- Restorative dentistry necessitates the use of different materials

with different physical properties and limitations.

There is no available restorative material free from weaknesses, -

and there is no ideal all purpose restorative material.

- Proper selection of the material, with respect to it's properties, the

location and extent of the lesion to be restored and the conditions
present in the oral cavity, is a paramount and major factor in the
success and failure of clinical restorations.
Requirements of ideal restorative
materials
1-It should be Indestructible and/or
insoluble in the oral fluids.
-Metallic, ceramic and resinous
restorative materials can resist
solubility in oral fluids.

-Glass ionomer and silicate cement

restorations cannot resist solubility.

-luting cements such as zinc phosphate

or zinc polycarboxylate cements are
relatively soluble in the oral fluids
particularly in acidic media.
2. It should bond chemically with the
surrounding hard tooth tissues, or at least, it
should maintain constant adaptation with
the surrounding cavity walls at the
restoration - tooth structure interface.

-The importance of adhesion or adaptation is

to provide marginal sealing (prevent
microleakage) .
-Thus, post restorative hypersensitivity of dentin ,recurrent
caries, pulp affections and discoloration of both
restorations and tooth structures will be absent.
Glass ionomer restoration and luting
cements bond chemically with the
surrounding tooth structures.

Gold foil provides satisfactory

adaptation with the surrounding
cavity walls.

Adaptation of amalgam, restorations

increased by time due to the presence
of the corrosion products.
-Cast restorations suffer from marginal leakage
due to the solubility of the luting cements.

-Acrylic resin and composite restorations do

not adhere or adapt to the cavity walls due to
their polymerization shrinkage and their
different coefficient of thermal expansions.
-This behaviour encourages marginal
percolation of the irritable materials through
the leakage space

-Loss of adaptation of silicate cement

restorations referred to their solubility,
particularly in acidic media.
3-It should withstand the functional forces
without fracture and it should protect the
surrounding hard tooth structures
from fracture.
-It should have high surface hardness to retain
its smooth shiny surface condition.

-Ceramic and gold restorations fulfil

this property.

-Amalgam restorations suffer from corrosion,

flow and creep.
creep - a slow longitudinal movement or
-Silicate restorations have low strength - deformation
properties and low wear resistance.

-Glass ionomer restorations and -

resinous restorations cannot resist wear.
4-It should maintain its dimensional stability inside the
cavity.
-The restoration should be free from any
volumetric changes after its placement inside the
cavity.

- If it expands it may overhang producing premature

contact, which may fracture due to stress
concentration.
- Also, it may exert pressure on dentin and create
discomfort for the patient (delay expansion of
amalgam)

- On the other hand, contraction or shrinkage of the

restoration inside its cavity may cause marginal
leakage with subsequent troubles.

-Ceramic and gold restorations are stable inside their

cavities.
 -Amalgam restorations may expand due to
either excess mercury or moisture
contamination.
-They may contract inside their cavities
during their hardening.

-Dental composite restorations shrink less

than acrylic resin during their
polymerization.
-Glass ionomer restorations contract
during their setting but they do not
create marginal leakage due to their
chemical bond with the adjacent tooth
tissues.
5-It should be biologically compatible with
the pulp and adjacent soft tissues.

-Normal pulp response to the new

situation as a condition of stimulation ,is
the formation of secondary reparative
dentin.

-Glass ionomer restorations are the best

regarding biologic compatibility.
-This can be attributed to their chemical
bond with the adjacent tooth structures
and to their large molecular size.
-Castable ceramic restorations are
biologically compatible due to their
thermal insulation and their highly
smooth glazed surfaces.

-Zinc phosphate cement may produce

chemical irritation to the pulp when used
as luting cement for ceramic restorations.

-Gold foil cause thermal and/or traumatic

irritation to the pulp. Moreover, it may
lead to chipping or crazing of enamel.
-Large amalgam restoration conducts thermal
shocks to the pulp and its metallic ions may
penetrate the dentinal tubules and gingival
tissues.
Permanent discoloration of both tooth and gingiva
will be the expected

-Pulp irritation after silicate restoration can be

attributed mainly to the phosphoric acid and
arsenic contents of the material.
The irritational affect of acrylic resin is referred to its
monomer contents and to the heat produced during
polymerization.

