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Copyright 2003, Elsevier Science (USA). All rights reserved.

Chapter 43Restorative and Esthetic

Dental Materials

Chapter 43Restorative and Esthetic

Dental Materials

Copyright 2003, Elsevier Science (USA).

All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher.

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Produced in the United States of America

ISBN 0-7216-9770-4


IntroductionIntroductionRestorative dental materials fulfill an important role in the way dentistry is delivered today.

Restorative dental materials fulfill an important role in the way dentistry is delivered today.


ADA: criteria for a new material• Must not be poisonous or harmful to the

body.• Must not be harmful or irritating to the

tissues of the oral cavity. • Must help protect the tooth and oral

tissues of the oral cavity. • Must resemble the natural dentition. • Must be easily formed and placed in the

mouth.

ADA: criteria for a new material• Must not be poisonous or harmful to the

body.• Must not be harmful or irritating to the

tissues of the oral cavity. • Must help protect the tooth and oral

tissues of the oral cavity. • Must resemble the natural dentition. • Must be easily formed and placed in the

mouth.

Standardization of Dental MaterialsStandardization of Dental Materials


Mechanical properties must withstand the biting and chewing force in the posterior area of the mouth.

Force is any push or pull on matter. Stress is the reaction within the

material that can cause distortion. Strain is the change produced within

the material that occurs as the result of stress.

Mechanical properties must withstand the biting and chewing force in the posterior area of the mouth.

Force is any push or pull on matter. Stress is the reaction within the

material that can cause distortion. Strain is the change produced within

the material that occurs as the result of stress.

Properties of Dental MaterialsProperties of Dental Materials


Types of stress and strain:• Tensile stress pulls and stretches

the material.• Compressive stress pushes the

material together.• Shear stress is the breakdown of the

material.

Types of stress and strain:• Tensile stress pulls and stretches

the material.• Compressive stress pushes the

material together.• Shear stress is the breakdown of the

material.

Mechanical PropertiesMechanical Properties


A change in temperature in the oral cavity due to either a hot or cold product.

Contraction and expansion • Dental materials will contract or

expand at their own rate. • Change in temperature can cause a

dental material to pull away from the tooth.

• Microleakage• Faulty restoration

A change in temperature in the oral cavity due to either a hot or cold product.

Contraction and expansion • Dental materials will contract or

expand at their own rate. • Change in temperature can cause a

dental material to pull away from the tooth.

• Microleakage• Faulty restoration

Thermal ChangesThermal Changes


An electrical current, or galvanic action, is created when two different or dissimilar metals are present in the oral cavity.

Conditions:• Saliva. • Two metallic components of different

composition. • Electrical current. • Galvanic action, or shock, is the coming

together of all conditions.

An electrical current, or galvanic action, is created when two different or dissimilar metals are present in the oral cavity.

Conditions:• Saliva. • Two metallic components of different

composition. • Electrical current. • Galvanic action, or shock, is the coming

together of all conditions.

Electrical PropertiesElectrical Properties


Reaction a metal has when it comes into contact with corrosive products.

Solubility is the degree to which a substance will dissolve in a given amount of another substance.

Reaction a metal has when it comes into contact with corrosive products.

Solubility is the degree to which a substance will dissolve in a given amount of another substance.

Corrosive PropertiesCorrosive Properties


Flow:• The dental material must be pliable

enough to be placed in the preparation. Adhesion:

• The force that causes unlike materials to adhere to each other.

Wetting is the ability of a liquid to flow over the surface.

Viscosity is the property of a liquid that causes it not to flow easily.

Flow:• The dental material must be pliable

enough to be placed in the preparation. Adhesion:

• The force that causes unlike materials to adhere to each other.

Wetting is the ability of a liquid to flow over the surface.

Viscosity is the property of a liquid that causes it not to flow easily.

Application Properties Application Properties


Surface characteristics is where a liquid flows more easily on a rough surface than on a very smooth surface.

Film thickness: In general, the thinner the film, the stronger the adhesive junction.

Retention is the ability to hold two things firmly together when they will not adhere to each other.

Curing• Auto-cured material hardens as the result of

a chemical reaction of the materials.• Light-cured material does not harden until it

has been exposed to a curing light.

Surface characteristics is where a liquid flows more easily on a rough surface than on a very smooth surface.

