RESTORATIVE

DENTISTRY
MFDS RSC (Edh.), MJDF RSC (Lon.), BDS (Misr
International University)
 Nomenclature:
Black’s classification of cavities is now not widely
used. It has been rejected by the following:
- Occlusal (Class 1) : cavity in pits and fissures
- Proximal (Class 2 or 3) ; cavity in proximal
surface(s) of any tooth.
- Incisal (Class 4) : proximal in anterior tooth, but
including incisal edge.
- Cervical (Class 5) : cavity in cervical third of
buccal or lingual surface of any tooth.
 Black’s classification of cavities:

 1 cavity originating in anatomical pit or fissure.

 2 cavity originating on mesial or distal aspect of molar/premolar
teeth.
 3 cavity originating on mesial or distal aspect incisors/canines
not involving incisal edge.
 4 cavity originating on mesial or distal aspect of incisors and
canines involving incisal edge.
 5 cavity originating in cervical third of buccal/lingual/palatal
aspects of teeth (excluding anatomical pits)
 6 cavities involving wear of incisal edges of upper and lower
anterior teeth
Hinge axis: the axis of rotation of the condyles during the first few
millimeters of mandibular opening.
Terminal hinge axis: the axis of rotation of the mandible when the
condyles are in their most superior position in the glenoid fossa.
Intercuspal position or centric occlusion: position of maximum
interdigitation.
Retruded or centric relation: position of the mandible where initial
tooth contact occurs on the retruded arc of closure. Occurs when
condyles are fully seated in the glenoid fossa. In 20% of patients RCP
and ICP are coincident; the remainder have forward slide from RCP
to ICP.

Freeway space: the difference between the rest and intercuspal

positions.

Cary Bopiah
Definitions:-
Ideal occlusion: anatomically perfect occlusion-rare.
Functional occlusion: an occlusion that is free of
interferences to smooth gliding movements of the
mandible, with absence of the pathology.
Balanced occlusion: balancing contacts in all excursions of
the mandible to provide therefore increase stability of F/F
dentures; not applicable to natural dentition (except rarely
in full –mouth reconstruction).
Group function: multiple tooth contacts on working side
during lateral excursions, but no contact on working side.
Canine-guided occlusion: during lateral excrusions there is
disclusion of all the teeth on the working side except for
the canine and no contacts on non-working side.
 Tunnel preparations: a tunnel approach to
interproximal caries has been described.
Access to the caries is made through easier
the occlusal or buccal surfaces, leaving the
marginal ridge intact
Occlusion :
Occlusal contacts can be identified with a
10um metal foil (Shimstock) and marked
using thin articulting paper (20um).
Occlusal considerations for
restorative procedures
1. conformative appraoch .
2. reorganized approach.
This is often the case when extensive crown and
bridgework is required, such that the patient’s
existing occlusion will be effectively destroyed
by the preparations. A new occlusion is
established, free of interferences and with the
patient occluding in retruded contact position,
which is the only reproducible position. This
approach to treatment is called the
Posts
Types of post and core systems:

Prefabricated or custom-made:
prefabricated posts obviously have the advantage of being cheap and quick, however,
the lack versatility and many of the systems require all coronal dentine to be removed. Custom made
technique s are preferred as they are more versatile , but they are also more expensive and require an
additional laboratory stage.

Parallel-sided or tapered: parallel-sided posts :

provide greater retention and do not generate as much stress within the root canal .
are likely to perforate in the apical region and are better for small tapered roots, e.g. lateral incisors.

Threaded, smooth, or serrated:

Threaded posts provide greater retention than smooth-sided; however, they will increase the stress
within the root canal and therefore contraindicated.
Serrated posts do not concentrate stress but simply increase the surface area for retention. Other
design features include antirotational components and cementation vents.
Veneers
Types:
Resin composite: Useful for the treatment of adolescent
patients. Can be made directly or, more commonly,
indirectly. Problems are shrinkage, staining and wear.
Advantage life span ~ 4 years.

