterized by high strength and resistance to the oral environment.

However, it is difficult to work with; the material irritates the pulp. Excess is difficult to remove.

Composites

The most common materials for filling teeth are light-curing composites. They freeze under the influence of light of the appropriate frequency. In appearance they are most compatible with the shade and structure of tooth enamel. They are distinguished by excellent strength, can be polished well and are almost invisible on the teeth. Due to their high height, these fillings are ideal for installation on the front teeth.

Plastic materials

Chemically cured plastics are used as filling materials. Such fillings harden fairly quickly, do not cause irritation to the oral cavity, and are resistant to chemical reagents.

Carbondent, acrylic oxide or polymethylsiloxane are used for manufacturing. The materials are resistant to abrasion, but due to subsidence, chemical toxicity and changes in the original shade in dentistry, plastic is used mainly for installing temporary fillings.

Metal fillings

To create metal fillings, alloys based on copper, silver, mercury and other metals are used. Since such materials do not serve an aesthetic function, dentists usually use them when filling molars. They are highly wear-resistant and affordable.

Almagams

Inexpensive and durable, almagam material consists of zinc, tin, silver and mercury, which gives it a dark color. Most often, almagama is used as a filling to treat chewing teeth. Advantages include durability, ductility, ease of installation and low cost. Disadvantages - unsightly appearance, long hardening, release of mercury vapor, increased thermal conductivity and shrinkage of the material.

Gold alloy

Fillings made from precious metals or their analogues are not particularly popular in dentistry. Most patients today prefer naturalness and authenticity. If the patient chooses a gold alloy as a filling material, then you should pay attention to some features: durability, excellent strength, but rather high cost.

Compomers

Good restoration materials for making fillings are compomers - composite-ionomer compositions. Compomers perfectly combine the best qualities of glass ionomers and composites, which provides the material with excellent chemical adhesion, biocompatibility, ease of installation, preservation of the original color and aesthetics.

This is interesting: Miramistin in dentistry - how to use correctly?

Due to the low release of fluoride and insufficient strength, filling teeth with compomers is advisable in cases where it is necessary to achieve maximum aesthetics.

Dental composite materials (composites)

Dental composites today are the main class of restorative (filling) material.
The advantages of composites over many other filling materials are their high strength, which allows them to be used in any clinical situations (both on anterior and chewing teeth); high and flexible aesthetic characteristics that allow you to manipulate the color of restorations and their gloss over a wide range of values; high technology when performing restorations; minimal polymerization shrinkage. However, composites, even with the maximum content of inorganic filler, still have some shrinkage during curing, a fairly high coefficient of thermal expansion and less rigidity than that of dental tissues. These disadvantages of composites contribute to the appearance of marginal gaps between the filling and the dental surface, leakage of oral fluids through these gaps and, as a result, depressurization of the cavity. This leads either to the loss of the filling (damage to the restoration) or to the development of secondary caries. The disadvantages of composites are eliminated by the use of adhesives (adhesive systems ensure “gluing” of the composite to dental tissue) or other techniques. Therefore, polymerization shrinkage of dental composites is currently not a problem in restorative dentistry.

By definition, a composite material is a mixture of several dissimilar components. In the case of dental composites, it is a mixture of filler (usually inorganic) and an organic matrix, and the filler content is very significant (at least 30% by volume; with a lower filler content, the material is usually classified as a “low-filled polymer”).

Additional components of the organic matrix (in the initial state) are a polymer inhibitor (to increase the curing time and shelf life of the material), a catalyst (in the case of chemically cured composites; a separate component in the form of a paste or liquid), a photoinitiator (in the case of light-cured composites), an accelerator polymerization (in chemically cured composites), ultraviolet light absorber (to improve light stability) and dyes.

Typical fillers for dental composites are amorphous silica, quartz, barium glass, strontium glass, zirconium silicate, titanium silicate, oxides and salts of other heavy metals, and polymer particles. Modern technologies for the production and introduction of fillers include: improved grinding technologies to produce smaller particles; technologies for producing chemically deposited filler particles (the so-called sol-gel process; allows you to obtain filler hybrids); strengthening of composites with fibers (reinforcement; but this leads to a decrease in the transparency of the composite); introduction of porous (chemically deposited) fillers and three-dimensional structures (to reduce shrinkage stress); introduction of fillers with anti-caries properties (primarily those that release fluoride; however, the limitation is the low permeability of the organic matrix of the composite); technologies for modifying the surface of filler particles to allow copolymerization with an organic matrix (for example, alkoxysilanes); nanotechnology.

The size and amount of filler are the basis of the most common classification of dental composites. Based on the size of filler particles, composites are distinguished: macrofilled, macrophiles (10-100 microns); midin-filled (1-10 microns); mini-filled (0.1-1 microns) micro-filled, microphiles (0.01-0.1 microns); hybrid (contain macro- and microparticles); heterogeneous (conventional or hybrid composites with additives of particles of polymer material 1-20 microns in size).

Based on the content of filler particles (the degree of filling of the dental composite), highly filled composites (more than 60% by volume), medium-filled composites (40-60% by volume) and lightly filled composites (30-40% by volume) are distinguished. The polishability, abrasion resistance and color stability of the dental composite depend on the size of the filler particles. Strength, degree of thermal expansion and polymerization shrinkage depend on the degree of filling.

Recently, so-called nanocomposites have been identified among dental composites, which can be conditionally considered as hybrid microphilic (microhybrid) materials. In nanocomposites, “nanosized” particles (nanomers), which have a size of up to 0.1 μm (100 nm), are used as fillers. Nanomers tend to aggregate to form nanoclusters, so in reality a nanocomposite contains a mixture of nanomers and nanoclusters as a filler. Nanoclusters behave like individual particles, and modern technologies make it possible to control their size and shape. As a result of combining nanometers and nanoclusters in one material, the material has a high fullness (more than 75%), which ensures high strength. In conventional hybrid dental composites, during the process of abrasion, strong filler particles leave the surface and leave behind “craters,” which reduces the shine of the restoration or filling. In the case of abrasion of nanocomposites, nanoclusters are removed not entirely, but their smaller components, which allows the nanocomposite to have a more durable shine and good polishability. Nanocomposites of the latest generations (for example, Estet-X) contain three filler phases: nanoparticles, midiparticles phase and miniparticles phase. The ratio of the three phases is strictly dosed. The name “micromatrix” has been proposed for such nanocomposites.

The basis of the organic matrix of dental composites (before the stage of their curing) are monomers, the molecules of which contain fragments of epoxy resin and two methacrylate groups. It is known that methacrylic acid and its derivatives easily enter into polymerization reactions (for example, with the formation of polymethyl methacrylate, which is usually called “plexiglass”), and the reaction proceeds by a free radical mechanism. The first monomer of this type was patented back in 1959 (GMA monomer) and since then GMA and its derivatives have been included in almost all modern dental composites and adhesives. The reason for the dominance of monomers of this type is the relatively low polymerization shrinkage (about 6% in pure form), rapid curing, low volatility, and good mechanical characteristics of the final polymer.

Polymerization initiators are substances that generate free radicals when exposed to light or chemically. Therefore, according to the polymerization (curing) method, dental composites are divided into light-curing composites (light-composites, photo-composites, gel-composites) and chemical-curing composites (self-curing).

Chemically cured dental composites are either paste-paste or powder-liquid systems. The reaction that initiates polymerization (curing) is the interaction (after mixing the starting components) of the amine and benzoyl peroxide with the formation of free radicals. The rate of polymerization depends on the number of initiators, temperature and the presence of inhibitors. The main advantage of such dental composites is uniform curing, regardless of cavity depth and filling size.

