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Bisphenol A Release: Survey of the Composition of Dental Composite Resins

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DOI: 10.2174/1874210601610010446

CASE REPORT
Bisphenol A Release: Survey of the Composition of Dental Composite
Resins
Elisabeth Dursun1,*, Hélène Fron-Chabouis2, Jean-Pierre Attal2 and Anne Raskin3
1
Unité de Recherche en Biomatériaux, Innovations et Interfaces - EA 4462, Faculté de Chirurgie Dentaire, Université
Paris Descartes, Paris, Groupe Hospitalier Mondor-Chenevier, Créteil, France
2
Unité de Recherche en Biomatériaux, Innovations et Interfaces - EA 4462, Faculté de Chirurgie Dentaire, Université
Paris Descartes, Paris, Hôpital Charles Foix, Ivry-sur-Seine, France
3
UMR 7268 ADES, EFS, CNRS Faculté d’Odontologie, Université d'Aix-Marseille, Marseille, Pôle d’Odontologie, UF
des soins spécifiques, APHM, Hôpital de la Timone, Marseille, France

Received: April 6, 2016 Revised: June 15, 2016 Accepted: July 27, 2016
Abstract:
Background:
Bisphenol A (BPA) is an endocrine disruptor with potential toxicity. Composite resins may not contain pure BPA, but its derivatives
are widely used. Several studies found doses of BPA or its derivatives in saliva or urine of patients after composite resin placement.

Objective:
The aims of this study were to establish an exhaustive list of composite resins marketed in Europe and their composition, and to
assess the extent of BPA derivatives used.

Methods:
A research on manufacturers' websites was performed to reference all composite resins marketed in Europe, then their composition
was determined from both material safety data sheets and a standardized questionnaire sent to manufacturers. Manufacturers had to
indicate whether their product contained the monomers listed, add other monomers if necessary, or indicate “not disclosed”.

Results:
160 composite resins were identified from 31 manufacturers and 23 manufacturers (74.2%) responded to the survey. From the survey
and websites, the composition of 130 composite resins (81.2%) was: 112 (86.2%) based on BPA derivatives, 97 (74.7%) on bis-
GMA, 17 (13.1%) without monomer derived from BPA (UDMA, sometimes with TEGDMA) and 6 (4.6%) with UDMA (only); 1
(0.8%) did not contain a BPA derivative or UDMA or TEGDMA. Pure BPA was never reported.

Conclusion:
This work has established a list of 18 composite resins that contain no BPA derivative. Manufacturers should be required to report
the exact composition of their products as it often remains unclear or incomplete.

Keywords: Biocompatibility, Bisphenol A, Composite resin, Monomer.

* Address correspondence to this author at the Faculté de Chirurgie Dentaire, 1 rue Maurice Arnoux 92120 MONTROUGE, France; Tel/Fax: +33 1
58 07 67 25; E-mail: elisabethdursun@gmail.com

1874-2106/16 2016 Bentham Open

Survey of the Composition of Dental Composite Resins The Open Dentistry Journal, 2016, Volume 10 447

