University of Science & Technology

Department of Operative Dentistry

Republic Of Yemen

Failure of

Dental Restoration
 Objective :

o Definition
o General Causes of Failure
o Failure of Dental Amalgam
o Failure of Dental Composite
o Conclusion
 Definition :

It is Inability or inadequacy of
a dental restoration or prosthesis
to perform as expected.
 What is Success ?

The criteria of success of a dental restoration

include :
 Restoration remains integral and in place.
 Absence of recurrent Caries.
 Marginal accuracy and adaptation.
 Perfect aesthetics.
 Maintain perfect anatomy and relations with
neighboring and opposing teeth and periodontal
Structures.
 Patient comfort and satisfaction.
 General Causes of Failure :

Causes of failure can be listed as either

inherent factors or induced factors :

1- Inherent Factors
 Tough conditions in the oral cavity:
 Different Types of Stress.
 Temperature fluctuations.
 PH Cycling.
 Humidity.
 Micro-organisms.
 Shelters and stagnation areas
 General Causes of Failure :

2- Induced Factors
 Misjudgment in selecting the correct
restorative material.
 Incorrect design of cavity preparation
 Imperfect manipulation of the restoration.
Failure of

Dental Amalgam
 Failures of dental amalgam :

 Usually amalgams lasts for about 10 years

 “Clinical failure is the point at which the
restoration is no longer serviceable or at
which time restoration posses other severe
risk if it is not replaced”
 Failures in amalgam restoration are not
usually because of poor material

 Everything done from time of cavity

preparation until restoration is polished
has a definite affect on the restoration
Amalgam failures can be :

At visual level

Secondary caries

Marginal fracture

Bulk fracture

Tooth fracture

Dimensional change
 Causes of amalgam failures :

Failures due to faulty case selection

Failures due to faulty cavity preparation

Failure due to poor matrix adaptation

Failures due to faulty amalgam manipulation

 Causes of amalgam failures :

1
Failures due to faulty case selection

 Extensive occlusal caries

 Wide open contacts
 Dissimilar metals
 Causes of amalgam failures :

2
Due to faulty cavity preparation

 Greatest single factor for failure

 Healey & philips (1949)
* 56% - cavity
* 42% - manipulation
 Faulty cavity preparation  recurrance of
caries and fracture
 Causes of amalgam failures :

During cavity preparation the failure occuar at various step :

A-Inadequate occlusal extension :

inadequate extension to pits and fissure increase
chance of caries recurrence particularly in high caries
risk individuals

B-Inadequate extension of proximal box :

If inadequately extended into embrasures, they are
not amenable to brushing and cleaning by mastication
 secondary caries.
 Causes of amalgam failures :

C-Overextension of cavity preparation walls :

 Ideal faciolingual width of cavity is ¼ of intercuspal
distance
 If the width is more than ½ ,capping should be considered
 If width more than 2/3, capping is a must
 Chance of fracture because restoration act as wedge and
tend to split opposing cusps apart
 During capping there should be an amalgam thickness of
2mm on functional and 1.5mm over non-functional cusps
 Causes of amalgam failures :

D-Amalgam cavity should have minimum depth :

of 1.5mm to provide it bulk and hence resistance to
fracture
 

E-If pulpal floor is not flat :

Restoration produces wedging effect  fracture of tooth

F-Cavosurface angle  butt joint

If acute  tooth fracture
If obtuse  collapse of marginal amalgam
 Causes of amalgam failures :

G-inadequate proximal retention form / narrow isthmus

fracture at isthmus portion
 

H-extensive mesio-distal extension

undermining of marginal ridge enamel  fracture
 

I-incomplete removal of carious tooth material

failure of amalgam restoration
 Causes of amalgam failures :

3
DUE TO POOR MATRIX ADAPTATION

 Proper contacts and contour in restoration obtained

by matrix
 Instability of matrix  distorted restoration,gross
marginal excess and uncondensed soft amalgam
with voids
 Cervical excess can result in periodontal irritation
destruction of periodontium
 Causes of amalgam failures :

4
DUE TO FAULTY AMALGAM MANIPULATION

1- Mercury alloy ratio :

 if residual mercury is in excess of 55% loss of
strength
 Under trituration  soft powdery non- coherent mix
 Over trituration  break already formed matrix
 Causes of amalgam failures :

