DENTAL RESTORATIVE MATERIALS SELECTION CRITERIA

1. Selection of proper
restorative material

2. Mona Mahmoud
Doaa Gamal Ashour
Hoda Mostafa Omar
Sherifa Ahmed
‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

3. Introduction
Requirements
for ideal
restorative
material
Factors influencing
selection of ideal
restorative material
Factors
concerning the
patient
Factors
concerning the
available
restorative
material
Factors related
to the operator

4. Factors influencing
selection of ideal
restorative material
Factors concerning the
patient
Factors concerning the
available restorative
material
Factors related to the
operator

5. Patient related factors:
1- General conditions of the patients
2- General conditions of the oral cavity
3- Caries risk assessment
4- Occlusal analysis
5- Tooth to be restored

6. 1-General conditions of the patients:
 Patient age.
 Patients sex
 Patients occupation
 Physical and mental conditions of the patient
 Socioeconomic conditions of the patient
 Patients habits

7. 2- General conditions of the oral cavity
Oral hygiene
A- Patients with
good oral hygiene
B- Patients with
poor oral hygiene

8. 3- Caries risk assessment
 Dental Caries is a Multi-factorial Disease. The
development of caries is dependent on the interaction of
four primary factors.
 Caries risk assessment (CRA) is the process of collecting
data regarding various factors (e.g. bacterial level) and
indicators (e.g. previous caries experience) to predict
caries activity in the immediate future.
 Caries risk was assessed to classify patients into low,
medium or high-risk patients

9.  Caries will not develop if any of these four primary factors are not
present. Several modifying risk factors and protective factors
influence the dental caries process, primary and secondary.

10. Caries-risk assessment models currently involve a
combination of factors including
 Diet ( carbohydrates intake)
 fluoride exposure
 previous caries experience
 salivary factors (e.g. flow rate and buffering capacity)
 levels of cariogenic bacteria (i.e. Streptococcus mutans
and Lactobacillus)
 socioeconomic characteristics

11.  CRA may be valuable in the clinical management
of caries by helping dental clinicians to:
1. Categorize the level of the patient’s risk of developing caries
to control the intensity of treatment rendered.
2. Pinpoint main etiological factors that contribute to the
development of decay and thus determine appropriate form
of therapy.
3. Assist in restorative treatment decisions (e.g. choice of
restorative material).
4. Improve prognosis of planned therapeutic care.
5. Provide information on what additional diagnostic tests and
screening are required.
6. Educate and motivate patients to improve and maintain
optimum oral health.
7. Guide timing of subsequent recall appointments

12.  So treatment is important after caries risk assessment as
failure to identify and treat the underlying causative
factors allows the disease to continue. It is based first on
risk assessment and then on modifying the biofilm
ecology to enhance protective factors and minimize
pathologic factors.
 caries risk models such as CAMBRA and cariogram

14.  This makes the balance between demineralization and
remineralization which is illustrated in terms of pathologic
factors (i.e., those favoring demineralization) and protective
factors (i.e., those favoring remineralization.

15. 4-Occlusal analysis:
 Occlusion literally means “closing”;
in dentistry, the term means the
contact of teeth in opposing dental
arches when the jaws are closed
(static occlusal relationships) and
during various jaw movements
(dynamic occlusal relationships).
 The results of the occlusal analysis
should be included in the dental
record and considered in the
restorative treatment plan.

16. The confirmative approach
 In practice this means that the occlusion of the new
restoration is provided in such a way that the occlusal
contacts of the other teeth remain unaltered (in simple
restorative dentistry)
 On the tooth level, ideal occlusion is described as an
occlusal contact that is: in line with the long axis This
means the elimination of incline contacts.

