RESTORATIVE MATERIALS

The principles of adhesive dentistry date back to 1955 when Buonocore,[1] employing
techniques of industrial bonding, suggested that acids could be used as a surface treatment before
applying resins. Along with adhesion, the most important phase has been the evolution of dental
restorative composites. These have come a long way from being traditionally macrofilled (8-mm
filler), to microfilled (0.01 to 0.04-mm filler), to hybrid (0.4 to 1-mm filler), and now to
nanofilled (0.005 to 0.01-m filler). But if we notice, all the changes have been made to the
fillers. Although the resin matrix significantly influences the properties of composites, it is
interesting to note that there have been few fundamental changes in that aspect of the restorative-
adhesive system since the introduction of dimethacrylates in the form of bisphenol A-diglycidyl
dimethacrylate (Bis-GMA), urethane dimethacrylate, and triethylene glycol dimethacrylate. One
of the greatest deficiencies associated with these resins is the high degree of polymerization
shrinkage and high content of residual monomers in the cured composite material.

ORMOCERS

In an attempt to overcome some of the limitations and concerns associated with the traditional
composites, a new packable restorative material was introduced called Ormocer,[2] which is an
acronym for organically modified ceramic technology. Ormocer materials contain inorganic-
organic co-polymers in addition to the inorganic silanated filler particles. It is synthesized
through a solution and gelation process[3] (sol-gel process) from multifunctional urethane and
thioether(meth)acrylate alkoxysilanes. Ormocers are described as three dimensionally cross-
linked copolymers. The ormocer matrix is a polymer even prior to light curing. It consists of
ceramic polysiloxane, which has low shrinkage as against the organic dimethacrylate monomer
matrix seen in composites. To the polysiloxane chains in ormocer, polymerisable side chains are
added to react during curing and form the setting matrix. These inorganic molecules are longer
than Bis-GMA, which could explain the material's lower volumetric shrinkage. Incorporation of
filler particles decreases volumetric shrinkage from 28% when it has no fillers to 13% when
fillers are incorporated. The filler particles are 11.5 m in size.[4,5] This material presents 77
78 wt% of filler loading, 61% filler volume, and a modulus of elasticity of 10.700MPA
(manufacturer's information)

The abundance of polymerization opportunities in these materials allows ormocers to cure

without leaving residual monomers, thus having greater biocompatibility with the tissues.
Ormocers have a capacity to double the conversion of monomers, improving the physical
properties of the material. Ormocers were formulated in an attempt to overcome the problems
created by the polymerization shrinkage of conventional composites and also because ormocers
include low shrinkage, high abrasion resistance, biocompatibility, and protection against caries.
[6] Their backbone is an inorganic network formed by polycondensation. This backbone is based
on silicon dioxide and functionalized with polymerisable organic units to produce so called
three-dimensional compound polymers. The silicon dioxide backbone of ormocers provides them
with their name and accounts for their relationship with ceramics. They combine glass-like
(inorganic) constituents with polymer (organic) constituents.

In restorative dentistry, choosing the correct restorative material is one of the primary variables
that determine its success. Particularly in recent years, a lot of research has been done on
adhesive dentistry. This has resulted in a number of positive developments and has provided
dentists with assistance in selecting the correct materials and methods. In order to lessen a
material's negative effects, we must know its physical, biological and clinical properties well
[Table ].

This study was carried out to compare the marginal sealing ability of an ormocer-based material
(Admira) and a hybrid composite (Spectrum TPH) when used with an ormocer-based bonding
agent (Admira Bond) and a conventional fifth-generation bonding agent (Prime and Bond NT).
We found that Admira used with Admira Bond exhibited lesser microleakage than Spectrum TPH
used with Prime and Bond NT, the difference being statistically insignificant.

Contemp Clin Dent. 2012 Jan-Mar; 3(1): 4853.

doi: 10.4103/0976-237X.94546
PMCID: PMC3341759

VOCO will present several innovations at this year's British Dental Conference and Exhibition in
Manchester, such as Admira Fusion, the world's first purely ceramic-based, universal, restorative
material. This is made possible by combining the proven nanohybrid technology with that of the
ORMOCER's. Silicon oxide forms the chemical base for this nanohybrid ORMOCER restorative
material, not only for the fillers but also for the resin matrix. This unique 'Pure Silicate
Technology' offers several remarkable advantages in one: for example, the fact that Admira
Fusion, in comparison with all restorative composites of market relevance, shows by far the
lowest level of polymerisation shrinkage (1.25% by volume) and, coupled with that, extremely
low shrinkage stress.

