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Conservative Dentistry

Recent Advances in Restorative Dentistry

Restorative dentistry has seen significant advancements in materials and techniques that enhance the effectiveness, efficiency, and aesthetic outcomes of dental treatments. Below are some of the notable recent innovations in restorative dentistry:

1. Teric Evoflow

A. Description

  • Type: Nano-optimized flow composite.
  • Characteristics:
    • Optimum Surface Affinity: Designed to adhere well to tooth surfaces.
    • Penetration: Capable of penetrating into areas that are difficult to reach, making it ideal for various restorative applications.

B. Applications

  • Class V Restorations: Particularly suitable for Class V cavities, which are often challenging due to their location and shape.
  • Extended Fissure Sealing: Effective for sealing deep fissures in teeth to prevent caries.
  • Adhesive Cementation Techniques: Can be used as an initial layer under medium-viscosity composites, enhancing the overall bonding and restoration process.

2. GO

A. Description

  • Type: Super quick adhesive.
  • Characteristics:
    • Time Efficiency: Designed to save valuable chair time during dental procedures.
    • Ease of Use: Fast application process, allowing for quicker restorations without compromising quality.

B. Applications

  • Versatile Use: Suitable for various adhesive applications in restorative dentistry, enhancing workflow efficiency.

3. New Optidisc

A. Description

  • Type: Finishing and polishing discs.
  • Characteristics:
    • Three-Grit System: Utilizes a three-grit system instead of the traditional four, aimed at achieving a higher surface gloss on restorations.
    • Extra Coarse Disc: An additional extra coarse disc is available for gross removal of material before the finishing and polishing stages.

B. Applications

  • Final Polish: Allows restorations to achieve a final polish that closely resembles the natural dentition, improving aesthetic outcomes and patient satisfaction.

4. Interval II Plus

A. Description

  • Type: Temporary filling material.
  • Composition: Made with glass ionomer and leachable fluoride.
  • Packaging: Available in a convenient 5 gm syringe.

B. Characteristics

  • Dependable: A one-component, ready-mixed material that simplifies the application process.
  • Safety: Safe to use on resin-based materials, as it does not contain zinc oxide eugenol (ZOE), which can interfere with bonding.

C. Applications

  • Temporary Restorations: Ideal for use in temporary fillings, providing a reliable and effective solution for managing carious lesions until permanent restorations can be placed.

Sealers fill the space between gutta-percha and canal walls, ensuring a fluid-tight seal.

 Functions:

  • Seal canal irregularities

  • Prevent microleakage

  • Lubricate during obturation

  • Provide antimicrobial action

Types of Sealers:

Type Examples Properties
Zinc Oxide Eugenol-based Tubliseal, Procosol Antimicrobial, but soluble and weak over time
Epoxy Resin-based AH Plus, AH 26 Strong adhesion, low solubility, long setting time
Calcium Hydroxide-based Sealapex, Apexit Antimicrobial, biocompatible, but less adhesive
Bioceramic-based iRoot SP, EndoSequence BC Bioactive, excellent sealing, promotes healing
Glass Ionomer-based Ketac Endo Good adhesion, limited antimicrobial action
Silicone-based GuttaFlow, RoekoSeal Flexible, biocompatible, easy to remove

These are used throughout the root canal procedure—from cleaning to filling—and include:

1. Instrumentation Materials

  • Stainless Steel & NiTi Files: For shaping canals; NiTi offers superior flexibility for curved canals.

  • Paper Points: Absorb moisture and disinfectant from canals before obturation.

2. Obturation Materials

  • Gutta-Percha: The gold standard for filling canals; inert, biocompatible, and thermoplastic.

  • Root Canal Sealers:

    • Zinc Oxide Eugenol-based: Traditional, antimicrobial.

    • Epoxy Resin-based (e.g., AH Plus): Excellent sealing ability.

    • Bioceramic Sealers: Promote healing and bond chemically to dentin.

3. Temporary Restorative Materials

  • Cavit, IRM, or Glass Ionomer Cement: Used between appointments to seal the access cavity.

4. Medicaments

  • Calcium Hydroxide: Antimicrobial and promotes periapical healing.

  • Chlorhexidine Gel: Used as an intracanal disinfectant.

Refractory materials are essential in the field of dentistry, particularly in the branch of conservative dentistry and prosthodontics, for the fabrication of various restorations and appliances. These materials are characterized by their ability to withstand high temperatures without undergoing significant deformation or chemical change. This is crucial for the longevity and stability of the dental work. The primary function of refractory materials is to provide a precise and durable mold or pattern for the casting of metal restorations, such as crowns, bridges, and inlays/onlays.