Light-curing dental composites are a one-component initial form (paste or flowable material). A light-absorbing substance (photoinitiator; the most traditional is camphoroquinine, maximum absorption spectrum is 475 nm), which, when absorbing light with a wavelength of 400-500 nm (blue light), forms free radicals, is used as an initiator of polymerization (curing). Light composites do not require mixing (therefore they are more homogeneous), they allow modeling of the restoration (filling) before light curing, and the absence of chemically active additives (the absence of amines) gives them color stability and aesthetics. However, it should be taken into account that the degree and depth of polymerization may be non-uniform and depends, first of all, on the transparency and color of the composite, and the power of the light source. Typically, layer-by-layer application and curing of the dental composite is carried out, which makes it possible to reduce shrinkage and stress in the matrix and more accurately select the color of the restoration (filling).

The light source for curing dental composites is usually conventional halogen lamps (halogen photopolymerizers). Their disadvantages are the small “useful” component of radiation (less than 2%), the need to use an interference filter that cuts off stray thermal radiation, and a fan (to remove heat). Recently, emitting LEDs are increasingly used as light sources, the emission spectrum of which practically coincides with the absorption spectrum of camphoroquinone, and which do not have all the disadvantages of halogen lamps.

A separate group of dental composites with which teeth are filled are restoration (filling) materials of a “hybrid” type – compomers.

Compomers are light-curing restoration (filling) materials that combine the main advantages of composites (ease of use, strength, aesthetic properties) and glass ionomer cements (chemical adhesion to tooth tissue, good biocompatibility, fluoride release). The term “compomer” comes from a combination of the words COMPOSITE and glass ionomer. The initial (before polymerization) organic matrix of compomers is a monomer (acid methacrylate), the molecule of which contains methacrylate (like a composite) and acid (like glass ionomer cement) groups. Compomer fillers are fluoroalumosilicate glass particles. Acid methacrylates can simultaneously cure by the free radical mechanism (as in the case of polymerization of light-curing composites) and by the ion exchange mechanism (as in the case of glass ionomer cements). Curing of compomers occurs only due to light-induced polymerization. Curing similar to glass ionomer cements (requiring the presence of water to dissociate acid groups) occurs only in areas of the material in contact with water.

Compomers differ from classical hybrid glass ionomer cements modified (reinforced) with composites. In the latter, the ion exchange reaction, which initiates the curing of the material, is the dominant part of the entire curing process. In contrast, compomers are materials that contain the main components of glass ionomer cements in quantities insufficient to maintain the ion exchange reaction under normal (anhydrous) conditions. Although compomers were developed to combine the best properties of resin composites and glass ionomer cements, their behavior is more similar to that of dental composites.

Disregarding the basic physical and chemical characteristics of materials, the entire range of modern dental composites, according to the features of their application, can be divided into 5 main groups.

1. Universal composites with one-color color restoration concept. This group includes almost all chemically cured composites and some light-cured composites.

Charisma PPF. Chemically cured composite material. Used for filling, restoration of the crown part of the tooth, fixation of mobile teeth.

Ceram X. Light-curing nanocomposite for small restorations (fillings) of chewing teeth. The material has been optimized for highly aesthetic restorations with a minimum number of shades.

1. Versatile composites with a two-layer color reproduction concept. Such composites (restorative systems) include one or more dentins, which provide the creation of the internal structure of the tooth, and a set of enamel shades (including a transparent cutting edge), which ensures the refraction of light on the tooth surface. These materials make it possible to achieve fairly high results in the restoration of anterior and chewing teeth, but still somewhat limit the creative possibilities of the dentist in reproducing color.

Filtek Z 250 (Filtek Z 250). Aesthetic light-curing microhybrid composite. Contains an increased amount of smaller particles. It is used for filling cavities of all types in the frontal and chewing teeth, making veneers, restoring the coronal part of the tooth, and splinting. Has 15 different shades.

Spectrum TPH. Light-curing microhybrid composite. The filler (barium glass and sintered silicon) has 2 fractions of 0.04-0.4 microns and 0.8-1 microns with a filling of 55-60% by volume. Due to the successful combination of aesthetic and mechanical properties, they are used for restoration (filling) of all types of defects in hard dental tissues. An entire generation of dentists grew up on this material and mastered the basics of cosmetic restoration techniques.

1. Restoration materials with a three-layer color reproduction concept. Restoration (filling) materials of this group are “artistic” systems. The range of shades includes a wide range of opane (opaque) dentin shades, basic tooth body shades and a set of transparent enamels.

Estet-X. Light-curing micromatrix composite material. The filler is presented in the form of three phases (up to 2.5 microns, 0.4-0.8 microns and nanoparticles 0.01-0.02 microns), the ratio of which is strictly dosed. Has extremely high aesthetic capabilities. Used by dentists who focus primarily on achieving high aesthetic results. With the same strength and color stability as, for example, Spectrum TRN, it is washed 3 times less, does not require updating the gloss and has 2 times less shrinkage (which justifies the high cost of this material).

Filtek Supreme. Light-curing nanocomposite material. The filler (zirconium silicate) is presented in the form of nanoparticles (0.02-0.75 microns in size) and nanoclusters. The technology allows you to control the size of nanoclusters (create a given size) and in this way influence the strength, polishability and polymerization shrinkage of the material. A universal restoration (filling) material that combines the mechanical properties of microhybrids and the aesthetics of microfills.

The choice of a dentist in favor of a specific material from these three groups is associated with a combination of several factors (price of the material, cost of work, time spent working with the patient and the qualifications of the doctor, the final aesthetic result). For relatively simple restoration (filling), dental composites of the 1st and 2nd groups are predominantly used. If the dentist is not very limited in time, and his patient is less limited in funds, he can use materials of the 3rd group, which provide him with wider opportunities.

1. Dental composite materials for restoration (filling) of chewing teeth. The main requirements are high resistance to abrasion and deformation under chewing load.

Quixfil. A light-curing composite material designed specifically for restoration (filling) of chewing teeth. It has a high (30% greater than most other composites) fullness, due to which it has increased hardness and low polymerization shrinkage. The filler (glass) is presented in the form of two fractions: 1 and 10 microns. A specially developed organic matrix (monomer) provides a large depth of polymerization (the thickness of the polymerized layer is up to 2.5 mm). The high level of transparency of the material makes the restorations (fillings) slightly different from natural enamel, which makes it easy to determine the location of the material in complex restorations of lateral teeth. Has one universal shade.

1. Liquid-flowing composite materials. Used for filling small cavities, fissures, and cervical defects using the minimal intervention technique. For small cavities, shrinkage and subsequent marginal permeability are not as important as for large cavities, so flowable materials are optimal for adapting the restorative material to the cavity. All fluid-flowing composites are classified as medium- and lightly filled (filler content less than 47%). Liquid-flowing composites have the property of thixotropy (fluid under the influence of instrument load and viscous after the load is removed), therefore, before polymerization, they do not flow beyond the boundaries of the cavity, even on the teeth of the upper jaw. Another important property of flowable composites is their low modulus of elasticity. This allows them to compensate for the stress that occurs under the influence of chewing load at the “filling-tooth” border (which is especially important when restoring cervical defects).