-Moreover, its Polymerization contraction and high

coefficient of thermal expansion encourage marginal
seepage of oral fluids and bacteria to endanger the pulp.
-Silane content of composite restorations is a source of
affection to the pulp vitality.
Most of the previously mentioned irritation factors can be
controlled by using suitable cavity linear and/or base
material.
6. It should have harmonious color
simulating the affected tooth.
-Porcelain restorations can provide perfect
color matching that of the affected tooth.

They can maintain their color unchanged

because they do not absorb fluids nor
retain any surface deposits.

-Composite restorations are very satisfactory

during their early placement.
However, by time, surface, marginal and
bulk discoloration were observed.
Glass ionomer restorations cannot maintain their
color for long time. Their surfaces change to
the chalky appearance as a result of their
solubility in the oral fluids.

Unfilled resins restorations change their color

faster than filled types. Water sorption,
porosity, and marginal leakage are factors
promoting discoloration of acrylic
restorations.

Solubility of silicate restorations endanger their

color stability due to creation of rough surfaces
which encourage collection of stains and
pigments.

Both gold and amalgam restorations have

poor esthetic due to their metallic colors.
7-It should have reasonable cost.
-Amalgam is relatively cheaper than gold as a
metallic restoration.

-Porcelain restoration is the most expensive

tooth-colored one.
-Composite restoration comes next to ceramic
restoration regarding its price.
-Acrylic resin restoration needs less cost.
-Silicate cement restoration is the cheapest
esthetic type.
-Glass ionomer restoration needs cost similar or
near to that of composite ones.
8. It should be convenient and easy in its
manipulation.

It should be produced easily without detailed

procedures or expensive special equipment.

Amalgam restorations satisfy this property.

Silicate, acrylic and glass ionomer restorations

are easy in their manipulation by the average
operator.

Dental technician participates in the production

of cast gold restorations.
Some participation can be observed in case of
castable ceramics.

Gold foil restorative procedures need skillful

operator.
-The foregoing discussion indicates that none of the
available restorative material is ideal.
-For this reason ,we have to compromise to select the
most suitable material for each particular case.
Factors influencing selection of the suitable restorative
material:
I-Factors concerning the available restorative materials.

II-Factors concerning the patient:

a- Factors related to the general condition of the patient.
b- Factors related to the oral cavity.
c- Factors concerning the tooth to be restored.
d- Factors related to the cavity to be restored.

III-Factors related to the operator

I- Factors concerning the available restorative materials

-The operator should have full knowledge about all available

restorative materials.

-This knowledge should include physical, chemical and biological

properties of each material.

-Furthermore, the operator should master the manipulative

techniques of these materials.

-Any restorative material should be used only where it is

indicated according to its advantages.

-The following is a summary concerning advantages and

disadvantages of the available restoratives
Metallic restorative materials:
Gold foil restoratives
Advantages:
1-They are indestructible in the oral fluids.

2-They have excellent adaptation to cavity walls and

margins.

3-Their coefficient of thermal expansion is very close

to that of the tooth structure.

4-They can restore and maintain tooth anatomy.

5-Their wear resistance is similar to that of the tooth

structure.

6-They can take and maintain surface polish.

7-They are biologically compatible with the

surrounding soft tissues.
8-They can be restored directly in the cavity just after
its preparation in one setting.
Disadvantages:
1. They can conduct thermal changes.
2-Their gold metallic color.
3-Their difficulty of manipulation.
4-They are expensive.
B. Cast gold restoratives:
a. Advantages:
1-They are indestructible in oral fluids. However, the
luting cement is soluble.

2-They can resist tarnish and corrosion.

3-They have high strength properties and can protect

the surrounding cavity margins.

4-They are dimensionally stable after their placement

in their cavities.

5-They have high surface hardness.

6-They need short chair side time.

7-Many teeth can be restored in one setting.

8- Good production of tooth anatomy

b. Disadvantages:
1-They have metallic gold color.

2-They can conduct thermal fluctuations to the pulp

which may cause some irritations.

