Selection suitable restoration Dr. Inas Ayoub Elalem inas.alalem@gmail.com Al Azhar University Gaza, Palestine Uploaded by Dr. Lama El Banna Operative dentistry fourth year

1. ALPINE SKI HOUSE
Dr. Inas Ayoub Elalem
inas.alalem@gmail.com
00970599448344
1
Operative Dentistry IV

2. ALPINE SKI HOUSE
Clinical
Part
2

26. Tips and tricks of
composite restoration
Done by: Dr. Ahmed Jouda
Supervisor by: Inas Ayoub Elalem

38. ALPINE SKI HOUSE
Selection of Suitable
Restorative Material
38

39. • A dental restoration or dental filling is a dental
restorative material used to restore the function,
integrity and morphology of missing or
damaged tooth structure.

40. • Requirements for an ideal restoration:
1. It should stop further progress of the
present lesion such as caries, erosion,
abrasion, attrition or fracture.
2. It should restore normal function of the
affected tooth which may be cutting,
tearing or mastication of food.
3. It should restore any speech defects due to
missing parts of the hard tooth structures.
4. It should restore normal esthetic.

41. 5. It should restore and maintain the integrity of
the dental arch and its surrounding
periodontium.
6. It should sustain the normal physiologic
occlusal load without fracture and it should
protect the remaining hard sound tooth
structures from fracture.
7. It should protect and maintain pulp vitality.

42. • According to the previously enumerated
requirements, still none of the available
restorative material is ideal. For this reason,
we have to compromise and select the most
suitable material for a particular case.

43. • Factors influencing selection of the suitable
restorative material:
I. Factors concerning the available restorative
materials.
II. Factors concerning the patient:
I. Factors related to the general condition of the
patient.
II. Factors related to the oral cavity.
III. Factors concerning the tooth to be restored.
IV. Factors related to the cavity to be restored.
III. Factors related to the operator.

45. I. Factors concerning the available
restorative materials
The operator should have full knowledge about all
available restorative materials.
This knowledge should include physical,
chemical and biological properties of each
material.
Furthermore, the operator should master the
manipulative techniques of these materials.

46. • Assessment of mostly used permanent
restorations properties:
A. Biocompatibility.
B. Physical properties.
C. Aesthetic properties.
D. Other material properties.

47. A. Biocompatibility:
Biocompatibility refers to how well the
material coexists with the biological equilibrium
of the tooth and body systems. Since fillings are
in close contact with mucosa, tooth, and pulp,
biocompatibility is very important.

48. • Metallic restoration can conduct thermal
shocks to the pulp due to its high thermal
conductivity which could lead to pulp
irritation.
• Amalgam restorations conduct thermal and
galvanic shocks to the pulp and its metallic
ions may penetrate the dentinal tubules and
gingival tissues. Permanent discoloration of
both tooth and gingiva will be the expected
failures after restoration of large cavity with
amalgam. Due to the known toxicity of the
element mercury, there is some controversy
about the use of amalgam.

49. • Moreover, the volumetric contraction of
polymeric resin and the relatively high-
coefficient of thermal expansion can create
leakage space at the restoration-tooth structure
interface and stimulate bacterial irritation for the
pulp.
• In addition to its monomer contents and the
heat produced during polymerization that lead to
chemical and thermal irritation to the pulp.

50. • On the other hand, tooth preparation of resin
composite restorations requires less tooth
structure removal compared to preparation for
other dental materials such as amalgam and
many of the indirect restorations. As
conservation of tooth structure is a key
ingredient in tooth preservation, many dentists
prefer placing materials like composite instead
of amalgam fillings whenever possible.

51. • Glass ionomer restorations are the best
regarding biologic compatibility. This can be
attributed to their chemical bond with the
adjacent tooth structures, to their high
molecular size of its acid contents, fluoride
release, minimal setting expansion and
preservative tooth preparation.
• Castable ceramic restorations are biologically
compatible due to their thermal insulation and
their highly smooth glazed surfaces.

52. • Most of the previously mentioned irritational
factors can be controlled by using suitable
cavity liner and/or base material. These
materials can protect the pulp from both
chemical and thermal irritation of the
restorations.

53. B. Physical properties:
1. Indestructible and/or insoluble in the oral
fluids.
2. Chemical adhesion with the surrounding
hard tooth tissues.
3. Withstand the functional forces without
fracture.
4. Maintain its dimensional stability inside the
cavity.

54. 1. Indestructible and/or insoluble in the oral
fluids
• Metallic, ceramic and resinous restorative
materials can resist solubility in oral fluids.
• However, glass ionomer restorations cannot
resist solubility.
• Moreover, luting cements such as zinc
phosphate or zinc polycarboxylate cements are
relatively soluble in the oral fluids particularly
in acidic media.

55. 2. Chemical adhesion with the surrounding
hard tooth tissues or at least, it should
maintain intimate adaptation with the
surrounding cavity walls at the restoration-
tooth structure interface.
The importance of adhesion or adaptation is to
provide marginal sealing to prevent micro-
leakage. Thus, post restorative
hypersensitivity of dentin, recurrent caries,
pulp affections and discoloration of both
restorations and tooth structures will be
prevented.

