Operative dentistry 4TH YEAR LECTURES

Lecture 2 WED 8-4-2020

Objective of the Chapter

(1) Types of available restorative materials.

(2) Requirements of ideal restorative materials.

(3) Assessment of restorative material behavior.

(4) Factors influencing selection of the suitable

restorative materials.

Factors related to the condition of the oral cavity

a. Oral hygiene: 1. Patients with good oral hygiene should be instructed to maintain this condition. Any restoration can be used. 2. Patients with poor oral hygiene should improve and maintain their mouths clean before the restorative procedures to decrease the acidity of saliva which may affect the success of the restoration.

Factors related to the condition of the oral cavity

b. Caries incidence: 1. Patients with high caries incidence need full coverage restorations, otherwise, short-term regular check up is imp. to discover any progress of caries to be treated early. 2. Teeth with rampant caries are better to be treated with temporary restorations until the condition subside.

Rampant caries

Factors related to the condition of the oral cavity

c. Condition of occlusion: 1. Normal occlusion has no troubles in the selection of the suitable restorations. 2. Conditions of malocclusion such as cross bite, sever overlap, plunger cusp and tilted teeth need restorations of high strength

Edge to edge Cross bite

Normal occlusion

Factors related to the condition of the oral cavity

d. Presence of metallic restoration: 1. The present metallic restoration is leading for the selection of the future metallic restoratives. Presence of different metallic restorations may cause tarnish and corrosion and/ or may cause pain due to galvanic shocks. 2. Non metallic restoration can be used with any type of metallic restoratives without any side effect.

Amalgam Gold

Factors related to the tooth to be restored

a. Position of the tooth: 1. Anterior teeth restored with esthetic R.M. such as castable ceramics, or resin composite. 2. Smiling teeth restored with esthetic materials few patients prefer gold color. 3. Abutment teeth restored with amalgam or composite restorations. However, those used with removable partial denture should be restored with cast gold restoration. 4. Wisdom teeth restored with zinc free amalgam or cast restorations.

Factors related to the tooth to be restored

b. Form of the tooth: 1. Hutchinson teeth or peg-shaped lateral incisors should be restored with full coverage restorations. 2. Mulberry molars should be corrected occlusally with cast gold restorations or full coverage restorations. 3. Normal teeth should be restored with the suitable restorative material.

Mulberry molar

Hutchinson teeth

Beg shaped lateral

Factors related to the tooth to be restored

d. Condition of calcification: Hypocalcified tooth or teeth with friable enamel should be restored with strong restoration to protect their cavity margins. These teeth indicate the use of cast gold restorations and contraindicate application of gold foil restorative material.

Decalcified anterior teeth Decalcified posterior teeth

Factors related to the tooth to be restored

d. Size and condition of the remaining coronal portion: 1. In regular condition the remaining tooth structures of the crown can confine the restoration. 2. If the remaining coronal portion cannot confine the restoration

Pin retained restoration Large cavity indicated for Post retained restoration

Factors related to the tooth to be restored

e. Vitality of the pulp: 1- Teeth with hyperemia should be restored with a suitable temporary R.M. until the irritational condition is relieved and then

restored permanently with a suitable restoration. 2- In deep cavities, apply base in deep areas to protect the pulp from thermal, chemical or traumatic irritation of the restorative material or its technique. 3- Post-retained restorations are indicated in non vital teeth.

Custom made post

Ready made post

Factors related to the cavity to be restored

a. Size of the cavity: 1. Small cavities can be restored with gold foil, amalgam, composite, or glass ionomer R. M. 2. Medium size cavities are better restored with amalgam, cast gold, composite or glass ionomer R.M.

3. Large cavities should be restored with cast gold, ceramics, amalgam or full coverage restorations.

Factors related to the cavity to be restored

b. Location of the cavity: Anterior teeth:

- Mesial cavities restored with esthetic restoratives. - Distal cavities of cuspids restored with amalgam or R.C. - Cervical cavities restored with resin composite. Posterior teeth:

- Occlusal cavities restored with metallic or esthetic R.M. - Cervical cavities restored with amalgam, R.C. or G.I.

C. Accessibility to the cavity: 1. Wide mouth opening provides sufficient accessibility. However, small mouth opening creates difficult in cavity preparation and restoration. 2. Anterior teeth, premolars and first molars are more accessible than second and third molars.

Factors related to the cavity to be restored

Factors concerning the operator

He should have sufficient information’s about available restorative materials.

He should have sufficient skill for manipulation and handling of restoratives.

He should use the material within its indications. He should provide patient with sufficient post-

restorative instructions. Successful dentist should satisfy his patients.

Selection of a Suitable Restorative Material

Chapter outline:

- Available restorative materials

a) Permanent restorative materials

b) Temporary restorative materials

-Requirements for an ideal restoration

-Assessment of restorative material behavior

-Factors influencing selection of the suitable restorative

material

I- Factors concerning the available restorative

materials

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.