18. Sequence of examining
occlusion:
A- Direct
restorations
B- Indirect
restorations:

19. This principles is applied in the direct and
indirect restorations:
Examine Design
Restore
cavity
Check

20. The essential difference between a direct and an indirect
restoration is that a laboratory technician is involved:
 First, The dentist not only has to examine the occlusion
but the results of that examination have to be accurately
recorded and that record has to be transferred to the
technician. This is the clinician's responsibility.
 Secondly, the technician has the responsibility to preserve
the accuracy of that record during the laboratory phase of
treatment
 Finally, the clinician has the responsibility to maintain the
patient in the same occlusion, with a temporary restoration
which will maintain the same relationship between the
prepared tooth and the adjacent and opposing teeth

21.  There are three ways in which this
anatomical information can be
transferred:
1. Two dimensional bite records: photographs
or occlusal sketch
2. Three dimensional bite records: bite
registration material e.g. wax or by using
impression material
3. A combination of both

22. Points also to be checked :
plunger cusps
tilted teeth
Edge to edge
Deep bite
Over jet
Overbite
Anterior guidance

23. Successful occlusal management leads to:
 Predictable fitting of restorations
 Restoration longevity
 absence of iatrogenic problems
 patient comfort
 Occlusal stability.
 Improved esthetics
 Decrease stresses

24. 4-Tooth to be restored:
A- Position of the tooth
B-Teeth with slight mobility
C-Form of the tooth
D- Condition of the tooth surface
C- Size and condition of the remaining coronal
portion

25. A- Position of the tooth:
 Anterior teeth should be restored with esthetic tooth
colored restorations
 Teeth which appears during smiling should be restored
also with esthetic tooth colored restorations
 Teeth which act as abutment for fixed bridges can be
restored with amalgam, composite or RMGI restorations
 Wisdom teeth are difficult to be isolated with rubber dam
so it is preferred to restore them with zinc free amalgam or
indirect restorations e.g. inlays or onlays

26. B- Teeth with slight mobility:
 According to the grade of mobility, decision will be
made, after knowing the cause of this mobility and
eliminate it, and if it is primary or secondary occlusal
trauma and adjusting it

27. C- Form of the tooth:
 if the tooth shape is normal so suitable restorative
material according to the design
 but if there is different tooth form:
Hutchinson teeth: full coverage esthetic restorations
Mulberry molars: should be restored with full coverage
metallic or ceramic crowns

28.  Peg shaped lateral: restore it to simulate normal lateral
tooth with esthetic restoration

29. D- Condition of the tooth surface :
Hypoplasia:
 which is a defect in in the matrix formation, in the form of
pits grooves, and lines in the whole enamel surface or in
certain areas. Possible reduction of the enamel thickness.
 depends on the location and severity of the condition.
 For mild cases it can be treated with composite restoration
of the pitted surfaces, and for moderate to sever cases it
will be treated with laminates or full coverage according
to the case.

31. Hypocalcification:
 which is a defective mineralization
of enamel matrix, in the form of
soft enamel of yellow - brownish
color, it also will be treated
according to the severity of the
case,
 if it is severe case in which enamel
is chipped of it should be covered
with strong restoration to protect it
e.g. full coverages

32. E- Size and condition of the remaining
coronal portion:
 If the remaining coronal portion is badly destructed so
extra means of retention or indirect restorations could be
used.

33. It is a dental restorative material used to restore function,
integrity and morphology of missing or damaged tooth
structure.

34. 1- Stop further progress of present lesions.
2- Restore normal function.
3- Restore any speech defects.
4- Restore normal esthetics.
5-Sustain the normal physiologic occlusal load
without fracture.
6- Restore and maintain integrity of dental arch
7- Protect and maintain pulp vitality.
8-Maintain a constant relationship with the
surrounding hard tooth structure.

35. There is no ideal available
restorative material, so we have to
be more conservative with selection
of most suitable material for each
particular case according to material
properties.

36. Permanent
Direct
Indirect
Temporary
Direct
Indirect

37. Permanent direct restoration
Metallic
Direct
gold foil
Amalgam
Non-
Metallic
Composite
Glass
ionomer

38. Indications:
 Occlusal, buccal and lingual pit and fissure cavities.
 Gingival third cavities on bicuspids and cuspids.
 Limited numbers of interproximal cavities.
 Repair of defective inlay or crown margins.

39. There are some requirements for placing amalgam
restoration:
 90` cavosurface angle (butt joint).
 Adequate depth.
 Adequate mechanical retention (Macro-mechanical).
It can restore:
 Simple, compound and complex class I cavities.
 Simple, compound and complex class II cavities.
 Slot preparation.
 Class III.
 Class V.

