RESTORATIVE

DENTISTRY
Lesson objectives
➢ Different types of restorations
➢ Temporary and permanent materials and
cements
➢ Classification of cavities
➢ Moisture control equipment
➢ Endodontic procedures
Restorative dentistry

▪ The aim of restorative dentistry is to restore and repair the tooth.

▪ Teeth can be affected by dental caries, fractures, trauma.

Types of restorations: permanent and temporary

• Permanent restorations → composite, amalgam, glass ionomer*
• Temporary restorations → zinc oxide and eugenol cement; zinc
phosphate cement; zinc polycarboxylate cement
 Black’s classification of cavities
Class 1 Class 2 Class 3 Class 4 Class 5

→ 1 surface (occlusal, → at least 2 surfaces → mesial or distal surface → Interproximal surfaces → cervical margin of any
buccal, or lingual) → Involves the of an incisor or canine of incisors and canine + tooth
Mainly for occlusal interproximal surface (interproximal surfaces) incisal edge
surfaces and pits → Molars and premolars
→ Any tooth
 IMPORTANCE OF MOISTURE CONTROL

• Moisture (blood, saliva, water sprays)

The role:
• Some filling materials are very moisture-sensitive and won’t set properly
• To protect patient’s airway and to make sure the patient feels comfortable
• To give the dentist a good visibility
• To allow adhesion of cements
• To avoid irritation (such as caused by the acid etch or sodium hypochlorite)
Moisture control - Rubber dam

▪ Best method of moisture control (especially for

endodontic treatment)
▪ Completely isolates one or more teeth from
saliva and bacteria – keeps them dry and safe
from contamination
▪ Offers better visibility to the operator
▪ Patient cannot swallow any instruments or
materials
 Air turbine handpieces cut very easily through enamel and dentine
Equipment- handpieces Slow handpieces can only remove dentine.
 Cavity liners and bases

Liner – thin layer in shallow cavities

Calcium hydroxide
❖ Non-irritant to the pulp
❖ Promotes the formation of secondary dentine
❖ Contains calcium and promotes remineralisation of the tooth tissue
❖ Best lining material for non-metallic fillings

Base - thick layer in deeper cavities – e.g. glass ionomer

 Temporary cements

▪ Can be used for temporary fillings, luting cement,

liners, bases, dressings etc.
 Temporary cements

Zinc oxide eugenol Zinc phosphate Zinc polycarboxylate

Can be used for/as:
1. Temporary filling
2. Sedative dressing
3. Base or liner
4. Sedative dressing for dry sockets
5. periodontal packs
6. root filling material
7. impression pastes
Can be used for/as: Can be used for/as:
1. Temporary filling
2. Cavity base 1. Temporary filling
3. Luting cement 2. Cavity base
3. Luting cement
o It is irritant to the pulp so it is not
used as a liner in deep cavities ➢ It is difficult to manipulate as very
sticky on the spatula, instruments

Cannot be used for/as:

• Under composite material (not
compatible)
• As a luting cement
 Permanent restorations

➢ Plastic fillings (soft on insertion, set/harden after)

These are materials that are used to permanently restore the tooth to its full
function and appearance.

The most common used materials are:

• Amalgam
• Composite
• Glass Ionomer
Inlays

Dental inlays are a type of dental restoration used to repair

and restore a damaged or decayed tooth.
They are a conservative alternative to dental crowns and are
often used when the damage to the tooth is too extensive for
a simple filling but not severe enough to require a crown.
Inlays are typically made of materials like porcelain,
composite resin, or gold.
Constructed in the laboratory (outside of the oral cavity)
The retention is offered by the luting cement (used to glue
them into place)
 Retention of fillings

Composite (relies on chemical retention)

• acid etch provides a rough surface to allow mechanical locking of
the material into the prisms

Amalgam
• Needs undercuts (relies on mechanical retention)

• Undercuts are tiny grooves created in the cavity walls to make the
entrance smaller than its side dimensions. As the materials are
initially soft, they can be packed into the cavity easily to fill all the
available space but cannot drop out of the cavity once set because
they have hardened and locked into position.
 Amalgam