3-They are less retentive to the cavities because they

depend for their retention on the friction with the
surrounding walls and the interlocks of the luting cement.

4-They are relatively expensive.

C. Amalgam restoratives:
a. Advantages:
1-They have high compressive strength.
2-They have high adaptability to the cavity walls.
3-They are indestructible in the oral fluids..
4-Their convenience of manipulation is easy.
5-They are relatively inexpensive.
6-They have reasonable dimension stability after placement
in their cavities.
creep - a slow longitudinal movement or deformation

b. Disadvantages:
1-They have low tensile and shear strengths.
2-They have objectionable metallic color.
3-They may flow and deform the restorations.
4-They can conduct thermal shocks to the pulps.
5-They can not maintain surface polish
Non- metallic restorative materials
A. Castable ceramic restoratives:
a. Advantages:
1-They are insoluble in the oral fluids but their luting
cement is soluble.

2-They have high compressive strength.

3-They provide excellent biologic compatibility with

the surrounding soft tissues.

4-They have excellent thermal insulating capacity.

5-The restore and maintain excellent esthetic.

6-They have high surface hardness.
7-Their clinical work is convenient.
8-Their coefficient of thermal expansion is very close
to that of the tooth structures.
b. Disadvantages:

1. They need over reduction of hard sound tooth structures.

2-They have poor adaptation with the cavity walls and
margins due to their both shrinkage during
solidification and solubility of the luting cement.

3-They have weak tensile and shear strengths (brittle).

4-Their laboratory fabrication is not easy and needs

skilful technician.
5-They are less retentive inside their cavities.
6-They are relatively expensive specially new types(CAD/CAM).
B. Resin composite restoratives:

Advantages:

1-They are insoluble in the oral fluids.

2-They withstand the oral physiologic forces without

fracture.

3-They provide satisfactory esthetic.

4-They do not conduct thermal or galvanic shocks to

the pulps.
5-They are manipulated easy in short time.

6-They are repairable.

7-They are inexpensive.

8-They can be used by the patient just after their polymerization.

Disadvantages:

1-They have low wear resistance.

2-Their adaptation to the surrounding walls may be
destroyed easy due to their polymerization
contraction and their relative high coefficient of
thermal expansion.

3-They are able for bulk, surface and/or marginal

discolorations .

4-Proximal posterior composite restorations need special skill

during matrix construction for proper adjustment of proximal
contact.
C. Glass ionomer restoratives:
a. Advantages:
1-They have perfect adaptation due to the chemical
bonding with surrounding cavity walls.

2-They are biologically compatible with the pulp.

3-Their coefficient of thermal expansion is very close

to that of the tooth structure.

4-They do not conduct thermal shocks.

5-They are relatively inexpensive.

6-They can be etched with acids.
7-They can be easily manipulated.
8-They do not need massive tooth reduction.
9-They have anti cariogenic properties (fluoride release)
10. They provide satisfactory esthetics when early placed in the
cavities.
Glass ionomer
b. Disadvantages:
1-They suffer from weak tensile and shear strengths.
2-They are relatively soluble in the oral fluids.
3-Their appearance change, to the chalky color after
short period.
4-They have low wear resistance.
D. Resin modified glass ionomer RMGIC:
Advantages:
1-Ease of handling as no mixing is required.
2-Fluoride release. .
3-Exhibit low solubility.
4-Good esthetics.
5-Less susceptible to dehydration.
6-Radioopaque.
7-Adequate bond strengths to tooth structure.

Disadvantages:
1-Expand over time by water sorption.
2-Questionable in stress bearing sites.
3-Low wear resistance.
Temporary restorations:
a. Advantages:

1-They are biologically compatible with the pulp and

surrounding tissues.

2-They provide a condition of rest for the pulp from

the irritational conditions of the lesion and cavity
preparation.

3-They are good thermal insulators.

4-The eugenol content of zinc oxide eugenol cement

has a sedative and palliative effects on the pulp.

5-Calcium hydroxide cement stimulates formation of

secondary dentin.

6-Some layers may be left to serve as a base under

restorations.