2- Condensation :
 to ensure amalgam reach all parts of the preparation
and obtain homogenous restoration devoid of voids
 Larger cavities  multiple mix should be used to get
homogenous restoration
 Small increments should be used to ensure proper
condensation
 Mechanical condenser should be used with caution
as it would cause fracture of enamel margins
 Causes of amalgam failures :

3- Contamination :
 Moisture contamination can occur during
- trituration
- condensation
 It result in marginal flaws, tarnish, pitting, corrosion.
Expansion may also lead to pain
 Causes of amalgam failures :

4- Finishing and polishing :

 Amalgam should be finished gently
 Excess spur like overhangs or thin flakes of amalgam
on margins can fracture easily which can leave crevices
in vulnerable areas
 Polishing should be done wisely, temperature above 65
0c leads to release of mercury leading to deffective
restoration
 Repairing of amalgam restoration :

 Appropriate depth and retention form must be

generated
 If necessary, another matrix must be placed
 A new mix of amalgam can be condensed directly into
the defect and will adhere to the amalgam already
present
 If the amalgam has been bonded, carefully condition and
apply adhesive to the exposed tooth structure in the
preparation
Failure of

Dental composite
 Causes of composite failures :

1. Incomplete removal of carious lesion

2. incomplete etching or incomplete removal of residual acid from
tooth surface
3. Excess or deficient application of bonding agent .
4. Lack of moisture control .
5. Contamination of composite with finger / saliva .
6. following bulk placement technique during polymerization of
composite .
7. Improper polymerization method .
8. Incomplete finishing and polishing of composite .
9. Inadequate occlusion of restored tooth .
 Causes of composite failures :
Following failures are commonly seen in composite
restoration with time :
Discoloratin

Accumulation Secondary
of plaque caries

Loss of Gross
fracture of
contact restoration

Fracture of Postoperate
margins sensitivity
 Marginal defect in composite restorations :

Marginal defect in composite restorations can be occur

in the following forms :

1 Surface fracture of excess material

2 Voids in restoration because of air

entrapment during placement

3 Composite wear resulting in progressive

exposure of axially directed wall

4 Gaps formation
 Guideline to minimize composite failure :

1. The tooth preparation should be kept as small as possible since

composite in bulk lead to failure .
2. Avoid sharp internal line angles ,which increase stress
concentration.
3. Deeper preparation should be given base of CA(OH) or GI cement.
4. Strict isolation is to be followed.
5. Avoid inadequate curing ,since it lead hydrolytic breakdown of
composite.
6. Use small increments, holding each increment with Teflon coated
instruments.
7. Fill proximal box separately and create proper contact areas .
8. Composite ,especially at beveled areas ,should be finished and
polished properly.
 Repairing composite restorations :

Restoration is indicated for replacement when

any of following occurs :
 Secondary caries which cannot be removed during repair
procedure.
 Need for aesthetics.
 Presence of pulpal pathology
 Repairing composite restorations :

If a patient presents with a composite

restoration that has a localized defect

• Easily accessible areas may be

roughened with a diamond stone
• the area is etched; primer may be
applied if dentin is exposed
• adhesive is applied
• finally the composite is inserted,
contoured, and polished
 Repairing composite restorations :

If the defect is not easily accessible

• a tooth preparation must be

created that exposes the defective
area and a matrix may be
necessary
• placement of the etchant, primer,
adhesive
• composite is then performed
 Repairing composite restorations :

If a void is detected

• more composite can be added directly to the

void area. These materials will bond because
the void area has an oxygen-inhibited
surface layer that permits composite
additions.
• If, however, any contouring has occurred, the
oxygen-inhibited layer may be removed or
altered and the area must be re-etched and
adhesive placed before adding more
composite.
 Conclusion :

1. The criteria of success of a dental restoration include

many factor
2. Causes of failure can be listed as either
3. inherent factors or induced factors
4. Failures in amalgam restoration are not usually
because of poor material
5. During cavity preparation the failure occuar at
various step
6. The tooth preparation should be kept as small as
possible since composite in bulk lead to failure
7. Composite ,especially at beveled areas ,should be
finished and polished properly.