Composite resins in the 21st century

Human enamel and dentin should be used as the physiologic standards with which to compare composite resins, especially in the posterior region. The intrinsic surface roughness of composite resins must be equal to or lower than the surface roughness of human enamel on enamel-to-enamel occlusal contact areas (Ra = 0.64 um). Roughness determines the biologic strength of composite resins. The nanoindentation hardness value of the filler particles (2.91 to 8.84 GPa) must not be higher than that of the hydroxyapatite crystals of human enamel (3.39 GPa). Composite resins intended for posterior use should have a Young's modulus at least equal to, and preferably higher than, that of dentin (18.500 MPa). The compressive strength of enamel (384 MPa) and dentin (297 MPa) and the fracture strength of a natural tooth (molar = 305 MPa; premolar = 248 MPa) offer excellent mechanical standards to select the optimal strength for posterior composite resins. The in vivo occlusal contact area wear rate of composite resins must be comparable to the attritional enamel wear rate (about 39 um/y) in molars. Differential wear between enamel and composite resin on the same tooth is a new criterion for visualizing and quantifying the wear resistance of composite resins in a biologic way. Posterior resins must have a radiographic opacity that is slightly in excess of that of human enamel (198% Al). Based on these standard criteria, it can be concluded that in the 21st century the ultrafine compact-filled composite resins may be the materials of choice for restoring posterior cavities.