7-Ready-made types do not take time for their

manipulations.
Temporary restorations
b. Disadvantages:
1-They are soluble in the oral fluids.
2-Zinc oxide eugenol cement prevent polymerization
of both acrylic resin and composite restorations.
3-Zinc phosphate cement may induce pulp affection.
Factors influencing selection of the suitable restorative
material:
I-Factors concerning the available restorative materials.

II-Factors concerning the patient:

a- Factors related to the general condition of the patient.
b- Factors related to the oral cavity.
c- Factors concerning the tooth to be restored.
d- Factors related to the cavity to be restored.

III-Factors related to the operator

II-Factors related to the patient
A.Factors related to the general condition of the patient:
a. Patient's age:

1-Young patient cannot stand long dental chair-side

work. They cannot follow post-restorative
instructions carefully. They prefer esthetic
restorations wherever indicated.

2-Middle aged patient prefers ideal restorations.

3-Old patient can not withstand long operations on

the dental chair. He prefers strong permanent
restorations.
b-Patient's sex:
I. Male patients prefer strong permanent
restorations.
2. Female patients advocate esthetic.

c-Patient's occupation:
1-Regular patients ask for restorations of reasonable
price. They prefer ideal restoration if possible.

2-Public personalities like esthetic restorations

Those are; politicians, professors and teachers.

3. Few technicians, butchers, fruit sellers,

shoemakers and mechanics advocate gold color in
esthetic areas.
d.Physical condition of the patient:
1-Patients with normal physical fitness can stay on
the dental chair for the required time without
creating any troubles.

2-Debilitated patients cannot tolerate long work on

the dental chair. They prefer cast restorations.

3-Handicapped patients prefer short term

restorations.
e. Educational and social conditions of the patient: .
1.Educated patient advocate the most suitable
restoration according to their satisfaction.

2.Less educated persons prefer esthetic restoratives.

3.Uneducated patients agree with the operator selection for the

suitable restoration

f. Mental condition of the patient:

1.Normal persons can easily be satisfied with the
most suitable restoration according to the
knowledge introduced by the dentist.

2.Psychic patients cannot withstand treatment for

long time and prefer esthetic restorations.
g. Patient's habits:

1.Patients with smoking habit suffer from stains on

rough surfaces in the oral cavity and from acidic
saliva.

2.Alcoholics always suffer from solubility of dental

cements.

3.Persons with bruxism need strong restorations

with high surface hardness.

4. Mouth breathers contraindicate the use of silicate

cement restorations
h. Economic condition of the patient:
1.Wealthy persons select the best restorations
whatever it costs.
2.Ordinary people should be informed about the
expenses before starting the restorative
procedures.
3.Poor patients prefer amalgam in posterior teeth
and silicate cement ones for esthetic restorations
B- Factors related to the condition of the patient ‘s oral cavity

a. Oral hygiene:
1. Patients with good oral hygiene should be instructed
to maintain this condition after restoration of the
tooth defects.

2. Patients with poor oral hygiene should improve and

maintain their mouths clean before the restorative
procedures to decrease the acidity of saliva which may
affect the success of the restoration.
b. Caries incidence:

1.Patients with high caries incidence need full

coverage restorations, otherwise, short-term
regular check up is important to discover any
progress of caries to be treated early.
-It is non advocated to use gold inlay as a restoration of choice.
-Application of caries control programme is mandatory

2.Teeth with rampant caries are better to be treated

with temporary restorations until the condition
subside.
-It is better to use fluoride release restorations
 posterior cross bite

c. Condition of occlusion:
-Normal occlusion has no troubles in the selection
of the suitable restorations.
-Conditions of malocclusion such as anterior or
posterior cross bite, sever overlap, plunger cusp
and tilted teeth need restorations of high strength
properties.
d. Presence of metallic restoration:
l. The present metallic restoration is leading for the
selection of the future metallic restoratives.
2-Presence of different metallic restorations may cause
tarnish and corrosion and/or may cause pain due to
galvanic shocks.
3-Avoid partial replacement of the proximal part of a
fractured old classII amalgam restoration (even if the
remaining occlusal part is perfect) to act against
galvanism.
C- Factors concerning the tooth to be restored:

a. Position of the tooth:

1.Anterior teeth are better to be restored with
esthetic restorative materials such as castable
ceramics, composite, acrylic resin or silicate
cement.

