Restorative materials in dental caries
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A brief description of various types of restorative materials in dentistry that can be used for restoring carious tooth
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Restorative materials in dental caries
- 1. PBL Coordinator: Dr. Jyotsna Rimal Resource Faculty: Dr. Sneha Shrestha Restorative Materials in Dental Caries Prepared By: Raman Dhungel BDS 2014, BPKIHS 1/13/2017 1© RAMAN2016
- 2. Contents: Restorative Materials : Introduction Classification Advantages and Disadvantages Choice of appropriate Restorative material Success and Failure of Restorative Material Summary 1/13/2017 2 © RAMAN2016
- 3. Introduction: Dental restorative materials are specially fabricated materials designed to restore the function, integrity and morphology of missing tooth structure, usually resulting from, but not limited to, dental caries. 1/13/2017 3 © RAMAN2016
- 4. Loss of tooth structure due to Caries 1/13/2017 4 © RAMAN2016
- 5. Classification: Temporary, intermediate and permanent • Zinc Oxide Eugenol (ZOE) -Temporary • Polymer reinforced cement (IRM) & improved ZOE – intermediate • Direct filling gold, amalgam, composite, GIC, Porcelain, composite & cast metal inlays and onlays - Permanent Direct and Indirect • Amalgam, composite, GIC, direct filling gold - direct • Porcelain, composite and cast metal inlays and onlays - indirect Esthetic and non esthetic • Composite , GIC & porcelain- esthetic • Amalgam, direct filling gold, cast metal inlays and onlays – non esthetic 1/13/2017 5 © RAMAN2016
- 6. Amalgam: Amalgam is a metal alloy of which one of the elements is mercury (Hg). Alloys are metals that are a combination of several elements. 1/13/2017 6 © RAMAN2016
- 7. Classification of amalgam alloys: Based on copper content • High Copper (13-30% copper) • Low Copper (<6% copper) Based on Zinc Content • Zinc-containing (>0.01% zinc) • Zinc –free (<0.01 % zinc) Based on size of alloy • Microcut • Macrocut 1/13/2017 7 © RAMAN2016
- 8. Classification of amalgam alloys: Based on shape of the alloy particle • Spherical • Spheroidal • Lathe cut Based on no of alloyed metals • Binary alloys, e.g., silver-tin • Ternary alloys, e.g., silver-tin-copper • Quaternary alloys, e.g., silver-tin-copper-indium. 1/13/2017 8 © RAMAN2016
- 9. Amalgam Inexpensive Easy to use Technique insensitive Durable Marginal seal improves with time 1/13/2017 9 Advantages: Disadvantages: Non adhesive Requires mechanical retention Poor esthetics Environmental and occupational hazards © RAMAN2016
- 10. Composites: Restorative material composed of two phases: Matrix and Filler bound together by coupling agents Further divided into macro-filled (70-80% filler), micro-filled (40-50 % filler) & hybrid (75-80% filler ) 1/13/2017 10 © RAMAN2016
- 11. Composites: Essential Components : Resin matrix/ binder — BisGMA or urethane dimethacrylate Filler — Quartz, colloidal silica or heavy metal glasses Coupling agent — Organo silanes Additionally, they also contain: A curing system , Inhibitors, UV absorbers Opacifiers — e.g. titanium dioxide and aluminum oxide Color pigments — to match tooth color 1/13/2017 11 © RAMAN2016
- 12. Composites: Adhesive Esthetic Reasonable wear properties Micromechanical bond to enamel Minimal tooth preparation required 1/13/2017 12 Advantages: Disadvantages: Technique sensitive Expensive Time consuming Post-operative sensitivity Polymerisation shrinkage © RAMAN2016
- 14. Glass Ionomer Cement: First truly adhesive restorative materials Release fluoride over time Biomimetic- resembles dentin Supplied as powder/liquid systems 1/13/2017 14 © RAMAN2016
- 15. Composition: Powder: Silica (SiO)2 — 41.9 % Alumina (Al2O3) — 28.6 % Aluminum fluoride (AlF3) Calcium fluoride (CaF2) — 15.7% Sodium fluoride (NaF) Aluminum phosphate (AlPO4) 1/13/2017 15 Liquid: Polyacrylic acid Tartaric acid & Water © RAMAN2016
- 16. Classification of GIC: Type I — For luting Type II — For restorations Type III — Liners and bases Difference between various types: Various types chemically identical: vary primarily in the powder/liquid ratio and particle size. 1/13/2017 16 © RAMAN2016
- 17. Glass Ionomer Cement: Esthetic Fluoride leaching -anticariogenic Chemically bonds to enamel and dentine Minimal tooth preparation Higher moisture tolerance than resin-based restorative materials Biocompatible: low pulpal toxicity if applied to intact dentine Thermal expansion similar to enamel and dentine 1/13/2017 17 Advantages: Disadvantages: Brittle Susceptible to erosion and wear Sensitivity to moisture in the early setting process Esthetics not as good as resin- based restorative materials © RAMAN2016
- 18. GIC : Esthetic Restoration 1/13/2017 18 © RAMAN2016
