Chapter 43

Restorative and Esthetic Dental Materials

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Introduction
Restorative dental materials fulfill an important role in the way dentistry is delivered today.

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Standardization of Dental Materials

ADA: criteria for a new material
Must not be poisonous or harmful to the body. Must not be harmful or irritating to the tissues of the oral cavity. Must help protect the tooth and oral tissues of the oral cavity. Must resemble the natural dentition. Must be easily formed and placed in the mouth.

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Properties of Dental Materials

Mechanical properties must withstand the
biting and chewing force in the posterior area of the mouth. Force is any push or pull on matter. Stress is the reaction within the material that can cause distortion. Strain is the change produced within the material that occurs as the result of stress.

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Mechanical Properties
Types of stress and strain:
Tensile stress pulls and stretches the material. Compressive stress pushes the material together. Shear stress is the breakdown of the material.

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Thermal Changes
A change in temperature in the oral cavity due

to either a hot or cold product. Contraction and expansion Dental materials will contract or expand at their own rate. Change in temperature can cause a dental material to pull away from the tooth. Microleakage Faulty restoration

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Electrical Properties
An electrical current, or galvanic action, is
created when two different or dissimilar metals are present in the oral cavity. Conditions: Saliva. Two metallic components of different composition. Electrical current. Galvanic action, or shock, is the coming together of all conditions.

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Corrosive Properties
Reaction a metal has when it comes into
contact with corrosive products. Solubility is the degree to which a substance will dissolve in a given amount of another substance.

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Application Properties
Flow:
The dental material must be pliable enough to be placed in the preparation. Adhesion: The force that causes unlike materials to adhere to each other. Wetting is the ability of a liquid to flow over the surface. Viscosity is the property of a liquid that causes it not to flow easily.

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Application Properties- contd

Surface characteristics is where a liquid flows
more easily on a rough surface than on a very smooth surface. Film thickness: In general, the thinner the film, the stronger the adhesive junction. Retention is the ability to hold two things firmly together when they will not adhere to each other. Curing Auto-cured material hardens as the result of a chemical reaction of the materials. Light-cured material does not harden until it has been exposed to a curing light.
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Restorative and Esthetic Materials

Restorative: To replace or bring something

back to its natural appearance and function. Esthetic: To replace or bring something back to its pleasing appearance.

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Direct Restorations
Restorative materials that are applied to the
tooth while the material is pliable and able to carve and finish. Amalgam Composite resins Glass ionomer Intermediate restorative materials Tooth-whitening products

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Amalgam
Amalgam is a safe, affordable, and durable
material that is used predominantly to restore premolars and molars (Figure 43-8).

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Fig. 43-8 Packing an amalgam carrier.

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Indications for Using Amalgam

In individuals of all ages. In stress-bearing areas of the mouth. When there is severe destruction of tooth

structure. As a foundation. When personal oral hygiene is poor. When moisture control is problematic. When cost is an overriding patient concern.

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Indications for Not Using Amalgam

Esthetics is important. Patient has a history of allergy to mercury or
other amalgam components. The cost of other restorative materials or treatment options is not a factor.

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Chemical Makeup of Amalgam

Mercury (43% to 54%) Alloy powder (57% to 46%)
Silver, which gives it its strength. Tin for its workability and strength. Copper for its strength and corrosion resistance. Zinc to suppress oxidation.

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Issues Concerning Amalgam

Harm to patients: Essentially harmless. The exception is with patients who have many
amalgam restorations, or a high sensitivity to metals. Harm to Dental Personnel: Health concerns with high exposure to mercury, not amalgam. Tremors Kidney dysfunction Depression Nervous system disorders

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Amalgam Hygiene

Do not contact mercury with your skin. Protect against spillage during trituration. Keep lid closed during trituration. Do not discard scrap amalgam into waste containers. Collect all scrap amalgam and store under water or photographic fixer solutions in a closed container.

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Preparation of Amalgam
Capsules (600 mg of alloy): For small or
single-surface restorations. Capsules (800 mg of alloy): For larger restorations. Trituration: The process by which the mercury and alloy are mixed together to form the mass of amalgam.

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Direct Application of Amalgam

1. Mixed amalgam placed in amalgam well. 2. Amalgam carried to the prepared tooth. 3. Amalgam placed in increments in the 4. 5. 6. 7.

prepared tooth. Each increment is condensed immediately. Carvers are used to carve anatomy into the amalgam. A burnisher is used to smooth the amalgam. The new restorations occlusion is checked.

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Composite Resins
Becoming the most widely accepted material of
choice by dentists and patients because of their esthetic qualities and new advances in their strength (Figure 43-13).

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Fig. 43-13 Resins supplied in a syringe.

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Indications for Using Composite Resins

Withstand the environments of the oral cavity. Be easily shaped to the anatomy of a tooth. Match the natural tooth color. Be bonded directly to the tooth surface.

