1. Restorative Dentistry
Charles Spalding DMD

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

3. 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

4. Caries Transmissible disease- bacteria goes from mother to infant
Xylitol sugar- has anti cavity properties
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

5. Restorations/Fillings
Gold
Amalgam
Composite
Glass ionomer
Compomer
Temporary
Sealants

6. 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

7. Preparation Design
G.V. Black classifications- Direct placement

8. Inlay, Onlay, Crown
Indirect restorations

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

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

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

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

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

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

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

16. 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

17. 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

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

19. Sealants Lightly filled resin applied to fissures in tooth
Preventive measure

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

21. 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

22. 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 ( mm) > PFM (1.5mm) > Zirconia ( mm) > Gold (0.5mm)

24. 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)

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

26. Historical implants
Strock Vitallium (Cobalt, Chromium, Molybdenum)

27. Historical implants
Plate/Blade

28. Historical implants
Sub-periosteal

29. 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.

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

31. 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

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