Film thickness: In general, the thinner the film, the stronger the adhesive junction.

Retention is the ability to hold two things firmly together when they will not adhere to each other.

Curing• Auto-cured material hardens as the result of

a chemical reaction of the materials.• Light-cured material does not harden until it

has been exposed to a curing light.

Application Propertiescont’d Application Propertiescont’d


Restorative: To replace or bring something back to its natural appearance and function.

Esthetic: To replace or bring something back to its pleasing appearance.

Restorative: To replace or bring something back to its natural appearance and function.

Esthetic: To replace or bring something back to its pleasing appearance.

Restorative and Esthetic MaterialsRestorative and Esthetic Materials


Restorative materials that are applied to the tooth while the material is pliable and able to carve and finish.• Amalgam• Composite resins• Glass ionomer• Intermediate restorative materials• Tooth-whitening products

Restorative materials that are applied to the tooth while the material is pliable and able to carve and finish.• Amalgam• Composite resins• Glass ionomer• Intermediate restorative materials• Tooth-whitening products

Direct Restorations Direct Restorations


Amalgam is a safe, affordable, and durable material that is used predominantly to restore premolars and molars (Figure 43-8).

Amalgam is a safe, affordable, and durable material that is used predominantly to restore premolars and molars (Figure 43-8).

AmalgamAmalgam


Fig. 43-8 Packing an amalgam carrier. Fig. 43-8 Packing an amalgam carrier.


In individuals of all ages. In stress-bearing areas of the mouth. When there is severe destruction of tooth

structure. As a foundation. When personal oral hygiene is poor. When moisture control is problematic. When cost is an overriding patient

concern.

In individuals of all ages. In stress-bearing areas of the mouth. When there is severe destruction of tooth

structure. As a foundation. When personal oral hygiene is poor. When moisture control is problematic. When cost is an overriding patient

concern.

Indications for Using Amalgam Indications for Using Amalgam


Indications for Not Using AmalgamIndications for Not Using Amalgam Esthetics is important. Patient has a history of allergy to

mercury or other amalgam components. The cost of other restorative materials or

treatment options is not a factor.

Esthetics is important. Patient has a history of allergy to

mercury or other amalgam components. The cost of other restorative materials or

treatment options is not a factor.


Mercury (43% to 54%) Alloy powder (57% to 46%)

• Silver, which gives it its strength.• Tin for its workability and strength.• Copper for its strength and corrosion

resistance.• Zinc to suppress oxidation.

Mercury (43% to 54%) Alloy powder (57% to 46%)

• Silver, which gives it its strength.• Tin for its workability and strength.• Copper for its strength and corrosion

resistance.• Zinc to suppress oxidation.

Chemical Makeup of AmalgamChemical Makeup of Amalgam


Harm to patients: Essentially harmless. The exception is with patients who have

many amalgam restorations, or a high sensitivity to metals.

Harm to Dental Personnel: Health concerns with high exposure to mercury, not amalgam.• Tremors• Kidney dysfunction • Depression• Nervous system disorders

Harm to patients: Essentially harmless. The exception is with patients who have

many amalgam restorations, or a high sensitivity to metals.

Harm to Dental Personnel: Health concerns with high exposure to mercury, not amalgam.• Tremors• Kidney dysfunction • Depression• Nervous system disorders

Issues Concerning Amalgam Issues Concerning Amalgam


Do not contact mercury with your skin. Protect against spillage during trituration. Keep lid closed during trituration. Do not discard scrap amalgam into waste

containers. Collect all scrap amalgam and store under

water or photographic fixer solutions in a closed container.

Do not contact mercury with your skin. Protect against spillage during trituration. Keep lid closed during trituration. Do not discard scrap amalgam into waste

containers. Collect all scrap amalgam and store under

water or photographic fixer solutions in a closed container.

Amalgam Hygiene Amalgam Hygiene


Capsules (600 mg of alloy): For small or single‑surface restorations.

Capsules (800 mg of alloy): For larger restorations.

Trituration: The process by which the mercury and alloy are mixed together to form the mass of amalgam.

Capsules (600 mg of alloy): For small or single‑surface restorations.

Capsules (800 mg of alloy): For larger restorations.

Trituration: The process by which the mercury and alloy are mixed together to form the mass of amalgam.