The ORMOCERs ('Organically Modified Ceramics') used in the manufacture of Admira Fusion
make it highly biocompatible, as there is no content of classic monomers. The light-curing,
radiopaque nanohybrid ORMOCER has an 84% (by weight) content of inorganic fillers and
covers a broad spectrum of indications. Admira Fusion's particularly high colour stability gives it
an additional edge and allows its absolutely universal use for highest demands in both the
anterior and posterior regions. This very homogeneous material offers outstanding handling and
is compatible with all conventional bonding materials. Admira Fusion is available in rotating
syringes and also caps for direct application.

Product News

British Dental Journal 220, 489 (2016)

Published online: 13 May 2016 | doi:10.1038/sj.bdj.2016.338

GIOMERS

Giomers are newly introduced hybrid aesthetic restorative materials for dental restorative
therapy. They are based on pre-reached glass-ionomer (PRG) technology. Chemically, they
consist of fluoroalumino silicate glass reacted with polyalkenoic acid in water prior to inclusion
into the silica-filled urethane resin. Giomers contain both of the essential components of glass-
ionomer cements and resins but they cannot be classified as compomers, in which a variable
amount of dehydrated polyalkeonic acid is incorporated in the resin matrix and the acid does not
react with the glass until water uptake occurs. Giomers are placed in a separate category of
composites known as PRG composites. These materials have significant fluoride release,
fluoride recharge biocompatibility, smooth surface finish, excellent aesthetics and clinical
stability which has made them popular for restoration of root caries, non-carious cervical lesions,
class V cavities, and deciduous tooth caries. As per todays knowledge, giomers are promising
restorative materials and are considered to be most interesting development of near future.

Journal of conservative dentistry

Year : 2002 | Volume : 5 | Issue : 4 | Page : 149-155

Composite restorations have become the most popular tooth colored direct filling materials. It
has good esthetic, physical and mechanical properties compared to other direct esthetic
restorative materials [1]. However, detected recurrent caries have been identified as a primary
cause for replacement of directly placed resin composite restorations [2]. Restoration
replacement is destructive for teeth containing a tooth colored restorations as it can result in an
increase in cavity size by up to 37% [3].

It was found that; conventional glass ionomer (GI) has the ability to inhibit the initiation and
progression of recurrent caries' [4]. This has stimulated scientists to develop a hybrid of
composite and GI. Compomer and Resin modified glass ionomer (RMGI) have been developed
to hybridize the advantages of both, the good mechanical properties, esthetic and hydrophopocity
of composite added to anticariogenic activity and chemical bonding to tooth structure of GI
advantages. However, properties of RMGI and compomer were still far from that of composite
restoration [5] and [6].

Thus, Giomer material has been introduced as the true hybridization of glass ionomer and
composite resin, containing surface pre-reacted glass ionomer (S-PRG) filler particles within a
resin matrix. Giomer combines the fluoride release, recharge of GIs and the esthetics, physical
and handling properties of composite resins [7].

Literature search reveals several clinical studies conducted on giomers in class V and in class I,
II lesions over a period of 18 years with good clinical performance [8], [9], [10], [11],
[12] and [13]. Yap et al. [13] found that a giomer, after polishing with Sof-Lex disks, had a
smoother surface than a glass ionomer, and one that was comparable to that of a compomer and a
resin composite. Jyothi et al. [14] reported that Beautifil II (a second giomer generation) had
superior surface finish compared to RMGIC (Fuji II LC) in non-carious cervical lesions in one
year clinical study. Moreover, a clinical study [15] has reported no significant difference between
Beautifil II giomer restorative material and a conventional resin-based composite material. These
results encouraged the manufacturer1 to develop flowable giomer materials with different
viscosities. Beautifil Flow Plus F00 is one of the flowable giomer products which claimed by the
manufacturer to have favorable adaptation, effortless delivery with the strength, durability and
aesthetics equal to or better than hybrid composites.

