RESTORATIVE

MATERIALS IN
PEDIATRIC
PATIENTS

Submitted by :
Dushyant Chopra
Varsha Bihani
B.D.S final prof.
INTRODUCTION
At least 1/3rd of the current dental research effort is
directly concerned with the development of better materials
and improved techniques for their manipulation.
The oral cavity is a formidable obstacle to the
maintenance of the integrity of the tooth structure and the
materials used in its restoration or replacement. Biting
stress on the cusp of the molar tooth may be as great as
207MPa. The pH of dental plaque, food and beverages
fluctuates daily from ranges of low acidity to high
alkalinity.The temperature during the course of a normal
meal may vary as much as 150*F. The warm , moist oral
cavity contains a variety of enzymes and debris providing
optimum conditions for the accumulation of surface
deposits that can tarnish or corrode metallic restorations.
For these and other reasons restorative materials are
readily subject to fracture, solubility, dimensional change
and discoloration.
CLASSIFICATION
 METALLIC RESTORATION
Silver amalgam
 TOOTH COLORED
Glass Ionomer Cement
Composites
Silicate cement
 TEMPORARY RESTORATIVE MATERIALS
Zinc Oxide Eugenol
Zinc Polycarboxylate
 BASES AND LINERS
Calcium Hydroxide
Zinc Phosphate
Glass Ionomer Cement
SILVER AMALGAM
Introduction
Amalgam is a special type of alloy that
contains mercury as one of its
constituents. Dental amalgam is an alloy
made by mixing mercury with a silver-tin
alloy powder.
It is most common material used for
class 1 and class 2 cavities.
COMPOSITION
 Ag(68.5%) - It whitens the alloy and increases the
strength.
 Sn(25.5%) - It controls the reaction b/w Ag and Hg
and reduces strength and resistance to corrosion.
 Cu(5%) - It increases strength and hardness.
 Zn(1%) - It acts as deoxidizer and causes delayed
expansion.
 Pt and Pd – It hardens the alloy.
 Hg is added to produce rapid reaction.
Classificatio
n
 DEPENDING ON ALLOY PARTICLE
SIZE AND SHAPE
 Lathe cut alloys
 Spherical alloys
 Admixed alloys
 DEPENDING ON COPPER/ZINC
CONTENT
 Low copper (contains Cu upto 2-5%)
 High copper (contains Cu upto 13%)
 Zinc containing
 Zinc free
 Depending on addition of
nobel metal
 1ST generation: 3 parts Ag + 1 part Sn
 2nd generation: Original alloy + Cu upto 4%+ Zn
upto 1%
 3rd generation: Ag-Cu eutectic alloy
 4th generation: Alloying of Cu + Ag + Sn upto
29%
 5th generation: Pd + Ag + Cu
Manipulation
 Proportioning: Recommended alloy: mercury ratio is 5:7or 5:8.In
EAMES Technique equal parts by wt of alloy and mercury is taken.

 Trituration: It’s the mixing of silver alloy with mercury

-Mechanical mixing
-Hand mixing by mortar and pastel
Ideal mixing time is 1 min.

 Mulling: It is done by pressing the squeezed mix in a piece of rubber dam

material to produce homogenous mass.

 Condensation: In this mixed material is packed in to the cavity in

increments. A load of 4-5 kg is applied to increment.

 Burnishing: It is continuation of condensation done by using round

burnisher and moving it over condensed amalgam from restoration
towards tooth surface so improving marginal adaptation.

 Carving: It is anatomical sculputuring of amalgam material to produce a

restoration functional, non interfering occlusal anatomy

 Finishing and polishing

PROPERTIES
 Strength: Compressive strength of high Cu amalgam are higher than low
Cu amalgams

 Creep: According to ADA specification no.1,amalgam must have a

maximum of 5%creep

 Hardness: It is similar to that of tooth structure

 Dimensional stability: According to ADA

specification no.1 expansion or contraction should not be more than 20
microns/sqcm

 Galvanism: When in contact with dissimilar metal an electrostatic

discharge is generated and patient feels pain.

 Thermal Conductivity: High

 Tarnish and corrosion: High Cu show less tarnish and corrosion than low
Cu

 Marginal Leakage: Decreases with time.

