Selection of restorative materials

SELECTION OF
RESTORATIVE MATERIALS
GUIDED BY:- DR. MANJU
PRESENTED BY:- CHARUL SAINI
P.G. 1ST YEAR
2

CONTENTS
Introduction
Factors regulating selection
Significance of good
selection
Materials related factors
Tooth related factors
Patient related factors
Restorative materials
Conclusion
3

The practice of clinical dentistry depends not only on a complete
understanding of the various clinical techniques but also on an
appreciation of the fundamental biological, chemical, and physical
principles that support the clinical applications.
Reciprocally, the higher surface energy of many restorative materials
compared with that of the tooth surface could result in a greater
tendency for the surface and margins of the restoration to accumulate
debris, saliva, and bacteria.
Craigs 13th edition ,International Journal of Current Research Vol. 9, Issue, 01, pp.45719-45722, January,
2017
5

Some restorative materials are more sensitive to technique
variations than others. For example, placement of resin composite
restorations in posterior teeth requires more steps than for an
amalgam.
There are numerous factors to be considered when restoring a tooth,
eg. the extent of lesion, the strength of the remaining tooth
structure, the preference of the dentist in using the material, and the
financial cost of the procedure and tooth related factors.
2017
6

Clinical expertise therefore is an important factor when developing
a treatment plan and selecting restorative materials, particularly
when the restoration is a direct application to the tooth.
Although it is important to know the comparative values of
properties of different restorative materials, it is also essential to
know the quality of the supporting and investing hard and soft
tissues.
2017
7

Factors regulating
Selection
• Teeth need restorative intervention most
commonly due to carious destruction.
• This must be accomplished with;
Restoration of proper form, function, esthetics,
and occlusal stability.
International Journal of Current Research Vol. 9, Issue, 01, pp.45719-45722, January, 2017
8

Significance of good selection
Restoration of
carious teeth
presents the dentist
with the dilemma of
selecting a suitable
restorative material.
Dentist must make this
selection with great
care because, in future
years, those
restorations needing
replacement will result
in the loss of
increasing amount of
tooth structure.
This setup a cycle
where the increasing
cavity size limits the
choice of the
materials that may
be used effectively.
9

Material-
related Factors
The ideal restorative material should-
Resist occlusal forces
Resist the wear
Indestructible in oral fluids
Adequately adapted to the cavity walls
Co-efficient of thermal expansion should be comparable to tooth
structure
Exhibit low thermal conductivity
10

Biocompatible
Accomplished
with minimal
tooth
preparation
Strengthen the
remaining
tooth structure
Antibacterial
Esthetically
pleasing
Compatible
with the
pulpal and
periodontal
health
Easily
manipulated
11

Tooth –
related Factors
Characteristics of
the Carious Lesion
• The choice of restorative material depends upon the tooth
type, its location in the arch, forces acting on the tooth,
the surface(s) to be restored, and lesion depth.
• If anterior tooth is involved then choice is made among
esthetic materials, in case posterior tooth is involved, then
material with high strength is used.
12

Status of the Pulp
If there is no threat to the
health of the pulp by
carious lesion, caries is
removed avoiding pulpal
exposure and then restore
the tooth with permanent
restoration.
Pulp capping is
performed in the teeth
with questionable
condition. If pulp is
irreversibly involved,
then endodontic
treatment is done.
13

Size of the
Periodontium
The operative
procedure must be
performed only
after evaluating the
health status of the
periodontium.
14

Size, Form and Structure of
Teeth
• When open proximal contacts are to be restored,
reestablishment of the space or slight alteration in
the usual size of the tooth is to be decided.
• Recontouring of interproximal surfaces is usually
done with cast gold or metal ceramic restorations,
as they have greater convenience and accuracy, as
these are made by indirect method.
• Amalgam often fails to close the contact and
produce an ideal interproximal contour due to its
physical properties, technique of placement and
condensation.
15

Patient- related Factors
Age of the patient
Physical condition of the
patient
Hygienic condition of the
mouth
Strength and character of
the bite
Expense of the operation
Bruxism
16