Preparation of Amalgam Preparation of Amalgam


1. Mixed amalgam placed in amalgam well.2. Amalgam carried to the prepared tooth. 3. Amalgam placed in increments in the

prepared tooth.4. Each increment is condensed immediately.5. Carvers are used to carve anatomy into the

amalgam.6. A burnisher is used to smooth the

amalgam.7. The new restorations occlusion is checked.

1. Mixed amalgam placed in amalgam well.2. Amalgam carried to the prepared tooth. 3. Amalgam placed in increments in the

prepared tooth.4. Each increment is condensed immediately.5. Carvers are used to carve anatomy into the

amalgam.6. A burnisher is used to smooth the

amalgam.7. The new restorations occlusion is checked.

Direct Application of AmalgamDirect Application of Amalgam


Becoming the most widely accepted material of choice by dentists and patients because of their esthetic qualities and new advances in their strength (Figure 43-13).

Becoming the most widely accepted material of choice by dentists and patients because of their esthetic qualities and new advances in their strength (Figure 43-13).

Composite ResinsComposite Resins


Fig. 43-13 Resins supplied in a syringe.Fig. 43-13 Resins supplied in a syringe.


Withstand the environments of the oral cavity.

Be easily shaped to the anatomy of a tooth.

Match the natural tooth color. Be bonded directly to the tooth surface.

Withstand the environments of the oral cavity.

Be easily shaped to the anatomy of a tooth.

Match the natural tooth color. Be bonded directly to the tooth surface.

Indications for Using Composite ResinsIndications for Using Composite Resins


Resin matrix • Dimethacrylate, referred to as BIS‑GMA

• Monomer used to make synthetic resins

• Polymerization additives • Allow the material to take form

through a chemical process• Initiator• Accelerator• Retarder• Ultraviolet (UV) stabilizers

Resin matrix • Dimethacrylate, referred to as BIS‑GMA

• Monomer used to make synthetic resins

• Polymerization additives • Allow the material to take form

through a chemical process• Initiator• Accelerator• Retarder• Ultraviolet (UV) stabilizers

Chemical Makeup of Composite ResinsChemical Makeup of Composite Resins


Fillers Add the strength and characteristics necessary for use as a restorative material.

Inorganic fillers• Quartz • Glass• Silica• Colorants

Fillers Add the strength and characteristics necessary for use as a restorative material.

Inorganic fillers• Quartz • Glass• Silica• Colorants

Chemical Makeup of Composite Resinscont’dChemical Makeup of Composite Resinscont’d


A coupling agent strengthens the resin by chemically bonding the filler to the resin matrix.• Organosilane compound

A coupling agent strengthens the resin by chemically bonding the filler to the resin matrix.• Organosilane compound

Chemical Makeup of Composite Resinscont’dChemical Makeup of Composite Resinscont’d


Types of CompositesTypes of Composites Macrofilled composites contain the

largest of filler particles, providing greater strength but a duller, rougher surface.

Microfilled composites: The inorganic filler is much smaller and is capable of producing a highly polishee, finished restoration, which is used primarily in anterior restoration.

Hybrid composites contain both macrofill and microfill particles.

Macrofilled composites contain the largest of filler particles, providing greater strength but a duller, rougher surface.

Microfilled composites: The inorganic filler is much smaller and is capable of producing a highly polishee, finished restoration, which is used primarily in anterior restoration.

Hybrid composites contain both macrofill and microfill particles.


The process in which the resin material is changed from a plastic state into a hardened restoration.

The process in which the resin material is changed from a plastic state into a hardened restoration.

Polymerization of Composite ResinsPolymerization of Composite Resins

• Auto-Cured• Light-Cured

• Auto-Cured• Light-Cured


1. Select the shade of the tooth. 2. Express the needed amount of material

onto the treated pad or in the light-protected well.

3. Material placed in increments.4. Material is light-cured.5. Material is finished and polished.

1. Select the shade of the tooth. 2. Express the needed amount of material

onto the treated pad or in the light-protected well.