2.Teeth, which may act as abutment for fixed bridge, can be

restored with amalgam or composite restorations.
-However, those which will be used as abutment for removable
partial denture should be restored with cast
gold restoration to facilitate preparation of occlusal rest seat

3. Wisdom teeth are difficult to be isolated by rubber dam

application. It is advisable to restore them with zinc free
amalgam or cast gold restorations.
b. Teeth with slight mobility:
-It is advisable to fix these teeth together with soldered
cast gold restorations
or splint them with reinforced type of composite resin at
their palatal surfaces.
c. Form of the tooth:
1.Hutchinsonian teeth or peg-shaped lateral incisors
should be restored with full coverage esthetic
restorations in the form of resinous or ceramic
crowns.
2.Mulberry molars should be corrected occlusally
with cast gold restorations or even full metallic or
ceramic crowns.
3.Normal teeth should be restored with the suitable
restorative material through their suggested
designs. Mulberry molars
d. Condition of calcification:
-Hypocalcified tooth or teeth with friable
enamel should be restored with strong
restoration to protect their cavity margins.

-These teeth indicate the use of cast gold

restorations and contraindicate application
of gold foil restorative material.
e. Size and condition of the remaining coronal portion:
1.In regular condition the remaining tooth structures
of the crown can confine the restoration.

2.If the remaining coronal portion of a vital tooth cannot confine

the restoration pin retained or bonded type is advisable.

3.Post-retained gold, ceramic, acrylic or composite restoration can

be fabricated in non vital teeth when pin retained restorations
are contraindicated.

4. Post and core restorations can be used in root canal

treated teeth. Post and core restorations
f. Vitality of the pulp:
1. It is advisable to preserve pulp vitality.

2.In deep cavities, apply calcium hydroxide in deep areas to protect

the pulp from thermal, chemical or traumatic irritation of the
restorative material or its technique.

3.Post-retained restorations are indicated in non vital teeth.

4.Teeth with hyperemic pulp should be restored with a suitable

temporary restorative material until the irritational condition
is relieved and then restored permanently with a suitable
restoration
D- Factors related to the cavity to be restored:
a.Size of the cavity:
-Small cavities can be restored with gold foil,
amalgam, composite, acrylic resin, glass ionomer
or silicate cement restorative materials.
-Medium size cavities are better restored with
amalgam, cast gold, composite or glass ionomer
restorations.
3.Large cavities should be restored with cast gold,
ceramics, amalgam or full coverage restorations.
b. Location of the cavity:
1.Occlusal cavities should be restored with metallic
or ceramic restorations to withstand occlusal
loads.
2.Mesial cavities in anterior teeth and premolars
should be restored with esthetic restoratives.
3.Distal cavities of cuspids and bicuspids and
molars can be restored with metallic restorations.
4.Labial cavities should be restored with esthetic
restorative materials.
5.Cervical cavities of anterior teeth should be
restored with composite, acrylic resin, glass ionomer ,or
silicate
cement.
6. Cervical cavities of posterior teeth may be restored
with metallic, composite or glass ionomer
restorations.
7.Subgingival cavities are better to be restored with cast gold
restorations. Silicate cement should not be used to avoid
gingival irritation( composite resin is not indicated because
of difficulty of isolation)
 c. Accessibility to the cavity:
l.Wide mouth opening provides sufficient accessibility.
However, small mouth opening creates difficult in
cavity preparation and restoration.
2. Anterior teeth, premolars and first molars are more
accessible than second and third molars.
Ill- Factors related to the dentist (operator):
1.Dentist should know full informations about population needs.

2.He should have sufficient informations about all

available restorative materials.

3.He should have sufficient skill for manipulation and

handling of all restorative materials .

4.He should provide his patients with sufficient

post restorative instructions.

5-laboratory support is important to provide precise cast with suitable

cost and at the suitable time

6.Succesfull dentist should satisfy his patients.

Questions
-Handicapped and debilitated patients.
A- should receive short chair side time treatments
B-Are considered no significant factors during selection
of restorative material
C-Should receive prolonged chair side time treatments.