40. Complex amalgam restorations:

41.  badly broken permanent teeth.
 sufficient amount of dentin.
 contraindicated in extremely large pulp chamber.
 Limitation in very high stress bearing area.
 possibility of perforation.
 need skillful operator.
 Types of pins : Cemented, Friction lock and Self-
threating pins.

42.  short clinical crowns
 cusps that have been reduced 2 to 3 mm for
amalgam. retention groove in dentin in a horizontal
plane.
 less likely to create perforation or
penetration into the pulp.

43.  It is prepared by placing 2 to 3 mm deep holes
with condensation of soft restoration.
 It is recommended in weak gingival area but
associated with greater tooth structure removal.

44. Recent advances in amalgam:

45. Silver alloy particles undergo self- welding after using
fluroboric acid to keep surface alloy particles clean and
can be condensed as direct gold restoration.

46.  In bonded amalgam technique, a dentin bonding
system is used along with a viscous resin liner
which mixes with the amalgam
 forms a micro-mechanical union to increase
amalgam`s retention to tooth structure.
 This is obtained by adding 4- META with its
hydrophilic and hydrophobic properties.

47. Composite restorations

48.  Class I,II, III, IV, V & VI.
 Pits & Fissure sealant.
 Esthetic restorations.
 Core build up.
 Splinting.

49.  Esthetics.
 Conservation of tooth structure.
 Good retention.
 Repairable.

50.  Polymerization shrinkage.
 Technique sensitive.
 Greater occlusal wear.
 Time consuming.

51.  Macro filled composite.
 Micro filled composite.
 Hybrid composite.
Nano fill and nano hybrids.
Micro hybrid.
 Packable composites.
 Flowable composite.

52.  Incomplete removal of caries.
 Incomplete etching or removal of acid etch.
 Excess application of bonding agent.
 Lack of moisture control.
 Excessive dryness of dentin.
 Contamination of composite.
 Bulk placement.
 Improper polymerization method.
 Incomplete finishing and polishing.

53.  Postoperative hypersensitivity.
 Discoloration.
 Fracture of margin.
 Loss of contact after period.

54. Glass ionomers

55. Types of glass ionomers
Conventional glass ionomer.
Resin modified glass ionomer.
Hybrid ionomer.
Tri-cure glass ionomer
Metal reinforced glass ionomer.

56.  Restoration of permanent teeth:
Class V, III and small class I.
Root caries.
Abrasion and erosion.
 Restoration of deciduous teeth.
 Luting cement.
 Preventive restoration:
Tunnel preparation.
Pits & fissure sealants.

57.  Liner under composite.
 Core build up.
 Repair of external root resorption.
 Repair of perforation.
 ART.
 Sandwich technique.

58.  In stress bearing areas.
 In cuspal replacement cases.
 In cases which require aesthetics.
Advantages:
 chemical bonding to tooth structure.
 Biocompatible.
 Anticariogenic
 Less technique sensitive.
 Conservation of tooth structure.
 Good marginal seal.

59.  Low fracture resistance.
 Low wear resistance.
 Less aesthetic due to opacity.
 Require moisture control during manipulation and
placement.
 Less fluoride in new types.

60. Compomer

61. Giomer:

62. Ormocer:

63. Cast
metals
Tooth
colored
• Inlays &onlays
• laminates
Indirect
Restoration
Gold alloys
Base Metal
Alloys
Porcelain
composite

65. The major reason for using cast
metal restorations is that
It is strong in
thin sections
Can be used to
protect weakened
tooth structure

66. GOLD
It is a noble ductile heavy metal.
It provides strength and resistance to tarnish and corrosion.
Insoluble except in a combination of nitric and hydrochloric
acids.
It impairs the yellowish color of the alloy.
Four types are available according to hardness
Type I
Soft
Type II
Medium
Type III
Hard
Type IV
Extra Hard

67. Type I (Soft) used for small inlays & in restoration of non
stress areas.
Type II (Medium) used for large inlays , onlays &suitable
for restorations in stress bearing areas as Class I, II
Type III (Hard) used for crown and bridge work and is
also suitable for onlays & posts
Type IV (Extra-hard) Its use is limited to the construction of
partial denture frameworks.
(The content of both gold and copper are the most
effective in this classification)