3. Material placed in increments.4. Material is light-cured.5. Material is finished and polished.

Direct Application of Composite ResinsDirect Application of Composite Resins


1. Reduction of the material is completed by the use of a white stone or a finishing diamond.

2. Fine finishing is completed with carbide finishing burs and diamond burs.

3. Polish with medium discs and finish with the superfine discs.

4. Finishing strips assist in the polishing of the interproximal surfaces.

5. Use polishing paste with a rubber cup.

1. Reduction of the material is completed by the use of a white stone or a finishing diamond.

2. Fine finishing is completed with carbide finishing burs and diamond burs.

3. Polish with medium discs and finish with the superfine discs.

4. Finishing strips assist in the polishing of the interproximal surfaces.

5. Use polishing paste with a rubber cup.

Steps in Finishing a Composite RestorationSteps in Finishing a Composite Restoration


Glass ionomer is a versatile material with chemical properties allowing it to be a restorative material, liner, bonding agent, and permanent cement.

Glass ionomer is a versatile material with chemical properties allowing it to be a restorative material, liner, bonding agent, and permanent cement.

Glass Ionomer Materials Glass Ionomer Materials


Primary teeth. Final restorations in non-stress areas. Intermediate restorations. Core material for a buildups. Long-term temporary restorations.

Primary teeth. Final restorations in non-stress areas. Intermediate restorations. Core material for a buildups. Long-term temporary restorations.

Indications for Using Glass IonomersIndications for Using Glass Ionomers


The ability to chemically bind to the teeth.

No need to prepare the tooth structure as extensively as for preparing for an amalgam or composite resin.

The release of fluoride after its final setting.

The ability to chemically bind to the teeth.

No need to prepare the tooth structure as extensively as for preparing for an amalgam or composite resin.

The release of fluoride after its final setting.

Qualities of Glass IonomersQualities of Glass Ionomers


Glass Ionomer Glass

• Ceramic particles• Glassy matrix

Acrylic acid Tartaric acid Maleic acid Metal-reinforced glass ionomer

• Silver-tin alloy + Glass ionomer

Glass Ionomer Glass

• Ceramic particles• Glassy matrix

Acrylic acid Tartaric acid Maleic acid Metal-reinforced glass ionomer

• Silver-tin alloy + Glass ionomer

Properties of Glass Ionomers Properties of Glass Ionomers


Powder and Liquid: Manually mixed together on a treated paper pad.

Light-Protected Tubes: Dispensed onto a treated paper pad.

Paste/Paste System: Mixed for application.

Premeasured Capsule: Triturated for application.

Powder and Liquid: Manually mixed together on a treated paper pad.

Light-Protected Tubes: Dispensed onto a treated paper pad.

Paste/Paste System: Mixed for application.

Premeasured Capsule: Triturated for application.

Supply of Glass IonomersSupply of Glass Ionomers


Designed to maintain or restore function to a tooth or teeth and keep the patient comfortable for a period of time.

Designed to maintain or restore function to a tooth or teeth and keep the patient comfortable for a period of time.

Temporary Restorative MaterialsTemporary Restorative Materials


Reduce sensitivity and discomfort of a tooth to determine its diagnosis.

Maintain the function and esthetics of a tooth until a permanent restoration can be placed.

Protect the margins of a prepared tooth that will receive a permanent casting at a later time.

Prevent shifting of the adjacent or opposing teeth because of open space.

Reduce sensitivity and discomfort of a tooth to determine its diagnosis.

Maintain the function and esthetics of a tooth until a permanent restoration can be placed.

Protect the margins of a prepared tooth that will receive a permanent casting at a later time.

Prevent shifting of the adjacent or opposing teeth because of open space.

Indications for Using a Temporary Restorative MaterialIndications for Using a Temporary Restorative Material


Composition:• Zinc-Oxide gives strength and

durability.• Eugenol has a sedative effect.

Composition:• Zinc-Oxide gives strength and

durability.• Eugenol has a sedative effect.

Intermediate Restorative Materials (IRM)Intermediate Restorative Materials (IRM)


Restoration of primary teeth Restorative emergencies Caries management program Supply of IRM

• Powder/liquid• Premeasured capsules

Restoration of primary teeth Restorative emergencies Caries management program Supply of IRM

• Powder/liquid• Premeasured capsules

Indications for Using IRM Indications for Using IRM


Restorative material that covers the major portion, if not the entire clinical portion of a tooth or several teeth for a period of time.

Restorative material that covers the major portion, if not the entire clinical portion of a tooth or several teeth for a period of time.

Provisional Restorative MaterialsProvisional Restorative Materials


Auto-cured acrylic (methylmethacrylate) Light-cured resin Process of application

• Material is placed in either an alginate impression or a vacuum-formed tray.

