C H A P T E R

1
Role and Significance of
Restorative Dental Materials
O U T L I N E

Scope of Materials Covered in Restorative Application of Various Sciences

Dentistry Future Developments in Biomaterials
Basic Sciences Applied to Restorative
Materials

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2 CRAIG’S RESTORATIVE DENTAL MATERIALS
Developments in materials science, robotics, and
biomechanics have dramatically changed the way we
look at the replacement of components of the human
anatomy. In the historical record, we find many
approaches to replacing missing tooth structure and
whole teeth. The replacement of tooth structure lost to
disease and injury continues to be a large part of gen-
eral dental practice. Restorative dental materials are
the foundation for the replacement of tooth structure.
Form and function are important considerations
in the replacement of lost tooth structure. Although
tooth form and appearance are aspects most easily
recognized, function of the teeth and supporting
tissues contributes greatly to the quality of life. The
links between oral and general health are widely
accepted. Proper function of the elements of the
oral cavity, including the teeth and soft tissues, is
needed for eating, speaking, swallowing, and proper
breathing.
Restorative dental materials make the reconstruc-
tion of the dental hard tissues possible. In many areas,
the development of dental materials has progressed
more rapidly than for other anatomical prostheses.
Because of their long-term success, patients often
expect dental prostheses to outperform the natural
materials they replace. The application of materials
science is unique in dentistry because of the com-
plexity of the oral cavity, which includes bacteria,
high forces, ever changing pH, and a warm, fluid
environment. The oral cavity is considered to be the
harshest environment for a material in the body. In
addition, when dental materials are placed directly
into tooth cavities as restorative materials, there are
very specific requirements for manipulation of the
material. Knowledge of materials science and biome-
chanics is very important when choosing materials
for specific dental applications and when designing
the best solution for restoration of tooth structure
and replacement of teeth.
SCOPE OF MATERIALS COVERED IN
RESTORATIVE DENTISTRY
Restorative dental materials include representa-
tives from the broad classes of materials: metals,
polymers, ceramics, and composites. Dental materi-
als include such items as resin composites, cements,
glass ionomers, ceramics, noble and base metals,
amalgam alloys, gypsum materials, casting invest-
ments, dental waxes, impression materials, denture
base resins, and other materials used in restorative
procedures. The demands for material characteristics
and performance range from high flexibility required
by impression materials to high stiffness required
in crowns and fixed dental prostheses. Materials
for dental implants require integration with bone.
Some materials are cast to achieve excellent adapta-
tion to existing tooth structure, whereas others are
machined to produce very reproducible dimensions
and structured geometries. When describing these
materials, physical and chemical characteristics are
often used as criteria for comparison. To understand
how a material works, we study its chemical struc-
ture, its physical and mechanical characteristics, and
how it should be manipulated to produce the best
performance.
Most restorative materials are characterized by
physical, chemical, and mechanical parameters that
are derived from test data. Improvements in these
characteristics might be attractive in laboratory stud-
ies, but the real test is the material’s performance
in the mouth and the ability of the material to be
manipulated properly by the dental team. In many
cases, manipulative errors can negate the techno-
logical advances for the material. It is therefore very
important for the dental team to understand funda-
mental materials science and biomechanics to select
and manipulate dental materials appropriately.
BASIC SCIENCES APPLIED TO
RESTORATIVE MATERIALS
The practice of clinical dentistry depends not only
on a complete understanding of the various clinical
techniques but also on an appreciation of the funda-
mental biological, chemical, and physical principles
that support the clinical applications. It is important
to understand the ‘how’ and ‘why’ associated with
the function of natural and synthetic dental materials.
A systems approach to assessing the chemical,
physical, and engineering aspects of dental materi-
als and oral function along with the physiological,
pathological, and other biological studies of the
tissues that support the restorative structures pro-
vides the best patient outcomes. This integrative
approach, when combined with the best available
scientific evidence, clinician experience, patient
preferences, and patient modifiers results in the best
patient-centered care.
APPLICATION OF VARIOUS
SCIENCES
In the chapters that follow, fundamental charac-
teristics of materials are presented along with numer-
ous practical examples of how the basic principles
relate to clinical applications. Test procedures and