INTRODUCTION
Bisphenol A (BPA) is an organic compound used in the industrial production of polycarbonates and epoxy resins
[1]. However, BPA is an endocrine disruptor, with potential toxicity in vitro [2] and in vivo [3]. Among other effects, it
can cause changes in the structure of the unborn child’s mammary glands - promoting further tumor development - and
has effects on the brain and behavior, the female reproductive system, and metabolism and obesity [4]. Infants, young
children and pregnant or lactating women are the most sensitive [5]. Thus, the manufacturing of baby bottles containing
BPA has been banned by the European Union since 2011. From January 1, 2015, France has banned BPA in all food
packaging. In its latest comprehensive re-evaluation of BPA exposure and toxicity, the European Food Safety
Authorities has concluded no risks at actual exposure levels [6]. However, a lower Tolerable Daily Intake (TDI) has
been set at 4µg/kg bw/day (ie 12.5 times less than the last TDI). Besides, its possible “low-dose effect” [7 - 9], defined
as “any biological changes occurring in the range of typical human exposures, or biological changes that occur at doses
below those used in traditional toxicology studies” was suspected.
Pure BPA is not a component of dental composite resins. However, derivatives of BPA - from pure BPA - are
widely used: bisphenol A diglycidyl methacrylate (bis-GMA) especially, but also bisphenol A dimethacrylate (bis-
DMA), polycarbonate-modified bis-GMA (PC bis-GMA), ethoxylated bisphenol A glycol dimethacrylate (bis-EMA)
and 2,2-bis[(4-methacryloxy polyethoxy)phenyl]propane (bis-MPEPP).
Several studies have investigated the levels of BPA and its derivatives in the saliva or urine after polymerization of
a restoration made of a composite resin containing at least one of these monomers. The results vary: some studies in
vitro [10] and in vivo [11] have detected some levels (in very low doses) and others do not detect any [12]. This BPA
elution would result from impurities in the synthesis of resins or their degradation [13]. These variations can be
explained by the different susceptibility of BPA derivatives to hydrolysis by salivary esterases. Bis-GMA does not
undergo this reaction, because its chemical structure with stable ether bonds prevents hydrolysis. However, bis-DMA
hydrolyzes at its ester bonds, releasing an amount of BPA that is not negligible. These differences could also be related
to the detection technique [14]. Furthermore, a recent study showed absorption of BPA by the sublingual area in dogs,
allowing its direct entry into the bloodstream, by passing the digestive system and liver and multiplying its
bioavailability by a factor of 80 [15].
Yet, the exact composition of the composite resins on the market and the potential composite resins without BPA
derivatives are not known. No study has sought to identify all monomers contained in the marketed composite resins.
The objectives of this study were first, to provide an exhaustive list of the composite resins sold in Europe and detail
their composition and second, to estimate the number of composite resins using BPA or BPA derivatives (bis-GMA,
bis-DMA, bis-EMA, bis-MPEPP, PC bis-GMA) in their manufacturing.

MATERIALS AND METHODOLOGY

To reference all composite resins sold in Europe, a search was conducted of the manufacturers' websites. Next, the
composition of the composite resins was searched on the materials’ safety data sheet (MSDS) and using a standardized
questionnaire sent to manufacturers. This questionnaire listed 13 monomers found in the MSDS and in the various
studies of these materials; the manufacturer had to indicate, for each product, if the material contained these monomers
or not, or else write “not disclosed” (ND). The manufacturer could also add monomers to the proposed list (Table 1).
Manufacturers were contacted by email and/or telephone and the details were transmitted by email; they had 4 months
to answer and an extra 2 months after a reminder email. When the manufacturer had not answered or the information
was not available (MSDS, internet), the result was noted as “ND”. All results were recorded and analyzed by using
Microsoft Excel 2008, v12.3.6.
Table 1. List of the surveyed monomers (found in materials’ safety data sheet and various studies of these resin composites
and proposed to manufacturers) that resin composites can contain.

Monomer
Monomer (detailed chemical name)
(abbreviation)
Bisphenol A 2,2-bis(4-hydroxyphényl)propane
Bis-GMA 2,2-bis[4-(3-methacryloxy-2-hydroxypropoxy)phenyl]propane
PC Bis-GMA Polycarbonate-modified bis-GMA
Bis-DMA 2,2-bis-(4-(méthacryloxy) phenyl) propane
Bis-EMA or EBPADMA Ethoxylated bisphenol-A glycol dimethacrylate
448 The Open Dentistry Journal, 2016, Volume 10 Dursun et al.

(Table 1) contd.....
Monomer
Monomer (detailed chemical name)
(abbreviation)
Bis-MPEPP or BPEDMA Bisphenol A polyethoxy dimethacrylate or 2,2-bis(4-methacryloxy poly-ethoxyphenyl)propane
UDMA Urethane dimethacrylate or 1,6-di(methacryloyloxyethylcarbamoyl)-3,3,5-trimethylhexan
TEGDMA Triethylene glycol dimethacrylate
HEMA Hydroxyethyl methacrylate
HEDMA Hexane diol dimethacrylate or 2-hydroxyethyl dimethacrylate
TMPTMA Trimethylolpropane trimethacrylate
4-MET 4-methacryloxyethyl trimellitic acid
IBMA Isobutyl methacrylate

RESULTS
A total of 160 composite resins were identified from 31 companies (Table 2); 23 companies (74.2%) responded to
the survey, with complete responses for 119/135 composite resins they marketed (88%). For the 8 manufacturers who
did not respond (25.8%), the search of the internet and especially the MSDS provided responses for 11 of the 25
composite resins marketed (44%).
Table 2. List of the 160 composite resins marketed in Europe by 31 manufacturers and type of response (R) from the
manufacturer (1: response; 2: partial response; 0: no response).

