You are on page 1of 31



Operative Dentistry Unit (ODU)

Selection of Dental Restorative
Dental restorative materials are materials used in
dentistry to restore teeth functionally and
Dental materials can be classified as direct or
indirect restorative materials
Direct restorative materials are inserted into cavity
preparation in soft pliable state and then set.
Indirect restorative materials such as inlays, onlays, and
crowns are fabricated in a dental laboratory on models
made from impressions of the tooth prepared by the
Factors to consider during selection
of a restorative material

The selection of the type of dental restorative

material is dependent on many factors, among
them the characteristics of the tooth itself, the
patient, the dentist, and the material.
The dentist must make this selection with great
care because, in future years, those restorations
needing replacement will result in the loss of
increasing amounts of tooth structure.
This sets up a cycle where the increasing cavity
size limits the selection of the materials that
may be used effectively.
Factors to consider during
selection of a restorative
material (cont.)
There are numerous factors to consider when
restoring a tooth, e.g., the extent of the lesion,
the strength of the remaining tooth structure,
the preference of the dentist in using the
material, and the financial cost of the
procedure, both out-of-pocket costs borne
directly by the patient and those covered by
In considering the characteristics of an ideal
restorative material, it is apparent that no
single material can fulfill all of the clinical
Factors to consider during
selection of a restorative
material (cont.)
1. Characteristics of the tooth
Extent of caries.
As the cavity size expand the range of restorative
materials to selectively employ becomes limited.
Also very small cavities need to be restored by material
that adhere to tooth e.g. GIC.
For small and medium sized cavities where preparation
for retentive features can allow, amalgam can be used.
For very large cavities with small walls remaining where
retentive features can not be created there is a need of
adhesive restorative materials one can employ
sandwich technique using composite and GIC.
Factors to consider during
selection of a restorative
material (cont.)
Strength of remaining tooth structure.
Walls of the remaining enamel of less than 1mm
material like amalgam can not be used because
fracture hence material that adhere to tooth are
2. The patient

Acceptance of the patient to the type of restorative
material according to his / her needs

Ability to incur the costs of the material and the
procedure as a whole

Patients caries activityPatients moisture control Patients
history of allergy to a certain restorative materials e.g.
allergy to mercury present in amalgam

Patient sensitive to residual monomers (e.g. in
Factors to consider during
selection of a restorative
material (cont.)
3. The material
Despite modern materials and

techniques the oral cavity presents a

demanding environment for restorative
Yet even though the ideal restorative

material doesnt exist ideal

characteristics can be outlined as below.
Factors to consider during
selection of a restorative
material (cont.)
Physical and mechanical properties
Stability in the acid base oral fluid

Low thermal conductivity as similar to that of

tooth substance as possible

Ability to resist permanent deformation or

fracture under the forcers of mastication

Ability to achieve and maintain a highly

polished or homogenous surface

Tooth colored

Resistance to fracture and marginal break down

Factors to consider during
selection of a restorative
material (cont.)
Wear rate similar to enamel
Adhesive to or chemically bonded to the tooth
Capacity to adapt well to the to the cavity walls
if not an adhesive material
Non-conductive of electrical currents in the oral
Not sensitive to moisture contamination during
Minimal thermal and dimensional changes
during setting and the set phase
Factors to consider during
selection of a restorative
material (cont.)
Technical features for the provider
Easy to manipulate, place and shape

Safe to handle

Requires minimal preparation for the tooth for

Able to be repaired in the mouth

When warranted, easy to diagnose the need for

replacement and then easy to replace or repair

Relatively insensitive to the technique of the

Factors to consider during
selection of a restorative
material (cont.)
Patient acceptability
Reasonable cost to patient
Long lasting
Clinical aspects
Biocompatible with oral tissues and normal metabolic and
physiological processes
Not predispose to the accumulation of dental plaque
Long lasting
Able to determine when replacement is necessary.
Dentist factors

Preference of the dentist





Least technique-sensitive of all

restorative materials
Applicable to broad range of clinical
Good long-term clinical performance
Amalgam (cont.)
Easy to manipulate for dentist
Less time needed for placement compared to
other restorative materials
Initially, corrosion products seal the tooth
restoration interface and prevent bacterial
Direct material (one-appointment placement)
Easy repair
Long-lasting when placed under ideal conditions
and, in a conservative preparation, may equal
or exceed the longevity of cast restorations.
Amalgam (cont.)
Marginal breakdown

Some destruction of sound tooth structure

Not esthetic

Long-term, corrosion at margins may cause

breakdown; however, newer formulations
have greater resistance to corrosion
Potential for galvanic reaction

Local allergenic potential

Public perception of mercury toxicity

Amalgam (cont.)
Dental amalgam is appropriate for use in
individuals of all ages, in stress-bearing situations,
small-to moderate-sized cavities in posterior teeth.
It can be used more successfully than the other
direct restorative materials in situations where
severe destruction of tooth structure has occurred.
Amalgam also functions well in nonstress-bearing
situations, but it may not be the material of choice
because of the lack of esthetics and the need to
remove more sound tooth structure than with
As foundations for cast metal, metal-ceramic, and
ceramic restorations.
Amalgam (cont.)
When patient compliance is poor or unknown or when a
periodic recall schedule has lengthy lapses in care. For
patients in whom moisture control is difficult.
When cost is an important concern for the patient,
including large stress-bearing restorations.
In visible areas where esthetics are important, or for
lingual endodontic-access restorations on anterior teeth
because of the potential for staining.
When the patient has a history of allergy to mercury or
other amalgam component.
For large restorations, when cost is not a concern.