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Chemical Makeup of Composite Resins

Resin matrix
Dimethacrylate, referred to as BIS-GMA Monomer used to make synthetic resins Polymerization additives Allow the material to take form through a chemical process Initiator Accelerator Retarder Ultraviolet (UV) stabilizers
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Chemical Makeup of Composite Resins-contd

Fillers Add the strength and characteristics

necessary for use as a restorative material. Inorganic fillers Quartz Glass Silica Colorants

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Chemical Makeup of Composite Resins-contd

A coupling agent strengthens the resin by
chemically bonding the filler to the resin matrix. Organosilane compound

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Types of Composites
Macrofilled composites contain the largest of
filler particles, providing greater strength but a duller, rougher surface. Microfilled composites: The inorganic filler is much smaller and is capable of producing a highly polishee, finished restoration, which is used primarily in anterior restoration. Hybrid composites contain both macrofill and microfill particles.

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Polymerization of Composite Resins

The process in which the resin material is
Auto-Cured Light-Cured changed from a plastic state into a hardened restoration.

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Direct Application of Composite Resins

1. Select the shade of the tooth. 2. Express the needed amount of material onto 3. 4. 5.
the treated pad or in the light-protected well. Material placed in increments. Material is light-cured. Material is finished and polished.

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Steps in Finishing a Composite Restoration

1. Reduction of the material is completed by the

2.
3. 4.

5.

use of a white stone or a finishing diamond. Fine finishing is completed with carbide finishing burs and diamond burs. Polish with medium discs and finish with the superfine discs. Finishing strips assist in the polishing of the interproximal surfaces. Use polishing paste with a rubber cup.

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Glass Ionomer Materials

Glass ionomer is a versatile material with
chemical properties allowing it to be a restorative material, liner, bonding agent, and permanent cement.

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Indications for Using Glass Ionomers

Primary teeth. Final restorations in non-stress areas. Intermediate restorations. Core material for a buildups. Long-term temporary restorations.

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Qualities of Glass Ionomers

The ability to chemically bind to the teeth. No need to prepare the tooth structure as
extensively as for preparing for an amalgam or composite resin. The release of fluoride after its final setting.

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Properties of Glass Ionomers

Glass Ionomer Glass
Ceramic particles Glassy matrix Acrylic acid Tartaric acid Maleic acid Metal-reinforced glass ionomer Silver-tin alloy + Glass ionomer

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Supply of Glass Ionomers

Powder and Liquid: Manually mixed together

on a treated paper pad. Light-Protected Tubes: Dispensed onto a treated paper pad. Paste/Paste System: Mixed for application. Premeasured Capsule: Triturated for application.

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Temporary Restorative Materials

Designed to maintain or restore function to a
tooth or teeth and keep the patient comfortable for a period of time.

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Indications for Using a Temporary Restorative Material

Reduce sensitivity and discomfort of a tooth to

determine its diagnosis. Maintain the function and esthetics of a tooth until a permanent restoration can be placed. Protect the margins of a prepared tooth that will receive a permanent casting at a later time. Prevent shifting of the adjacent or opposing teeth because of open space.

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Intermediate Restorative Materials (IRM)

Composition:
Zinc-Oxide gives strength and durability. Eugenol has a sedative effect.

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Indications for Using IRM

Restoration of primary teeth Restorative emergencies Caries management program Supply of IRM Powder/liquid Premeasured capsules

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Provisional Restorative Materials

Restorative material that covers the major
portion, if not the entire clinical portion of a tooth or several teeth for a period of time.

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Types of Materials Used

Auto-cured acrylic (methylmethacrylate) Light-cured resin Process of application
Material is placed in either an alginate impression or a vacuum-formed tray. Material is seated over the prepared tooth and allowed to cure. Occlusion is adjusted. Material is cemented in place with temporary cement.
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Tooth Whitening Materials

The process of applying a material on anterior
teeth for a prescribed period of time to whiten the color of ones teeth.

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Indications for Using Tooth-Whitening Products

Teeth discolored Aging Consumption of staining substances Trauma Tetracycline staining Excessive fluoride Nerve degeneration Old restorations

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Tooth-Whitening Products
Carbamide Peroxide: When the carbamide
peroxide breaks down, oxygen enters the enamel and dentin and bleaches the colored substances. Concentrations: 10%, 16%, 22%

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Indirect Restorations
Types of dental restorations that dental
laboratory technicians create in the dental laboratory. These restorations are also referred to as castings, cannot be reshaped, and are carved once they are in this stage.

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Gold Alloys
By combining gold with other metals to form
an alloy, it creates the characteristics and hardness required as an excellent choice for an indirect restoration. Gold Palladium Platinum

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Types of Casting Alloys

Soft, Type I alloys are used for casting inlays

subject to slight stress during mastication. Medium, Type II alloys can be used for practically all types of cast inlays and possibly posterior bridge abutments. Hard, Type III alloys are acceptable for inlays, full crowns, three-quarter crowns, and anterior or posterior bridge abutments. Extra-hard, Type IV alloys are designed for cast-removable partial dentures.

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Ceramics
Ceramics are compounds that involve a
combination of metallic and nonmetallic elements, creating strength and aesthetics.

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Types of Ceramic Restorations

Porcelain fused to metal (PFM) Porcelain bonded to metal (PBM) Ceramco-metal restorations Porcelain-metal restorations (P-M)

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Porcelain
Type of ceramic that is most commonly used in
dentistry. It combines strength, translucence and the ability to match the natural tooth color.

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Indications for Using Porcelain

The shading of colors matches the tooth color

well. It esthetically improves the appearance of anterior teeth. It has the strength of metal. The material is a good insulator. The material has a low coefficient of thermal expansion.

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