▪ It is the oldest and most used material for restoring

posterior teeth.
▪ It is made of various metal powders which are
mixed with liquid mercury.
▪ It comes under pre-made capsules
▪ As amalgam is non-adhesive plastic filling material
and a good thermal conductor, cavities are made
retentive and lined to insulate the pulp against
thermal injury.
 Composite

❖ Tooth-coloured restorative material made of glass particles and resin

❖ They require a longer appointment as they are moisture sensitive and

need to be set layer by layer

❖ Acid etch must be used carefully → it contains 33% phosphoric acid

and may cause burns to the soft tissues and permanent scaring

❖ The blue light can cause damage to the retina if looked at it directly.

Microfine composites – give superior polishing and gloss finish for anterior
restorations
Hybrid and nano composites – give higher strength and better wear
resistance for posterior restorations
Universal composites – combination of microfine and hybrids, to be used for
both anterior and posterior restorations.
 Glass ionomer

Can be used as:

1. temporary filling in adult teeth
2. permanent filling on baby teeth
3. fissure sealants
4. luting cement
5. cavity liner or base (non irritant to the pulp)

Main advantages – releases fluoride, non-irritant in deep cavities

Disadvantages- not very aesthetic, wears away due to chewing forces
and not ideal for the back teeth
ENDODONTICS
 Endodontics
• Endodontics – the branch of dentistry concerned with diseases and injuries of
the soft tissues inside a tooth (the dental pulp)

When is it needed?
• The pulp is affected by deep unrestorable caries, trauma, thermal injury, chemical
injury or irritation and accidental pulp exposure.

• Non-surgical endodontics (pulpectomy, pulpotomy, pulp capping, open apex root

filling)
• Surgical endodontics (apicectomy)
 Reversible and Irreversible pulpitis

Reversible Pulpitis – refers to instances where the inflammation of the pulp is mild, and the tooth pulp
remains healthy enough to be saved.

Irreversible pulpitis – With irreversible pulpitis, the pulp is no longer able to heal itself. Irreversible pulpitis
may lead to a type of infection called periapical abscess.
 Pulpectomy- root canal treatment

▪ Done when the tooth suffers irreversible pulpitis.

▪ Used to save a fully formed permanent tooth
▪ Involves removal of all pulpal tissue from pulp chamber
and root canal(s) and insertion of a sterile root filling
material.
▪ The aim is to save the tooth from extraction
Instruments and materials used

• Rubber dam
• Barbed broach to extirpate the nerve
• Endodontic files – to gradually
enlarge the canals
• Irrigation with sodium hypochlorite or
chlorhexidine- to disinfect the root canals
• Periapical radiograph or Apex Locator
• Paper points
• Antiseptic dressing
• Gutta Percha
• Sealant cement
Pulpotomy

◊ Used for deciduous or permanent teeth

(children)

◊ The procedure involves removing of the

infected part of the pulp from the crown
part only.

◊ The root is still growing and is not completed

until up to 3 years after eruption → wide
open apex

◊ Calcium hydroxide material is very important

as it will stimulate the formation of
secondary dentine
 Open apex root filling

▪ If pulpotomy is not successful and the tooth becomes

non-vital, the dead pulp must be removed from the
canals.
▪ The canals are filled with special non setting calcium
hydroxide paste
▪ The tooth is monitored and when apex of tooth is fully
formed , the calcium hydroxide is removed and
replaced with conventional root filling. (can take up to
6 months)
 Pulp capping

➢ Done when there is a small and unexpected pulp exposure

due to restorative treatment or after a trauma.
➢ The aim is to seal the exposed pulp from the oral cavity
➢ Carried out on both deciduous and permanent teeth.
➢ Calcium hydroxide
➢ Pin-point pulp exposure
Surgical endodontics-
Apicectomy

❖ Aim→ removal of an infected apex of a

tooth and its surrounded infected tissue.
❖ The purpose of apicectomy is to save the
tooth in cases where root filling is either
unsuccessful or impossible.
Levison’s textbook: chapter 15
Q&A book: chapter 10