- 19. Others: Dental cements: zinc phosphate , zinc polycarboxylate, Zinc oxide eugenol cement, calcium hydroxide cement Metal reinforced GIC, highly viscous condensed GIC, resin modified GIC Compomers: resin cements 1/13/2017 19 © RAMAN2016
- 20. Indirect Restorative Materials: 1/13/2017 20 Based on amount of tooth material restored: • Inlays • Onlays • Veneers • Dental bridges • Crowns • Complex restorations Classification by material: • Metals • Ceramic materials • Ceramometals • Composite Materials Indirect restorations are those restorations that are constructed outside the mouth. © RAMAN2016
- 22. Choice of appropriate Restorative material: The choice of material mainly depends on: Location and extent of caries Age and sex of patient (esthetic reasons) Strength of material desired Economic factors Allergy to specific material 1/13/2017 22 © RAMAN2016
- 23. Success and Failure of Restoration: Depends upon: Material Contamination during restoration Technical expertise Oral hygiene Dietary habits 1/13/2017 23 © RAMAN2016
- 24. Summary: A wide range of restorative materials available Have different properties to meet the requirements Advantages and disadvantages of different materials Choice of material Success and failure of restoration 1/13/2017 24 © RAMAN2016
- 25. Classification: Temporary, intermediate and permanent • Zinc Oxide Eugenol (ZOE) -Temporary • Polymer reinforced cement (IRM) & improved ZOE – intermediate • Direct filling gold, amalgam, composite, GIC, Porcelain, composite & cast metal inlays and onlays - Permanent Direct and Indirect • Amalgam, composite, GIC, direct filling gold - direct • Porcelain, composite and cast metal inlays and onlays - indirect Esthetic and non esthetic • Composite , GIC & porcelain- esthetic • Amalgam, direct filling gold, cast metal inlays and onlays – non esthetic 1/13/2017 25 © RAMAN2016
- 27. Our Team 1/13/2017 27 © RAMAN2016
Hinweis der Redaktion
- Tooth material is often lost as a result of caries and trauma. A material which substitutes the missing tooth structure and restores the form and function of the tooth is called Restorative material.
- The right maxillary central and lateral incisors and left maxillary lateral tooth structures are lost due to caries and need to be restored.
- Restorations may be classified in a number of different ways: On the basis of longevity of restoration, it can be Temporary, intermediate or permanent. On the basis of fabrication inside or outside mouth, it can be direct or indirect. And , on the basis of its capability to simulate natural tooth color, it can be Esthetic or non esthetic.
- The powdered metal is called an amalgam alloy and is predominantly silver (Ag) and tin (Sn). Dental amalgam was developed in France in the 1800s. It was introduced to the United States in 1833, and the mercury toxicity controversy started immediately.
- Increasing the copper content reduced the percentage of the weakest phase of the resulting dental amalgam. Clinical performance improved markedly. Zinc reduces oxidation of the other metals in the alloy. For many years, the clinical effect of zinc was debated. Recently, clinical research has shown that zinc-containing dental amalgams have a longer clinical life expectancy than non zinc amalgams.
- Amalgam has the ability to seal its margins during service. As the margins corrode, the tooth/restoration interface fills with corrosion products so that microleakage is reduced.
- The first tooth colored restorative system were developed in the late 1950s and early 1960s by Bowen (also known as Bowen’s resin). Fillers play a crucial role in the wearing of composite resins. The smaller the size and higher the concentration of fillers the better the wear resistance. Fillers play a crucial role in the surface smoothness and subsequent esthetics of the composite. Most commonly used coupling agents are Organo silanes, Zirconates and titanates can also be used as coupling agents.
- Bis- GMA= Bisphenol-A-glycidyl methacrylate Curing system- Chemically cured or light cured or dual cured Inhibitor : (0.01%) — Prevents premature polymerization, e.g., butylated hydroxytoluene (BHT) UV absorbers — to improve color stability Opacifiers (0.001 to 0.007%) — e.g., titanium dioxide and aluminum oxide Color pigments — to match tooth color Light-cure materials are more commonly used and are supplied as single-paste materials. No mixing is required; therefore, voids are minimized and result in a stronger restoration. With light-cure composites, working time is essentially unlimited because they will not set until the curing light is activated. A number of curing lights are manufactured:QTH (Quartz tungsten halogen), Argon laser,LEDs,etc. Most use visible light in the blue spectrum (between 400 and 500 nm). Most commonly used coupling agents are Organo silanes, Zirconates and titanates can also be used as coupling agents.