Low thermal conductivity

No galvanic reactions

Direct material (one-appointment

Easily repaired

Bonded resin may enhance tooth strength

Conservative preparation technique

minimizes removal of sound tooth structure.
Composite (cont.)
No self-sealing quality like amalgam, nor fluoride release
like glass ionomers; once the bond is broken between
the adhesive and tooth, leakage occurs with a high rate
of secondary caries
Excessive wear under stress

Low fracture strength

High technique sensitivity

Polymerization shrinkage may cause bacterial leakage

and high stress in the tooth
The generation and subsequent inhalation of dust
during finishing procedures represent potential hazards
for the patient and especially the dental staff.
Composite (cont.)
In small-to-moderate cavities in posterior teeth in
no- to minimal-stress-bearing situations
For all small-to-moderate anterior restorations

For repair of porcelain crowns

As a preventive resin.

For stress-bearing posterior restorations; the more
posterior the restoration, the greater the wear
(molars wear twice as fast as premolars); the larger
the surface area covered, the greater the wear.
When moisture control is poor.
Glass Ionomer Cement
Glass ionomers were introduced commercially about 10
years after dental composites and enamel-bonding
materials came to the market.
Some esthetic advantage

Fluoride releaseanticariogenic

Low thermal conductivity

No galvanic reaction

Direct placementone appointment

Minimal healthy tooth structure removed during

Often placed without the need for a local anesthetic.
Glass Ionomer Cement

Difficult to manipulate

Slow setsensitive to moisture over extended

periods (30 minutes).

For small-to-moderate restorations in deciduous

As a cavity liner

During caries control procedures

For cervical restorations

Glass Ionomer Cement
In adult teeth - occlusal surfaces

For stress-bearing restorations

Where moisture control is difficult.

Gold Foil

Durable and long-lasting if conservative in size

and placed in non stress-bearing situations.

High cost


Requires high level of clinical skill

Placement may cause periodontal or pulpal

Time-consuming in placement

Poor esthetics for anterior teeth.

Gold Foil (cont.)
For incipient cavities in nonstress-bearing

situations where esthetics is not a concern

For the repair of endodontic access

openings in gold crown or gold crown

In children and young adults

In stress-bearing areas
Cast Metal and Metal-
Ceramic Restorations
Superior to direct materials in high stress-bearing areas

Excellent wear resistance; low abusiveness against

tooth enamel (gold and glazed or polished porcelain)
Excellent longevity

Esthetic (metal-ceramics).

High cost

Require at least two appointments for fabrication

Possible wear of opposing teeth

Allergic reactions in some people

Cast Metal and Metal-
Ceramic Restorations
Potential for galvanic reaction

Technique-sensitiverequires moderately
high level of clinical skill
In situations where high stress is expected

For moderate-to-severe breakdown of the

natural tooth, requiring cusp replacement
When the patient demands esthetics rather
than conservative treatment (metal-ceramic
Cast Metal and Metal-
Ceramic Restorations
In patients under 18 years of age

In patients with extremely high biting forces; in

moderate to high occlusal force situations, metal
occlusal surfaces are indicated to reduce wear of
opposing teeth/restorations and to reduce the
risk of ceramic fracture
Where there is evidence of extensive bruxing
and/or clenching
When there is documented allergy to the metals
used in casting alloys (special concern in females
for whom up to 9 percent may demonstrate
nickel allergy).
Ceramic Restorations

No galvanic reactions

Low thermal conductivity

No corrosionexcellent chemical durability.

High cost

High clinical skill level needed


Requires removal of considerable sound tooth structure

Ceramic Restorations
Not as strong as metal-ceramic restorations
High and unpredictable fracture rates

Postoperative pain associated with cementation

and bonding techniques
Excessive wear of opposing tooth may occur if the
chronic surface is not properly glazed or polished.
For anterior crowns when esthetics cannot be
assured with PFM crowns (ceramic crowns)
For posterior teeth subjected to low biting forces

When the patient demands esthetics rather than

more conservative treatment.
Ceramic Restorations
In patients under 18 years of age

When all details are not captured in the impression of

the prepared tooth

For posterior areas subjected to extremely high biting

forces in situations where PFM crowns cannot be

used. For moderate-to-high force situations, metal
occlusal surfaces are indicated to reduce wear of
opposing teeth/restorations and to reduce the risk of
ceramic fracture
When there is evidence of extensive bracing and/or

When the technician is insufficiently experienced in

using the processing technique.

Ceramic Restorations
Because the failure rates of all-ceramic restorations are
relatively high, the esthetic demands for posterior
restorations are not sufficient to recommend their general
use in preference to metallic restorations, especially for
molar sites. Metal ceramic restorations, which are
indicated for moderate-to-high stress conditions, can be
recommended when esthetics are of concern.
Example of Dental Materials for Restoring
Posterior Teeth
The restorative materials available for posterior
restorations are described briefly below and summarized
according to their relative advantages, disadvantages,
clinical indications, and contraindications. The table
provides a quick summary of the most frequently used
materials for restoring posterior teeth.