X-flow. A universal, flowable, light-curing composite. Adapts to cavity walls without the use of hand tools. The filler (38% by volume, particles 1.6 microns in size) is represented by special glass, highly dispersed silicon dioxide, titanium dioxide. Used for filling small cavities of anterior and lateral teeth (without chewing load), sealing fissures, and restoring shallow cervical defects. Can be used for fixation of orthopedic structures (for example, indirect veneers), provided there is light access to the tooth/restoration interface. Has a number of shades.

Filtek Flow. Liquid-flowing light-curing composite. Filler content is 47% by volume, particle diameter is 1.4-1.6 microns. It has high wear resistance and is compatible with other composites. Has a number of shades.

Dyract Seal. Light-curing compomer material (sealant), developed specifically for filling (sealing) fissures. Thanks to its good fluidity and ideal wetting ability, it penetrates deeply into recesses and fissures and ensures a high-quality marginal seal. Abrasion resistant. Being a compomer, it releases active fluoride for a long time, which provides additional protection for dental tissues.

Make an appointment with the best dentists in Moscow!

Overview characteristics

Compomers get their name from the combination of restorative materials such as composites and glass ionomers.

This type of material is polymerized through double curing. Initially, methacrylate resins are activated under the influence of ultraviolet rays. Subsequently, under the influence of oral fluid, glass ionomer components are bound directly inside the filling.

It is important to know! During the second stage of curing, the installed filling can increase in volume by up to 3%. This compensates for the process of possible shrinkage of the material.

Initially, it was assumed that the combination of composite materials and glass ionomer cements would absorb the best positive qualities of these compounds. But, as practice has shown, these expectations were not met. Therefore, to ensure high strength, glaciosites are used in tandem with adhesives.

Basic properties of compomers

1. One-component.
2. Chemical type of adhesion (due to the presence of GIC).
3. Acceptable aesthetic qualities inherited from composites.
4. Small total shrinkage.
5. Relatively high strength.
6. Accumulative effect on fluoride (absorption from dental care products and release into tooth tissue).
7. Low solubility in oral fluid.
8. Thermal expansion similar to that of dentin.
9. Good polishability.

Curing (polymerization) of compomers occurs in two stages. First, acrylic resins are polymerized under the influence of light irradiation. Then, as oral fluid is absorbed, the glass ionomer fillers begin to harden.

During the second stage, dentin and enamel are enriched with fluoride ions. At the same time, due to the absorption of liquid, the filling material increases in volume, which partially compensates for the shrinkage that occurred during the 1st stage.

Compound

Compomers contain many chemicals that provide different properties of the material and distinguish them from each other. The main components of glaciosites are:

• acrylic resins (UDMA, dimethacrylate, triethylene glycol-dimethacrylate, trimethacrylate) – acting as a matrix (binder), providing strength, viscosity, polishability and other physical and mechanical properties;
• camphorquinone, ethyl 4-dimethylaminobenzoate – polymerization initiators;
• strontium-aluminium-sodium-fluoro-phosphorosilicate glass>;
• silicone dioxide - thickener;
• strontium fluoride – a source of fluoride ions for fluoride therapy;
• titanium dioxide and iron oxide are coloring pigments.

According to their intended purpose, there are restoration, fixing and isolating compounds, materials for the treatment of baby teeth, restoration of the cervical area (with a color to match the gum), for filling fissures, etc.

Indications

The use of the first compomers was limited by insufficient strength and wear resistance.

Over time, manufacturers have improved the quality of the drug by reducing the particle size of the filler and modifying the composite monomers by forming cross-links.

This made it possible to increase the strength and wear resistance of the material, and expand the scope of its application. Currently, compomer indications are determined by the specific brand and grade.

Generally speaking, without reference to the brand or mark, compomers can be used in the following cases:

1. Filling cavities of class 1-5 in temporary teeth, provided that the tooth cavity is well isolated from saliva, blood and oral fluid.
2. Filling small (not exceeding 2/3 of the distance between the cusps) class 1 and 2 cavities in permanent teeth.
3. Restoration of defects in the cervical area exposed during tooth preparation.
4. Filling areas of enamel erosion.
5. Restoration of cervical defects of non-carious origin (erosions, wedge-shaped defects).
6. Filling traumatic injuries as a temporary measure.
7. Use as protective gaskets.
8. Filling small cavities of classes 1 and 2 in permanent teeth after minimally invasive preparation (preferably using packable compomers).
9. Temporary filling of permanent teeth.
10. Treatment of cavities of any class in teeth covered with a crown.
11. Fixation of orthodontic and orthopedic structures.

Contraindications

1. Allergy to meth and acrylate plastics or adhesive components.
2. Class 1 and 2 cavities with dimensions exceeding 2/3 of the intertubercular distance.
3. Restoration of the tooth stump.

Goals and features of the use of compomers in modern dentistry

Hello, Alena! No, Voco Twinky Star kits are only suitable for filling baby teeth - they all have colored shades (green, blue, pink, etc.). That is, aesthetically, such a filling will clearly catch the eye of others. The second point is that your carious cavity is deep. And, most likely, the filling will be subject to heavy chewing load. This is a direct contraindication for placing compomer fillings. Moreover, if about 80% of the chewing surface is destroyed, then orthopedic treatment using an inlay is indicated. The optimal solution for filling deep cavities is the sandwich technique (“open” - for fillings in contact with the gingival edge, for example, on the lateral surfaces of teeth or at their necks, or “closed” - for fillings on the chewing surface of premolars and molars). In addition, in case of deep caries, a targeted application of a therapeutic pad is necessary (materials based on calcium hydroxide (Ca(OH)2) are most often used). It has an antimicrobial effect due to pH = 11-12, and an osteotropic effect due to Ca2+ ions ). If you do not apply a therapeutic bandage, caries will easily be complicated by pulpitis, and the freshly made filling will have to be cut down in order to treat the pulpitis. Before applying the restoration material, therapeutic dressings are always covered with an insulating pad - for the sandwich technique, its role can easily be fulfilled by a thick layer of GIC or compomer. In this case, it is possible to use Twinky Star, but it is still undesirable - to fully recreate the appearance of the tooth, materials of varying degrees of opacity are used. Through the layer that recreates the tooth enamel, the colored gasket can be seen through. The top layer in the sandwich technique is a composite restoration material (photopolymer). Treatment of deep caries in this case has a number of advantages: the bacteriostatic and osteotropic effect of the therapeutic dressing, isolation of the pulp from toxic monomers of the composite, a biologically inert insulating gasket that releases fluoride, an aesthetic appearance of the filling as a whole, and a reduction in its cost through the use of more affordable GIC. In this case, it is not advisable to use a compomer for temporary fillings for reasons of economy (compomers are more expensive than GIC), the ability to release fluoride in the tooth tissue (GIC is better), aesthetics (GIC imitates dentin in color, and Twinky Star is a set of multi-colored compomers) .

Classification and main components

The chemical composition of compomer materials includes:

• two types of acid (composite and polyacrylic);
• strontium fluorosilicon glass;
• strontium fluoride compounds;
• stabilizers giving the necessary consistency;
• substances that initiate the polymerization process.

Depending on the area of ​​application of these restoration materials, they are either packable or fluid.

Packable

Allowed for use when the elimination of carious cavities does not occur on the frontal incisors of the front row due to the low level of aesthetic value.

The material is mainly used when installing fillings on molars or premolars, but only in that part of the tooth that experiences minimal pressure during the chewing process.

All materials in this group are characterized by high density and are highly filled. According to clinical studies, compomers do not differ in their characteristics from hybrid composites, and in some situations they are even inferior in strength.