- The polymerization shrinkage ranges from 0.6 - 1.4% (in composites with higher filler content) to 2-3% (in composites with lower filler content like microfilled composites). This creates tensile stresses as high as 130 kg/cm2 which severely strains the bond and can lead to marginal leakage. Composites release some resin components for weeks after insertion. In cases where the pulp is exposed some form of pulp capping overlayed with a glass ionomer liner is recommended. Glass ionomer liners are applied as pulp protection in deep cavities. Zinc oxide eugenol is contraindicated as it interferes with polymerization. Bacterial contamination should be avoided by using rubber dam isolation. Composites wear faster than amalgam. However, the newer materials like hybrids and nanocomposites have less wear (20 μm per year), which approaches that of amalgam (10 μm). In terms of years the average life expectancy of the composite resin is around 8 years which is near to that of amalgam (10 years).
- This is the reason composites are becoming popular these days!!! This figure shows replacement of amalgam restoration with composite restoration which greatly mimics the natural tooth structure and is more esthetic.
- It was named glass ionomer because, the powder is a type of glass and the setting reaction and adhesive bonding to tooth structure is due to ionic bond. Unlike other restorative materials, this cement requires minimal cavity preparation as it bonds adhesively to tooth structure. Synonyms Poly (alkenoate) cement GIC (glass ionomer cement) ASPA (alumino silicate polyacrylic acid)
- Polyacrylic acid in the form of copolymer with itaconic acid, maleic acid and tricarballylic acid -Copolymerizing with itaconic, maleic acid, etc. tends to increase reactivity of the liquid, decrease viscosity and reduce tendency for gelation. Tartaric acid Improves the handling characteristics, increases working time and shortens setting time. Water is the most important constituent of the cement liquid, it is the medium of reaction and it hydrates the reaction products. The amount of water in the liquid is critical. Too much water results in a weak cement. Too little water impairs the reaction and subsequent hydration.
- The Type I GICs used for luting have a lower powder/liquid ratio and a smaller particle size when compared to the Type II restorative variety.
- Because of the popularity of glass ionomer materials and composite/dentinal bonding systems, a combination of the two materials was developed and was once quite popular. The “compomer” label is used to describe materials that bond and set like dentinal bonding/composite systems but that initially release some fluoride-like glass ionomers.
- They can be inlays, onlays, veneers, crowns, complex restorations or dental bridge based on the amount of tooth restored. Inlays are intracoronal (inside the crown) restorations that replace small to medium amounts of tooth structure.They are most commonly used to restore pits, fissures,and grooves (Class I) as well as proximal surfaces (Class II) of posterior teeth. They do not restore the cusps. They are retained by luting cements. Onlays (or overlays) involve replacing more tooth structure than inlays. In addition to the pits, fissures, and proximal surfaces of an inlay, onlays restore one or more cusps and, at times, the entire occlusal surface of a tooth. Onlays are used when the likelihood of cusp fracture is high. A veneer is a thin layer of material that covers another material (like the shell of a hard-boiled egg). In dentistry, veneers are restorations that are placed on the facial surface of anterior teeth to treat an esthetic problem, such as discolorations, rotations, or spaces (diastema).
- Based on clinical research, the life expectancy for a conservative Class I amalgam is 15 to 18 years. A Class II amalgam should last 12 to 15 years. It is important to remember that the patient has a great deal of influence on the longevity of restorations.
- Intrinsic property of materials determine the strength of the material as well as resistance to wear. Contamination by saliva during composite restoration may affect the bonding. Polymerisation shrinkage can lead to marginal leakage and secondary caries. Poor oral hygiene and unhealthy dietary habits may lead to staining and corrosion of the restoration. Even the staining without corrosion is considered as failure if the restoration has been used purely for esthetics.
- Restorations may be classified in a number of different ways: On the basis of longevity of restoration, it can be Temporary, intermediate or permanent. On the basis of fabrication inside or outside mouth, it can be direct or indirect. And , on the basis of its capability to simulate natural tooth color, it can be Esthetic or non esthetic.
- From Right to left: Smarak Dahal, Ajay Kamat, Raman Dhungel (Me) , Eden Kafle , Dr. Sneha Shrestha (Associate Professor) Department of Pediatric Dentistry, Nayansha Karki, Susmita Shrestha, Pratima Rai, Sanjana Gupta, Asha Rai