Nanofilled Resin Composite Properties and Clinical Performance: A Review
Nanofilled Resin Composite Properties and Clinical Performance: A Review
Nanofilled Resin Composite Properties and Clinical Performance: A Review
Clinical Relevance
Nanocomposites have been found to exhibit properties and clinical performance
comparable to those of several hybrid composites but better than microfilled composites.
However, there is no long-term evidence yet to show a superior performance that justifies
their use in stress-bearing areas.
age, strength, and wear resistance.5-9 A wide range esthetics and polishability in addition to excellent
of resin composites is available for anterior and wear resistance and strength.21,22
posterior restorations. This implies a wide range of In his review of resin composites, Ferracane2
organic and inorganic constituents that will influ- described the chronological development of resin
ence their clinical handling and performance.1 The composites outlining their classification according to
main composition of resin composites consists of an the filler particle size as follows: macrofill (10 to 50
organic polymeric matrix, inorganic fillers, and a lm), microfill (40 to 50 nm), and hybrid (10 to 50
silane coupling agent that links the first two lm þ40 nm). Hybrid composites were further distin-
components together.10 Mechanical properties and guished as ‘‘midifill resin composites’’ with an
esthetic appearance of resin composites have been average particle size slightly greater than 1 lm
Previous research has focused on testing various rial and significantly higher than the microfilled
properties of resin composites to evaluate their composite (Table 2). Similarly, Pontes and others29
performance in both laboratory and clinical studies. reported significantly higher FS of a nanocomposite
A large number of these studies aimed at comparing compared with a hybrid. On the other hand, several
nanocomposites with hybrid and microfilled resin investigators reported FS values of several nano-
composites.28 Therefore, the objective of the present composites comparable to or significantly lower than
work was to review laboratory studies that were a number of hybrid materials but significantly
undertaken on the so-called nanocomposites to higher than microfilled composites.11,31,36,40-42
examine strength, fracture toughness, surface hard- A number of studies examined the influence of
ness, abrasive wear, water sorption, and solubility. several factors, such as light polymerization mode,
composite (FW 64%). However, it has been reported highest values of FS were observed at a filler
that the fracture behavior and the structural volume of 60%. Lin and others38 also suggested
reliability seem to not be affected in highly filled higher FS values being associated with higher filler
composites compared with composites with lower content when testing FS of several nanocomposites;
filler content, such as microfilled resin composites.42 however, in their study, spherical filler particles
This is because the volume percent content of the were not associated with higher strength values.
fillers may not be markedly different. A number of Contrary to the results reported by Lin and others,38
investigators indicated that filler content and Pontes and others29 reported no positive correlation
material category had a significant influence on between filler content and FS, which could be
mechanical properties of resin composites, including related to the fact that different products where
nanocomposites.28,39,47-49 Higher strength was asso- examined in the two previously mentioned studies.