The advantages of this type of material include:

• ease of use;
• high strength;
• radiopacity.

The disadvantages are the short working time (up to 1 minute) due to the rapid setting. Also, in some cases, problems arise with edge adaptation.

Liquid-flowing

Materials of this group are divided into high-, medium- and low-flow. Most often they are used as filling agents to eliminate carious cavities of classes III, V, when it becomes difficult to use conventional composites (narrow and hard-to-reach cavities, chips).

They can also be used to fix fixed dentures. In some cases, the combination of compomers with other materials allows them to be used as a base layer, which provides a good marginal seal.

Most practitioners note the following positive qualities of these materials:

• high degree of aesthetics;
• good for polishing.

The main disadvantage is high shrinkage and low strength.

Medium in density

Compomers have a regular (medium, creamy) consistency. The most commonly used compomers, represented by the world-famous brands Dyract, Compoglass, Twinky Star, Glasiosite, MagicFil, have this density.

Positive and negative points

The main advantages of compomer materials are the following qualities:

1. Duration of action. Over the course of 300 days, there is a constant release of fluoride ions, which helps strengthen tooth tissue.
2. They have a high degree of biocompatibility and adhesion.
3. Accumulation effect. When the supply of fluoride ions in the filling runs out, its adsorption from toothpastes or elixirs begins.
4. There is no need for total etching. The use of adhesive systems is sufficient.
5. Ease of operation compared to composite materials.
6. When filling incisors, better aesthetic results can be achieved compared to glass ionomer cements. Also, unlike them, it has increased strength, ductility and durability.
7. No stress is caused in the filling due to two-phase curing.

The disadvantages of using this type of restoration material include:

• may fade and change color over time;
• poorly ensure the marginal seal of the filling;
• compared to composites, they are less aesthetically pleasing;
• wears out faster than established hybrid composites;
• do not have the properties to bind to tooth dentin.

Mechanism of interaction with dental tissues.

There are several stages of polymerization. In the first stage, polyacrylic acid reacts with glass (in the powder) and hydroxyapatite of tooth tissue. The glass surface loses aluminum, calcium, sodium and fluorine ions. Silicon dioxide remains in the form of a gel. This is the second stage of polymerization (gel). The carboxyl groups of polyacrylic acid are cross-linked between each other and calcium ions and undissolved hydroxyapatite of tooth tissue. Chelate compounds of polyacrylic acid with calcium are formed, due to this we have chemical adhesion to tooth tissues. In the third stage of “maturation,” as mentioned above, which can last up to 24 hours, cross-links of aluminum polyalkenate and fluorine are formed, and the material acquires maximum strength. If the surgical field is not dry enough, the cement may lose aluminum ions, which will ultimately affect the strength of the glass ionomer.

Scope of application and indications for use

Compomers are widely used in dentistry for the following purposes:

• filling carious cavities in temporary teeth (class lV according to Black), if it is possible to isolate the tooth cavity from oral fluid;
• used after mandatory preparation - filling defects located in the neck of the tooth;
• with enamel erosion or wedge-shaped defects in permanent teeth;
• for traumatic damage to teeth (used as a temporary filling);
• filling the defect if it is on the approximal surface of the incisors, without affecting the cutting edge;
• as an insulating gasket;
• as a sealant.

Types of compomers:

1. Packable . Universal materials for fillings and restoration are used instead of composites in cases where high demands are not placed on the aesthetic appearance of the filling and it will not be located in the part of the tooth that is most susceptible to chewing pressure.
2. Liquid-flowing (flow-) are used for filling narrow defects that are difficult to access with conventional, condensable materials, as a sealant for fissures, or for fixing orthopedic fixed structures.

Modern filling materials

It is believed that people first began to treat teeth 8-9 thousand years ago - relevant evidence was discovered in 2001 during excavations in Pakistan. Dental disease is mentioned in the famous ancient Egyptian medical treatise known as the Ebers Papyrus. The Ebers Papyrus contains eleven recipes for pastes and ointments that were used for diseases of the teeth and gums. Egyptian doctors believed that these compounds had the ability to relieve toothache, reduce inflammation, heal the oral cavity and prevent loosening of teeth.

About a dozen oral diseases and methods of treating them are described in Chinese medical manuscripts, which are about 3 thousand years old.

A wide variety of drugs were used to treat toothache, including instillation of various tinctures into the ears. Celsius recommended poultices, inhalations and even laxatives. It was proposed to fill carious cavities with alum or hot oil. And Avicenna and Scribonius, for example, considered the cause of toothache to be a toothworm, which can be destroyed by smoke when burning a mixture of henbane, onions and goat fat. If teething is difficult, Avicenna advised lubricating the child’s gums with hare brain or dog milk. And for cleaning teeth, ground pumice, deer antlers or snail shells were considered the most suitable. However, the most original recipe for those suffering from toothache was proposed by Pliny the Elder. He advised catching a toad on the night of the full moon, opening its mouth and spitting in it, and then saying something like “Go away and take my pain for yourself!”

The main method of dental treatment was to remove the diseased tooth, however, many ancient doctors wrote about the importance of preserving teeth. It's a shame that not everyone understands this yet!

Since ancient times, many doctors began to try to close the defect formed in the tooth with some material, the so-called filling. Throughout the existence of the science of dentistry, ideas about filling materials have constantly changed.

But where do filling materials get their history? What date can be considered the opening of the filling? How did the idea of ​​them develop and what do we have in modern dentistry at the moment?

We can find the first information about filling materials, and indeed about dental treatment methods in general, in the 9th century BC.

Even the Mayan peoples in the 9th century BC. We understood that the filling should not only protect the tooth, but also look quite aesthetically pleasing. Guided by their ideas of beauty, they drilled out a diseased (and sometimes healthy) tooth using a tube made of durable material, and filled the resulting cavities with gold, jade or turquoise.

The modern market, where there are incomparably more filling materials and technologies, poses an even more difficult task for contemporaries - to find, among all this abundance, their “gold standard” that satisfies the strict criteria of quality, cost and beauty.

So, modern filling materials are divided into several main groups: cements, amalgam, compomers and composites.

Cements.

Fillings made from silicate and silicophosphate cements (“Silidont”, “Silicin”, “Alumodent”, etc.) have low mechanical strength, a high toxic effect on the dental pulp, and poor “marginal adherence” to the tooth tissues, i.e. A gap is formed between the filling and the tooth, as a result of which secondary caries gradually forms under the filling. Currently, they are practically not used.

Glass ionomer cements (Vitrebond, Fugi Ionoseal, etc.), in addition to low cost, have the following advantages: high chemical adhesion to hard dental tissues and filling materials, long-term release of fluoride (anticaries effect). They are not toxic to the pulp, do not require acid etching and significant preparation of hard dental tissues. However, like all cements, they are abrasive and brittle. Therefore, they are used in crown fillings, for securing inlays, orthopedic and orthodontic structures, as insulating spacers, underlays or spacers under restorations made with composite material (Sandwich technique), as well as for filling small cavities on chewing surfaces.

Amalgam.

The use of amalgam in dentistry has a long tradition.

The first reports of the use of silver-tin paste are known from ancient Chinese manuscripts. In Europe, amalgam was used to fill teeth in the 17th century. However, only the Frenchman Tageap in the first half of the 19th century. introduced silver amalgam into the then developing dental practice. From a filling material that was mixed by the doctor himself, amalgam turned into a product manufactured by companies using special technology.

