Esthetic Restorative Materials /prosthodontic courses
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Esthetic Restorative Materials /prosthodontic courses
- 1. S UO Esthetic Restorative Materials www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing Dental
- 2. S UO Esthetic Restorative Materials • Dent 730 -- Dr. Stephen Rosenstiel, • Course Director • Lecturer -- Dr. Peter Monaghan • monaghan.15@osu.edu • Sources for Lecture Information: • Sturdevant et al, 3rd ed: 207 - 287; 534 - 625 (review) • Craig, 10th ed: 244 - 280 (review) • Exam questions to cover all sources • Sit in your assigned seats!
- 3. S UO www.indi andentalac ademy.co m Direct-filling Tooth-Colored Materials • Composite Resin • Glass Ionomer Cement • New Materials Update
- 4. S UO www.indi andentalac ademy.co m Composite Resin -- Glass Ionomer Cement • Classification • Polymerization and setting reactions • Clinical use
- 5. S UO www.indi andentalac ademy.co m Classification of Composite Resins • Filler type and size (most common) • Cure method • Radiopacity • Matrix composition (least common)
- 6. S UO www.indi andentalac ademy.co m Filler Size and Type Classification • Macrofill: 1 to 100 µm • Small: 1 - 5 µm • Medium: 5 - 10 µm • Large: 10 - 20 µm • Microfill: < 0.05 µm • Hybrid: combined microfill and macrofill particles
- 7. S UO www.indi andentalac ademy.co m Filler Particles • Silica glass • Barium glass • Strontium glass • Lithium glass • Alumina glass • Combination glass • Sodium-calcium-alumino-fluoro-silicate glass • Sodium fluoride • Source of fluoride ion
- 8. S UO www.indi andentalac ademy.co m Silica Glass (SiO2) • Beach sand and ordinary glass • Crystalline quartz • Larger particles • Not polishable • Pyrolytic silica • Sub micron particles • Barium, strontium, lithium • Engineered aluminum silicates • Radiopaque • Polishable • All have good optical properties
- 9. S UO www.indi andentalac ademy.co m Alumina Glass (Al2O3) • Crystalline corundum • Like a sapphire and ruby gemstones • Very hard • Not polishable • Opacifier due to optical properties
- 10. S UO www.indi andentalac ademy.co m Combination Glass • Sodium-calcium-alumino-fluoro-silicate glass • Glass ionomer cement • Compomers • Engineered mishmash of glasses • Source of fluoride ion
- 11. S UO www.indi andentalac ademy.co m Filler Particle Incorporation • Initially mechanically retained • Lost after wear or resin matrix • Silane coupling agent • Chemically bonds fillers to matrix • Silane bond to glass • C=C bond to resin monomers during polymerization
- 12. S UO www.indi andentalac ademy.co m Filler Loading • Macrofils up to 80 w% or 50 v% • Microfils up to 50 w% or 35 v% • Hybrids up to 80 w% or 50 v% • Filler pre-polymerization • Heterogeneous filler • React filler and resin • Grind to powder • Mix with unreacted filler • Increase filler loading to 75 w% or 42 v% • Poor bonding to matrix • NOTE: Volume %age is the critical factor
- 13. S UO www.indi andentalac ademy.co m Cure Method • Self or Auto or Chemical cure • Light cure • Ultraviolet light • Visible light • Dual cure
- 14. S UO www.indi andentalac ademy.co m Chemical Cure Resins • Also know as Self or Auto Cure • Requires mixing • Incorporation of air voids • Benzoyl Peroxide or Benzene Sulfinic Acid • Aromatic tertiary amine • Color instability with time • Production of free radical species
- 15. S UO www.indi andentalac ademy.co m Ultraviolet Light Cure Resin • Benzoin alkyl (methyl) ether • 365 nm UV light (EMR) • Minimal mixing required • Slow reaction • Long curing times • 30 day shelf life after activation • Production of free radical species
- 16. S UO www.indi andentalac ademy.co m Visible Light Cure Resin • Camphorquinone • Aliphatic tertiary amine • 470 ± 20 nm light (EMR) • No mixing required • Fast reaction • Short curing time • Long shelf lived • Production of free radical species
