Restorative Materials

Introduction: There is a continuous development in dentistry originating from changing professional perception, demands of the patient and progress in industrial possibilities. Dentistry can be characterized by a move away from metal toward non- metal restorations. For direct restorations, three different materials are used: Amalgam, Resin-based composite, and Glass- ionomer cements.

AMALGAM: It is the most favoured restorative material in dentistry, Since the time of its used by G.V. Black, The first commercial product was (True Dentalloy) manufactured in 1900. Amalgam non aesthetic appearance, its inability to bond tooth, incapability to release fluoride and regarding the presence and possible harmful effects of mercury has prompted researchers to find other modifications.

Gallium

was suggested as early as 1928 in Germany, and its first commercial alloy, Gallium Alloy GF was introduce in Tokyo. Where gallium, indium and tin replaced mercury and a spherical alloy powder similar in composition to that used for amalgam restorations was employed. A spherical, high- copper alloy powder (Galloy) was later introduced. Gallium alloy has proved to be extremely inconvenient due to adherence to the walls of the mixing capsule and instruments. This led to the development of Galloy special capsules for mixing and delivery and condensers for packing. Also it has been suggested that excessive expansion of a setting gallium alloy can produce stress sufficient to crack the tooth. Also when Gallium used in primary molars of the children observed discoloration, tarnish or surface roughening leading to poor esthetic and food accumulation.

Bonded Amalgam: Two types of bond used with amalgam. 1-Superbond which was based on 4-META monomer. 2-Panavia based on MDP monomer. The bond strength is up to 9.7 MPa on etched enamel and 3.2 MPa on dentine have been reported. The microleakage was also found to be inhibited particularly on etched enamel margins. Lately many more products with bond strength between 12-15MPa have been introduce such as Amalgambond plus.

Fluoridated Amalgam: This type of amalgam also tried, Although an initial increase of up to 10-20 fold in the fluoride content of whole saliva has been observed, but this type of amalgam showed a limited clinical success.

Consolidated Silver alloy system: This type of material was developed at the national institute of standards and technology, which use a fluorobic acid solution to keep0 the surface of the silver alloy particles clean and Ag-coated Ag-Sn particles that can be self welded into a prepared cavity in a manner similar to that for placing compacted gold. Due to the problem of strain hardening on insertion it is difficult to compact it without using excessive force to avoid internal voids.

GLASS IONOMER CEMENTS Metal modified Glass Ionomers: This type has been in effect since it developed in 1983 by Simmons by the addition of silver amalgam powder to the glass of conventional Glass Ionomer cement.

A further combined the glass powder with elemental silver by sintering to produce the glass cement. These materials have marginally improved the mechanical properties of Glass Ionomer cement but at the same time their unesthetic appearance and reduce fluoride release have limited their use to core building. Quick setting Glass Ionomer Cement: It was introduce to overcome the problem of early moisture sensitivity, with the decrease of calcium content this material has been developed. This limits the production of calcium polyalkaline chains which are highly water soluble and allow maturation of the material in 120 seconds but on the other hand this will compromises the translucency. Commercially it is available as GC EXTRA. Resin modified Glass ionomer system: Base / liner, was introduced in the late 1980s.the curing process initiated by light or chemical ways, the glass ionomer hardening reaction continues, should be protected from moisture, this will decrease initial hardening time and handling difficulties and substantially increase wear resistance and physical strength of the cement making it particularly useful in pediatric dentistry. The addition of resin introduce drawbacks such as setting shrinkage and limited depth of cure.It is marketed as disposable capsules, bottles.

Highly Viscous conventional Glass Ionomer Cement: Offer higher viscosity as a result of the addition of polyacrylic acid to the powder and finer grain size distribution. The high compressive strength and rapid setting gives a distinct advantage over the conventional Glass Ionomer cement particularly for a traumatic restorative technique.

Fiber Reinforced Glass Ionomer Cement: Which has high tensile strength and flexural strength 1.8 and 4.5 times respectively compared to conventional Glass Ionomer cement.