56. • Gold foil provides satisfactory adaptation with
the surrounding cavity walls.
• Adaptation of amalgam restorations increases
by time due to the presence of the corrosion
products.
• Resin composite restorations do not adhere or
adapt to the cavity walls due to their
polymerization shrinkage and their different
coefficient of thermal expansions.

58. • Glass ionomer restoration bond chemically
with the surrounding tooth structures.
• Casted restorations suffer from marginal
deterioration due to the polymerization
shrinkage of their luting cements .

59. 3. Withstand the functional forces without
fracture and it should protect the
surrounding hard tooth structures from
fracture.

60. • Ceramic and gold restorations fulfill this
property.
• Amalgam restorations suffer from low tensile
and shear strength (brittle) and creep.
• Glass ionomer restorations cannot resist
wear. Resin composite restorations suffer
from decreased to wear resistance compared
to the amalgam, however, recent types had an
increased in its wear resistance given the
restorations an average finite lifespan 7-8
years.

61. 4. Maintain its dimensional stability inside the
cavity:
The restoration should be free from any
volumetric changes after its placement inside
the cavity.
If it expands, it may overhang producing premature
contact, which may fracture due to stress
concentration.
On the other hand, contraction or shrinkage of the
restoration inside its cavity may cause marginal
leakage with subsequent troubles or it may lead
to its looseness and displacement.

62. • Ceramic and gold restorations are stable inside
their cavities.
• Amalgam restorations may contract inside their
cavities during their hardening. And, then, they
may expand due to either excess mercury or
moisture contamination.
• Dental composite restorations shrink during their
polymerization.
• Glass ionomer restorations has less dimensional
changes compared to the other restorations and
they do not create marginal leakage due to their
chemical bond with the adjacent tooth tissues.

64. C) Aesthetic properties:
• Porcelain restorations can provide perfect
esthetic with that of the natural tooth.
• Resin composite restorations provide superior
esthetic. However, by time, some resin
composites restorations suffer from surface,
marginal and bulk discolorations. The rate of
discoloration is changeable from a person to
the other according to the type of material,
technique of application and patient habits i.e.
drinks and smoking habits.

65. • Although Glass-ionomers are tooth-colored,
they vary in translucency. Despite they can be
used to achieve an aesthetic result; their
aesthetic potential does not measure up to that
provided by resin composite because their
surfaces change to the chalky appearance as a
result of their solubility in the oral fluids.

66. • Both gold and amalgam restorations have poor
esthetic due to their metallic colors. However,
it is expected to find few patients enjoying this
metallic appearance of their teeth. These
persons are most probably technicians and
butchers.

67. D. Other material properties:
1. It should have reasonable cost.
Amalgam is relatively cheaper than gold as a
metallic restoration.
• Porcelain restoration is the most expensive
tooth-colored one.
• Composite restoration comes next to ceramic
restoration regarding its price.
• Glass ionomer restoration needs cost similar
or near to that of composite ones.

68. 2. It should be convenient and easy in its
manipulation.
• Amalgam restorations satisfy this property.
• Gold foil restorative procedures need skillful
operator.
• Resin composite is a technique sensitive
material; needs complete isolation, and
skillful manipulation.

69. • In considering these properties of an ideal
restorative material, it is apparent that no
single material can fulfill all of the clinical
needs.

70. • Factors influencing selection of the suitable
restorative material:
I. Factors concerning the available restorative
materials.
II. Factors concerning the patient.
III. Factors related to the operator.

71. II. Factors concerning the patient:
A. Factors related to the general condition of
the patient.
B. Factors related to the oral cavity.
C. Factors concerning the tooth to be
restored.
D. Factors related to the cavity to be
restored.

72. A. Factors related to the general condition of
the patient:
1) Patient's age:
 Young patient cannot stand long dental
chair-side work. They cannot follow post-
restorative instructions carefully. They
prefer esthetic restorations wherever
indicated.

73.  Middle aged patient prefers ideal
restorations.
 Old patient cannot withstand long
operations on the dental chair. He prefers
strong permanent restorations.
2) Patient's sex:
 Male patients prefer strong permanent
restorations.
 Female patients advocate esthetic.

74. 3) Patient's occupation:
 Regular patients ask for restorations of
reasonable price. They prefer ideal
restoration if possible.
 Public personalities like esthetic
restorations. Those are; politicians,
professors and teachers, spokesmen,
television and movie stars, diplomats and
artists etc.
 Few technicians, butchers, fruit sellers,
shoemakers and mechanics advocate gold
color in esthetic areas.

75. 4) Physical condition of the patient:
 Patients with normal physical fitness can
stay on the dental chair for the required time
without creating any troubles.
 Debilitated patients cannot tolerate long
work on the dental chair. They prefer cast
restorations or short term restorations.
 Handicapped patients prefer short term
restorations.