Procelain: better performance and esthetics than resin

composite and long term follow up is now available. In
addition, porcelain is less plaque retentive. They are made
indirectly in the laboratory and roughened on their fitting
surfce by etching or sandblasting. This surface is treated
with a silane coupling agent prior to bonding to the
etched tooth enamel with resin composite luting cement.

Cary Bopiah
BRIDGES:

Types:

-Fixed fixed
-Fixed removable
-Direct cantilever
-spring cantilever
-Resin bonded
-Compound/hybrid
-Removable.
RCT

 Anticurvature filling: this was developed to minimize the possibility of

creating a strip perforation on the inner walls of curved root canals.

 Canal obturation:

 Sealers:
- Zinc oxide eugenol bases sealers (e.g Tubliseal)
- Calcium hydroxide-based materials (e.g Sealapex)
- Resin-based sealers (e.g AH Plus), Realseal for use with Resilon.
Warm gutta percha
techniques:
Warm lateral condensation: Special heat carriers
can be used with a flame or a special electronically
heated device (Touch and heat)
Vertical condensation: GP is warmed using a
heated instrument and then packed vertically. A
good apical stop is necessary to prevent apical
extrusion of the filling, but with practice a very
dense root filling can result. Time consuming. The
system B heat carrier has simplified this
technique.
 Thermoplasticized injectable GP
 Thermomechanical compaction: this involves a
reverse turning (e.g.McSpadden compactor or GP
condenser) instrument which, like an inverted
Hedstrom files, soften the GP, forcing it ahead of,
and lateral to the compactor shaft
 Coated carriers (e.g. Thermafil) these are cores of
metal or plastic coated with GP. They are heated in
an oven and then simply pushed into the root canal
to the correct length after size verification and sealer
placement. The core is then severed with bur
PROTHODONTICS

 Kennedy classification:
1 bilateral free end saddles
2 unilateral free end saddles
3 unilateral bounded saddle
4 anterior bounded saddle, only.
 Depth of the undercut; 0.25mm-cast cobalt chrome;
0.5mm-SS wire; <0.75mm—wrought gold.
Position of undercut on tooth and relative to saddle,
e.g.:
 High survey line gingival approaching clasp or
modify tooth shape by grinding.
 Diagonal survey line:
(a) sloping down from saddle: gingivally or occlusally
approaching (ring or recurved) clasp
(b) sloping up from saddle: gingivally or occlusally
(circumferential) approaching clasp.
 medium survery line: as above.
 low survery line: modify tooth shape
Denture copying:
Treatment planning
Consider:
Fitting surface– if this is the only feature that requires
improvments, then rebasing is a possibility.
Polished surface shapes.
Occlusal surface; jaw relationships; OVD. The effect of an
increase on OVD can be assessed by self-cure addition to
the existing dentures (occlusal pivots), but remember that
this irreversibly alters them.
Anterior tooth size, arrangement, relation to lips.
Posterior tooth mould and arch width (relation to tongue
and cheeks)
 Hank’s Balanced Salt Solution
 (HBSS).
  The best known and most extensively tested
 It has all of the metabolites such as Ca,
phosphate ions, K+ and glucose that are
necessary to maintain normal cell metabolism
for long periods of time.
 HBSS has been extensively tested in dental and 
medical research for the past twenty years.
 This research has shown that 90% of cells
stored in HBSS for 24 hours maintain their
normal viability and after four days, still have
70%viable
Amalgam

 Definition:
An amalgam is a special type of alloy in which
one of it’s constituents is mercury.
Low upper containing amalgam
Ag - 65% Tin - 29% Cu < 6%
High cupper containing amalgums
Shape and method of production of
alloy particles
 To make amalgam mercury is mixed with
dental alloys
 A cast ingot of the alloy is passed through a
lathe machine – Lathe-cut alloy
 A cast ingot is milled – Milled alloy
 Molten alloy is sprayed into a column of inert
gas and solidify as fine droplets of alloy –
Spherical alloy
 Hence the alloy powder can be supplied as
either:

1. Lathe-cut
2. Spherical particles
3. Admixed
Setting reactions of conventional
alloys
Ag3Sn + Hg → Ag2Hg3 +SnHg + Ag3Sn

Gamma + Hg → Gamma 1 + Gamma 2 + Gamma

Ag3Sn – Gamma

Ag2 Hg3 – Gamma 1

SnHg - Gamma 2 (weakest phase)

• Cooper is added to eliminate the gamma 2
phase.

