• Amalgam

Restorative • Glass ionomer

• Resin modified glass ionomer
Materials Available • High viscosity glass ionomer
Materials • Composite
• Polyacid modified composite resin
• Stainless crowns

Failures due to :
• Recurrent caries, fracture or
• Historically - owing to the simplicity- of involvement of pulp or periodontal
use it is the most popular restorative membrane
material. • Caused due to – improper design of
• Least technique sensitive, lack of cavity or faulty manipulation or choice of
dimensional change during hardening alloy
Amalgam • Excellent physical properties and its use
• Disadvantages:
• Amalgam is not adhesive, cavity design -
in primary molars has resulted in highly to include some form of mechanical
successful long-term restorations. retention resulting in larger restorations
• Microleakage reduces with aging of which are inevitably closer to the pulp.
restoration in oral cavity • Concerns about safety- more
environmental than toxicity
 • Maybe useful in children - Moderate caries risk -
not totally cooperative, i.e. when moisture
control is a problem. • Bond to enamel and dentin
• Since high-viscosity GI, compomer or composite • Significant fluoride release, can be recharged
Indications of resin will provide a comparably successful Glass • Coefficient of thermal expansion similar to
restoration while preserving the tooth tissue, tooth structure
Amalgam there is limited indication for the use of amalgam Ionomers • Low thermal conductivity
in Class I cavities in children.
• Success Rate: Class II amalgam restorations in
primary molars between 70% and 80%.

• Shorter Working Time

• Slow Development of Ultimate Properties
DISADVANTAGES • Type I – Luting
• Opacity higher than resin
of • Type II – Restorative ( Conventional and
GLASS
• Less polishability than resin Types Reinforced)
• Poor wear resistance
IONOMERS • Type III – Lining & Bases
• Brittle, poor tensile strength
 • Chemical-set
• Weakest mechanical properties
• Setting reaction is complete within minutes Resin Modified Glass
but continues to ‘mature’ over the following Ionomer
months.
Conventional • Important to protect these materials from
salivary contamination in the hours following
GIC placement or the material may shrink, crack
and even debond. Conventional Resins & Photo-
RMGIC
initiators
• Adhesion of all GICs is enhanced by the use GIC
of enamel and dentine conditioning agents
before placement.
• Eg: Fuji (GC)

• Developed to overcome the problems of moisture

sensitivity and low initial mechanical strength.
• Consist of a GIC along with a water-based resin system • Developed as an alternative to amalgam.
• Resin monomers or a co-monomer of acrylic acid and a • Packable / condensable glass ionomer
methacrylate like HEMA cements
• This allows curing with light before the acid–base reaction
of the glass ionomer takes place – initial set – rapid set
leads to a material that is much less sensitive to HIGH • INDICATIONS:
dehydration or moisture
• Acid base reaction then occurs within the light
VISCOSITY GIC • Molar restoration of primary teeth
polymerized resin framework – continues more slowly • Intermediate restoration
than conventional GIC
• Core build up material
• No etching, priming & bonding for some ( steps vary
amongst different products) • For ART
• Advantage: Resin increases the fracture strength and wear
resistance of the GIC.
 • Developed as an alternative to amalgam. • Can be applied when saliva control is not
possible
• Packable / condensable glass ionomer
cements
GC • Self curing conventional GIC with optional
Command set with VLC unit
• INDICATIONS: FUJI
• Molar restoration of primary teeth
• Intermediate restoration
TRIAGE • To treat newly erupted molars (partially)
covered by tissue
• Core build up material
• For ART

• Polyacid-modified composite resin

• Disadv: As larger posterior restorations • Contain a calcium aluminium fluorosilicate glass
limitations: filler and polyacid components similar to acids
• wear resistance, used in glass ionomer cements.
• water absorption and • They contain either or both essential
components of a GIC.
• polymerization contraction
COMPOSITE • GIC is not water-based and therefore no
• Primary dentition –Increasingly used in
COMPOMERS significant acid–base reaction occurs.
RESINS combination with GICs in a ‘sandwich’-style
aesthetic restoration. • As such, they cannot strictly be described as
glass ionomers.
• Limitations: • Highly technique sensitive,
• They set by resin photopolymerization.
• Patient compliance and adequate moisture
isolation can prove difficult in the younger, more • Successful adhesion requires the use of dentine-
challenging child patient. bonding primers before placement • Eg :
Dyract(Caulk), Compoglass(Vivadent)
 • GICs, Compomers, Resin modified GIC
• Small occlusal and interproximal cavities. • Success Rate:
• Where possible, use the stronger, high-viscosity • The average survival time for a GIC has been
GIC and, as wear resistance is better. reported as 33 months.
• Avoid using resin-modified GICs for posterior • The failure rate of GICs is higher than
restorations. amalgam (33% over 5 years compared
INDICATIONS • Because of their lack of strength GICs should
not be used in large restorations that are to be
with 20% for amalgam).
• The incidence of secondary caries is
subject to significant occlusal load in teeth that
need to be retained for more than 3 years. reduced around fluoride-releasing
materials. • Compomers – Limited
fluoride leachability .

Use of Composites in Primary Molars

• In primary molars, there is strong evidence from randomized
controlled trials that composite resins are successful when used in • ART may be used for caries control in children
Class I restorations. with multiple open carious lesions, prior to
definitive restoration of the teeth.
• For Class II lesions in primary teeth, there is one randomized USE OF GICS • Class I restorations in primary teeth.
controlled trial showing success of composite resin restorations for
two years. • Small Class II

• Evidence from a meta-analysis shows enamel and dentin bonding

agents decrease marginal staining and detectable margins for the
different types of composites.
 • The use of resin-modified glass ionomer
cement is a viable treatment option for
Class III and Class V restorations in the
primary and permanent dentition.
• Compomers can be an alternative
USE OF • The use of resin-modified glass ionomer
cement is a viable treatment option for
USE OF to other restorative materials in the
RMGICS Class III and Class V restorations for COMPOMERS primary dentition in Class I and
primary teeth, particularly in Class II restorations.
circumstances where adequate isolation
of the tooth to be restored is difficult.
 Tunnel Restorations

Breaking through the marginal ridge destroys the structural integrity of the tooth and
weakens cusps that eventually lead to fracture. A “tunnel” or slot restoration will
maintain this structural integrity and is the most conservative and efficient way to
manage such lesions
If the lesion is visible on either the facial or lingual aspect of
the tooth, slot restorations are preferable;
If the lesion is not visible, then a tunnel restoration is
indicated
Tunnel Restorations
Prepare a “T” cavity in the enamel above the lesion with a water-cooled high-
speed bur 2 mm in from the marginal ridge, extending 2 mm facially, 2 mm
lingually and 2 mm over the occlusal surface. This will conservatively
maximize both mechanical and visual access to the preparation.