It has been an accepted part of dental therapeutics for more than 150 yrs. It is
still used for more than 75% of direct posterior restorations today.
Amalgam is a metallic material which is composed of-
Mixture of mercury + powdered alloy(Ag, Sn, Zn, Cu)
This mixture is –Amalgam alloy.
Marzouk 1st edition, Vimal K Sikri 4th edition
19

Clinical
considerations
Along the
margins of the
amalgam
corrosion
products help to
seal the space
against
microleakage.
Compressive
strength of high
copper amalgams
is greater than
low copper
amalgams
20

High copper amalgams
have a clinical longevity
of 24-25 years. The
average replacement age
of conventional (low
copper) amalgams in
clinical practice is 5-8
years.
▪ Amalgam is a brittle
material. Traumatic
stresses during chewing
can produce fracture in an
amalgam without
sufficient bulk.
21

Extrusion at margins is promoted
by electrochemical corrosion,
during which mercury from Sn-Hg
re-reacts with Ag-Sn particles and
produces further expansion during
the new reaction -mercuroscopic
expansion resulting in marginal
fracture. The most common
evidence of degradation of low
copper amalgams is marginal
fracture. High copper amalgams
display only modest marginal
fracture over long periods.
▪ An amalgam restoration done in a
tooth with the opposing tooth
having a gold inlay may result in
sharp pain due to development of
galvanic currents.
Marzouk 1st edition, Vimal K
Sikri 4th edition
22

Advantages of amalgam restorations
over other direct-placement materials
include
- resistance to wear;
- tolerance to a wide range of clinical
placement conditions especially wet
fields
- excellent load-bearing properties
- clinical longevity
- greater radiopacity
- ability to seal the marginal gap space
over time
23

They can conduct
thermal shocks to the
pulp
They may flow and
deform the
restorations.
They have objectionable
metallic color.
Vimal K Sikri 4th edition
24

INDICATIONS
Class I and
class II
cavities
(moderate to
large
restorations).
Restorations
with heavy
occlusal
forces.
Restorati
ons that
can’t be
well
isolated.
Resin
veneer
over
amalga
m
Class III in
unaestheic
areas (eg-
distal aspect
of canine
especially; if
preparation is
extensive with
minimal facial
involvement).
In class V,
where non-
esthetic areas
especially;
when access is
limited &
moisture
control is
difficult & for
significantly
deep gingival
areas.
25

Contraindications
▪ Prominent esthetic areas of the mouth.
▪ Because the tooth preparation for
amalgam is larger than for a
composite, most small to large defects
in posterior teeth should be restored
with composite rather than amalgam.
▪ Small Class VI restorations
26

Glass-ionomers are materials
consisting of ion-cross-linked
polymer matrices surrounding
glass-reinforcing filler
particles. Formulated in
1970s by bringing together
the silicate and polyacrylate
systems.
Applications
Luting agents
Orthodontic
bracket adhesives
Pit and fissure
sealants
Liners and bases
Core build-ups
Intermediate
restorations
Restoration of
eroded areas
Craigs 13th edition ,Marzouk 1st edition, Vimal K
Sikri 4th edition
28

Advantages
▪ Easy mixing
▪ Leachable fluoride and caries
preventive potential
▪ Adhesion to tooth structure
29

Clinical
considerations
▪ Well suited for
situations
involving high
caries risks.
▪ When bonding
composite to
gingival areas
with little or no
enamel, a GIC
liner extended just
short of the
margins has been
suggested as a
way to reduce
caries risk if
microleakage
occurs.
▪ Low fracture
toughness -
recommended
principally for
non-stress-bearing
areas, e.g., carious
and non-carious
cervical lesions
and approximal
anterior lesions.
30

GICs have a low modulus of elasticity -counter forces at
the cervical of the tooth that might otherwise disrupt the
bond.
▪ Pediatric restorations - service longevity requirements
are low.
▪ Role in minimal intervention dentistry. For small
proximal caries lesions, the tunnel preparation and GI-
fillings were recommended in 1984. Advantages include
small cavity preparations, preservation of marginal ridge
and proximal contact
31