• Gamma 2 phase is least stable in corrosive

environment

• In a high copper system gamma 2 phase is

virtually eliminated by the (Cu-Sn phase) and
to accomplish this at least 12 % copper is
required in the alloy powder
 Role of Copper

 To eliminate the weakest (tin-Hg or gamma-

2) phase in amalgam the content of copper is
increased
 Copper therefore hardens and strengthens
the amalgam.
 Role of zinc
 Scavenges the available oxygen to stop oxidisation of Ag,
Sn or Cu during the melting of the alloy.
 Zinc-containing alloy > .01 %
 Non-zinc containing alloy ≤ .01 %
 Alloys without zinc are brittle and less plastic
 Prevents early corrosion and enhances marginal integrity
 Disadvantage is it causes an abnormal expansion if
amalgam is condensed in presence of moisture
 Spherical vs Lathe-cut vs
Admixed
 Amalgams with lesser Hg content have better
properties
 Spherical alloys have smaller surface area and
hence require lesser mercury
 Spherical alloys give a more fluid mix, easy to
condense and can be carved immediately
 Spherical alloys preferred for Class V and
pinned restorations.
Contd.

 Bcos they are very plastic establishing

proximal contours is difficult
 Admixed alloys resist condensation better
 Spherical alloys occlusal strength – 3hr
 Lathe-cut alloy occlusal strength > 6hr
 Dimensional change

 Severe contraction – microleakage and caries

 Expansion – pressure on pulp and post-op
sensitivity
 ↓Hg, ↑condensation pressures and longer
trituration times will favour contraction
Effect of moisture contamination

 Some admixed alloys expand upto 2 yrs

 If zinc containing alloy is contaminated
during trituration or condensation –
expansion starts 3-5 days later and may
continue for months sometimes > 4 % -
DELAYED EXPANSION
STRENGTH

 Weaker in tension and stronger in

compression
 Single composition are strongest followed by
admixed followed by high copper amalgam.
 Effect of mercury content

 Too less or too much weakens amalgam

 Should be sufficient to wet alloy powder
otherwise a dry granular mix results
 If Hg content ↑es above 54-55 % the
strength rapidly reduces
 Excess Hg also causes more of the weak
gamma 2 phase to form
Cont.

 Corrosion – more gamma 2 more corrosion, copper

enriched – less corrosion.
 Corrosion – when in contact with gold corrosion
accelerated due to large difference in potential
 Tarnish – loss of surface lustre due to formation of
sulphide layer
 Thermal diffusivity – 78 x 10 (dentine is 2 x 10)
 Coefficient of thermal expansion 25 x 10 (dentine 8 x 10)
three times more than dentin. Amalgam contracts and
expands more than dentine when subjected to thermal
changes
 Condensation pressure – 3-4 pounds

Cary Bopiah
Disadvantages

 Micro-mercurial poisoning / Micro-leakage

 Thermal conductivity/ Bruxism release of
mercury
 Replacement release of mercury
 Allergy
 Galvansim
 Delayed expansion
 Plaque accumulation
Advantages

 Used for over 80 years in the UK

 Excellent track record
 Studies are longer for amalgam
Mercury toxicity

 Paraesthesia - ~500µg/kg

 Ataxia - ~ 1000 µg/kg

 Joint pain - ~ 2000 µg/kg

 Death - ~ 4000 µg/kg

 Casting alloys:
Additions to gold alloys:
- Copper increase strength and hardness but
decrease ductility
- Silver increases hardness and strength but
increase tarnishing and increase porosity.
- Platinum/pallidum increases melting point
- Zinc or indium scavenger, preventing oxidation
of other metals during melting and casting.
Recommendations