ciated with spherical filler particles,47 and the Lawson and Burgess46 attempted to evaluate the
Alzraikat & Others: Nanofilled Resin Composites E177
influence of nanofiller weight percent on mechanical by de Moraes and others,1 Pontes and others,29 and
properties of experimental resin composites. Three Lien and Vandewalle.36 This was attributed to the
experimental nanocomposites were formulated with presence of large individual filler particles in all of
different weight percent filler loads (25%, 50%, and them (Table 3).1
65%). There was an increase in the FS of all The CS and DTS of a number of nanocomposites
experimental composites up to 50% weight content were evaluated compared with hybrid, microfilled,
of the fillers. flowable, and ormocer-based composites.28 Large
Ilie and Hickel28 reported that large variations variations were observed in the strength values
exist between resin composites within the same (CS: 103 to 267 MPa; DTS: 32 to 45 MPa). Nano-
category. Flexural strength values ranging from 82 composites displayed the highest DTS values and
Table 2: Flexural Strength (FS, MPa) of Resin Composites (N, Nanocomposite; H, Hybrid; M, Microfilled)
Study Material Category FS (MPa)a Test Conditions
22
Mitra and others Filtek A110 M 94 E
Esthet X H 140 C
Esthet X H 145 B
Rodrigues Junior and others42 Filtek Supreme N 135 A Three-point bending test
Filtek Z250 H 140 A
Grandio N 110 A
Point 4 H 110 A
Table 3: Compressive Strength (CS) and Diametral Tensile Strength (DTS, MPa) of Resin Composites (N, Nanocomposite; H,
Hybrid; M, Microfilled)
Study Material Category CS (MPa)a DTS (MPa) Test Conditions
22
Mitra and others Filtek A110 M 376 B 52 D NA
TPH Spectrum H 378 B 80 B
Esthet X H 422 AB 66 C
Point 4 H 433 A 76 B
TPH N 53 AB
Filtek Z250 H 53 AB
Grandio N 54 AB
Filtek Supreme XT N 58 A
Table 4: Fracture Toughness (FT, MPa=m) of Resin Composites (N, Nanocomposite; H, Hybrid; M, Microfilled)
Study Material Category FT (MPa=m)a Test Conditions
22
Mitra and others Filtek A110 M 0.9 C Chevron-shaped notched short
Filtek Supreme Translucent N 1.2 B
rod method,
7-d storage
Esthet X H 1.2 B
Point 4 H 1.2 B
Rodrigues Junior and others42 Filtek Supreme N 1.3 B Notched bar method,
Filtek Z250 H 1.5 A
24-h storage
Hamouda and Abd Elkader30 Prime Dent H 6.28 A Sharp notch bar method,
Filtek Supreme N 6.54 A
24-h storage
Thomaidis and others55 Filtek Ultimate N 1.20 A Single-edge notched beam
Filtek Z250 H 1.43 A
method
a
Means with the same letters within each study are not statistically different.
b
Approximate values are used since data were reported using a bar chart.
Various trends have been reported when micro- 5).36,42,58,62-64 Cao and others65 reported significantly
hardness of nanocomposites was compared to other lower Vickers hardness (VH) values of the nano-
types of resin composites (Table 5). Mota and composite compared with all tested hybrid compos-
others21 reported a wide range of Knoop microhard- ites in their study. Each composite showed a distinct
ness values of nanocomposites that were attributed performance in terms of hardness and wear that was
mainly to differences in the filler content (55 to 123 attributed to the formulation of each material.
KHN). Beun and others31 reported significantly Comparable microhardness values were reported
higher hardness values of the nanocomposites by da Silva and others41 for a nanocomposite and a
compared to most of the hybrid and microfilled hybrid. However, using high-intensity light yielded
composites tested in their study. Several researchers the highest microhardness values. A positive corre-
reported higher hardness values for a number of lation between curing method, depth of cure, curing
nanocomposites compared to hybrid composites. This time, and the hardness of nanocomposites were also
was attributed to higher filler content, large and reported by others.66-68 Similarly, Marchan and
densely packed filler particles, and resin content of others69 reported better microhardness values of
the nanocomposite tested (Table 5).1,12,29,59 Similarly tested nanocomposites when light cured for 20
Lombardini and others57, and Poggio and others60 seconds using QTH and LED units compared to 10
reported greater surface microhardness of nano- seconds. The majority of the nanocomposites pro-
composites tested compared with the hybrid com- duced better VH when cured by LED compared with
posites, a finding that was statistically significant QTH, the reason for which was unclear. One nano-
(Table 5). The hardness values were not influenced composite showed higher VH compared to the other
by varying polymerization mode or time or sample nanocomposites due to its higher filler content (Table
thickness, something that was also reported by other 5).
researchers.29,61 The different values of microhardness reported
On the other hand, the microhardness of a nano- indicate the influence of the specific formulation of
composite was found to be inferior to that of a hybrid each material, ultimately affecting its hardness
by several researchers who attributed this to the behavior.40,65 Moreover, different study protocols
complex nature of the nanocomposites’ filler content, and testing methods may account for this variability
larger filler volume, and greater amount of pigment. in reported values. Consequently, it would be
These proposed factors may lead to light attenuation difficult to accurately compare results. Therefore,
yielding a decreased degree of polymerization (Table further investigations using comparable methodolo-
Alzraikat & Others: Nanofilled Resin Composites E181
Premise N 62 C
Filtek Z250 H 69 B
Filtek Supreme XT N 72 B
Grandio N 111 A
Filtek Supreme N 57 B
Filtek Z250 H 63 A
Tetric Ceram H 40 E
Venus H 45 E
Point 4 H 50 D
Filtek Supreme N 60 C
Grandio flow N 60 C
Grandio N 98 B
Table 5: Continued.