- 17. S UO www.indi andentalac ademy.co m Dual Cure Resins • Visible light cure reactants • Self cure reactants • Most require mixing • Uses • Resin cements • Cervical increments in Class II, III, or IV situations
- 18. S UO www.indi andentalac ademy.co m Free Radical Species • Highly reactive • Unstable • Attack and open C=C bonds in monomers • Vinyl polymerization • Initiate polymerization • Cause chain growth • Cause chain crosslinking
- 19. S UO www.indi andentalac ademy.co m Radiopacity • Radiopaque • Glasses with barium, strontium, or lithium • Ytterbium fluoride (YF3) • Source of fluoride ion • Not radiopaque
- 20. S UO www.indi andentalac ademy.co m Matrix Composition • Bis-GMA • UDMA (Urethane dimethacrylate) • Bis-EMA • TEGDMA • Other resins
- 21. S UO www.indi andentalac ademy.co m Clinical Use of Composite Resins • Indications • Contraindications • Bonding to tooth structure • Enamel • Dentin • Material placement • Restoration finishing • Wear of composite resins
- 22. S UO www.indi andentalac ademy.co m Indications • Anterior restorations • Esthetic restorations • Conservative restorations • Preventive resin restoration • Proximal slot restoration
- 23. S UO www.indi andentalac ademy.co m Contraindications • Uncontrolled bruxism • Excessively wide preparations • Inability to bond to tooth structure • Poor operating field isolation
- 24. S UO www.indi andentalac ademy.co m Bonding to Tooth Structure • Enamel • Conditioning (etching) of enamel • Wetting with low viscosity resin • Dentin • Smear layer • Conditioning of dentin • Wetting with low viscosity resin • Poor with sclerotic dentin
- 25. S UO www.indi andentalac ademy.co m Conditioning (Etching) of Enamel • 20 - 50% phosphoric acid • 20 to 120 seconds • Rinsed with water • Dried with air • Up to 10 µm penetration • Surface irregularities • Surface area increase Tubular Dentin Etched Enamel
- 26. S UO www.indi andentalac ademy.co m Wetting with Low Viscosity Resin • Low viscosity resin • HEMA-rich • Coats irregularities • Polymerized for 20 seconds • Creates “resin tags” • Strong mechanical interlock Low Viscosity Resin Tubular Dentin Etched Enamel
- 27. S UO www.indi andentalac ademy.co m Smear Layer • Preparation debris • Thin (< 5µm) • Irregularly arranged • Sticky but chemically removable • Penetrates tubules (Smear Plugs)
- 28. S UO www.indi andentalac ademy.co m Conditioning of Dentin • Removes or restructures smear layer • Dissolves inorganic component of dentin • Exposes and denatures collagen • Phosphoric acid • Dentin primer • Hydrates collagen
- 29. S UO www.indi andentalac ademy.co m Wetting with Low Viscosity Resin • Low viscosity resin • HEMA-rich • Surrounds collagen • Polymerized for 20 seconds • Strong mechanical interlock • “hybrid layer”
- 30. S UO www.indi andentalac ademy.co m Clinical Uses of Composite Resin • Class III and IV restorations • Anterior teeth • Class I and II restorations • Anterior teeth • Posterior teeth • Class V restorations • Anterior teeth • Posterior teeth • Preventive resin restoration
- 31. S UO www.indi andentalac ademy.co m Class III and IV Composite Resin Restorations • Isolation • Lingual or facial access • Break cervical and facial or lingual contact area • Preserve incisal half of contact (Class III) • Bevel accessible enamel margins • Pumice cleansing of area • Matrix and Wedge (prewedging helpful) • Incremental build-up including bonding • Initial cure from cervical direction
- 32. S UO www.indi andentalac ademy.co m Class I and II Composite Resin Restorations • Narrow cavities with enamel margins • Isolation • Minimally break contacts (Class II) • Prewedging required (Class II) • Bevel accessible enamel margins • Pumice cleansing of the area • Matrix and Wedge • Incremental build-up including bonding • Initial cure from the cervical direction (Class II)