The disadvantages of amalgam include discoloration of the tooth, possible breakage of one of its walls due to the large difference between the coefficients of thermal expansion of amalgam and tooth tissue, and most importantly, the filling emits mercury vapor.

Most experts consider this discharge to be insignificant and are confident that it cannot lead to intoxication of the body. But some argue that the mercury contained in amalgam is found in the blood, urine, and body tissues and can cause various diseases. Discussions around the use of amalgams are still ongoing. But despite this, it remains one of the most popular filling materials in the world for more than 100 years. In Russia, amalgam fillings are now practically not installed.

Ormokers

This is a new group of polymer filling materials based on a new organic compound - ceramic polysiloxane. The name comes from a combination of the words “ORGANICALLY MODIFIED CERAMICS”.

The material has the ability to release phosphates, calcium and fluorine ions. Ormokers are distinguished by significant strength, biocompatibility, and a high degree of polymerization. However, many doctors, including our clinic, note significant shrinkage of these materials, insufficient shine of the restoration, and poor polishability. As an example, they can be called “Definite”, Degussa; "Admira", Voco.

Composites

In dentistry, composites consist of an inorganic substance and an organic binding mass. In modern dentistry, fluid-flowing composites, chemical composites, and photocomposites are used. Flowable composites are used for filling small cavities and repairing minor restoration defects. This polymer does not stick to tools, does not leak out of the cavity, and is perfectly combined with other materials; in addition, it is a durable and wear-resistant material. Chemical composite is a cheaper, although not the most aesthetic, material. It is used for the restoration of lateral teeth and wisdom teeth. Before applying the chemical composite, the dentist etches the enamel, covers the cavity with bonding agent and places a filling. The chemical composite must be polished, otherwise it changes color. Photocomposite is one of the modern materials and one of the most expensive. A photocomposite filling hardens in 30 seconds under the light of a halogen lamp. Photocomposites hardly wear out, do not darken over time, and perfectly match the natural color of the teeth. The doctor can apply the photocomposite layer by layer, and ideally restore absolutely any tooth - the filling will look perfect.

What is COMPOMER?

In 1993, the next generation of filling material was released. It combined the protective properties of glass ionomers, and the excellent aesthetic qualities and durability of composite materials, resulting in the name “compomer” - a term derived from two words - COMPOSITE and glass ionomer.

Compomers (Dyract, F-2000 (3M), Hytac (ESPE), Septoglass (Septodent) are mainly used for filling small carious cavities in permanent teeth, any carious cavities in temporary (baby) teeth, as well as non-carious lesions without significant chewing load (wedge-shaped defects, enamel erosion).The disadvantages of modern compomers are their lower wear resistance than composites and weaker fluoride release than most GICs.

Hitech

Dentistry is a dynamically developing branch of medicine, and therefore, we can note the constant search for new composite materials. The most advanced dental materials today are NANOCOMPOSITES. These modern fillings boast an optimal combination of safety, durability and high aesthetic properties. Doctors at our clinic use the most modern composites in their work: Enamel PLUS, Tetric, Filtek Supreme XT. These materials, having absorbed all the best, have acquired new features that make it possible to achieve excellent aesthetic results in a simpler way while reducing time costs. The fundamental difference between nanocomposites is the presence of microparticles that provide high saturation of the material, resulting in a high degree of strength and high quality polishing, as well as the original shine of the restoration.

Thus, nanocomposites are the most modern filling material, applicable to restorations of absolutely any complexity.

Application technique and operating rules

Working with compomers is done in approximately the same way as with universal composite materials:

1. Carrying out professional hygiene of the sector (sextant) in which there is a tooth with a defect (completely carious, wedge-shaped defect, enamel erosion).
2. Treatment of a cavity in a tooth according to the principle of “preventive preparation” to prevent relapse of the carious process. When forming a cavity, there is no need to create a box-like shape or additional platforms - all this will increase the volume of the filling, which will reduce its strength.
3. If the damage to the tooth tissue has reached the zone of peripulpal dentin, then it is necessary to spot cover this area with a calcium-containing therapeutic pad, which must be isolated by local application of hybrid GIC. When isolating a spacer, you should try to leave as much area of ​​dentin uncovered as possible.
4. Apply the adhesive system in accordance with the manufacturer's instructions.
5. Adding compomer into the tooth cavity. It is carried out layer by layer, as for composite materials.
6. Grinding and polishing of the filling (immediately upon completion of the process of filling the defect).

Rules for working with compomers:

• filling wedge-shaped defects and enamel erosion with glaciosites always requires preliminary tissue preparation;
• the thickness of one layer when adding material layer by layer should not exceed 2.5 mm;
• exposure for curing one layer is at least 40 seconds;
• During light curing, the principle of “directional polymerization” must be observed.

Compomers. Purpose, properties

Compomers (glasiosites) are restoration materials that are composite ionomer compositions. This group of materials received its name as a result of a combination of the words COMPOSITE and glass ionomer.

Compared to glass ionomers, the material has very high aesthetic properties and color stability for several years. The use of adhesives in combination with the glass ionomer mechanism of attachment to the hard tissues of teeth provides the compomer with high strength of attachment and marginal adhesion, and the release of fluoride provides an anti-caries effect. Like glass ionomers, the material does not require layer-by-layer introduction into the cavity, which greatly facilitates its clinical use.

Indications for use of compomers:

1. Filling carious cavities of all classes in primary teeth, if it is possible to ensure absolute dryness of the cavity during the entire filling period.

2. Filling class V carious cavities, wedge-shaped defects, enamel erosions of permanent teeth (cavity preparation is required).

3. Filling class III cavities in permanent teeth.

4. Temporary filling of cavities in case of dental trauma.

5. Applying a base gasket under the composite when filling using the sandwich technique

Compomers are produced in syringes and capsules. Preparation for filling the cavity and the initial stages of filling do not differ from those in the case of using light-cured composites. The stage of adding the material is different, since compomers can be applied in a thick layer, practically filling medium-sized carious cavities completely. Compomers react less to the direction of light of the polymerization lamp, since they additionally have a glass ionomer hardening mechanism. Finishing and polishing are the same as for composites. The first compomer is “Dyract”

23.Adhesive composite systems. Purpose, mechanisms of interaction with dental tissues. In dentistry, there are two types of adhesion: Mechanical

– due to micromechanical adhesion of the material to the tooth tissues;
Chemical – due to the formation of a chemical bond between the material and dentin and enamel. Only GIC has chemical adhesion. All other materials used in dentistry have mechanical and micromechanical adhesion. Mechanical adhesion is the connection of materials with hard dental tissues due to mechanical retention with the participation of micromechanical pores and roughness on their surface.
Mechanisms of adhesion of composites to the enamel surface. Under the influence of acids, selective dissolution of the peripheral and central zones of enamel prisms occurs to a depth of 5-10 nm and transformation of the enamel surface. As a result of mechanical beveling of enamel prisms and treatment of enamel with acid, the active adhesion surface with composite materials increases and the possibility of enveloping the surface layer of enamel with hydrophobic and viscous adhesives improves. Due to their high viscosity, they penetrate slowly to the entire depth of the etched enamel. After polymerization of the adhesive, processes are formed in the interprismatic areas, which mechanically adhere to the enamel surface and thus contribute to the microretention adhesion of the composite to the enamel surface. When etching enamel with acid, a layer 10 microns thick is removed from the surface and micropores 5-50 microns deep are formed. Most often in modern dentistry, phosphoric acid is used for acid etching of tooth tissue. The most optimal acid concentration is 30-40%. In some cases, the use of weak solutions of organic acids is recommended for etching dentin. The duration of acid etching of enamel is usually 30 seconds. Experimental studies using SEM showed that there were no differences in the degree of porosity of the enamel surface between exposures of 30 seconds and 60 seconds. In addition, it has been proven that exposure to acid for more than 60 seconds leads to the destruction of enamel prisms and deterioration of adhesion.