Study Material Category Hardnessa Test Conditions
59
Kaminedi and others Filtek Z250 H 61 B Vickers hardness
Filtek Z350 N 67 A
Filtek P 60 H 82 B
Clearfil AP-X H 87 A
Filtek Z250 H 72 A 71 A
Thome and others62b Filtek Supreme N Top surface Hardness Vickers hardness
A3.5: 76, 74, 61 Shade: A1, A3.5 Curing
A1: 83, 79, 67 B distance: 0, 6, 12 mm
Filtek Z250 H A3.5: 90, 76, 71
A1: 98, 81, 68 A
Suzuki and others12c Tetric Evo Ceram N 35 D Knoop hardness
Venus Diamond N 45 C
Filtek Supreme XT N 57 B
Grandio N 80 A
Marchan and others69b Clearfil Majesty N 33, 27, 28 26, 26, 26 D Vickers hardness
Tetric Evo Ceram N 34, 33, 30 28, 33, 30 D
Curing mode and time:
QTH: 495 mW/cm2 for 20 s
Ice N 51, 51, 47 43, 45, 43 C
LED: 890 mW/cm2 for 20 s
Filtek Z350 N 65, 61, 64 64, 59, 54 B LED: 890 mW/cm2 for 10 s
Grandio N 73, 75, 72 70, 70, 66 A
a
Means with the same s letters within each study are not statistically different. For studies with multiple values, letter was used to indicate significant difference
between different materials.
b
Multiple values for each material property indicate the reported value under each test condition in the study.
c
Approximate values are used since data were reported using a bar chart.
gy should be done in order to be able to directly Mitra and others22 examined the wear rate of
compare results. nanocomposites (standard and translucent) com-
pared with hybrid and microfilled composites using
ABRASIVE WEAR a three-body wear test. The wear rate of the
standard nanocomposite was equivalent to a hybrid
Wear has been defined as the gradual removal of but significantly lower than the other hybrid and
material as a result of the interaction between two microfilled composites. The translucent nanocompo-
surfaces moving against each other.70 Wear of resin site demonstrated equivalent wear values to the
composite has been reported to be dependent on filler microfilled composite but was significantly lower
loading and size in addition to the formulation of its than the other hybrid materials. Comparable results
resin matrix and the adhesion of fillers to the were shown by Cao and others,65 who reported
matrix.27 significantly lower volume loss of the tested nano-
composite compared with hybrid materials. Similar-
Several studies investigated abrasive wear of
ly, Yesil and others72 reported comparable wear rate
nanocomposites compared with hybrid and micro- of a nanocomposite to that of a microfilled and a
filled composites by measuring specimen thickness hybrid composite. Hamouda and Abd Elkader30
using calipers,71 assessing surface roughness,12 and reported that the nanocomposite tested in their
measuring weight loss of tested samples following study demonstrated a significantly lower wear value
abrasion.30 Table 6 shows abrasive wear values compared to the hybrid composite that was attribut-
reported by the studies included in the current ed to the higher filler loading and smaller particle
literature review. size associated with the nanocomposites. Suzuki and
Alzraikat & Others: Nanofilled Resin Composites E183
Point 4 H 3.4 A
Esthet X H 3.5 A
Filtek P60 H 8 B
Clearfil AP-X H 8 B
Surefil H 10 A
72
Yesil and others Point 4 H 7 B Simulated masticatory wear
Heliomolar RO M 12 AB
mechanism using human enamel
as opposing cusp (lm)
Filtek Supreme N 14 AB
Premise N 19 A
Table 7: Sorption and Solubility Values (lg/mm3) of Resin Composites (N, Nanocomposite; H, Hybrid; M, Microfilled)
Study Material Category Sorption (lg/mm3)a Solubility (lg/mm3) Test Conditions
77b
da Silvaand others Filtek P60 H 6.7, D 7.04 C 0.38, C 0.43 B Curing modes:
Filtek Supreme N 7.35, B 8.74 A 0.41, B 0.49 A
Conventional: 850 mW/
cm2 (10 s)
Ramped: 100 to 1000
mW/cm2 (10 s and 1000
for 20 s)
Kumar and Sangi32b Filtek Z250 H 17.3, 23.5 B 1.5, 1.1 B Storage period:
Filtek Supreme N 18.7, 24.9 B 1.1, 1.0 B