- 33. S UO www.indi andentalac ademy.co m Class V Composite Resin Restorations • Isolation, rubber dam with 212 retractor or cord • Caries removal • Bevel of accessible enamel margins • Cementum margin at right angle • Pumice cleansing of the area • Incremental buildup including bonding • Initial cure from the cervical direction
- 34. S UO www.indi andentalac ademy.co m Preventive Resin Restoraion • Sealant • Isolation • Pumice cleansing of the area • Conditioning of the enamel • Bonding of sealant resin • Selective caries removal plus sealant • Isolation • Remove caries with minimal preparation • Pumice cleansing of the area • Conditioning of the enamel and dentin • Incremental buildup including bonding and sealant
- 35. S UO www.indi andentalac ademy.co m Finishing of Composite Resins • Hand operated devices • Composite resin carvers, scalers, scalpel blades • Abrasive finishing strips • Rotary instruments • Multi-fluted carbide burs • Diamond points • Rubber wheels and points • Various discs • Pastes • Alumina and diamond grit abrasives
- 36. S UO www.indi andentalac ademy.co m Finishing of Composite Resins • Best finish • Against a Mylar strip with no polishing • Not always possible • Excellent finish • Sof-Lex Discs • Medium rubber wheels and discs • Fine finishing diamonds (Micron) • Average finish • Other discs • Burs • Stones • Other rubber wheels and points • High Luster • Pastes
- 37. S UO www.indi andentalac ademy.co m Wear of Composite Resins • Microfracture Theory • Hydrolysis Theory • Chemical Degradation Theory • Protection Theory • Combination Theory • Any and all processes occur
- 38. S UO www.indi andentalac ademy.co m Microfracture Theory of Wear • Filler particles loaded during function • Initiates and propagates cracks • Cracks interconnect • Material weakens and sloughs • Process continues
- 39. S UO www.indi andentalac ademy.co m Hydrolysis Theory of Wear • Water or alcohol breaks the silane bond • Filler particles debond • Filler particles slough • Softer resin wears quickly • Process continues
- 40. S UO www.indi andentalac ademy.co m Chemical Degradation Theory of Wear • Food substances chemically degrade matrix • Matrix softens and cracks • Filler detaches • Matrix sloughs • Process continues
- 41. S UO www.indi andentalac ademy.co m Protection Theory of Wear • Micro-protection • Inter filler particle distance controls wear • Large → high wear • Small → low wear • Soft matrix ablates • Filler particles slough • Macro-protection • Inter-particle wear continues until opposing teeth come into enamel vs enamel contact
- 42. S UO www.indi andentalac ademy.co m Classification of Glass Ionomer Cements • Traditional Classification • Use • Other methods
- 43. S UO www.indi andentalac ademy.co m Traditional Classification - Glass Ionomer Cements • Type I - luting agents • < 20 µm film thickness • Type II - low stress bearing restorative materials • < 45 µm film thickness • Type III - pit and fissure sealants • 25 - 35 µm film thickness • Type IV - high stress bearing restorative materials • > 45 µm film thickness • Includes metal-reinforced materials
- 44. S UO www.indi andentalac ademy.co m Use Classification -- Glass Ionomer Cements • Luting agents • Restorative materials • Metal mixtures - no chemical bond with metal • Cermet materials - chemical bond with metal • Liners - thin layers under restorative materials • Bases - thick layers under restorative materials • Sealants - pit and fissure sealants • Resin modified materials • Light cure • Dual cure
- 45. S UO www.indi andentalac ademy.co m Components of Glass Ionomer Cements • Conventional and resin modified tyoes • Sodium-calcium-alumino-fluoro-silicate glass • Polyacrylic acid • Tartaric acid -- speeds setting • Resin modified types • Methacrylate functionality • Free radical initiators
- 46. S UO www.indi andentalac ademy.co m Acid-Base Setting Reaction • Aqueous reaction • Three stage process • Ion leaching • Acid attacks glass • Hydrogel formation • Chains crosslink • Polysalt gelation • Polysalt captures unreacted glass • Swell on setting -- lowest microleakage • Cannot add incrementally