But clinical characteristics of the material have been compromised due to difficulty in mixing and a lack of bonding between fiber and matrix leading to decrease abrasion resistance. A Nano-Ionomer: Developed in 2007 is supplied as a double-capsule containing two paste. The addition of nanofillers allow for high polish, enhanced tooth shade-matching potential and better physical properties. It has been recommended for primary teeth restoration, repair of all permanent teeth, relatively confined Class I,II and V tooth repair, and core build up.

Compomer: Essentially polymer-based composites in which the filler is a glass similar to the aluminofluorosilicate glass used for Glass ionomer cements. The dehydrated polyalkenoic acid incorporated absorbs water from the saliva and a limited degree of acid base reaction release small quantities of fluoride. Although the fluoride release of compomers is far less than resin modified glass ionomer cement, the mechanical properties are superior to resin modified glass ionomer cement and conventional glass ionomer cement. There putty consistency allow for easy handling compared to the sticky consistency of resin modified glass ionomer cement, offer by Ivoclar, 3M Companies.

COMPOSITE; The magnitude of advancement in composite cannot reach by any other restorative material. The excellent esthetics combined with tooth adhesion and fine mechanical properties has made composite to become the material of choice for many clinician and patient. Addition of a higher percentage of irregular filler allows for reduction of the resin content and an increase in viscosity, thus facilitating easy packing of the material.

Packable, Condensable: Exhibite minimal polymerization shrinkage, bulk placement up to 5 mm and decreased adherence to the condensing instrument. The bulk placement technique has certain disadvantages such as the uncured resin at the base of the restoration or gaps at the composite-tooth interface resulting from polymerization shrinkage, which further lead to microleakage , pulpal sensitivity, staining and recurrent caries. Packable composite also display inferior esthetic and poor surface finish.

Flowable composite: This type of composite provided the practitioner an opportunity to place composite in difficult areas and employ composite as liners and sealants. The reduced filler content decrease the viscosity of the mixture and allows complete wetting of all areas of the cavity. This on the other hand also leads to decrease radio opacity and hence it has been suggested that their use be avoided in Class II restorations to prevent confusion in determination of recurrent caries. Their clinical application is also restricted by high coefficient of thermal expansion, surface wear and roughness and inferior physical properties, though the microleakage of flowable composite is less than injectable resin-modified glass ionomer and compomer.

Giomer: Composite containing pre-reacted Glass ionomer filler, where in fluoroaluminosilicate glass is reacted with acid in water prior to inclusion into silica-filled resin. This material combine the esthetics and resistance to wear of composite with fluoride release. Although the success of the fluoride release has been controversial with some studies indicating that they are not as effective as compomers and conventional Glass ionomer cement, and others indicating higher initial fluoride release compared to compomer and fluoride containing composite.

Ormocer: It was developed in 1998 , related to organically modified ceramic technology, containing inorganic-organic copolymers in addition to the inorganic silanated filler particles. These materials cures without leaving a residual monomer and demonstrates a minor contraction of polymerization and reduction of microleakage. It has multiple application in the field of dentistry such as direct restoration for all types of cavities , cosmetic veneers, orthodontic bonding adhesive, sealant. Ion releasing composite (Smart composite): It works based on the newly developed alkaline glass filler that permit the release of fluoride, hudroxyl and calcium ions when PH falls. This allow the composite to resist demineralization , promote remineralization and inhibit bacterial growth. Good adaptation to the cavosurface margin has been demonstrated but the surface of the filling must be carefully polished to prevent surface roughness. These materials have demonstrated a decreased depth of cure, unsatisfactory esthetic and a fluoride release lesser than conventional Glass ionomer cement. Due to their ease of application their use has been suggested in the treatment of less cooperative children. Anti bacterial composite: By the addition of 5 % Novaron and 0.4-0.5% Dodecyl-pyridinium bromide, it has been found to be effective in inhibiting the progression of root caries through combination of its antimicrobial activity and sealing of the demineralized dentin, but its addition compromised the color stability causing rapid discoloration.