This document provides information on various types of direct and indirect tooth-colored restorative materials and procedures. It discusses class I, II, III, V, and VI cavity preparations for direct composite restorations. It also describes indirect restorations including heat-cured composite inlays/onlays and ceramic inlays/onlays made from machinable ceramics, feldspathic porcelain, or hot-pressed ceramics. The chronological development of restorative materials is summarized starting from gold and silicate cements and progressing to composite resins, glass ionomer cements, and various hybrid composites.

2. Introduction

3. I. Class 1 Direct
Composite Restoration
Preparation design:
Conventional (class I,II,V)
in amalgam/90˚or buttjoint
Modified (classV)
Bevealed conventional
(rarely used)

4. I. Class 1 Direct
Composite Restoration
B. Inverted cone with rounded
caries
Provide flat floors
Produces a more stronger margin on the
occlusal cavosurface
Creates preparation walls that converge
occlusally
Occlusally more conservative facial –
lingual preparation width

5. Class II Conventional
direct composite
A. Occlusal preparation:
330 or 245 diamond made parallel to the
long axis of the tooth.
Pulpal depth is 1.5 mm from the central
groove (about 0.2mm in dentin); follows
the rise and fall of DEJ mesiodistally but
relatively flat faciolingually.

6. Class II Conventional
direct composite
B. Proximal Box:
Facial, lingual and gingival extensions
dictated by extend of caries or old
restoration; may not be extended beyond
the contact with the adjacent tooth.
Walls at 90˚, axial wall to 0.2mm in
dentin
Gingival floor flat with minimal extension
Retained by micromechanical retention,
no secondary retention necessary.

7. III. Class VI Composite
Restoration
A. Preparation design
The typical class VI tooth preparation
should be as small in diameter and as
shallow in depth as possible.
B. Flame - shape or round diamond
Either a flame-shaped or round diamond
instrument to roughen the prepared
surfaces.

9. Indirect tooth colored
Restoration
Indications:
Esthetic
Large defects or previous restorations
Economic factors
Contraindications:
Heavy occlusal forces
Inability to maintain a dry field
Deep subgingival preparation

10. Definition of terms
Indirect:
Inlay
- restoration of metal, porcelain/ceramic or
composite made to fit a tapered cavity
preparation and luted into it by a cementing
medium.
Onlay (overlay)
- an inlay that includes the restoration of all
of the cusp of a tooth.

11. Definition of terms
Taper
-permits an unobstructed removal of the wax
pattern and subsequent seating of the
material. The wax pattern should be removed
from the tooth without distortion.
Taper
Intracoronal
-divergence from the floor of the
preparation outwards.

12. Definition of terms
Extracoronal
- converge from the cervical to the
occlusal or incisal surface.
●shallow cavities (vertical walls unusually short)
Requires minimal taper of 2˚ occlusal divergence
to enhance resistance and retention.
●deep cavities (increased gingivo-occlusal height of
vertical walls)
As much as 5˚ taper to facilitate:
Pattern withdrawal, trail seating and
cementing of restoration

13. Types of restorative
materials
Laboratory-processed inlays and
onlays
Ceramic inlays and onlays
Machinable ceramics or CAD/CAM
Feldspathic porcelain
Hot-pressed ceramic

14. Laboratory-processed
inlays and onlays
Polymerized under pressure, vacuum, inert
gas, intense light, heat, or a combination of
these devices to optimize physical properties
of composite resins.
More resistant to occlusal wear vs direct
composites but less wear resistance than
ceramics.
Easily adjusted, low wear of opposing teeth
good esthetics and has potential for repair.

15. Laboratory-processed
inlays and onlays
Indications:
If maximum resistance is desired from
composite restoration.
Achievement of proper contour and
contacts would be difficult with direct
composite.
If ceramic restoration is
contraindicated because of wear of
opposing dentition.

16. Advantages of heat cured
composite inlay/onlay restoration
Improved physical properties/durability and
wear resistance compared to direct composite
systems.
Depth of cure not a problem unlike with
direct composite where there is limited depth
of cure.
Excellent marginal adaptation since the luting
composite fills any marginal contraction gap
present.
Non-extent polymerization shrinkage except
in luting resin cement.
Post-operative sensitivity seldom

17. Ceramic inlays and onlays
Esthetics, durable, improved
materials, fabrication techniques,
adhesives and non based luting
agents.

18. Fabrication steps for
ceramic inlays and onlays
After tooth preparation, an impression
is made and a “master” working cast is
poured of die stone.
The die is duplicated and poured with a
refractory investment capable of
withstanding porcelain firing
temperatures. The duplication method
must result in the master die and the
refractory die being accurately
interchangable.

19. Fabrication steps for
ceramic inlays and onlays
Porcelain is added into the preparation
area of the refractory die and fired in
an oven. Multiple increments and firings
are necessary to compensate for
sintering shrinkage.
The ceramic restoration is recovered
from the refractory die, cleaned of all
investment, and seated on the master
die and working cast for final
adjustments and finishing.