• Material is seated over the prepared tooth and allowed to cure.

• Occlusion is adjusted.• Material is cemented in place with

temporary cement.

Auto-cured acrylic (methylmethacrylate) Light-cured resin Process of application

• Material is placed in either an alginate impression or a vacuum-formed tray.

• Material is seated over the prepared tooth and allowed to cure.

• Occlusion is adjusted.• Material is cemented in place with

temporary cement.

Types of Materials UsedTypes of Materials Used


The process of applying a material on anterior teeth for a prescribed period of time to whiten the color of one’s teeth.

The process of applying a material on anterior teeth for a prescribed period of time to whiten the color of one’s teeth.

Tooth Whitening MaterialsTooth Whitening Materials


Teeth discolored Aging Consumption of staining substances Trauma Tetracycline staining Excessive fluoride Nerve degeneration Old restorations

Teeth discolored Aging Consumption of staining substances Trauma Tetracycline staining Excessive fluoride Nerve degeneration Old restorations

Indications for Using Tooth-WhiteningProducts Indications for Using Tooth-WhiteningProducts


Carbamide Peroxide: When the carbamide peroxide breaks down, oxygen enters the enamel and dentin and bleaches the colored substances.

Concentrations: 10%, 16%, 22%

Carbamide Peroxide: When the carbamide peroxide breaks down, oxygen enters the enamel and dentin and bleaches the colored substances.

Concentrations: 10%, 16%, 22%

Tooth-Whitening ProductsTooth-Whitening Products


Types of dental restorations that dental laboratory technicians create in the dental laboratory.

These restorations are also referred to as castings, cannot be reshaped, and are carved once they are in this stage.

Types of dental restorations that dental laboratory technicians create in the dental laboratory.

These restorations are also referred to as castings, cannot be reshaped, and are carved once they are in this stage.

Indirect RestorationsIndirect Restorations


By combining gold with other metals to form an alloy, it creates the characteristics and hardness required as an excellent choice for an indirect restoration.• Gold• Palladium• Platinum

By combining gold with other metals to form an alloy, it creates the characteristics and hardness required as an excellent choice for an indirect restoration.• Gold• Palladium• Platinum

Gold AlloysGold Alloys


Soft, Type I alloys are used for casting inlays subject to slight stress during mastication.

Medium, Type II alloys can be used for practically all types of cast inlays and possibly posterior bridge abutments.

Hard, Type III alloys are acceptable for inlays, full crowns, three‑quarter crowns, and anterior or posterior bridge abutments.

Extra-hard, Type IV alloys are designed for cast-removable partial dentures.

Soft, Type I alloys are used for casting inlays subject to slight stress during mastication.

Medium, Type II alloys can be used for practically all types of cast inlays and possibly posterior bridge abutments.

Hard, Type III alloys are acceptable for inlays, full crowns, three‑quarter crowns, and anterior or posterior bridge abutments.

Extra-hard, Type IV alloys are designed for cast-removable partial dentures.

Types of Casting AlloysTypes of Casting Alloys


Ceramics are compounds that involve a combination of metallic and nonmetallic elements, creating strength and aesthetics.

Ceramics are compounds that involve a combination of metallic and nonmetallic elements, creating strength and aesthetics.

CeramicsCeramics


Porcelain fused to metal (PFM) Porcelain bonded to metal (PBM) Ceramco-metal restorations Porcelain-metal restorations (P-M)

Porcelain fused to metal (PFM) Porcelain bonded to metal (PBM) Ceramco-metal restorations Porcelain-metal restorations (P-M)

Types of Ceramic RestorationsTypes of Ceramic Restorations


Type of ceramic that is most commonly used in dentistry. It combines strength, translucence and the ability to match the natural tooth color.

Type of ceramic that is most commonly used in dentistry. It combines strength, translucence and the ability to match the natural tooth color.

PorcelainPorcelain


The shading of colors matches the tooth color well.

It esthetically improves the appearance of anterior teeth.

It has the strength of metal. The material is a good insulator. The material has a low coefficient of

thermal expansion.

The shading of colors matches the tooth color well.

It esthetically improves the appearance of anterior teeth.

It has the strength of metal. The material is a good insulator. The material has a low coefficient of

thermal expansion.

Indications for Using PorcelainIndications for Using Porcelain

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