Mechanisms of adhesion of composites to the dentin surface. The nature of living dentin is such that its surface is always wet, and drying under clinical conditions is practically impossible. Due to the speed of fluid movement in the dentinal tubules, complete renewal of moisture repeatedly occurs on the surface of the dentin. In clinical conditions, even after drying the carious cavity, unnoticeable residual moisture is observed, which can affect the strength of the bond between dentin and composite. In this regard, dentinal adhesive systems must be hydrophilic, i.e. water compatible.

Another problem in the mechanism of adhesion of the composite to dentin is the smear layer, which is formed as a result of instrumental processing of dentin and consists of hydroxyapatite particles, destroyed remains of odontoblasts and denatured collagen fibers. Depending on the type of preparation, this layer reaches a thickness of up to 5 nm; it clogs the dentinal tubules and covers the intertubular dentin like a gasket. If at first it was considered as an insulator that prevents the penetration of microorganisms into the dentinal tubules, now there is no doubt that it interferes with the adhesion of the composite to the dentin surface and, accordingly, the formation of a strong adhesive connection.

Analyzing various adhesive systems for dentin and their adhesion mechanisms, two approaches are fundamentally distinguished. In the first case, the smear layer is completely preserved on the surface of the dentin and is impregnated with hydrophilic low-viscosity monomers and is directly used as a connecting layer between the dentin and the composite.

In the second approach, by dissolving the smear layer and superficial decalcification of dentin. This approach is the most common currently.

Dentin conditioning is a chemical modification of the dentin surface using acids such as citric, polyacrylic, lactic, etc. In this case, the smear layer is removed completely or partially, and the dentinal tubules are also fully or partially opened. In addition, demineralization of the surface layer of dentin occurs, exposure of collagen fibers of the organic matrix and activation of dentin ions and apatites.

Conditioners in some adhesive systems must be removed using a stream of running water. The dentin surface must then be slightly dried. One of the main conditions for high-quality adhesion is the degree of moisture of the dentin after removing the etching solution. This is primarily due to the hyphrophilicity of the primer. Thus, the adhesion force decreases sharply when dentin overdries. In this case, collapse and loss of collagen fibers are noted, which impairs the penetration of the primer between them to form a strong bond. Dentin that is too wet also does not provide sufficient adhesion. The main criterion for the degree of dentin moisture is “sparkling” dentin, on which there are no “wet puddles”.

Subsequent application of a dentin adhesive system (primer) ensures the penetration of hydrophilic monomers into the open dentinal tubules, saturating the demineralized surface layer of dentin and adhesion to its exposed collagen fibers. With the formation of a hybrid zone. The hydrophilic resins that make up the dentinal adhesive penetrate into the dentinal tubules; the spaces previously occupied by hydroxyapatite encapsulate collagen fibers. After polymerization of the adhesive, a thin layer of new substance is formed, consisting of adhesive components and dentin collagen fibers. This is called the hybrid layer.

The hybrid layer not only provides reliable fixation of the composite to dentin, but also is an effective protective barrier against the invasion of microorganisms and chemicals into the dentinal tubules and tooth cavity. In addition, it blocks the movement of cerebrospinal fluid in the dentinal tubules and prevents postoperative sensitivity.

Adhesive systems for enamel. Stages of working with adhesive systems for enamel:

etching the enamel surface for 30 seconds using 37% phosphoric acid, which is part of the etching gels;

removing the etching gel with a stream of running water for 30 seconds;

drying the enamel and controlling the quality of the etching (etched enamel has a matte tint);

mixing the components of the adhesive system in a 1:1 ratio;

introducing the adhesive system into the carious cavity using an applicator (applied to prepared enamel and an insulating lining);

distribution of the enamel adhesive system using a weak air stream;

introduction of composite material.

Adhesive systems for dentin (primers). First generation. The first generation of adhesives appeared in

late 70s of the last century. They are characterized by high rates of adhesion to enamel, but adhesion to dentin is extremely low - as a rule, no more than 2 MPa. Adhesion was achieved through the interaction of the bond and calcium contained in the dentin. Second generation. Here, an attempt was made to utilize the smear layer to obtain higher adhesion rates to dentin. The result was an increase in this indicator to 2-8 MPa, which, of course, is absolutely insufficient for reliable fixation. In addition, microleakage was often observed with these systems, and the problem of postoperative sensitivity was also not resolved. Third generation. with their use, a significant decrease in postoperative sensitivity was observed. For the first time, adhesives of this generation provided adhesion not only to teeth, but also to metals and ceramics. The main problem was the fragility of bonding agents. Some studies have demonstrated a significant decrease in adhesion rates as early as 3 years after restoration. 4th generation contain 3 components: an etching agent or conditioner (for etching enamel and dentin), a primer (a mixture of hydrophilic monomers) and an adhesive. A three-stage technique is provided - etching (enamel takes a longer time than dentin) followed by washing and drying, application of a primer with drying (primer contact with the enamel does not affect the adhesion strength; when etching only enamel, the use of a primer is not necessary), application and polymerization of the adhesive. They provide an adhesion force to enamel and dentin of about 30 MPa. 5th generation - preparations in which the primer and adhesive are combined (one-component system). They provide a two-stage technique - etching (conditioning) and application of a one-component adhesive. These adhesive systems are easier to use, but the adhesion strength is slightly less (10-30% in laboratory conditions) than that of the 4th generation adhesive systems. 6th and 7th generations are one-step preparations that combine the properties of a cleaner (conditioner, etching agent), primer and adhesive. Not yet widely used.

24. Restorative dentistry is different from filling teeth in dental treatment. The difference between a conventional filling and the efforts of a specialist in restorative dentistry is that during dental restoration, not only the functionality of the tooth is restored, but also the lost tissues using materials that imitate natural dentin and enamel, similar in color and transparency. Thus, especially aesthetic restoration in dentistry includes both dental treatment in dentistry and artistic work to restore the shape, color and transparency of a damaged tooth.

In restorative dentistry, an artificial tooth or part of a tooth does not differ from natural ones in color, transparency, shape, and surface gloss. In addition, such a tooth actively participates in the chewing process, that is, its functionality is completely restored.

25. Endodontic instruments. Endodontic instruments are used for mechanical (instrumental) treatment of root canals. Currently, endodontic instruments are made of carbon steel, chromium-nickel and nickel-titanium alloy. The latter have a number of advantages: safety of the top of the working part, high flexibility and “memory”, due to which they tend to their original shape when they are bent, which in turn facilitates the expansion of the canal. Endodontic instruments are designed for both manual and machine treatment of root canals.

For the convenience of working with endodontic instruments, the following set of code options has been adopted according to ISO (International System of Standards).

Digital coding of endodontic instruments (from 6 to 140), which is applied directly to the handle or to the factory packaging of the endodontic instrument and corresponds to the diameter of the instrument. For example, number 6 corresponds to a diameter of 0.06mm.

Geometric coding of endodontic instruments (circle, triangle, square, spiral, octagon), which displays the cross-section of the working part of the endodontic instrument.

The color coding of endodontic instruments consists of 6 primary and three intermediate colors. When expanding the channel, not a single color should be missed!