Contraindications
• ▪ In stress bearing areas.
• ▪ Labial build ups
• ▪ Cuspal coverage
32

Indications
Class I, II,
III, IV, V &
VI
restorations
.
Indications
for Class I
and II:
– small and
moderate
restorations
preferably
with
enamel
margins
– most
premolars
or first
molars
where
esthetics is
important
– some
large
restorations
-to
strengthen
remaining
weakened
tooth
structure (
for
economic
or interim
use
reasons)
Marzouk 1st edition, Vimal K Sikri
4th edition
34

Foundations and core build-ups
▪ Sealants and preventive resin restorations.
▪ Esthetic enhancement procedures – veneers,
tooth color modifications, diastema closure.
▪ Cements for indirect restorations
▪ Temporary restorations
▪ Periodontal splinting
35

Contraindic
ations
▪ An operating
area that
cannot be
adequately
isolated
▪ Patients with
heavy occlusion,
bruxism, or
restorations that
provide all of the
tooth contacts
▪ Class V
restorations
that are not
aesthetically
critical
▪ Restorations that
extend onto the root
surface. A V-shaped
gap is formed between
the root and the
composite because
polymerization
shrinkage of the
composite is greater
than the initial bond
strength of the
composite to root
dentin.
36

Advantage:
▪ Esthetic
▪ Conservative of tooth structure removal.
▪ Less complex when preparing tooth.
▪ Insulative, having low thermal conductivity.
▪ Used almost universally.
▪ Bonded to tooth structure, resulting in good retention, low microleakage, minimal
interfacial staining, and increased strength of remaining tooth structure.
▪ Repairable
37

Disadvantage:
• ▪ They have low wear resistance.
• ▪ Their adaptation to the surrounding walls may be
destroyed easy due to their polymerization contraction
and their relative high co-efficient of thermal expansion.
• ▪ Are more technique sensitive
Marzouk 1st edition, Vimal K Sikri 4th
edition
38

INDIRECT COMPOSITE INLAY
Teeth can be restored using indirect techniques, in which restorations are fabricated
outside the mouth.
Most indirect restorations are made on a replica of the prepared tooth in a dental
laboratory by a trained technician.
39

INDICATIONS
Esthetics
Large defects or
previous
restorations
For improvement
in contacts and
contours
Vimal K Sikri 4th edition 40

CONTRAINDICATIONS
Heavy occlusal force
Inability to maintain a dry
field
Deep subgingival
preparations
41

Indirect tooth-colored restorative materials are more durable than direct
composites, especially in regard to maintaining occlusal surfaces and occlusal
contacts.
Indirect restorations have better physical properties than direct composite
restorations because they are fabricated under relatively ideal laboratory
conditions.
Reduced polymerization shrinkage
42

DISADVANTAGE
Difficulty in resin
to resin bonding
Low potential for
repair
43

Dental ceramics are non-metallic
inorganic structures, primarily containing
compounds of oxygen with one or more
metallic or semi-metallic elements
45

ADVANTAGE:
▪ Esthetics
▪ Biocompatibility
▪ Insulation
▪ Wear resistance
▪ Can be formed into
precise shapes
▪ Can be bonded to tooth
structure
46

DISADVANTAGE
▪ Brittleness
▪ Technique
sensitive
▪ High cost
▪ Difficult to
repair
intraorally.
47

Metal
ceramics
Materials for metal-ceramic
restorations contain a vitreous phase,
also called glassy matrix, that
represents 75 to 85% by volume and
are reinforced by various crystalline
phases.
▪ The choice of the crystalline phase
in compositions for metal-ceramic
restorations was initially dictated by
the need for matching the thermal
contraction coefficient of the
porcelain close to that of the metallic
infrastructure in order to avoid the
development of tensile stresses within
the porcelain when cooled.
48

▪ Less tooth structure needs to be removed
compared to all ceramic prostheses
especially if metal only is used on occlusal
and lingual surfaces.
▪ Advantages are permanent
aesthetic quality of a properly
designed reinforced ceramic
unit and their resistance to
fracture.
Clinical considerations
49