Fabricant R Composite Resins

1 Filtek Bulk Fill Fluide, Filtek P60, Filtek Silorane, Filtek Supreme XTE, Filtek Supreme XTE fluide, Filtek Z250,
3M ESPE
Filtek Z500, Z100 MP
Alpha Dent 0 Alpha II AP, Alpha Flow, Alpha-Dent Light Cure, Alpha-Dent Self Cure
Apol 1 Ivoa, Ivoa flow, Xtrem nano, Sharkcomp, Sharkflow
Bisco 1 Aelite Aesthetic Enamel, Aelite All Purpose Body, Aelite LS Posterior, Aelite LS Packable, Aelite Flo, Aelite Flo LV
Cavex 1 Quadrant Anterior Shine, Quadrant Universal LC, Quadrant Flow
Centrix 1 C-R Hybrid, VersaFlo, VersaLite
Coltene Whaledent 1 Miris 2, Synergy D6, Synergy D6 Flow, Synergy Nano formula Duo Shades
0 Renamel Flowable Microhybrid, Renamel Flowable Microfill, Renamel Microfill (+ superBrite), Renamel Posterior,
Cosmedent Renamel Microhybrid (+ SuperBrite), Renamel Nano
DenMat 2 Virtuoso Flowable, Virtuoso Universal, Nuance, Nuance Flow
Dentoria 0 Flexfil
Dentsply 2 Ceram.X Duo, Ceram.X Mono +, Esthet.X HD, Esthet.X Flow, Quixfil TM, Spectrum TPH3, SDR, Surefill
Elsodent 1 Cirus, Must Flow
1 EverX posterior, G-Aenial Anterior, G-Aenial posterior, G-Aenial Flow, G-Aenial Universal Flo, Kalore, Gradia
GC
Direct (X), Gradia Direct Flo, Gradia Direct LoFlo
Henry Schein 0 Natural Elegance, 20/20, Natural Elegance Flowable
1 Charisma, Charisma Classic, Durafill VS, Charisma Flow, Solitaire 2, Venus, Venus Diamond, Venus Pearl, Venus
Heraeus Kulzer
Diamond flow, Venus Bulk Fill, Venus Flow
Itena 1 Reflectys, Reflectys Flow, Perfect Feel Flow
1 IPS Empress Direct, IPS Empress Direct Flow, Tetric, Tetric Ceram HB, Tetric EvoCeram, Tetric EvoCeram Bulk
Ivoclar Vivadent
Fill, Tetric EvoFlow
Jeneric Pentron 1 Alert, Artiste, Flow-It ALC, Fusio Self-adhesive, Simile
Kent Dental 0 Kentfil Anterior, Kentflow, Kentfil Posterior, Microhybrid + Kent, Nanohybrid Kent Dental
2 Herculite XRV Ultra, Herculite XRV, Point 4, Premise, Premise Flowable, Revolution 2, SonicFill, Vertise Flow
Kerr Hawe
(autoadhésif)
1 Clearfil AP-X, Clearfil Majesty ES-2, Clearfil Majesty Esthetic, Clearfil Majesty Flow, Clearfil Majesty ES Flow,
Kuraray
Clearfil Majesty Posterior, Clearfil Photo Bright, Clearfil Photo Posterior, Clearfil Posterior 3, Clearfil F II
Micerium 1 Enamel Plus HFO, Enamel Plus HFO Flow, Enamel Plus HRi, Enamel Plus HRi Flow
Pulpdent 0 Flows-Rite
R&S 0 Nanofil, Suprafil
Saremco 1 Saremco microhybrid composite, els (extra low shrinkage)
Shofu 0 Beautifil II, Beautifil Flow, Beautifil Flow Plus
Southern Dental 2 Glacier, Ice, Rok, Wave (3 viscosities)
Industries (SDI)
Sun Medical 1 Fantasista, Metafil CX, Metafil Flo
1 Estelite Sigma Quick, Estelite Posterior, Estelite Asteria, Estelite Color, Estelite Flow Quick, Estelite Flow Quick
Tokuyama
High Flow, Palfique Estelite LV
Survey of the Composition of Dental Composite Resins The Open Dentistry Journal, 2016, Volume 10 449