1 wk
13 wk
Almeida and others78b Filtek P60 H 2.8, 8.9, 7.3, 4.0 B 2.4, 6.4, 3.4, 2.4 A Storage media:
Filtek Z350 N 14.1, 20.4, 11.9, 14.8 A 3.1, 6.2, 4.4, 3.0 A
Artificial saliva
Listerine
Plax fresh mint
Plax
a
Means with the same letters within each study for each property are not statistically different. For studies with multiple values, one letter was used to indicate
significant difference between different materials.
b
Multiple values for each material property indicate the reported value under each test condition in the study.
tion at the filler–matrix interface and inside the no effect on sorption values of the tested composites
aggregates of the nanocomposite. Similarly, Kumar when varying polymerization mode. One nanocom-
and Sangi32 reported significantly higher water posite displayed the lowest sorption and second-
sorption and solubility for one nanocomposite com- lowest solubility compared to a hybrid composite.
pared with the other nanocomposite and a hybrid This was attributed to its high and dense filler
following 13 weeks of water storage. Furthermore, content. Similarly, de Moraes and others1 reported
lower strength values were reported for the nano- significantly lower sorption of a nanocomposite
composite that showed the highest sorption and compared to a hybrid and other nanocomposites
solubility values. The lower strength values of the tested, while all tested composites displayed compa-
nanocomposite were attributed to the poor silane rable solubility values. The authors suggest that
penetration of the porous nanoclusters. This made results of water sorption and solubility are probably
the nanocomposite susceptible to degradation when related to the nature of the organic matrix chemical
stored in water. Lower sorption by the hybrid was rather than to the filler content of the material
attributed to the better coupling between filler
(Table 7).
content and matrix.80 On the other hand, Lopes
and others81 demonstrated no influence of varying The effect of using different storage media on
polymerization mode on sorption and solubility of a sorption and solubility of resin composites was
nanocomposite. This was attributed to the formation assessed by several researchers.78,81,83 Almeida and
of a densely cross-linked polymer network due to the others78 and Lopes and others81 demonstrated an
use of an adequate energy density in all the curing influence of storage media on the sorption of resin
methods used. Similarly, Shin and others82 reported composites tested. Negative values of solubility were
Alzraikat & Others: Nanofilled Resin Composites E185
reported by researchers for a number of nano- Several clinical studies extending from one to four
composites indicating weight gain masking the real years reported comparable performance between
solubility. Almeida and others78 reported significant- nanocomposites and hybrid composites in posterior
ly higher sorption of a nanocomposite compared with teeth and noncarious cervical cavities.88-102 There
a hybrid in Listerine (Warner Lambert Health Care, was no detection of restoration failure, good surface
Eastleigh, UK), Plax fresh (Colgate-Palmolive, Guil- characteristics, good color match, and no postopera-
ford, UK), Plax (Colgate-Palmolive), and artificial tive sensitivity.103-106 Better polishability and sur-
saliva. The solubility of the nanocomposite and face gloss retention in favor of the nanocomposites
hybrid composites was comparable, with significant- were reported and attributed to the reduced filler
ly higher values obtained when placed in Listerine plucking and less wear of the nanofillers.107-109
the use of different nanocomposite material in each 2. Ferracane JL (2011) Resin composite—State of the art
study. Furthermore, the inclusion criteria for re- Dental Materials 27(1) 29-38.