techniques of manipulation are discussed briefly but
not emphasized. Many of the details of manipulation
have been moved to the book’s website at http://
evolve.elsevier.com/sakaguchi/restorative
 1.  ROLE AND SIGNIFICANCE OF RESTORATIVE DENTAL MATERIALS
A more complete understanding of fundamental
principles of materials and mechanics is important
for the clinician to design and provide a prognosis for
restorations. For example, the prognosis of long-span
fixed dental prostheses, or bridges, is dependent on
the stiffness and elasticity of the materials. When
considering esthetics, the hardness of the material
is an important property because it influences the
ability to polish the material. Some materials release
fluoride when exposed to water, which might be ben-
eficial in high-caries-risk patients. When selecting a
ceramic for in-office fabrication of an all-ceramic
crown, the machining characteristic of ceramics is
important. Implants have a range of bone and soft
tissue adaptation that are dependent on surface tex-
ture, coatings, and implant geometry. These are just
a few examples of the many interactions between the
clinical performance of dental materials and funda-
mental scientific principles.
The toxicity of and tissue reactions to dental mate-
rials are receiving more attention as a wider variety
of materials are being used and as federal agencies
demonstrate more concern in this area. A further
indication of the importance of the interaction of
materials and tissues is the development of recom-
mended standard practices and tests for the biologi-
cal interaction of materials through the auspices of
the American Dental Association (ADA).
After many centuries of dental practice, we con-
tinue to be confronted with the problem of replacing
tooth tissue lost by either accident or disease. In an
effort to constantly improve our restorative capa-
bilities, the dental profession will continue to draw
from materials science, product design, engineering,
biology, chemistry, and the arts to further develop an
integrated practice of dentistry.
FUTURE DEVELOPMENTS IN
BIOMATERIALS
In the United States over 60% of adults aged 35 to
44 have lost at least one permanent tooth to an acci-
dent, gum disease, a failed root canal, or tooth decay.
In the 64- to 65-year-old category, 25% of adults have
lost all of their natural teeth. For children aged 6 to 8,
26% have untreated dental caries, and 50% have been
treated for dental decay. The demand for restorative
care is tremendous. Advances in endodontology and
periodontology enable people to retain teeth longer,
shifting restorative care from replacement of teeth
to long-term restoration and maintenance. Develop-
ment of successful implant therapies has encouraged
patients to replace individual teeth with fixed, single
tooth restorations rather than with fixed or remov-
able dental prostheses. For those patients with good
access to dental care, single tooth replacements with
3
implants are becoming a more popular option because
they do not involve the preparation of adjacent teeth
as for a fixed, multi-unit restoration. Research into
implant coatings, surface textures, graded proper-
ties, alternative materials, and new geometries will
continue to grow. For those with less adequate access,
removable prostheses will continue to be used.
An emphasis on esthetics continues to be popu-
lar among consumers, and this will continue to drive
the development of tooth whitening systems and
esthetic restorations. There appears to be an emerg-
ing trend for a more natural looking appearance with
some individuality as opposed to the uniform, spar-
kling white dentition that was previously requested
by many patients. This will encourage manufactur-
ers to develop materials that mimic natural dentition
even more closely by providing the same depth of
color and optical characteristics of natural teeth.
With the aging of the population, restorations
for exposed root surfaces and worn dentitions will
become more common. These materials will need to
function in an environment with reduced salivary
flow and atypical salivary pH and chemistry. Adhe-
sion to these surfaces will be more challenging. This
segment of the population will be managing multi-
ple chronic diseases with many medications and will
have difficulty maintaining an adequate regimen of
oral home care. Restorative materials will be chal-
lenged in this difficult environment.
The interaction between the fields of biomaterials
and molecular biology is growing rapidly. Advances
in tissue regeneration will accelerate. The develop-
ments in nanotechnology will soon have a major
impact on materials science. The properties we cur-
rently understand at the macro and micro levels will
be very different at the nano level. Biofabrication and
bioprinting methods are creating new structures and
materials. This is a very exciting time for materials
research and clinicians will have much to look for-
ward to in the near future as this body of research
develops new materials for clinical applications.
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4 CRAIG’S RESTORATIVE DENTAL MATERIALS
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