 An average of 5 amalgams a year is unlikely

to cause mercury posioning
 Mercury released from a normal number of
surfaces unlikely to cause any posioning
 Pregnant patient should not take part in
removal or replacement of amalgam fillings
 Not advisable to replace amalgam with non-
amalgam if the reason is one of suspected
mercury posioning
Bonded amalgam restorations

Advantages
 Less tooth structure removed
 Increased fracture resistance
 Repair easy of ditched or fractured amalgam
Composites are resins consisting of
organic and inorganic phase
bonded by a coupling agent.
COMPOSTION

 RESIN - BISGMA
- UDMA
- plus TEGDMA (to reduce viscosity of resin and to allow fillers to
be added to resin)

 FILLER
- Quartz: conventional composites (1-5 µm)

- Glass : conventional composites (aluminosilicate or

borosilicate) (1-5 µm)

- Fused silicon (microfilled 0.4µm)

 Coupling agent – Silane (coats filler particles
to enhance bond between resin matrix and
fillers)
 Opacifier – barium oxide
 Initiator – benzoyl peroxide
 Photo initiator – camphoroquinone
Classification

 According to filler size

 Macrofilled – quartz or glass
 Microfilled – silica
 Hybrid – quartz or glass + silica (80-90% by
weight)
Use of filler

 To increase strength
 Increase abrasion resistance
 Decrease polymerization shrinkage
 Better polishability
Classification (contd.)

 According to method of curing:

 Chemically cured
 Light cured
 Dual cure
GLASS IONOMERS
Glass ionomers

Setting rection
Acid base reaction between glass and
polyalkenoic acid.
Dissolution phase, protons displace calcium ions
Gelation phase protons displace aluminum ions
Maturation phase

Cary Bopiah
Types:
-Type 1 luting cements for crowns, bridges and
orthodontic bands.
-Type 2 restorative cements. There are two subtypes:
(1) eshtetic (2) reinforced.
-Type 3 fast setting lining materials
-Type 4 inlcude light cure and dual cure GI (use of
light source optimizes the properties of the dual cure
materials, alhtough they will self-polymerize
without)
Cary Bopiah
COMPOSITION

 Aluminosilicate glass + polyalkenoic acid acid

 Resin modified GIC – HEMA is added

Properties

 Adhesion – to enamel and dentin, there is

ionic displacement of Ca and Po4 ions by
polyacrylate ions and adsorption of
polyalknoic acids onto collagen
 Cariostatic – due to flouride release
 Thermal expansion – similar to enamel and
dentin
 Radiolucent except ketac-bond
 Abrasion resistance is poor
 Biocompatibility good (not resin modified
GIC)
 Polyacrylic acid is mild and molecule is large
and cannot diffuse into dentinal tubule
Contra-indicated

 High stress bearing areas

 Esthetic areas
 Large class IV
IMPRESSION MATERIALS
A. Elastomeric
B. Non-elastomeric
C. Hydrocolloids
COMPOSITION OF ALGINATE

 K or Na alginate – reacts with water to form a

solution
 Calcium sulfate – reactor
 Diatomaceous earth – filler
 Trisodium phosphate – retarder
 Potassium titanium flouride – accelerator
 Zn oxide - filler
USES OF ALGINATE

 Bleaching trays, mouthguards

 RPD, crown and bridge
 Ortho study casts
 Mouth protectors for sportsmen
Problems with alginate

 Sticks to teeth
 Voids in impression
 Tears during removal
 Lack of detail
 Grainy appearance
 Early setting
 Pulls away from tray
Syneresis : continued cross link formation after
initial set so impression shrinks and water is
forced out; happens almost immediately.