68. INDICATIONS
Always remember the following advantages
High
strength
Dimensional
Stability
Bio-
compatible
Convenient
manipulation
Optimum
contact,contour,
occlusion

69. 1-Extensive tooth involvement
Badly broken down tooth
Where the steepness of the cusps
increases there tendency to split
Cracked or crazed teeth
Restoration of endodontically treated
teeth
To restore cavities extending
deep subgingivally
INDICATIONS

70. 2- Correction of occlusion or when teeth
suffer from wear ,attrition or erosion or for
diastema closure.
3- Fixed or removable prosthesis abutment.
4- As a restoration for cases that requires
saving of clinic chair time since most of work
can be completed in the lab.
5- Adjunct to perio-therapy ,Inlay restorations
may be constructed to splint periodontaly
affected teeth together.

71. Always remember the following disadvantages
Inharmonious
color
High thermal
conductivity Lack of
adaptability
(cement line)
Time & cost
CONTRA -INDICATIONS

72. CONTRA -INDICATIONS
1. Bad oral hygiene and high caries susceptibility since this
will enhance the failure of cement line and increase its solubility
with high risk of caries recurrence.
2. The presence of an opposing amalgam restoration
because this may elicit a galvanic cell with pain and/or enhanced
corrosion activity.
3. Where esthetics is a prime requisite, cast gold should not
be used since it attracts attention of the observer.
4. Where other permanent direct restoration is indicated
for tooth conservation.

75. Base metals
generally have
Low density
Not applicable
to be casted in
thin sections
High rigidity
Not burnishable
into thin
margins
So need modifications
in cavity design
(mainly finishing cavo-
surface margin into
butt joint)
Lower cost
compared to noble
metals like cast gold

76. Base Metal Casting Alloys
Titanium &
Titanium alloys
Cobalt-
Chromium alloys
Nickel-
Chromium
alloys
Hardness :3 times
more than that of
type IV gold alloys
The alloy is difficult
to be finished and
polished
Could cause wear of
the opposing natural
teeth
Presence of nickel
instead of cobalt
renders the alloy:
Less hard
Owns strength
properties similar to
type III gold alloys
Mechanical properties
of pure TI similar to
gold type III & IV
While TI alloy similar
to Cobalt-Chromium
& Nickel-Chromium

77. Titanium &
Titanium
alloys
1-All-metallic
restorations
2-Metal-ceramic
restorations
3-RPD Frame
works
Nickel-
Chromium
alloys
1-Full metal
crown and bridge
2-Metal-ceramic
restoration
Cobalt-
Chromium alloys
1-Complete
denture bases &
RPD Frameworks
2-Sub-periosteal
implant
3-Bone plates and
screws
Applications

78. Titanium & Titanium alloys
 Difficult to be casted because of their low density
,high fusion temperature and high reactivity with
the surrounding environment.
 So nowadays Blocks of Ti or Ti-alloys
could be milled into inlays or crowns using the
CAD-CAM or copy milling technologies.
-Trade Terms:
FOB, CIF, CIP
-Baoji Talent Hi-
Tech Titanium
Industry Co.,
Ltd.
Shaanxi, China

79. Cast
metals
Tooth
colored
• Inlays &onlays
• laminates
Indirect
Restoration
Gold alloys
Base Metal
Alloys
Porcelain
composite

81. large defects or replacement of large
existing compromised restorations
Cavities free from marked undercuts
Sufficient tooth structure available for
bonding with cavity margins at enamel
Occlusal load not exceed flexural strength of
restoration/tooth complex.
Regular attenders requesting tooth
colored restorations beside being well
oriented dentaly
Inlays & onlays
INDICATIONS

82. Heavy occlusal forces with
restoration lack suffient bulk
Excessive tooth wear or
insufficient enamel for bonding.
Severe undercuts in the remaining
tooth structure.
For patients with bad oral hygiene.
Uncooperative patients.
CONTRA-INDICATIONS