Structure of endodontic instruments

The endodontic instrument consists of a polymer handle with color, digital and geometric coding, a rod with a working part and a silicone stopper for fixing the working length of the instrument. It should be noted that the tool shaft can have different lengths (21, 25, 28, 31), but the length of the working part is constant and equal to 16 mm.

Endodontic instruments, according to their purpose, are divided into the following groups:

Endodontic diagnostic instruments

Endodontic instruments for expanding the root canal orifice

Endodontic instruments for removing soft tissue from the root canal

Endodontic instruments for root canal

Endodontic instruments for root canal expansion

Endodontic instruments for root canal filling

Endodontic diagnostic instruments

A) A Miller root needle is used to determine the patency and direction of the root canal. In cross section it has a round or triangular shape.

A depth gauge , as the name suggests, is used to determine the length of the root canal.

Verifier - used for preliminary determination of the size of a gutta-percha pin during obturation of root canals with thermophiles. It is a uniformly tapering flexible needle, which has a rounded cross-section.

Endodontic instruments for expanding the canal mouth

The Gates Glidden is a drill consisting of a shank that holds the tool in the tip, a long shaft and a short teardrop-shaped working part. The working part of the tool consists of a blunt tip and cutting areas. The Gates Glidden series includes 6 tools of different sizes: 50, 70, 90, 110, 130, 150.

B) Largo or PeesoReamer is a drill that, compared to the Gates Glidden, has a longer working part. Despite the fact that the largo has a blunt tip, nevertheless, the instrument has a very pronounced cutting ability, and therefore it is rarely used to expand the mouth of the root canal. Basically, a largo drill is used to make room for a post in a pre-expanded root canal.

Orifice opener is a uniformly tapering isosceles drill, which is designed to expand straight sections of the root canal.

Beutelrock reamer 1 - Has a flame-shaped working part with 4 sharp edges. The length of this endodontic instrument is 11mm.

E) Beutelrock reamer 2 is a cylindrical drill, which is obtained by twisting a sharp plate around its own axis. Used to widen straight sections of the root canal.

Endodontic instruments for removing soft tissue of the root canal

A pulp extractor is a metal rod with small spikes located at an acute angle that engage and remove the tooth pulp. It should be noted that the pulp extractor is extremely fragile, and therefore it is not recommended to rotate it in the root canal more than 360. In addition, when removing the instrument from the root canal, the spikes cling to the dentin and become bent, and therefore the pulp extractor is intended for one-time use.

Endodontic instruments for root canal

K Reamer - Made by twisting a metal rod with a square cross section. This instrument is characterized by greater flexibility and the presence of sharp cutting edges, which work when removing the instrument from the root canal.

K Flexoreamer - Compared to K Reamer, it has greater flexibility, which is due to both the reduced helix pitch and the triangular cross-section of the tool shaft. Used to pass curved canals.

K Reamer Farside – used for short and narrow root canals. Compared to other reamers, it is less flexible and shorter (the length of the rod is only 18mm).

Endodontic instruments for root canal expansion

K File , like K Reamer, is obtained by twisting metal wire with a square cross-section, but has a larger number of cutting planes due to the greater number of turns. Thanks to this arrangement of cutting planes and the aggressive tip, the K File has very high cutting performance. The tool can be used in both rotary and reciprocating movements.

K Flexofile is almost identical in structure to the K Flexoreamer and differs from it only in the smaller distance between the cutting edges. Used to widen curved root canals.

K File Nitiflex is a K File made from nickel titanium alloy, which gives the tool flexibility. For safety reasons, the tip of this tool is blunt.

H File - Made by milling a spiral groove. It has sharp cutting edges that are located at an angle of 60° to the rod. The tool is used in a reciprocating motion.

Safety is essentially an H file with one side smoothed out. This structure of the instrument helps to expand curved root canals without perforation.

E) Ergo File is a nickel-titanium modification of the H File and has a non-aggressive (blunt) tip.

G) A File - like the previous two tools, it is a modification of the H File, but unlike it, the cutting edges of the A file are located at a more acute angle to the rod. Used to navigate curved root canals.

Endodontic instruments for root canal filling

The channel filler is a conical spiral twisted counterclockwise.

The Spreader is a cone-shaped hand-held endodontic instrument designed for lateral condensation of gutta-percha points.

The Plugger is a cylindrical hand-held endodontic instrument designed for vertical condensation of gutta-percha points. Unlike the Spreader, the apical part of this instrument is blunt.

Gutta Condensor is an endodontic instrument designed to condense gutta-percha with a thermophile. The working part of Condensor-a is similar to the reverse HFile and is used to work with the tip.

The most popular types

Despite the wide variety of restorative materials of this type, dentists choose compomers from certain manufacturers. They differ in their characteristics and can be used in different cases.

Dyract Extra

These are Dentsply's most renowned, versatile restorative compomers. 20 years of experience, many clinical studies and hundreds of scientific papers have ensured that Dentsply compomer materials are widely known and in demand.

Dyract Extra is a third generation material. Designed for filling cavities of all classes in the chewing and anterior segments. Has a cariesstatic effect (contains fluoride).

The creamy consistency allows for easy and quick application. The material has increased abrasion resistance, a wide range of colors, and physical properties comparable to a good composite.

Glasiosite

The restoration composition is available in capsules with a volume of 0.25 g. It is used in the following cases:

• to eliminate carious cavities in baby teeth;
• when performing veneering work on teeth located in the smile zone;
• for long-term restoration of class I and II;
• if extended sealing of fissures (natural pits and depressions on the chewing surface of teeth) is necessary.

When using Glasiosite material, the following advantages are noted:

• high level of strength ensures resistance to abrasion;
• there is a good connection with surface enamel and dentin;
• stable and long-term fluoride production;
• good color rendition, which is why the filling is almost invisible in the smile area.

Twinky Star

German manufacturers have taken an original approach to solving dental problems that arise in childhood.

The bright and different colors of the filling composition can reduce the child’s feeling of fear when visiting the dentist.

The compomer curing process occurs in two stages:

• under the influence of a halogen lamp during the filling installation procedure;
• within two months, under the influence of moisture, the hardness coefficient increases.

When using this composition, high quality of the final result is ensured. In addition, it has a high degree of biocompatibility and prevents the development of caries.

Twinky Star does not apply:

• if allergic reactions occur to its components;
• in case of need of direct covering of dental pulp;
• when it is not possible to completely isolate the tooth;
• in combination with cements containing zinc oxide;
• if a heart rate pacemaker is installed.

Comp Natur

Voco Compomer is intended primarily for the treatment of exposed tooth necks due to gum recession, as well as for the treatment of class 5 cavities. Three options of gum-like color - light, dark and white (can be mixed with each other) - allow you to choose a shade that accurately imitates the color of the gum. Comp Natur has color stability, high strength and abrasion resistance.

Ionosit Seal

A type of light-curing radiopaque material that is used to fill fissures (most often on baby teeth).

It contains fluorine and zinc ions, which prevents the development of caries. When used, no adverse reactions are observed, except in cases where one of the components causes symptoms of an allergic process.

MagicFil

Compomer "Magic Phil" is intended for filling baby teeth in children. Available in 3 glitter colors - gold, blue and wild berry. Provides minimal shrinkage, long-term release of fluoride ions, no resorption, strong marginal adhesion.

Ionosit-Baseliner

Glaciosite is used as an insulating gasket. When used, practitioners note the following advantages of the material:

• has a natural tooth color;
• well adapted to narrow fissures;
• fills even minor depressions and pits;
• releasing zinc and fluoride ions, prevents relapse of caries;
• The convenient applicator ensures comfortable work.