(Table 2) contd.....
Fabricant R Composite Resins
Ultradent 1 Amelogen Plus, Permaflo, Permaflo DC
2 Admira, Admira Flow, Alfacomp LC, Amaris, Amaris Flow, Arabesk Flow, Arabesk, Arabesk Top, Grandio, Grandio
Voco
Flow, Grandio SO, Grandio SO Flow, Grandio SO Heavy Flow, X-tra Base, X-tra fil

In total, 12 monomers were found in these 130 (119+11) composite resins; pure BPA was never reported. Table 3
reports their frequency of use.
Table 3. List of the 12 monomers contained in the surveyed composite resins (CR) and their frequency of use (among the 130
CR whose composition was established).

Monomers Number of CR (%)

Bis-GMA 97 (74,6)
TEGDMA 79 (60, 8)
UDMA 68 (52,3)
Bis-EMA ou EBPADMA 28 (21,5)
Bis-MPEPP ou BPEDMA 10 (7,7)
HEDMA 4 (3,1)
PC Bis-GMA 3 (2,3)
TPPTMA 3 (2,3)
HEMA 2 (1,5)
Bis-DMA 1 (0,8)
4-MET 1 (0,8)
IBMA 1 (0,8)

Table 4. List of the composite resins that contain no bis-GMA, no BPA-derivative (with UDMA), or neither BPA-derivative
nor UDMA.

Composite resins Manufacturers

Aelite Flo Bisco
Aelite Flo LV Bisco
Alert* Jeneric Pentron
Quixfil TM Dentsply
SDR Dentsply
Venus Bulk Fill Heraeus Kulzer
Venus Diamond flow Heraeus Kulzer
Estelite Flow Quick Tokuyama
G-Aenial Anterior GC
G-Aenial Flow GC
G-Aenial posterior GC
G-Aenial Universal Flo GC
Kalore GC
Aelite LS Packable Bisco Without bis-GMA
Clearfil Majesty ES Flow* Kuraray
Clearfil Majesty Flow* Kuraray
Fantasista* Sun Medical
Fusio* Jeneric Pentron
Gradia Direct (X) GC
Gradia Direct Flo* GC
Gradia Direct LoFlo* GC
Metafil CX* Sun Medical Without bis-GMA or BPA-derivative: resin
Perfect Feel Itena composite with UDMA
Perfect Feel Flow* Itena * with also TEGDMA
Renamel Microfill (+ superBrite) Cosmedent
Tetric* Ivoclar Vivadent
Venus Diamond Heraeus Kulzer
Venus Pearl Heraeus Kulzer
Wave (3 viscosités) Southern Dental
Xtrem nano Apol
Without BPA-derivative or
Filtek Silorane 3M
UDMA
450 The Open Dentistry Journal, 2016, Volume 10 Dursun et al.

Among the 130 composite resins: 112 (86.2%) contained BPA derivatives, 97 (74.7%) bis-GMA and 43 (33.1%)
bis-GMA and urethane dimethacrylate (UDMA); 17 (13.1%) contained no monomer derived from BPA (UDMA,
sometimes with TEGDMA) and 6 (4,6%) with UDMA (only); 1 (0.8%) did not contain a BPA derivative or UDMA or
TEGDMA (Table 4). 18 (13.8%) composite resins without any BPA derivative were identified. Among the 33
composite resins (25.4%) that did not contain bis-GMA, 24 (18.5%) did not contain bis-EMA and 18 (13.8%) did not
contain bis-MPEPP. A single composite resin contained bis-DMA.