83. Indirect composite inlays & onlays
Targis ceromer
(Ivoclar Vivadent)
Artglass (Heraeus
Kulzer, Germany)
BelleGlass HP
(Kerr/Sybron, U.S.A.)
The matrix contains
a new
multifunctional
methacrylate
monomer
characterized by
higher degree of
conversion.
Its mechanism of
curing is performed
under pressure, at an
elevated temperature
in the presence of
nitrogen. This
increases the degree
of conversion.
three-dimensional fine-
particle ceramic fillers
which are densely
packed in an advanced
organic matrix.
Also contain
polyfunctional groups
allowing a higher level
of cross-linking with
higher mechanical
properties

84. The advantages of composite over
ceramics inlays & onlays are:
1. Less brittle restoration.
2. Transmit lower stresses to underlying tooth structure,
due to lower rigidity of the material.
3. Can be easily adjusted, contoured and repaired
intraorally after cementation.
4. Less expensive.
5. Less abrasion to the opposing teeth. The wear rate of
second-generation of composites is nearly like the
natural enamel.
6. More conservative preparation, as ceramics need more
bulk owing to its brittleness.
7. Easily removed, if replacement is necessary.

85. Indirect ceramic inlays & onlays
Machined
restorations
Man-made
ceramic inlays

86. The advantages of ceramic over
composite inlays & onlays are:
1. Adhesion of resin cement is more favorable with
ceramics than composite restorations.
2. Excellent shades match with surrounding natural tooth
structure.
3. Offering superior mechanical & physical properties.
4. Highly biocompatible to the gingiva.

87. Indirect
Laminate
veneers
composite
ceramic

88. Indications:
Hypocalcification Peg laterals Chipped teeth
Rotated teeth
Foreshortened
teeth

89. Which one indicated for laminates???
distema
Excessive
interdental
spacing

90. Which one indicated for laminates???
labioversion
Lingoversion

91. Contraindications:
Insufficient enamel
Poor oral hygiene &
Mouth breathing
Clenching or bruxing
Extreme
crowded cases
Some contact sports

92. Composite vs ceramic veneers
Composite veneers Ceramic veneers
Easier in fabrication Very high color stability
Easy to be repaired Biocompatible to the gums
Lower cost than ceramics Highly mimic natural tooth looking

93. Temporary restorations

94. Temporary restorations
 Definition.
 Classification.
 Indications .
 Advantages.
 Types of temporary restorations.
 Factors affecting the selection of the temporary
restoration materials.

95. Temporary restorations
Definition
 a restoration for a prepared
tooth for a certain period
of time until replaced by
permanent restoration

96. Classification of temporary
restorations
Short
term
(1-2
weeks)
Medium
term
(several
weeks)
Long
term
(6
months)

97. Indications of Temporary
restorations
-insufficient time.
-In-between appointments. e ,g internal
bleaching on a tooth, so easily and quickly
removed.
-In case of active caries lesions e, g, glass
ionomer to control caries then
finalization is done.

98. Indications of Temporary
restorations
-Sensitive tooth.
Some nerves following a filling
become hyper sensitive (to cold, hot
and sweet).
the dentist may remove the filling
and place a sedative temporary to
allow the nerve to settle first.

99. Advantages of temporary
restorations
 Protection and sedation dentin-pulpal
organ(cover exposed dentin).
 putting tooth into function.
 Maintain aesthetics.
 Restoration of occlusion and maintain
space by preventing over eruption of the
opposing tooth and drifting of the
adjacent teeth.

100. Types of temporary restorations:
 Conventional Zinc Oxide and eugenol.
 Modified zinc oxide and eugenol.
 Non-eugenol Zinc Oxide.
 Temporary resin restoration.
 Glass ionomer.
 Zinc phosphate cement.
 Zinc polycarboxylate cement.

101. conventional Zinc Oxide and
eugenol
 combination of zinc oxide and
eugenol contained in oil of cloves.
 An acid-base reaction catalysed by
water..

102. conventional Zinc Oxide and
eugenol
-The chemical composition :
 Zinc oxide, ~69.0%
 White rosin, ~29.3%
 Zinc acetate, ~1.0% (improves strength)
 Zinc stearate, ~0.7% (acts as accelerator)
 Liquid (eugenol, ~85%, olive oil ~15%)

103. conventional Zinc Oxide and
eugenol
-Properties
 antibacterial effect.
 Sedative action .
 Adverse effects on resin-based products
by reducing the bond strength.