20. Feldspathic porcelain
Partially crystalline minerals (feldspar,
silica, alumina) dispersed in a glass
matrix.
Porcelain restorations are made from
finely ground ceramic powders that are
mixed with distilled water or a special
liquid, shaped into the desired form,
then fired and fused together to form a
translucent material that looks like
tooth structure.

21. Feldspathic porcelain
Some ceramic inlays and onlays are
fabricated in the dental laboratory by
firing dental porcelains on refractory
dies.
Advantage:
Low start-up cost
Disadvantage:
its technique sensitivity

22. Hot Pressed Glass
ceramics
Glass could be modified with nucleating
agents and on heat treatment, be
changed into ceramics with organized
crystalline forms.
Such “glass ceramics” were stronger,
had a higher melting point than non
crystalline glass, and had variable
coefficients of thermal expansion.

23. Hot Pressed Glass
ceramics
Advantages:
Similarity to traditional “wax-up” processes
Excellent marginal fit
Relatively high strength
The surface hardness and occlusal wear of
these ceramics are similar to those of
enamel.
Stronger than porcelain inlays made on
refractory dies, they are still quite fragile
until cemented.

24. Hot Pressed Glass
ceramics
Disadvantges:
its translucency, which necessitated
external application of all shading.
Not significantly stronger than fired
feldspathic porcelains they do seem
to provide better clinical service.

25. Chronological Events of
Restorative Materials
History
First recommended over 25 years ago
for posterior use.
1907 – cast gold
1908 – silicate cement
First direct tooth colored restorative
material.
Disadventage:
Insoluble to oral fluid

26. Chronological Events of
Restorative Materials
1950 – bonding agents
1955 – acid etching by
Micheal J. Buonocore
1960 – sealants
1962 – composite resin
-direct filled restorative material

27. Chronological Events of
Restorative Materials
1962 – composite resin
According to the size of the filler:
Macrofill – for class V
(problem: abfraction)
Microfill – anterior restoration
Hybrid
Microhybrid composite
Nanofilled composite

28. Chronological Events of
Restorative Materials
1962 – composite resin
Two types of composite:
1. Packable composite
alternative to amalgam
Supplied: unit dose, compules or in
syringe
Higher filler loading
Fibers
Porous filler particles
Irregular filler particles
Viscosity modifiers

29. Chronological Events of
Restorative Materials
1962 – composite resin
Advantages:
Produce acceptable class II restoration
High depth of cure possible
Bulk fill technique
Filler loading: 80%
Medium to high strength
High stiffness
Low wear rate: 3.5um/year
Molecules of elasticity :similar to amalgam

30. Chronological Events of
Restorative Materials
1962 – composite resin
Disadvantages:
New technique
Less polishable
Limited shades
Increased post-operative sensitivity
Increased sensitivity to ambient light

31. Chronological Events of
Restorative Materials
1962 – composite resin
Recommended uses:
Class I restoration
Class II restoration

32. Chronological Events of
Restorative Materials
1962 – composite resin
2. Flowable composites
Low viscosity composites
Low filler content
Ideal for cervical lesion
Ideal for non stress bearing area
Ideal for first increment in Class I
composite

33. Chronological Events of
Restorative Materials
1962 – composite resin
Advantages:
Syringeable
Dispensed directly into cavity
Adequate strength
Disadvantages:
Higher polymerization shrinkage
Greater potential for microleakage
Low wear resistance

34. Chronological Events of
Restorative Materials
1968 – Glass ionomer cement
Different types:
Luting or cementing medium
Liner or base
Restorative material

35. Chronological Events of
Restorative Materials
1970 – microfill “polishable”
composite
1973 – ultraviolet light
1977 – microfill composite
Advantages: polishability, wear and
resistance and color stability
Disadvantages: low flexural/tensil
strength, localized wear and thus
limited uses posteriorly.

36. Chronological Events of
Restorative Materials
1978 – visible light curing
composite
Mid 1980’s hybrid:
Hybrid – 0.04-3um particle size
range
Examples: brands of hybrid
Herculite
Prisma APH
P-30

37. Chronological Events of
Restorative Materials
Mid 1980’s hybrid
Intended for universal use
Disadvantage of hybrid:
Generalized wear

38. Chronological Events of
Restorative Materials
Mid 1980’s microhybrid:
Microhybrid – 0.6-0.7um particle
size range
Examples: brands of microhybrid
Prisma TPH
Herculite XRV
Charisma
Tetric ceram

39. Chronological Events of
Restorative Materials
Mid 1980’s microhybrid:
Advantages:
Excellent physical properties
Good finishing and polishing
characteristics
Relatively non sticky materials
Disadvantage:
Do not hold a high polish over time

40. Chronological Events of
Restorative Materials
1985 – CEREC ceramic system
1991 – CEREC 1 as modified by
siemens
1994 – CEREC 2 with an upgrade
dimensional camera
2000 – CEREC 3 with split
acquisition/design

41. CEREC
Chairside Economical Restoration of
Esthetic Ceramiics

42. Chronological Events of
Restorative Materials
1986 – Heliomolar
The sole exception to the microfill
group of resins that were introduced
for posterior use.
70% filled anterior/posterior
microfill resin.
very good wear characteristic
Less than perfect esthetics

43. Thank you!