How Universal are Universal Materials?

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A universal material that you can use anywhere sounds excellent to many clinicians. However, one material that works in every case and every mouth sounds too good to be true, which may leave some dentists feeling skeptical. We spoke with 2 dentists about universals today and whether the term “universal” is accurate or aspirational.

What Are Universal Materials?

Universal materials describe products that you can use anywhere in the mouth, on any tooth, and expect to get consistent results. For example, a universal composite resin is intended for use in anterior and posterior cases. It should produce long-lasting restorations that have the mechanical properties and esthetics needed for either area. Dental professionals want to ensure that a universal composite has:

• enough strength to stand up to compressive forces;
• sufficient esthetics to look natural and blend in with surrounding dentition;
• satisfactory polishability to maintain the restoration's luster; and
• adequate handling that can produce the desired results when working with it.

Jeff Lineberry, DDSDDS, FAGD, FICOI, AAACD is a cosmetic dentist in private practice in Mooresville, North Carolina. He has a streamlined definition.

“It’s a no-nonsense, keep-it-simple kind of resin,” Dr Lineberry says.

Jason Goodchild, DMD, vice president of clinical affairs for Premier Dental Products, says the idea of universals comes from 20th-century hybrid composites. In the earlier days of composite resin technology, dentists used macro fills in the posterior for their strength and micro fills in the front for their esthetics. The next idea was to mix the resin’s particle sizes to make a hybrid, which had the macroparticles strength and the microparticles esthetics.

“It’s almost like universal composites may be evolutionary of hybrid composites because we used to use hybrids everywhere,” Dr Goodchild says.

Simplicity is essential with universal composites. Dr Lineberry uses shade matching as an example of how universal composites streamline the restorative process. Also, he says many universal composites are more translucent than other composite resins, creating the chameleon effect so the composite blends with the surrounding dentition. The chameleon effect makes it easier to shade match with a single shade, which is convenient for dentists.

“People want a composite where they don’t have to figure out shade. They don’t want to have to think about whether it’s an A2 or a B3. They want something they can stick in the tooth, and it blends in well. They don’t want to have to think about it much more than that,” Dr Lineberry says.

Dr Goodchild says manufacturers and dentists would also like to get to a place with universal materials where there are fewer things to consider. He thinks dentists would like to know if they see “this,” then they use “that”—what he calls “cookbook style” dentistry.

“That ‘if-then’ approach is beneficial for a dentist, who is moving fast and encountering so many different clinical situations,” Dr Goodchild explains. “Wouldn’t it be nice if you just had a material that works everywhere?”

Does Universal Really Mean Compromise?

Today’s universal composites are no longer struggling with the balance of strength and esthetics. Dr Lineberry credits that to the development of nano-hybrids and the mechanical properties their composition produces. Esthetics are a concern only in specific cases when using a universal.

“It’s where you get into some of the odd colors or characterizations when you see that one composite doesn’t do it all,” Dr Lineberry says.

Knowing the limitations of your product is essential too. Dr Lineberry says that he would not layer enamel and dentin shades with a universal on a complicated case because the results might not be as predictable as if he used his composite kit. Moreover, those universals that rely heavily on the chameleon effect for shade matching might not work in every case you encounter in your chair.

“It works,” Dr Lineberry says of universal composites that use the chameleon effect, “and probably for a lot of your patients, they will be excellent. But if you have an esthetically demanding situation, it might not fit the bill for that.”

Part of the desire for finding that universal material is feeling overwhelmed by the number of new materials that launch in the industry. Dr Goodchild says it is a lot to digest and challenging to stay up-to-date to get the best results possible.

Dr Goodchild counts himself among dentists who want a material with minimal considerations that can work almost anywhere with as few compromises as possible. However, he adds that it isn’t possible to have one material optimal for use in every tooth and area of the mouth for every clinical situation without making compromises. The manufacturers’ approach, he says, is to give clinicians a material that minimizes those trade-offs—an approach that goes beyond composites.

“That’s true on every level in dentistry. That’s cement, adhesives, composites, and even impression materials, although we don’t call them ‘universal’ impression materials,” Dr Goodchild says. “We want to be able to use them anywhere in the mouth.”

What to Look for in a Universal Composite

Some dentists love digging into the details of materials. Others only want what produces consistent results, which means they might be using a composite that’s been around for 10 years or more. Moreover, Dr Goodchild says, if dentists can get a universal material that works pretty well most of the time, then why change?

“It takes a lot to get the dentist to switch because that’s an unknown for them,” Dr Goodchild says. “They think, “I know how this stuff works. I don’t know how your stuff works.’”

He says the idea of a universal material is still evolving. Manufacturers and clinicians are still working on what universal means to them. Does it mean inject it into the cavity in one step? One layer and done? Or should there be a couple steps so that it blends into the tooth? Moreover, there are different features that clinicians like more than others. For example, in the traditional packable composite category, 3M™ Filtek™ features excellent handling, but in the chameleon category, Tokuyama’s Omnichromalends exceptionally well, he says.

“Having both would be better. To me, that’s the home run if you have the chameleon effect and the handling all in one,” Dr Goodchild says of the universal composites.

He adds that the improvements now are incremental, not monumental. The characteristics he notices now about the different composites are details like whether it blends, works well in his hands, tends to pull back, or packs easily.

“Don’t get me wrong,” Dr Goodchild says. “I don’t think we’ve reached the pinnacle of resin technology in dentistry. We still have room. But on our current path of methacrylate-based resins, we’re doing incremental changes.”

Dr Lineberry agrees: “Most of the universal composites, and composites in general, have the same wear characteristics, volumetric shrinkage, and things like that. But some handle differently. Some stick to the instruments. Some slump and are not as firm. Others are very firm. So I would say find the one that works well in your hands.”

In addition, Dr Goodchild notes that the universal label in dentistry might be overused, with many players in the market now with different universal features.

"There are the packable ones, the blending types, and the ‘all in ones,’ which are like self-cures,” Dr Goodchild explains. “It doesn’t necessarily simplify things, and now we’re numb to the idea of universal because we hear it so much.”

“It’s kind of a marketing thing,” says Dr Lineberry.

That being said, Dr Goodchild says that choices and options are good for universals and that he enjoys the fact that if you ask 10 dentists about how they do a composite, you get 10 different answers—which, he says, is OK as long as the result is the same.

“It’s like typing an address into Google Maps. You get 3 different ways,” he says. “Each of them gets you there. They are just taking you on a different path.”