Tanta Dental Journal

Volume 11, Issue 3, December 2014, Pages 213222

Three-year clinical evaluation of two nano-hybrid giomer restorative composites

Posterior composites are the restorative backbone of many practices today, however there are
clinical issues that must be dealt with including potential sensitivity, marginal integrity, leakage,
placement efficiency, depth of cure, shrinkage stress, contact formation, and longevity.1-3

Many newer materials and techniques today have been designed to address such issues.4 A
popular trend today is bulk filling of posterior restorations while attempting to gain speed by
replacing tooth structure in 4mm or more light cured layers. These materials provide a potential
mechanism for reducing time and effort but the handling of these materials must be understood
and the technique is meticulous.
The balance between efficient placement, aesthetics, comfort, and durability must be considered.
Reducing the time or steps, such as with bulk fill materials, may result in less than an optimal
restoration. Clinician concerns with bulk fill materials include gap formation of the pulpal floor,
damaging shrinkage stresses at the enamel interface, and incomplete polymerization of the
material.5,6

The thorough and meticulous sealing of the dentinal surface and the cavosurface margins with a
regenerative material BEFORE bulk placement may minimize the potential problems associated
with bulk filling techniques. This article describes the attention to detail and placement
techniques that provide maximum sealing where it matters most.

BULK FILL MATERIALS

The two classes of bulk fill materials are the flowables and the packables. Flowable type
materials like SureFil SDR (Dentsply), Filtek Bulk Flow (3M), and BeautiFil Bulk Flowable
(Shofu) all are fairly non-viscous, self-leveling materials that have a predictable 4mm depth of
cure. These materials can certainly be a time saver but they all need to be capped with a more
wear resistant material like a microhybrid composite. This additional layering adds another
material to the system and care must be taken to leave sufficient room for the final covering.

The bulk fill packables have perhaps a greater inherent efficiency because they can be filled to
the cavosurface/occlusal surface and do not require a covering layer. Materials such as Tetric
EvoCeram Bulk Fill (Ivoclar), SonicFill (Kerr), and BeautiFil Bulk (Shofu) provide the 4mm
depth of cure and wear that is similar to most other microhybrids on the market. Therefore, these
materials may have the potential for the highest clinical efficiency if used properly.

THE GIOMER

The giomer (Shofu, San Marcos, CA) is a unique class of restorative materials that have the
distinguishing feature of a stable glass ionomer core in a protective resin matrix.7 This
arrangement allows for protection of the glass core from moisture giving it long-term aesthetics
and durability of conventional composites with ion release and recharge.8 This surface pre-
reacted glass ionomer (S-PRG) gives these materials composite-like durability, handling, and
aesthetics as well as significant release of fluoride ions re-chargeability.9,10

Included in this family are both bulk fill flowables and packable composites that feature
excellent clinical characteristics with the anti-bacterial, anti-plaque, anti-sensitivity features of
the entire giomer class.11 The giomer line also includes flowables, sealants, nano-hybrids, and
posterior microhybrids.

With the giomer family, we have a regenerative type material that is bio-friendly and may
provide an environment where dentin prospers which may lead to less sensitivity and longer
restoration durability.12 Given the ion release and their anti-plaque nature, they are excellent
choices for placement at the margins and on the dentin BEFORE the bulk restorative material is
placed. This allows regenerative activity to occur where it matters most.13
WHERE IT MATTERS MOST

There are two critical areas of concern with any direct composite restoration: the margins and the
dentin surface. How those areas are treated determine in large measure the degree of longevity
and sensitivity with the restoration. When both of those areas are handled correctly, there is a
higher chance of restoration success. Despite the efficiency that comes with bulk filling
materials, the margins and dentin surface are best handled with meticulous attention to detail.
Once those areas are sealed and polymerization in a bio-friendly manner, the bulk filling of the
preparation is relatively simple.

By placing these biofriendly materials in thin, easily light curable layers on a well bonded dentin
surface and at the cavosurface margins, we are providing an environment where bulk filling can
be most successful. In other words, we are treating the places where failure most readily happens
in a separate, methodical manner BEFORE bulk filling occurs.

April 1, 2014
by Jack D. Griffin Jr., DMD, MAGD, ABAD, AAACD

Where It Matters Most Giomer Pre-Sealing of the Margins and Dentin When Bulk
Filling