104. conventional Zinc Oxide and
eugenol
-Indication:
 in posterior teeth prepared for
amalgam restorations.
-Examples:
 Algenol (Kem-Dent, England)
 Nobetec (nordiska dental
,Nijeria)

105. Modified zinc oxide and eugenol
 conventional zinc oxide powder reinforced with several
additive e,g silica and alumina fillers to increase the
strength but also have adverse effects on resin-based
products.
 Indicated in either extensive cavities or for long term
temporization and large cavities.

106. Modified zinc oxide and eugenol
-Example:
 IRM (Caulk/Densply, USA).
•For intermediate restorations
intended to remain in place for
up to 1 year
•Provides sedative like qualities
on hypersensitive tooth pulp

107. Non-eugenol Zinc Oxide
 Eugenol free
-It does not have a sedative effect on the tooth.
- No interference with resin restoration.
 Indicated mainly with resin-based restorations and For
those restoration who use a resin cement e.g. inlays
and onlays.

108. Non-eugenol Zinc Oxide
 Examples:
-Nogenol, (GC America,USA)
--Cavit (3M ESPE , USA)
effective sealing ability of Cavit due to
its expansion during setting.

109. Temporary resin restoration
 Characterized by enough strength , hardness and
insolubility in oral fluids .
 Used for temporary restorations for large size cavity
and temporary crown.

110. examples of
Temporary resin restoration
Systemp.inlay / Systemp.onlay
(Ivoclar Vivadent ,United States and
Canada)
-Light-curing single-component
materials .
-Do not require use of a temporary
cementation.
-They are composed of Paste of polyester
urethane dimethacrylate, silicon dioxide,
copolymer, triclosan, initiators and
stabilizers.

111. examples of
Temporary resin restoration
 Protamp (3M ESPE ,USA)
-It is self-curing resins or light cured .
-cemented by temporary cement e.g.RelyX Temp NE (3M
ESPE,USA)
-It is composed of Bis-Acrylic Composite With Nanofillers

112. Glass Ionomer
 used as cement, base or a temporary
restoration .
 ant cariogenic (fluoride release) ,so
used in case of acute active caries.

113. Zinc phosphate cement
 used as cements, , a base and as
temporary fillings.
 high-strength .
 mixed from zinc oxide powder
and phosphoric acid liquid.

114. zinc polycarboxylate cement
 Used as cement ,
base or a temporary
restorative material.
 lower compressive
strength than zinc
phosphate.
 bonds chemically to
tooth structure.

115. Factors affecting the selection
of the temporary restoration

116. 1-Type of final restoration:
-for metallic restorations zinc oxide and eugenol or
modified zinc oxide eugenol.
-for resin restorations non eugenol dressing.

117. Factors affecting the selection of
the temporary restoration
2- Size of the cavity:
 For large cavities use reinforced ZOE and
temporary resin restorations.

118. Factors affecting the selection of
the temporary restoration
3- Length of time before permanent
restorations
 If less than 2 weeks ZOE temporary
filling can be used(short term).
 If more than 2 weeks reinforced ZOE or
temporary resin restoration can be
used(medium or long term) .

119. Factors related to the operator
influencing selection of restoration:
information about all restorative
materials.
Information about properties
indication of each restorative
material.
Dentist’s clinical experiences and
skills.

120. SIZE OF THE CAVITY
LOCATION OF THE CAVIY
ACCESSIBITY TO THE CAVITY

121. Size of the cavity
 Small cavities resin composite.
 Medium cavities amalgam or composite .
 Extensive large cavities indirect restorations.

122. Location of the cavity :
 Occlusal cavities better to
be restored with metallic or
ceramic restorations to withstand
occlusal loads.
 Labial of anterior teeth
composite restorations.

124. Location of the cavity :
 Cervical cavities of posterior teeth
can be restored with
amalgam, composite or glass ionomer
restorations.
 cervical cavities of anterior teeth
composite restorations.
 Subgingival cavities cast
gold ,ceramic or glass ionomer
restorations.

125. Accessibility
 Difficult accessibility :
-small mouth opening .
-Distal surface of second and third
molars.
(Indirect restorations)

127. Clinical cases

133. INLAY