MERCURY TOXICITY
Mercury poisoning (also known as mercurialism, hydrargyria,
Hunter-Russell syndrome, or acrodynia when affecting children) is
a disease caused by exposure to mercury or its toxic compounds.
Mercury is a cumulative heavy metal poison which occurs in its
elemental form, inorganically as salts, or organically as
organomercury compounds; the three groups vary in effects due
to differences in their absorption and metabolism, among other
factors. However, with sufficient exposure all mercury-based toxic
compounds damage the central nervous system and other organs
or organ systems such as the liver or gastrointestinal tract.

Symptoms typically include sensory impairment (vision, hearing,

speech), disturbed sensation and a lack of coordination. The type
and degree of symptoms exhibited depend upon the individual
toxin, the dose, and the method and duration of exposure.
Due to its toxicity, there have been campaigns in many countries
to ban mercury altogether.
PREVENTIVE MEASURES
 Capsules used with amalgamator should
have a tight fitting cap.
 When inserted into cavity mixture has not
fully reacted. High volume evacuation
should be used to prevent vapors from
diffusing.
 Polishing should be done at slow speed.
 Left out material should be stored in tight
sealed container.
Advantages of amalgam
restoration.
 Reasonably easy to insert.
 Maintain anatomic form well
 Resistance to fracture.
 Long service life.
 Cheap
 Not overly technique sensitive.
 After a period of time prevents marginal
leakage.
Disadvantages of amalgam
restoration.
 The color does not match tooth structure.
 They are subject to corrosion and galvanic
action.
 Risk of mercury toxicity
 They eventually show marginal
breakdown.
 They do not bond to the tooth structure.
GLASS IONOMER CEMENT
INTRODUCTION
Developed by McLean, Wilson and
Kent in 1971. It is a salt formed by
reaction between polyalkenoic acid
and calcium-alumino-fluorosilicate
glass. It offers true chemical bond to
enamel and dentin.
Classification
1 ) Traditional Glass Ionomer :

Type I: Luting cement.

Type II: Restorative cement.
Type III : Liners & Bases.

2) Metal modified Glass Ionomer :

a)Miracle Mix .
b)Cermet cement.

3 ) Light cure Glass Ionomer :

HEMA added to liquid

4 ) Resin modified Glass ionomers / Hybrid Glass ionomers

Composite resin in which fillers substituted with glass ionomer particles.

Pre cured glasses blended into composites.
Classification according to
application
 Type I: Luting agent.
 Type II: Restorative cements.
Type II a : Aesthetic filling materials
Type II b: Reinforced materials ( Fuji IX ,Fuji II LC )
 Type III : Lining cements.
 Type IV : Fissure sealent.
 Type V : Orthodontic cements.
 Type VI : Core build up cements.
COMPOSITION
POWDER LIQUID
 SiO2 35-40%  Polyacrylic acid in the
 Al2O3 20-25% form of copolymer
 AlF3 1.5-3% with itaconic,maleic
 CaF2 15-20% and tricarballylic acid.
 NaF 4-10% Acid increases the
 Al2 (PO4)3 4-15% reactivity and
decreases viscosity.
Compomers
It is a combination of composites (the “comp” in
their name) and glass ionomers (“omer”). These
materials have two main constituents:
dimethacrylate monomer with two carboxylic
groups present in their structure, and filler that
is similar to the ion-leachable glass present in
GICs. There is no water in the composition of
these materials, and the ion-leachable glass is
partially silanized to ensure some bonding with
the matrix. These materials set via a free radical
polymerization reaction, do not have the ability to
bond to hard tooth tissues and have significantly
lower levels of fluoride release than GICs.
Miracle Mix
Restore-pf vic
tgrestoglass
Fuji IX gp
Ketac-cem
Composites
Introduction
These properties make them superior to silicates but high
polymerization shrinkage and high coefficient of thermal
expansion lead to clinical deficiencies and premature
failure.
To resolve these deficiencies, inert filler particles are added
to reduce the volume of resinous component. The
incomplete filler resin bond leads to defects between
mechanically retained filler particles and the surrounding
resin. These defective areas stain because of fluid leakage
and surface appearance of restorations is often
unacceptable.
A new type of composite was then introduced by Bowen.
He used BISGMA and dimethacrylate resin. Silane was then
used to coat filler particles that could bond chemically to
the resin.
CLASSIFICATION
Based on curing mechanism
 Chemically activated
 Light activated
Based on size of filler particle
 Conventional 8-12 um
 Small particle 1-5 um
 Microfilled 0.04-0.4 um
 Hybrid 0.6-1.0 um
Components
 Resin matrix
 Inorganic filler particle
 Coupling agents (silane) to provide bond
between inorganic filler particles and resin
matrix
 Activator initiator system to polymerize the
resin
 Additives to improve colour stability
 Pigments to achieve an acceptable match to
colour of tooth structure
Resin Matrix
 Most dental composite materials use
monomers that are aromatic or aliphatic
diacrylates
 Most commonly used dimethacrylates
 BISGMA
 Tegdma
 Uedma
Filler Particles
They improve the properties of matrix materials. Since less resin
is present in a composite the polymerization shrinkage is reduced
as compared with unfilled resins.
Shrinkage varies with product and is on the order of 3% vol at 24
hrs
As compared with unfilled resins, filled resins have following
properties:
Reduces:
Polymerization shrinkage
Water sorption
Coefficient of thermal expansion
Improves:
Mechanical properties
Compressive strength
Tensile strength
Modulus of elasticity
Abrasion resistance
Coupling Agents
#Provides bond between 2 phases of composites
*Uses
 To bind filler particles to resin matrix
 More flexible polymer matrix to transfer stresses to the filler
particles
 Provide hydrolytic stability by preventing water from penetrating
along filler resin interface
 Improves physical and mechanical properties