- 47. S UO www.indi andentalac ademy.co m Leaching Stage • Ca++, Al+++ , and F- ions • Heat is liberated • Glossy appearance • Bonds to tooth
- 48. S UO www.indi andentalac ademy.co m Hydrogel Stage • Initial matrix • Mainly calcium ions • Highly mobile • Crosslink polyacid chains • Opaque and rigid • Prone to desiccation and imbibition
- 49. S UO www.indi andentalac ademy.co m Polysalt Gel Stage • Final matrix • Can take months to complete • Mainly aluminum ions • Low mobility • Depleted calcium ions • Silica gel • Binds the initial matrix to the unreacted glass • Tooth-like optical properties
- 50. S UO www.indi andentalac ademy.co m Resin Modified Polymerization • Identical to the resin polymerization • Free radical species are generated • Polymers result from growing chains • Acid-base reaction is slow (if present) • Incremental addition • Less susceptible to dehydration • Less swelling on setting -- more microleakage
- 51. S UO www.indi andentalac ademy.co m Bonding to Tooth Structure • Carboxylic acid groups • Bond to calcium ions • Chelation -- covalent/ionic bond • Bonds to sclerotic dentin • Methacrylate functionality • Needs dentin bonding agent
- 52. S UO www.indi andentalac ademy.co m Balance of Glass Ionomer Materials • Glass ionomer cements • Ketac • Resin modified glass ionomer cements • Vitremer, Fuji II LC • Polyacid modified composite resins • Dyract • Ionomer modified composite resins • Geristore Vinyl Polymerization Acid:Base Reaction
- 53. S UO www.indi andentalac ademy.co m Clinical Use • Luting agents • Bases and liners • Restorations • Dentin Conditioner • Polyacrylic acid • Gently rub the dentin • Rinse/dry gently • Not indicated for luting
- 54. S UO www.indi andentalac ademy.co m Glass Ionomer Cement Luting Agents • Produce thin films • Release fluoride ion • Displaced zinc phosphate and zinc polycarboxylate cements • Short setting time • Follow manufacturer’s directions • Mixed “en mass” • Clean up at the rubbery stage
- 55. S UO www.indi andentalac ademy.co m Glass Ionomer Cement Bases and liners • Cover and bond to dentin • Reduce post operative sensitivity • Seal well • Conditioner indicated • Can be conditioned (etched) with phosphoric acid • Release fluoride • May promote dentinogenesis
- 56. S UO www.indi andentalac ademy.co m Glass Ionomer Cement Restorations • Fluoride ion release • Conditioner indicated • Bonds to tooth • Class V • No or minimal preparation • High success • Sandwich technique • Composite resin veneer • Class I or II • Low to average success
- 57. S UO www.indi andentalac ademy.co m Finishing of Glass Ionomer Cement Restorations • Similar to composite resins • Same armamentarium • Do not over-wet • Do not desiccate • Wait until opacity disappears
- 58. S UO www.indi andentalac ademy.co m Guidelines for Successful Glass Ionomer Cement Restorations • Remove all caries • Good, clean finish lines • Control moisture • Avoid contamination • Follow manufacturer’s directions • Take care with finishing not to ditch cementum
- 59. S UO www.indi andentalac ademy.co m New Materials Update • Conventional bonding agents • Primer • Hydrophilic monomers • Water, alcohol, acetone • Low viscosity resin • “One-step” bonding agents • Primer-resin • Hydrophilic monomers • Volatile solvent • Low viscosity resin • All still require phosphoric acid conditioning!
- 60. S UO www.indi andentalac ademy.co m New Materials Update • Flowable Composite Resins • Low viscosity • Less filled (50 w%) • Class V restorations • Liners for condensable resins • Condensable Composite Resins • High viscosity • Higher filler loading • Fiber or “star”-shaped particles • “Feel like amalgam”
- 61. S UO www.indi andentalac ademy.co m New Materials Update • Laser and Plasma Lights • High intensity light • Proper wavelength • Programmable • Full on • Ramp power • Pulse power • Designed to delay gel point • More flexible restoration