Imbibiton: impression swells as water is

imbibed by osmosis due to presence of
electrolytes between polymer chains.
ELASTOMERS

 ADDITIONAL SILICONES (Reprosil, Aquasil)

 Base – Poly methyl hydrogen siloxane
(PMHS) and fillers
 Reactor – divinyl polydimethyl siloxane
(DPDS) and fillers
Elastomers (contd.)

 Advantages
 Dimensionally stable
 Easy manipulation
 Most elastic of all impression materials
 Multiple pours possible
 Compatable with gypsum products
 Long shelf life (approx 14 days)
Elastomers (contd.)

 Disadvantages
 Latex inhibits reaction
 Hydrophobic
 Hydrogen gas evolution (wait 1 hr before
pouring)
 Low tear strength
Impression techniques:
-Monophosphate technique
-Double mix technique
-Putty and wash technique
-Automixing dispensers.
Disinfection of impressions: impressions should
be rinsed to remove debris and then immered ina
solution of a sodium hypochlorite (1000ppm
available chlorine) or a gluteraldehyde-free.
Mineral Trioxide Aggregate
(MTA)
 Composition
 Calcium oxide
 Zinc oxide
 Aluminum oxide
 Uses
 Pulp capping
 Perforation repair
 Apexification
 Root end restoration after apicectomy
DENTAL CEMENTS
Ideal requirements

 Healing of pulp dentin organ

 Sedative action
 Seal dentinal tubules
 Provide insulation
 Dentin bridge formation
Zn Oxide Eugenol Cement

 Powder – Zn Oxide Liquid – Eugenol

 Resin bonded ZOE – 10 % hydrogenated
powder added (HEMA)
 Weakest cement – eugenol is an obtundent,
has analgesic action
 Antiseptic-antiinflammatory
 Contraindicated under resins (interfers with
polymerization)
Calcium Hydroxide

 Powder – CaOH2 + fillers

 Liquid – polysalicylate fluid
 Or paste + paste
 Ph is 11
 Bacteriostatic – can induce mineralization of
adjacent pulp
 Uses- pulp capping, perforations, root cabal
medicament, apexification
Zn Phosphate

 Powder – Zn oxide and Mg oxide

 Liquid – 50 % phosphoric acid
 Always use varnish underneath
 Advantage – good strength, good
adaptability
 Disadv – irritant to pulp, exothermic reaction
Zn Polycarboxylate

 Powder – Zn oxides and Mg oxides

 Liquid – 40 % acqeous polyacrylic acid
 Similar to ZnPo4, good strength,
Dental Porcelain
Porcelain refers to a family of ceramic
materials composed essentially of
Kaolin, Feldspar, Quartz fired at a
high temperature

Other constituents – fluxes, colour

pigments, opacifying agents, stains,
colour modifiers
Ceramic-dental porcelain
The main types currently used are:
-Feldspathic.
-Leucite reinforced.
-Pressable
-Castable
-Aluminous
-Zirconium-based
Properties

 Chemically stable
 Excellent compressive strength 350-500 mpa
 Thermal cond and coefficient of expansion
similar to dentin
 Biocompatable
 Minimal plaque accumulation
 Excellent esthetics
Types of Ceramics

 Metal ceramics
 Castable glass ceramics
 Pressable ceramics (IPS empress, IPS
empress 2)
 IN-CERAM (infiltrated ceramics)
 Cad-Cam technology (machinable ceramics)
METAL ALLOYS
Use in dentistry

 Precious – Crown and Bridge

 Non-precious
- Metal ceramic alloy
- RPD alloy – Co-Cr
- Ni-Cr
- Co-Cr-Ni
Investment materials
Types of dental investments

Low temperature – gypsum bonded, used for

gold casting
High temperature – phosphate bonded: silica
bonded used for cobalt-chromium casting.
BIOCOMPATABILITY OF DENTAL MATERIALS:

Hazards to patient:
Systemic effects:-
Allergic reactions:
-Amalgam
-Nickel
-Acrylic monomer
-Epimine

Directly toxic:
- Beryllium