*Various coupling agents

 Zirconates
 Organosilanes-most commonly used
 The hydrolysed silane molecule contains silanol grps and carbonyl
grps.hydrogen bonds develop between these grps and hydroxyl
grps of silica.this leads to expulsion of water.
Activator initiator
system
 Chemically activated resins
a. benzoyl peroxide(initiator)
b. tertiary amine(activator)
When two pastes are spatulated, free radicals are generated when benzoyl
peroxide reacts with tertiary amine and addition polymerization is
initiated. Used for build ups that are not readily cured with light source.
 Light activated resins-1 paste containing
a. Photoinitiator(camphoroquinone)which has absorption range between
400-500 nm (blue region).
b. Amine accelerator(dimethyl 1 aminoethyl methacrylate)
When these compounds are left unexposed in this paste they do not react
however exposure to light of correct wavelenghth 468nm produces an
excited state of photoinitiator & an interaction with amine resulting in
formation of free radicals that course addition polymerization reactions.
INHIBITORS
Are added to prevent spontaneous polymerization of
monomers.
Butylated hydroxytoluene used in conc. of 0.01
wt%.

Mechanism of action:
If a free radical has been formed by a brief exposure
to light when material was dispensed the inhibitor
reacts with the free radical. This inhibits chain
propagation by terminating the ability of the free
radical to initiate polymerization process. When all
inhibitors have been consumed chain propagation will
occur.
Indications
# Classes I, II, IV, V, VI restoration
# Foundations or core buildups
# Sealants and conservative composite restorations
# Esthetic enhancement procedures
# Partial veneers
# Full veneers
# Tooth contour modifications
# Diastema closures
# Cements
# Temporary restorations
# Periodontal splinting
Contraindications
 Patients who do not maintain oral hygiene.
 Uncooperative patients.
 Teeth broken down to the extent that inadequate tooth
tissues remain to create adequate resistance and
retention forms for the purposes of bonding.
 Teeth in which outline form includes marked undercuts.
 Teeth which show excessive wear.
 Situations where moisture control for appropriate
bonding of inlays and onlays cannot be secured and
maintained.
 Teeth that experience heavy occlusal forces like in
bruxism, clenching etc.
 Teeth in which there are deep gingival margins that
have insufficient enamel for bonding.
3M Filtek P60
Heliomolar HB
Bright Light
C-Fill MH
PRODIGY condensar
CALCIUM HYDROXIDE
Introduction
Calcium hydroxide is mainly used as pulp
protecting agent. It is used as liners in deep
cavities. It provides pulp protection in
preparations very close to pulp. It performs
two main functions :-
1) Sedation of existing pulpal inflammation.
2) Prevention of further irritation by sudden
temperature change.
AVAILABLE AS
 2 paste system containing base and
catalyst paste in collapsible tubes.
 Light cured system.
 Single paste in syringe form.
 Powder form mixed with distilled water.
Composition
BASE PASTE:
1) Glycol Salicylate 40%
2) CaSO4
3) Titanium dioxide
4) Calcium tungstate or BaSO4
CATALYST PASTE:
1) Ca (OH)2 50%
2) ZnO 10%
3) Zinc Stearate 0.5%
4) Ethylene toluene
5) Sulfonamide 39.5%
PROPERTIES
 Poor mechanical property but better than zinc
oxide eugenol.
 Compressive strength is 10 to 27 MPa after 24
hr. strength continue to increase with time.
 Tensile strength is 1 MPa.
 If used in thick layer provide good thermal
insulation.
 High solubility and increases when exposed to
pgospheric acid and esters.
 It is highly alkaline and kills bacteria by
breakdown of proteins.
MANIPULATION
Equal length of two pastes are
dispensed on a paper and
mixed to a uniform color.
Material carried and applied
using an applicator.
 SETTING
REACTION