A Metal ceramic crown is not the
best aesthetic choice for an
anterior crown.
Metal-ceramic FPDs
should be
considered first as
choice for posterior
FPDs. Only when
the patient is highly
resistant to
accepting metallic
components during
treatment should all-
ceramic FPDS be
considered for
posterior sites.
50

ALL
CERAMIC
Materials for all-ceramic restorations
use a wider variety of crystalline phases
as reinforcing agents and contain up to
90% by volume of crystalline phase.
Nature, amount, and particle size
distribution of the crystalline phase
directly influence the mechanical and
optical properties of the material.
51

Advantages:
• – Low shrinkage due to high molecular wt.
• – Good abrasion resistance
• – Fluoride release
• – Good esthetics .
• – Condensable
• – Biocompatible
Vimal K Sikri 4th
edition
52

Uses:
– Fillings in anterior and
posterior regions
53

CEROMERS
Ceramic optimized polymer(light cured)
Advantages:
– Good wear resistance
– Good strength
– Adhesive bonding
– Fluoride release (Tetric Ceram)
54

– Needs complete
isolation
– Cannot be used in
very high stress regions
– Preferably
supragingival margins
55

Uses:
– Posterior
bridge with
single pontic
– Implant
superstructures
– Fillings
56

An inlay is an indirect restoration
(filling) consisting of a solid
substance fitted into a cavity in a
tooth between cusps and cemented
into place.
An inlay is an indirect restoration
that caps none or one or more
cusps but not all
57
CERAMIC INLAY

• Ceramic inlays permit preservation of much
coronal tissue.
• They can be used in lieu of a metal-casting or
amalgam restoration in patients who require a
class II restoration.
• They are stronger than direct posterior
composite resins, offering superior physical
properties than the latter, as the degree of
polymerization conversion of direct posterior
composites limits their strength
INDICATIONS
58

CONTRAINDICATIONS
Areas where
heavy
occlusal
forces are
present
Inability to
maintain a dry
field
Cases
involving
deep
subgingival
preparations
In the presence of an unfavorable occlusion, a
group-function occlusal arrangement, or in
patients exhibiting evidence of parafunctional
activity such as bruxism or clenching.
Marzouk 1st edition, Vimal K Sikri 4thedition
59

ADVANTAGE
Wear resistance: Ceramic
restorations are more wear
resistant than direct
composite restorations
Biocompatibility and good
tissue response: Ceramics
are considered chemically
inert materials with
excellent biocompatibility
and soft tissue response
60

DISADVANTAGE
Technique
sensitive
Brittleness of
Ceramics
Wear of
opposing
dentition and
restorations
Low potential
for repair
61

It is an indirect restoration that caps all cusps (combination of intracoronal
and extracoronal restoration).
Sturdevant’s Art And Science Of Operative Dentistry Fifth Edition
62
CERAMIC ONLAY

Materials used for indirect
restorations ; classified in to
Esthetic ( composite
/ceramics)
Non esthetic (metal)
63

Among ceramic materials used include feldspathic porcelain, hot pressed
ceramics and machinable ceramics designed for use with CAD/CAM systems.
They have excellent wear resistance and coefficient of thermal expansion close
to tooth structure.
64

INDICATIONS
Esthetics
Large
defects or
previous
restorations
Economic
factors
CONTRAINDICATIONS
Heavy
occlusal
forces
Inability to
maintain a
dry field
Deep
subgingival
preparation
s
65

ADVANTAGES
Improved physical properties
Variety of materials and techniques
Wear resistance
Reduced polymerization shrinkage
Ability to strengthen remaining tooth structure
More precise control of contour and contact
Biocompatibility and good tissue response
66

DISADVANTAGES
Increased cost and time
Technique sensitive
Brittleness of ceramics
Wear of opposing dentition and restorations
Short clinical track record
Low potential for repair
Difficult try in and delivery
67