In rare cases, due to hypersensitivity to the main or additional components, allergic reactions may occur.

Manufacturers

Compomer filling materials are available from many brands, including Dentsply, Voco, Vivadent, DMG, 3M, Espe and Kerr.

Dentsply offers restorative universal materials from the manufacturer Dyract Extra 3rd generation. They are used for filling cavities of various types for units at any position in the row. The filling material contains fluoride; the materials have a cariesstatic effect. The product has a creamy consistency, which allows you to quickly apply the material, filling cavities. The advantages include abrasion resistance, properties comparable to composites, and a good range of shades.

VOCO offers Glasiosite materials - a condensable, easy-to-use, universal material with radiopaque properties, used to fill cavities of four classes - 1-3, 5. The product is suitable for restoration, including aesthetic, sealing of existing fissures, treatment of the frontal part of the row. The advantages of Glasiosite materials include:

• conducting fluoride therapy;
• stability, transparency of the shade;
• surface polishability after polymerization;
• abrasion resistance;
• strong bond with dentin tissues, thanks to self-etching special glue.

Twinkie Star is a material used to restore time series units. The eight-color compound with a slight glitter effect contains fluorine and is durable and abrasion-resistant. Thanks to its interesting glitter effect, the composition has an excellent motivating effect for the treatment of caries and other problems in children.

The cost of using the product depends on the chosen option, for example, a set of 40 compules produced by Dyract Extra costs approximately 8.5 thousand rubles. A set from Twinkie Star for treating children with colored sparkles - about 7 thousand rubles for a similar volume. Installation for one cavity also depends on the material and complexity of treatment; on average, the cost is 1-2.5 thousand rubles, excluding other measures aimed at eliminating the problem.

Compomers

Thanks to the widespread use of glass ionomers, it has been proven that filling materials that release fluoride ions can reduce the risk of caries around the filling.
However, glass ionomers are characterized by low strength, their surface is rough, and their structure is opaque. Composites, on the contrary, differ favorably in these properties, but they cannot release fluorine for a long time. By modifying the composition and structure of the composite, it was possible to obtain a new filling material that combines the properties of glass ionomers and composites. This material was named compomer by combining the words COMPOSITE and glass ionomer. In terms of properties and structure, compomers are closer to composites than to glass ionomers; accordingly, they have all the properties of polymer materials. The main features of compomers lie in their structure - a reactive filler and an acid-modified oranic matrix - and properties - the presence of two polymerization reactions: free radical and acid-base, the ability to long-term release of fluoride ions and attachment to dental tissues using an adhesive system.

The organic matrix of compomers consists of a monomer, usual for composites, modified with polycarboxylic acid groups. The presence of methacrylates allows the formation of long polymer chains, like composites, and acid groups interact with the reactive filler like glass ionomers. Typically, compomers are light-curing materials. The acid-base reaction can only occur in an aqueous environment and begins after the compomer is saturated with moisture in the oral cavity. Water absorption occurs very slowly over several months, as a result of which the volume of the filling increases by approximately 2%.

The inorganic filler is presented in the form of particles of strontium-fluorosilicate glass and strontium fluoride, crushed to 0.8-1 microns. The filler content is 70-73% by weight.

Compomers have all the typical properties of composites. Hardening of compomers occurs in two stages. As a result of polymerization of the monomer, primary hardness is achieved. After undergoing an acid-base reaction, the strength increases further. The main indications for use are filling cavities of classes III, IV and V. Some compomers can also be used for filling class I and II cavities on chewing surfaces.

Since compomers are highly sensitive to moisture, they are produced in hermetically sealed containers. After removing the material from the container, it can be used within 2-3 weeks, since air moisture can cause an acid-base reaction.

The transparency and polishability of compomers are practically not inferior to those of composites. Polymerization shrinkage is about 3% (5% for liquid compomers) and is almost compensated by volumetric hygroscopic expansion. The final treatment of the filling is carried out during the same visit as placement.

Since compomers are polymer filling materials and are not self-adhesive (with the exception of fixation compomer cements), adhesive systems are used to attach them to dental tissues. In most cases, the prepared cavity is treated with a polymer primer-adhesive without acid etching. This is due to the gentle indications for the use of compomers and the properties of modern adhesive systems. Long-term clinical use of these materials has confirmed the validity of this approach. To obtain higher bonding strength, dentin and enamel can be treated with mineral or a mixture of organic acids.

Based on consistency, compomers are divided into groups with medium density (regular) and low density (fluid). With an increase in the proportion of organic components, the physical properties of compomers deteriorate.

Compomers are widely used as an effective, fast and aesthetic filling material capable of releasing fluoride. It is most advisable to use compomers in small cavities without significant occlusal load, especially if additional resistance to caries is required. Compomers show excellent results in pediatric practice.

Principles of caring for fillings

In order for the filling to serve for a long time and efficiently, it is necessary:

• Regularly treat all areas of caries;
• Carefully observe oral hygiene;
• Review your diet, exclude those that destroy enamel - sweets, lemonades, carbonated drinks, unnatural juices, ketchups and sauces;
• Avoid temperature changes while eating;
• The lack of calcium in the body must be replenished with cottage cheese, natural dairy products and calcium carbonate tablets.

Price

Compomer compositions, despite some negative aspects, are widely used in dentistry. This is due to the fact that they have high strength, low shrinkage, and, importantly, prevent the re-development of carious cavities. In addition, they can be used for the restoration of frontal teeth.

The pricing of compomer cements is influenced by their release form and the brand name of the company.

So the cost of restoration material from the manufacturer Ionosit-Baseliner (DMG) will range from 600 to 800 rubles.

The average price for a Twinky Star set is approximately 5500-7000 rubles. For most types of material, the cost will be within 7,000 rubles.

Experts' opinions

Today, experts advise using high-quality composite materials for the treatment of permanent teeth in children. Photopolymers are used if the patient sits quietly in the doctor’s chair and gives him the opportunity to thoroughly clean the aching tooth.

You should not place such fillings if the carious process is advanced and hygienic care is insufficient. In this case, the photopolymer will be fixed to the weak enamel.

When installed correctly, the composite will last a long time. The product ensures the aesthetics of the tooth and has excellent adhesion. Minimal preparation is required to apply the composite.

If primary molars are subject to repair, then cement filling materials are suitable . They are not strong enough to be placed on chewing teeth. They are best used for temporary fillings.

Reviews

Filling with compomers differs little from treatment with composite materials. In both cases, light-curing pastes are used.

If you have had your child have MagicFil or Twinky Star colored fillings, please tell us about his or her reaction to the procedure. You can leave a review at the bottom of this page.

Sources:

• https://zubovv.ru/detskaya-stomatologia/d-zubi/plombirovochnyih-materialov.html
• https://www.vash-dentist.ru/detskaya-stomatologia/d-zubi/plombirovochnyie-materialyi.html
• https://berezkadent.ru/service/terapiya/lechenie-kariesa/plombirovanie-zubov/
• https://zubovv.ru/lechenie/zubyi/plombyi/kompomernyih-materialov.html
• https://www.vash-dentist.ru/lechenie/zubyi/plombyi/kompomernyih-materialov.html
• https://dentazone.ru/preparaty-oborudovanie/materialy/kompomery.html
• https://my-ort.ru/novosti/kompomery/
• https://uvr.spb.ru/healing/plomby.html