Restorative Dentistry Charles Spalding DMD charlesspaldingdmd@gmail.com 907-272-6288

Reasons to Restore Restore Form and Function Loss of tooth due to Decay/Caries Loss of tooth due to Trauma/Fracture Aesthetic improvement

Caries/Decay Transmissible disease caused by bacteria Streptococcus mutans is a key player Plaque is a biofilm that consists of salivary protein and bacterial colonies Bacteria produce Lactic acid as a byproduct of fermentation of carbohydrates Acid demineralizes enamel and bacteria enter the tooth

Caries Transmissible disease- bacteria goes from mother to infant Xylitol sugar- has anti cavity properties www.drjohns.com Mentos Pure gum, Ice Cubes gum Risk for caries is determined by amount of time the plaque (bacteria) spend on the teeth and the amount of time carbohydrates are present in the mouth

Restorations/Fillings Gold Amalgam Composite Glass ionomer Compomer Temporary Sealants

Direct vs. Indirect Direct restorations- placed directly in the mouth the same day as the tooth was drilled. Advantage- time, cost Disadvantage- shrinkage or expansion Indirect- fabricated in a lab and placed in the mouth at a later date. Advantage- lack of shrinkage Disadvantage- time, cost

Preparation Design G.V. Black classifications- Direct placement

Inlay, Onlay, Crown Indirect restorations

Gold One of the oldest restorative materials “The gold standard” Gold Foil- Direct placement Inlay Onlay Crown

Amalgam Mixture of Mercury, Silver, Tin, Copper Now comes in pre-packaged units for mechanized mixing (no chance of spills)

Matrix system Used to contain material and provide shape to the restoration Toffelmire- for Amalgam Sectional matrix- for composite

Matrix System Toffelmire doesn’t give good profile for composite (traps food)

Composite Quartz like granules (Silica) or Zirconia 4-20nm particle size ~85% filler 15% Resin Binder- Bis-GMA acrylic Photo initiator (starts polymerization reaction)

Bonding Agents Currently 7 Generations Gen 4-7 are currently used

Bonding Enamel bond strength is greater than Dentin bond strength in complete etch. Self etching adhesives show higher dentin bond strength than enamel bond

Glass Ionomer Silica and Alumina mixed with Polyacrylic acid Benefits- Fluoride releasing, less technique sensitive, very biocompatable, good bonding Drawbacks- not as aesthetic, less resistant to wear Ideal for children, high caries risk adults Also used a cement for crowns

Compomer/Resin Modified GI Not commonly used for restorations Mixture of Glass Ionomer and resin composite Drawbacks of each material were more noticeable than the benefits of each material RMGI cements- commonly used

Temporary Restorations Zinc Oxide & Euganol Acid/Base reaction Very soft material- not suitable for long term use

Sealants Lightly filled resin applied to fissures in tooth Preventive measure

Crowns and Bridges Crowns can be gold, porcelain, or a combination Crowns encase teeth to prevent future fracture Bridges replace missing teeth

Materials Gold- alloy of gold, silver, palladium, copper PFM- porcelain fused to metal (gold alloy, less gold) All porcelain- Lithium disilicate, zirconia PFZ- porcelain fused to zirconia Choosing a crown is based on: aesthetics, strength, material thickness Monolithic- single piece, non laminated. Gold, emax, zirconia. Less risk of fracture

Aesthetics vs Strength vs Thickness Translucency/Light Transmission Lithium Disilicate (Emax) > PFM > Zirconia > Gold Strength Zirconia > Emax > PFM (Gold can’t fracture) Material Thickness Emax (1.5-2.0mm) > PFM (1.5mm) > Zirconia (0.5-1.0mm) > Gold (0.5mm)

Bridge Design Root surface area of supporting teeth > root surface area of teeth to be replaced Tooth-Tooth Implant-implant Can not bridge from tooth to implant Maryland Bridge (just glued to the tongue side)

Implants Plate/Blade form implant Sub-periosteal implant Root form implant (used today) First implant was Vitallium Titanium (most common) Zirconia

Historical implants Strock 1937- Vitallium (Cobalt, Chromium, Molybdenum)

Historical implants Plate/Blade

Historical implants Sub-periosteal

Root Form Implants Titanium alloy- osteointegrates Zirconia- white “ceramic” that osteointegrates Strict minimum amounts of bone needed Zirconia implants received FDA approval ~2011 and do not have as much data as traditional titanium. They have been used in Europe for about 10 years now and are showing good results.

Implant Restorations Single tooth Bridge Full arch “all on four”

Screw vs Cement Retained Screw retained Advantage- easily removed for inspection/cleaning Disadvantage- less aesthetic, access hole/angle Cement retained Advantage- more aesthetic Disadvantage- excess cement can cause implant loss

Removable prosthesis Full Denture- acrylic base Partial Denture- metal base or flexible base Implant supported/retained- generally 2-4 implants