III- Factors related to the operator

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B- Factors related to the condition of the oral cavity:

a. Oral hygiene: 1. Patients with good oral hygiene should instruct to

maintain this condition. Any restorative material

can be used.

2. Patients with poor oral hygiene should improve and

maintain their mouths clean before the restorative

procedures to decrease the acidity of saliva which

may affect the success of the restoration.

b. Caries incidence: 1. Patients with high caries incidence need full

coverage restorations and regular check up to

discover any progress of caries to be treated early.

2. Teeth with rampant caries are better to be treated

with temporary restorations until the condition

subside.

c. Condition of occlusion: 1. Normal occlusion has no troubles in the selection of

the suitable restorations.

2. Conditions of malocclusion such as cross bite,

sever overlap, plunger cusp and tilted teeth need

restorations of high strength properties.

d. Presence of metallic restoration: 1. The present metallic restoration is leading for the

selection of the future metallic restoratives.

Presence of different metallic restorations may

cause tarnish and corrosion and/or may cause pain

due to galvanic shocks.

2. No metallic restoration can be used with any type of

metallic restoratives without any dangerous effect.

C- Factors concerning the tooth to be restored:

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a. Position of the tooth: 1. Anterior teeth are better to be restored with

esthetic restorative materials such as castable

ceramics or resin composite.

2. Teeth that appear during smiling should be

restored with esthetic materials. However, few

patients prefer gold color to appear during smiling.

3. Teeth, which may act as abutment for fixed bridge,

can be restored with amalgam or composite

restorations. However, those which will be used as

abutment for removable partial denture should be

restored with cast gold restoration facilitate

preparation of occlusal rest seat.

4. Wisdom teeth are difficult to be isolated by rubber

dam application. It is advisable to restore them

with zinc free amalgam or cast restorations.

b. Teeth with slight mobility: It is advisable to fix these teeth together with

soldered cast gold restorations.

c. Form of the tooth: 1. Hutchinsonian teeth or peg-shaped lateral incisors

should be restored with full coverage esthetic

restorations in the form of resinous or ceramic crowns.

2. Mulberry molars should be corrected occlusally

with cast gold restorations or even full metallic or

ceramic crowns.

3. Normal teeth should be restored with the suitable

restorative material through their suggested designs.

d. Condition of calcification: Hypocalcified tooth or teeth with friable enamel

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should be restored with strong restoration to protect their

cavity margins. These teeth indicate the use of cast gold

restorations and contraindicate application of gold foil

restorative material.

e. Size and condition of the remaining coronal portion: 1. In regular condition the remaining tooth structures

of the crown can confine the restoration.

2. If the remaining coronal portion cannot confine

the restoration, pin retained type is advisable.

3. Post-retained gold, ceramic, or composite

restoration can be fabricated in non-vital teeth

when pin retained restorations are contraindicated.

4. Post-retained restorations can be used in root canal

treated teeth.

f. Vitality of the pulp: 1. It is advisable to preserve pulp vitality.

2. In deep cavities, apply calcium hydroxide in deep

areas to protect the pulp from thermal, chemical or

traumatic irritation of the restorative material or its

technique.

3. The space of the vital pulp can be used for

retention of the missing coronal portion if

necessary.

4. Post-retained restorations are indicated in non vital

teeth.

5. 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.

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D- Factors related to the cavity to be restored:

a. Size of the cavity: 1. Small cavities can be restored with direct gold,

amalgam, composite, or glass ionomer restorative

materials.

2. Medium size cavities are better restored with

amalgam, cast gold, composite or glass ionomer

restorations.

3. Large cavities should be restored with cast gold,

ceramics, amalgam or full coverage restorations.

b. Location of the cavity: 1. Occlusal cavities should be restored with metallic

or ceramic restorations to withstand occlusal loads.

2. Mesial cavities in anterior teeth and premolars

should be restored with esthetic restoratives.

3. Distal cavities of cuspids and bicuspids and molars

can be restored with metallic restorations.

4. Labial cavities should be restored with esthetic

restorative materials.

5. Cervical cavities of anterior teeth should be

restored with resin composite.

6. Cervical cavities of posterior teeth may be restored

with metallic, composite or glass ionomer

restorations.

7. Sub-gingival cavities are better to be restored with

cast gold restorations.

C. Accessibility to the cavity: 1. Wide mouth opening provides sufficient

accessibility. However, small mouth opening

creates difficult in cavity preparation and

restoration.

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2. Anterior teeth, premolars and first molars are more

accessible than second and third molars.

III- Factors related to the dentist (operator):

a. Dentist should know full information’s about

population needs.

b. He should have sufficient information’s about available restorative materials.

c. He should have sufficient skill for manipulation

and handling of restoratives.

d. He should use the material within its indications.

e. He should provide his patients with sufficient

post-restorative instructions.

f. Successful dentist should satisfy his patients'

needs.