Introduction

I. Class 1 Direct Composite Restoration

Preparation design: Conventional (class I,II,V) in amalgam/90or buttjoint Modified (classV) Bevealed conventional (rarely used)

I. Class 1 Direct Composite Restoration

B. Inverted cone with rounded caries
Provide flat floors Produces a more stronger margin on the occlusal cavosurface Creates preparation walls that converge occlusally Occlusally more conservative facial lingual preparation width

Class II Conventional direct composite

A. Occlusal preparation:
330 or 245 diamond made parallel to the long axis of the tooth. Pulpal depth is 1.5 mm from the central groove (about 0.2mm in dentin); follows the rise and fall of DEJ mesiodistally but relatively flat faciolingually.

Class II Conventional direct composite

B. Proximal Box:
Facial, lingual and gingival extensions dictated by extend of caries or old restoration; may not be extended beyond the contact with the adjacent tooth. Walls at 90, axial wall to 0.2mm in dentin Gingival floor flat with minimal extension Retained by micromechanical retention, no secondary retention necessary.

III. Class VI Composite Restoration

A. Preparation design
The typical class VI tooth preparation should be as small in diameter and as shallow in depth as possible.

B. Flame - shape or round diamond

Either a flame-shaped or round diamond instrument to roughen the prepared surfaces.

Indirect tooth colored Restoration

Indications:
Esthetic Large defects or previous restorations Economic factors

Contraindications:
Heavy occlusal forces Inability to maintain a dry field Deep subgingival preparation

Definition of terms
Indirect:
Inlay
- restoration of metal, porcelain/ceramic or composite made to fit a tapered cavity preparation and luted into it by a cementing medium.

Onlay (overlay)
- an inlay that includes the restoration of all of the cusp of a tooth.

Definition of terms
Taper
-permits an unobstructed removal of the wax pattern and subsequent seating of the material. The wax pattern should be removed from the tooth without distortion.

Taper
Intracoronal
-divergence from the floor of the preparation outwards.

Definition of terms
Extracoronal
- converge from the cervical to the occlusal or incisal surface.
shallow cavities (vertical walls unusually short) Requires minimal taper of 2 occlusal divergence to enhance resistance and retention. deep cavities (increased gingivo-occlusal height of vertical walls) As much as 5 taper to facilitate: Pattern withdrawal, trail seating and cementing of restoration

Types of restorative materials

Laboratory-processed inlays and onlays Ceramic inlays and onlays Machinable ceramics or CAD/CAM Feldspathic porcelain Hot-pressed ceramic

Laboratory-processed inlays and onlays

Polymerized under pressure, vacuum, inert gas, intense light, heat, or a combination of these devices to optimize physical properties of composite resins. More resistant to occlusal wear vs direct composites but less wear resistance than ceramics. Easily adjusted, low wear of opposing teeth good esthetics and has potential for repair.

Laboratory-processed inlays and onlays

Indications:
If maximum resistance is desired from composite restoration. Achievement of proper contour and contacts would be difficult with direct composite. If ceramic restoration is contraindicated because of wear of opposing dentition.

Advantages of heat cured composite inlay/onlay restoration

Improved physical properties/durability and wear resistance compared to direct composite systems. Depth of cure not a problem unlike with direct composite where there is limited depth of cure. Excellent marginal adaptation since the luting composite fills any marginal contraction gap present. Non-extent polymerization shrinkage except in luting resin cement. Post-operative sensitivity seldom encounetered

Ceramic inlays and onlays

Esthetics, durable, improved materials, fabrication techniques, adhesives and non based luting agents.

Fabrication steps for ceramic inlays and onlays

After tooth preparation, an impression is made and a master working cast is poured of die stone. The die is duplicated and poured with a refractory investment capable of withstanding porcelain firing temperatures. The duplication method must result in the master die and the refractory die being accurately interchangable.

Fabrication steps for ceramic inlays and onlays

Porcelain is added into the preparation area of the refractory die and fired in an oven. Multiple increments and firings are necessary to compensate for sintering shrinkage. The ceramic restoration is recovered from the refractory die, cleaned of all investment, and seated on the master die and working cast for final adjustments and finishing.

Feldspathic porcelain
Partially crystalline minerals (feldspar, silica, alumina) dispersed in a glass matrix. Porcelain restorations are made from finely ground ceramic powders that are mixed with distilled water or a special liquid, shaped into the desired form, then fired and fused together to form a translucent material that looks like tooth structure.