Calcium hydroxide reacts with
salicylate ester to form chelate
i.e. calcium disalicylate.
 SETTING TIME
2.5 to 5.5 mins. Reaction is
accelerated by moisture
therefore sets faster in cavity.
USES
 Cavity liner :- It helps in formation of reparative dentine
and used in deep cavity preparations.
 Pulp capping :- It is an excellent dressing for exposed
pulp for maintaining the pulp vitality due to formation of
secondary dentine.
 Root canal filling :- It is used as intra-canal
medicaments for killing bacteria in root canal. But rarely
used in primary dentition.
 Perforation repair :- It causes hemostasis so used for
controlling bleeding in case of perforation.
 Apexification :- It is defined as process of creating
environment within which root canal and periapical tissue
after pulp death is formed that allow calcific barrier to
form across open apex. Calcium hydroxide is the material
of choice. But is is mainly used in young permanent teeth
in which root apex is not formed.
Bosworth Hydrox
Pulpdent Paste
PULPDENT Root Canal
Sealer
CALCIDOR
ZINC PHOPSHATE
CEMENT
Introduction
Zinc phosphate cement the one of the oldest and
widely used cements, and is commonly used for
luting permanent metal restorations and as a
base. It is a high-strength cement base, mixed
from zinc oxide powder and phosphoric acid
liquid. Due to its low initial pH, it may cause
pulpal irritation, especially where only a thin layer
of dentin exists between the cement and the
pulp; thus is especially important to follow the
correct procedures and precautions when using
zinc phosphate cement.
 APPLICATIONS
 Luting of restoration
 High strength base
 Temporary restorations
 Luting or orthodontic bands and brackets.
COMPOSITION
 Powder  Liquid
 Zinc oxide – 90.2%  Phosphoric acid –
 Magnesium oxide - 8.2 38.2%
%  Water – 36%
 Other oxide - 0.2 %  Aluminum phosphate
 Silica - 1.4 % – 16.2%
 Aluminum – 2.5%
 Zinc – 7.1%
CLASSIFICATION
 Type I – Fine grained for luting.
 Type II – Medium grained for luting and
filling.
MANIPULATION
 Cool glass slab is used.
 Powder added in increments.
 Mixing done with stainless steel spatula in circular
motion.
 Large area covered while mixing to dissipate
heat.
 Material inserted immediately.
 Area should be dry.
 Powder:liquid ratio -1.4gm/0.5ml
 SETTING TIME :- 5-9 mins.
 MIXING TIME :- 1.5 mins.
SETTING REACTION
Phosphoric acid attacks the surface of
the particle, dissolving zinc oxide and
forming zinc phosphate. The aluminium
complexes with the phosphoric acid to
form zinc aluminophosphate gel. This
reaction is exothermic.
PROPERTIES
1) Compressive strength: It gains 75% of its max strength
in 1st hour
2) Tensile strength: It is less so making it brittle (5.5 MPa).
3) Modulus of elasticity: Comparatively high so makes it
stiff and resistant to elastic deformation (13.5GPa).
4) Solubility and disintegration: In mouth shows more
disintegration. Solubility is more in dilute organic acid.
5) Film Thickness:
For luting: thickness should be 25microns or less.
For filling: thickness should not be more than 40microns.
6) Thermal properties: Good thermal insulator.
7) Adhesion: Mechanical interlocking.
8) Biological properties: At the time of insertion, high
acidity ‘coz of phosphoric acid so thin mixes are
avoided.
9) Pulp protection: Lining is provided of Zinc oxide eugenol, calcium
hydroxide, or varnish.
Bosworth
ZINC PHOSPHATE
CEMENT
tgzincem
Conclusions
# GICs are favourable for Class I cavities and in
uncooperative children.
# Compomers show best long-term performance
in primary teeth. The cooperation has to be
sufficient, at least during bonding and layering.
# The biggest effort is needed for resin
composites. After rubber dam application and
correct establishment of technique-sensitive
adhesion, resin composites reach the level of
compomers.