VENEERS
A well-defined protocol for the
treatment of complex esthetic cases
with the use of ceramic veneers has
become a modern tool to mask the
unpleasant smile.
A veneer is a layer of tooth-colored
material that is applied to a tooth to
restore localized or generalized
defects and intrinsic discolorations.
Sturdevant’s Art and science of operative dentistry (fifth edition)
68

Partial veneers are indicated for
the restoration of localized
defects or areas of intrinsic
discoloration
Full veneers are indicated for the
restoration of generalized defects
or areas of intrinsic staining
involving the majority of the
facial surface of the tooth
69

INDICATIONS
For treatment of discolored teeth that do
not respond to tooth-whitening or micro-
abrasion procedures
The closure of interdental spacing and
restoration of malformed teeth where
crowns are not indicated
Realignment of in-standing, rotated or
protruding teeth
Discrepancies in the size and shape of
teeth that are not correctable by
orthodontics alone
70

CONTRAINDICATIONS
Available Enamel
Ability To Etch The
Enamel
Oral Habits : Bruxism
and Biting On
Foreign Object
71

ADVANTAGES
1. Minimally
invasive
2. Aesthetically
pleasing
3. Durable
4. The ability to
elicit a good
tissue response
72

DISADVANTAGES
They are technique-sensitive
and time-consuming to place
Repair can
be difficult
Their color cannot easily
be modified once placed
Prior to cementation they are
fragile and difficult to manipulate
73

Direct gold filling
▪ Granular
▪ Electrolytic
precipitate
▪ Foil
Forms of
direct filling
gold
Gold is the oldest dental restorative
material, having been used for dental
repairs for more than 4000 years. A gold foil
restoration is a filling technique of decayed
teeth that exploits the properties of gold of
being welded in its cold state, due to its
highly cohesive nature.
74

CLINICAL CONSIDERATIONS
▪ Resilience of dentine and the adaptability of gold allow an
almost perfect seal between the tooth structure and gold.
▪ Gold is resistant to corrosion, shows no shrinkage or
expansion, and therefore is an ideal dental filling material.
▪ The advantages of gold foils restorations are that they can last
for a long time if correctly done
Vimal K Sikri 4th edition , Sturdevant’s Art and science of operative dentistry (fifth edition)
75

ADVANTAGE:
▪ When properly
placed, direct
gold is the most
durable
restorative
material available.
▪ It does not
undergo tarnish
and corrosion in
the oral cavity.
▪ It exhibits good
adaptation to the
cavity walls.
▪ The density and
hardness of
compacted gold
provide adequate
compressive
strength.
Vimal K Sikri 4th edition, Sturdevant’s Art and science of operative dentistry (fifth edition)
76

DISADVANTAGES
Technique sensitive, and to achieve excellence great skill, patience and time is required.
▪ The welding technique, with or without a mallet, can generate a pulpal trauma.
▪ Do not have high mechanical resistance against masticatory forces, they are only suitable
for very small cavities.
▪ Because of the high thermal conductivity of gold, larger restoration can enhance
sensitivity, and a larger restoration is very complex to finish and polish.
▪ Gold foil is more expensive than any other restoration material
77

INDICATIONS
▪ Generally, gold
foil restorations
are used for
incipient or early
lesions,
generating small
cavities in non
stress-bearing
areas, and where
aesthetic concern
is limited.
▪ The American
Academy of
Gold Foil
Operators
indicates class 1,
class 2, class 3,
class 5, and class
6 cavities. The
dimensions
illustrated in
their guidelines
are small.
▪ Repair of
casting margins.
▪ Technical skill
of dentist is
important
Craigs 13th edition ,Marzouk 1st edition, Vimal K Sikri 4th edition ,International Journal of Current Research Vol. 9, Issue, 01, pp.45719-45722,
January, 2017
78

CONTRAINDICATIONS
Teeth with very large pulp chambers because of their greater susceptibility to get
damaged during condensation.
▪ Severely periodontally weakened teeth -unable to withstand the condensation forces.
▪ They are not generally used in children, elderly and handicapped patients who cannot
give very long sittings.
▪ Root canal filled teeth are generally not restored with DFG as these teeth are brittle.
▪ Large carious lesions as DFGs cannot withstand heavy masticatory forces and also a
greater expenditure would be required.
▪ Poor accessibility and isolation.
79