cruited subjects differed in that high-caries-risk 3. Curtis AR, Palin WM, Fleming GJ, Shortall AC, &
patients were not excluded from the six-year evalu- Marquis PM (2009) The mechanical properties of nano-
filled resin-based composites: The impact of dry and wet
ation period study.116 On the other hand, Frank-
cyclic pre-loading on bi-axial flexure strength Dental
enberger and others118 included subjects with a high Materials 25(2) 188-197.
level of oral hygiene, which may have contributed to
4. Lu H, Roeder LB, Lei L, & Powers JM (2005) Effect of
the reported higher success rate after eight years surface roughness on stain resistance of dental resin
compared with six years. The authors reported no composites Journal of Esthetic and Restorative Dentistry
significant difference in the clinical behavior be- 17(2) 102-108; discussion 109.
On the basis of the results of the previous studies, 6. Ferracane JL, & Mitchem JC (1994) Properties of
posterior composite: Results of round robin testing for
it seems reasonable to conclude that there is no a specification Dental Materials 10(2) 92-99.
evidence yet that the nanocomposites perform
7. Lu H, Stansbury JW, & Bowman CN (2005) Impact of
clinically better than hybrid composites.
curing protocol on conversion and shrinkage stress
Journal of Dental Research 84(9) 822-826.
CONCLUSION
8. Tyas MJ (1990) Correlation between fracture properties
The current review of the published literature has and clinical performance of composite resins in Class IV
shown that commercially available nanocomposite cavities Australian Dental Journal 35(1) 46-49.
materials do not hold any significant advantage over 9. Watts DC, Marouf AS, & Al-Hindi AM (2003) Photo-
hybrid composites in terms of strength and hard- polymerization shrinkage-stress kinetics in resin-com-
posites: Methods development Dental Materials 19(1)
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1-11.
values were found for nanocomposites compared
10. Rawls HR, & Esquivel-Upshaw JF (2003) Restorative
with hybrid composites, and these might influence
resins In: Anusavice KJ (ed) Phillips’ Science of Dental
their clinical performance. On the other hand, the Materials Elsevier Science, St Louis, MO 399-437.
incorporation of nanofillers into resin composite
11. Rodrigues Junior SA, Zanchi CH, Carvalho RV, &
materials was associated with lower abrasive wear Demarco FF (2007) Flexural strength and modulus of
of nanocomposites. However, attention should be elasticity of different types of resin-based composites
focused on the resin matrix composition and not only Brazilian Oral Research 21(1) 16-21.
the filler system to be able to assess abrasive wear 12. Suzuki T, Kyoizumi H, Finger WJ, Kanehira M, Endo T,
behavior. In the current review, nanocomposites Utterodt A, Hisamitsu H, & Komatsu M (2009) Resis-
demonstrated acceptable clinical performance com- tance of nanofill and nanohybrid resin composites to
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Dental Materials Journal 28(6) 708-716.
periods ranging from one to 10 years. However,
there was no definitive report of the superior 13. Lu H, Lee YK, Oguri M, & Powers JM (2006) Properties
of a dental resin composite with a spherical inorganic
performance of nanocomposites in the majority of filler Operative Dentistry 31(6) 734-740.
evaluation criteria used.
14. Foster J, & Walker R (1674) US Patent No. 3825518.
15. Maghaireh GA, Taha NA, & Alzraikat H (2017) The
Conflict of Interest
silorane-based resin composites: A review Operative
The authors of this article certify that they have no Dentistry 42(1) E24-E34.
proprietary, financial, or other personal interest of any nature
or kind in any product, service, and/or company that is 16. Ilie N, & Hickel R (2011) Resin composite restorative
presented in this article. materials Australian Dental Journal 56(Supplement
1) 59-66.
(Accepted 8 December 2017) 17. Tagtekin DA, Yanikoglu FC, Bozkurt FO, Kologlu B, &
Sur H (2004) Selected characteristics of an ormocer and
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