DISCUSSION
The adverse estrogenic effects of BPA are well established, which explains the new regulations banning this
molecule, especially in food containers [4]. The elution of BPA sometimes detected after the making of a composite
resin restoration remains far below toxic levels and at a certain time after placement, unpolymerized monomers would
be completely absorbed into saliva, posing little risk of chronic low-dose BPA exposure, so some authors still
encourage the use of molecules made from BPA [14, 16].
However, two factors seem to follow the recommendations against BPA content in composite resins. The first is
related to the 2008 results of Bellinger et al. [17], who demonstrated that in children 6 to 10 years’ old, the presence of
composite resins was associated with a psychosocial behavior that was worse than with amalgams. These results were
confirmed and clarified by Maserejian et al. in 2012 [18], who indicated that the psychosocial behavior was worse for
children with bis-GMA than UDMA composite resin restorations. Fortunately, the last studies of this team are more
reassuring concerning sealants and fluid composite resin [19] and concerning the renal function of the children [20] or
their immunity markers [21]. Recently, Maserejian et al. [22] in 2016 showed that placement of bis-GMA-based
restorations in children and adolescents may temporarily increase BPA concentration in urine, but no longer detectable
14 days or 6 months after treatment. Second, BPA may have greater effects at low than high doses. Wozniack et al. [23]
registered effects at doses of 1 pmol. The American National Toxicology Program [24] states that these low-dose
effects can occur from 0.23 mg/L. This theory remains controversial [25]. However, the European Food Safety
Authority decided last year recently to divide by 10 the maximum daily dose allowed (or 5 mg/kg/day).
Moreover, exposure to BPA during gestation could induce increased spontaneous abortion, abnormal gestation time,
reduced birth weight, increased male genital abnormalities, childhood obesity, but also altered behavior, disrupted
neurodevelopment in children and increased asthma risk [26]. Because of these potential adverse developmental effects
after prenatal exposure to BPA, it would be cautious to limit exposure to unpolymerized dental resin materials during
pregnancy. Thus, it could be relevant to select composite resins that do not contain these derivatives for at-risk
populations, such pregnant women [27] and as children [28].
Moreover, patients may ask about the possible bis-GMA content of composite resins. Whatever the opinion of the
practitioner, he or she must know the composition of the composite resins used. In this study, 160 composite resins
currently marketed by 31 manufacturers in Europe were identified. The composition of 130 (marketed by 23
manufacturers) was established: 112 (86.2%) contain BPA derivatives. Although we had a good response rate (74.2%),
we could not obtain the composition of all the products because of strategic reasons, lack of reliable representatives or
trade secrets.
In total, 25.8% of the manufacturers did not agree to communicate the composition of their composite resins. They
are not required to indicate the exact composition of the materials, which should be required as for drugs. MSDS forms
indicate the product’s composition only partially, often mentioning only the family of the molecules.
However, we should be cautioned against choosing one of the 18 composite resins without BPA derivatives: the
latter contain other monomers that are not necessarily more biocompatible. Indeed, BPA is not the only potentially toxic
monomer in composite resins; others may be toxic [29]. In particular, the structure of TEGDMA and HEMA can be
degraded by salivary esterases and result in liposoluble metabolites that could accumulate in fatty tissues [30]. Even
UDMA, deemed less risky, may present some cytotoxicity beyond a certain concentration [31]. Whatever the composite
resin, a certain rate of unpolymerized monomers is released, which is associated with their characteristics, the degree of
polymerization and the release medium [32].
Indirect and CAD-CAM composite restorations maximize the conversion rate and thus minimize the release. Certain
procedures reduce exposure to free monomers due to direct composite restorations: rubber dam use, prolonged curing
(up to double the recommended time) or a second curing step after covering the restoration with glycerin. In addition,
these free monomers are mostly present on the surface of the material, where the exposure to oxygen inhibits
Survey of the Composition of Dental Composite Resins The Open Dentistry Journal, 2016, Volume 10 451

polymerization. Hence, Rueggeberg et al. [33] and Komurcuoglu et al. [34] showed that brushing the restoration’s
surface with pumice allowed for removal of the inhibition layer and eliminated more than 90% of the residual
monomers. Applying a dry or wet cotton roll and, to a lesser extent, water/air spray also enables their withdrawal up to
70%. Sasaki et al. [35] showed that gargling with warm water for 30 sec after placement of the composite resin may
reduce salivary levels of BPA.
Finally, using alternative materials without resin would be ideal; some high-viscosity glass ionomers or inorganic
biomaterials, carbomers (albeit with lower mechanical and aesthetic properties) or ceramic (for extended restorations)
may be considered.

CONCLUSION
This study has established a list of 18 BPA derivative-free products that can be used on a daily basis by the general
practitioner. The respective long-term effects on human health of the different monomers remain unclear and deserve to
be the subject of cohort studies.
Manufacturers should be required to report the exact composition of their products, as is required in the
pharmaceutical industry, so that practitioners are able to communicate it to patients and to meet the traceability
requirements.

CONFLICT OF INTEREST
The authors confirm that this article content has no conflict of interest.

ACKNOWLEDGEMENTS
Declared none.
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