CAST GOLD RESTORATIONS
Advantage:
• ▪ Strength
• ▪ Accurate reproduction of contacts and contours.
• ▪ Noble and inert
• ▪ Abrasion resistance
• ▪ Reduced internal stresses
• ▪ Extra oral finishing and polishing
80

Disadvantage:
• ▪ Microleakage
• ▪ More number of appointment
• ▪ Need for temporary restoration
• ▪ Cost
• ▪ Technique sensitive
• ▪ Esthetics
81

Indications
• ▪ When the cavity width does not exceed 1/3rd the intercuspal distance.
• ▪ In case of extensive proximal caries involving the buccal and lingual line
angles of the tooth.
• ▪ In grossly carious tooth where one or more but not all cusps need coverage.
Vimal K Sikri 4th
edition
82

Contraindication
▪ Not used as a
abutment for a
fixed or
removable
prosthesis.
▪ High caries
rate
As post endodontic
restorations as they can
wedge and fracture the
remaining tooth structure.
▪ When cost is a
major factors.
Not preferred in
case of grossly
destroyed teeth
with weak cusps
Vimal K Sikri 4th edition 83

In summary, three interrelated factors are important in the long-term function of
dental restorative materials: (1) material choice, (2) component geometry (3)
component design
Selection of the suitable restorative material may determine the success of the final
restoration.
Intelligent selection of restorative material depends upon thorough evaluation of the
currently available restorative materials in the light of all the conditioning factors
presented by each individual case.
Craigs 13th edition ,Marzouk 1st edition, Vimal K Sikri 4th edition ,International Journal of Current
Research Vol. 9, Issue, 01, pp.45719-45722, January, 2017
85

Some of the conditioning factors may modify the selection of
restorative materials but should never justify using material of
inferior qualities unless decided by the patient after being
discussed with him.
In the absence of the ideal restorative material combination of
two or more materials may be used to obtained the required
qualities.
Craigs 13th edition ,Marzouk 1st edition, Vimal K Sikri 4th edition ,International Journal of Current Research Vol. 9, Issue,
01, pp.45719-45722, January, 2017
86

International Journal of Current Research Vol. 9, Issue, 01, pp.45719-45722, January, 2017 SELECTION OF RESTORATIVE MATERIALS IN
CONSERVATIVE DENTISTRY
Sturdevants operative dentistry 5th edition
Roberson TM, Heymann H., Swift EJ. Sturdevant’s Art and Science of Operative Dentistry: 5th edition; 2006 by Mosby Inc
Sikri VK. Textbook of Operative Dentistry: 2nd edition; 2008 by CBS
Kenneth J. Anusavice. Phillips’ Science of Dental Materials: 11th edition; 2003 by Elsevier
Craigs 11th edition
87

PROPERTY OF A MATERIAL IS IMPORTANT TO REATAIN
MATERIAL IN NCCL’S?
• ELASTIC MODULUS property of a material is important to retain a material
in NCCL’s
• The term elastic modulus describes the relative stiffness or rigidity of a
material within elastic range
• This property is independent of heat/ mechanical treatment, but is quite
dependent on COMPOSITION of material
89

COMPOSITE FOR CLASS V RESTORATIONS AND WHY?
• Microfilled composite; because of extended working time & control of contour
before polymerization
• It tends to flex with tooth when used in abfracture lesions
• Surface lusture similar to enamel
91

RMGIC
• The diametral tensile strength of
RMGIC is higher than that of the
conventional.
• show a very small initial shrinkage of
the resin component at the time of light
activation
• They exhibit a greater degree of
shrinkage on setting due to
polymerization
• Lower wear resistance as compared to
composite
PMCR
• Superior working characteristics to
RMGIC
• Restorations of class III cavities
• Restoration of Class V lesions
• Restorations of erosion lesion
92

Selection of restorative materials

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Selection of restorative materials

Similar to Selection of restorative materials (20)

Recently uploaded

Recently uploaded (20)

Selection of restorative materials

Editor's Notes