76. 5) Educational and social conditions of the
patient:
 Educated patient advocate the most suitable
restoration according to their satisfaction.
 Less educated persons prefer esthetic
restoratives.
 Uneducated patients agree with the operator
selection for the suitable restoration.

77. 7) Patient's habits:
 Patients with smoking habit suffer from
stains on rough surfaces in the oral cavity
and from acidic saliva.
 Alcoholics always suffer from solubility of
dental cements.
 Persons with bruxism need strong
restorations with high surface hardness.

78. 8) Economic condition of the patient:
 Wealthy persons select the best restoration
whatever it costs.
 Ordinary people should be informed about
the expenses before starting the restorative
procedures.
 Poor patients prefer amalgam in posterior
teeth and glass-ionomers for esthetic
restorations.

79. B. Factors related to the condition of the oral
cavity:
I. Oral hygiene:
 Patients with good oral hygiene are ideal
candidates for all types of permanent
restorations.
 Patients with poor oral hygiene should
improve and maintain their mouths clean
before the restorative procedures.

80. II. Caries incidence:
 Selection of suitable restorations for
patients with high caries incidence should
be done cautiously to prevent failure of the
restorations due to recurrent caries.
 Teeth with rampant caries are better to be
treated with glass-ionomer restorations as
intermediate restorations until the condition
subsides.

81. III. Condition of occlusion:
 Normal occlusion has no troubles in the
selection of the suitable restorations.
 Conditions of malocclusion such as
anterior or posterior cross bite, severe
overlap, tilted teeth have to be treated
before the selection of the suitable
restorations.

82. IV. Presence of metallic restoration:
The present metallic restoration is leading
for the selection of the future metallic
restoratives. Presence of different metallic
restorations may lead to galvanic shocks.

83. C. Factors concerning the tooth to be restored:
1) Position of the tooth:
 Anterior teeth are better to be restored
with esthetic tooth-colored restorative
materials.
 Teeth that appear during smiling should
be restored with esthetic materials.

84. Teeth, which may act as abutment for fixed
bridge, can be restored with amalgam or resin
composite or reinforced glass-ionomer
restorations.
Wisdom teeth are difficult to be isolated by
rubber dam application. It is advisable to
restore them with zinc free amalgam or cast
gold restorations.

85. 3) Form of the tooth:
 Hutchinsonian teeth or peg-shaped lateral
incisors should be restored with full
coverage esthetic restorations.
 Mulberry molars should be corrected
occlusally with cast gold restorations or
even full metallic or ceramic crowns.
 Normal teeth should be restored with the
suitable restorative material through their
suggested designs.

86. 5) Size and condition of the remaining coronal
portion:
 In regular condition the remaining tooth
structures of the crown can confine the
restoration.
 If the remaining coronal portion cannot
confine the restoration and are greatly
destructed so that extra means of retention
or indirect restorations are advisable.

87. 6) Vitality of the pulp:
 It is advisable to preserve pulp vitality.
 In deep cavities, apply calcium hydroxide??
then suitable base material in deep areas to
protect the pulp from thermal, chemical or
traumatic irritation of the restorative material
or its technique.
 Teeth with hyperemic pulp should be
restored with a suitable temporary
restorative material until the irritational
condition is relieved and then restored
permanently with a suitable restoration.

88. D. Factors related to the cavity to be restored:
1) Size of the cavity:
 Relatively small cavities can be restored
with amalgam, resin composite, glass
ionomer restorative materials.
 Medium size cavities are better restored
with amalgam, resin composite or glass
ionomer restorations.
 Large cavities should be restored with
amalgam or indirect restorations.

89. 2) Location of the cavity:
 Occlusal cavities should be restored with
metallic or ceramic restorations to
withstand occlusal loads.
 Mesial cavities in anterior teeth and
premolars should be restored with esthetic
restoratives.
 Distal cavities of cuspids and bicuspids and
molars can be restored with metallic
restorations.

90.  Labial cavities and cervical cavities of
anterior teeth should be restored with esthetic
restorative materials.
 Cervical cavities of posterior teeth may be
restored with amalgam, resin composite or
glass ionomer restorations.

91. 3) Accessibility to the cavity:
 Wide mouth opening provides sufficient
accessibility. However, small mouth
opening creates difficulty in cavity
preparation and restoration.
 Anterior teeth, premolars and first molars
are more accessible than second and third
molars.

92. III. Factors related to the dentist (operator):
 Dentist should know full information about
population needs.
 He should have sufficient information about
all available restorative materials.
 He should have sufficient skill for
manipulation and handling of restoratives.

93.  He should use the material within its
indications.
 He should provide his patients with sufficient
post-restorative instructions.
 Successful dentist should satisfy his patients.

94. 4st Assignment :
Clinical Technique of class II amalgam restoration ( Textbook Art and
science of operative dentistry) CHAPTER 10 Clinical Technique for
Amalgam RestorationPages 350-380
94

95. Tuesday 9:00 P.M
95
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