Feldspathic porcelain
Some ceramic inlays and onlays are fabricated in the dental laboratory by firing dental porcelains on refractory dies.

Advantage:
Low start-up cost

Disadvantage:
its technique sensitivity

Hot Pressed Glass ceramics

Glass could be modified with nucleating agents and on heat treatment, be changed into ceramics with organized crystalline forms. Such glass ceramics were stronger, had a higher melting point than non crystalline glass, and had variable coefficients of thermal expansion.

Hot Pressed Glass ceramics

Advantages:
Similarity to traditional wax-up processes Excellent marginal fit Relatively high strength The surface hardness and occlusal wear of these ceramics are similar to those of enamel. Stronger than porcelain inlays made on refractory dies, they are still quite fragile until cemented.

Hot Pressed Glass ceramics

Disadvantges:
its translucency, which necessitated external application of all shading. Not significantly stronger than fired feldspathic porcelains they do seem to provide better clinical service.

Chronological Events of Restorative Materials

History
First recommended over 25 years ago for posterior use.

1907 cast gold 1908 silicate cement

First direct tooth colored restorative material. Disadventage:
Insoluble to oral fluid

Chronological Events of Restorative Materials

1950 bonding agents 1955 acid etching by
Micheal J. Buonocore

1960 sealants 1962 composite resin

-direct filled restorative material

Chronological Events of Restorative Materials

1962 composite resin
According to the size of the filler:
Macrofill for class V (problem: abfraction) Microfill anterior restoration Hybrid Microhybrid composite Nanofilled composite

Chronological Events of Restorative Materials

1962 composite resin
Two types of composite:
1. Packable composite
alternative to amalgam Supplied: unit dose, compules or in syringe Higher filler loading Fibers Porous filler particles Irregular filler particles Viscosity modifiers

Chronological Events of Restorative Materials

1962 composite resin
Advantages:
Produce acceptable class II restoration High depth of cure possible Bulk fill technique Filler loading: 80% Medium to high strength High stiffness Low wear rate: 3.5um/year Molecules of elasticity :similar to amalgam

Chronological Events of Restorative Materials

1962 composite resin
Disadvantages:
New technique Less polishable Limited shades Increased post-operative sensitivity Increased sensitivity to ambient light

Chronological Events of Restorative Materials

1962 composite resin
Recommended uses:
Class I restoration Class II restoration

Chronological Events of Restorative Materials

1962 composite resin
2. Flowable composites
Low viscosity composites Low filler content Ideal for cervical lesion Ideal for non stress bearing area Ideal for first increment in Class I composite

Chronological Events of Restorative Materials

1962 composite resin
Advantages:
Syringeable Dispensed directly into cavity Adequate strength

Disadvantages:
Higher polymerization shrinkage Greater potential for microleakage Low wear resistance

Chronological Events of Restorative Materials

1968 Glass ionomer cement Different types: Luting or cementing medium Liner or base Restorative material

Chronological Events of Restorative Materials

1970 microfill polishable composite 1973 ultraviolet light 1977 microfill composite
Advantages: polishability, wear and resistance and color stability Disadvantages: low flexural/tensil strength, localized wear and thus limited uses posteriorly.

Chronological Events of Restorative Materials

1978 visible light curing composite Mid 1980s hybrid:
Hybrid 0.04-3um particle size range
Examples: brands of hybrid Herculite Prisma APH P-30

Chronological Events of Restorative Materials

Mid 1980s hybrid
Intended for universal use

Disadvantage of hybrid:
Generalized wear

Chronological Events of Restorative Materials

Mid 1980s microhybrid:
Microhybrid 0.6-0.7um particle size range
Examples: brands of microhybrid Prisma TPH Herculite XRV Charisma Tetric ceram

Chronological Events of Restorative Materials

Mid 1980s microhybrid:
Advantages:
Excellent physical properties Good finishing and polishing characteristics Relatively non sticky materials

Disadvantage:
Do not hold a high polish over time

Chronological Events of Restorative Materials

1985 CEREC ceramic system
1991 CEREC 1 as modified by siemens 1994 CEREC 2 with an upgrade dimensional camera 2000 CEREC 3 with split acquisition/design

CEREC

Chairside Economical Restoration of Esthetic Ceramiics

Chronological Events of Restorative Materials

1986 Heliomolar
The sole exception to the microfill group of resins that were introduced for posterior use. 70% filled anterior/posterior microfill resin. very good wear characteristic Less than perfect esthetics

Thank you!