Refractory materials include:

- Plaster of Paris: The most commonly used refractory material in dentistry, plaster is composed of calcium sulfate hemihydrate. It is mixed with water to form a paste that is used to make study models and casts. It has a relatively low expansion coefficient and is easy to manipulate, making it suitable for various applications.


- Dental stone: A more precise alternative to plaster, dental stone is a type of gypsum product that offers higher strength and less dimensional change. It is commonly used for master models and die fabrication due to its excellent surface detail reproduction.


- Investment materials: Used in the casting process of fabricating indirect restorations, investment materials are refractory and encapsulate the wax pattern to create a mold. They can withstand the high temperatures required for metal casting without distortion.


- Zirconia: A newer refractory material gaining popularity, zirconia is a ceramic that is used for the fabrication of all-ceramic crowns and bridges. It is extremely durable and has a high resistance to wear and fracture.


- Refractory die materials: These are used in the production of metal-ceramic restorations. They are capable of withstanding the high temperatures involved in the ceramic firing process and provide a reliable foundation for the ceramic layers.

The selection of a refractory material is based on factors such as the intended use, the required accuracy, and the specific properties needed for the final restoration. The material must have a low thermal expansion coefficient to minimize the thermal stress during the casting process and maintain the integrity of the final product. Additionally, the material should be able to reproduce the fine details of the oral anatomy and have good physical and mechanical properties to ensure stability and longevity.

Refractory materials are typically used in the following procedures:

- Impression taking: Refractory materials are used to make models from the patient's impressions.
- Casting of metal restorations: A refractory mold is created from the model to cast the metal framework.
- Ceramic firing: Refractory die materials hold the ceramic in place while it is fired at high temperatures.
- Temporary restorations: Some refractory materials can be used to produce temporary restorations that are highly accurate and durable.

Refractory materials are critical for achieving the correct fit and function of dental restorations, as well as ensuring patient satisfaction with the aesthetics and comfort of the final product.

Glass ionomer cement is a tooth coloured material 
Material was based on reaction between silicate glass powder & polyacrylicacid.
They bond chemically to tooth structure & release fluoride for relatively long period

CLASSIFICATION 

Type I. For luting

Type II. For restoration 

Type II.1 Restorative esthetic 

Type II.2 Restorative reinforced

Type III. For liner & bases

Type IV. Fissure & sealent

Type V. As Orthodontic cement

Type VI. For core build up

Physical Properties

1. Low solubility
2. Coefficient of thermal expansion similar to dentin
3. Fluoride release and fluoride recharge
4. High compressive strengths
5. Bonds to tooth structure
6. Low flexural strength
7. Low shear strength
8. Dimensional change (slight expansion) (shrinks on setting, expands with water sorption)
9. Brittle
10.Lacks translucency
11.Rough surface texture

Indications for use of Type II glass ionomer cements 

1) non-stress bearing areas 

2) class III and V restorations in adults 

3) class I and II restorations in primary dentition 

4) temporary or “caries control” restorations 

5) crown margin repairs 

6) cement base under amalgam, resin, ceramics, direct and indirect gold 

7) core buildups when at least 3 walls of tooth are remaining (after crown preparation)

Contraindications 

1) high stress applications I. class IV and class II restorations II. cusp replacement III. core build-ups with less than 3 sound walls remaining

Composition

 

Factors affecting the rate or setting

1. Glass composition:Higher Alumina – Silica ratio, faster set and shorter working time.
2. Particle Size: finer the powder, faster the set.
3. Addition of Tartaric Acid:-Sharpens set without shortening the working time.
4. Relative proportions of the constituents: Greater the proportion of glass and lower the proportion of water, the faster the set.
5. Temperature

Setting Time

Type 1 - 4-5 min
type II - 7 min


PROPERTIES 

Adhesion :

- Glass ionomer cement bonds chemically to the tooth structure->reaction occur between carboxyl group of poly acid & calcium of hydroxyl apatite.
 
- Bonding with enamel is higher than that of dentin ,due to greater inorganic content. 

Esthetics :
-GIC is tooth coloured material & available in different shades.
Inferior to composites.
They lack translucency & rough surface texture.
Potential for discolouration & staining.

Biocompatibilty :

- Pulpal response to glass ionomer cement is favorable. 
- Pulpal response is mild due to 
- High buffering capacity of hydroxy apatite. 
- Large molecular weight of the polyacrylic acid ,which prevents entry into dentinal tubules. 

a) Pulp reaction – ZOE < Glass Ionomer < Zinc Phosphate 

b) Powder:liquid ratio influences acidity 

c) Solubility & Disintegration:-Initial solubility is high due to leaching of intermediate products.The complete setting reaction takes place in 24 hrs, cement should be protected from saliva during this period.

Anticariogenic properties :
- Fluoride is released from glass ionomer at the time of mixing & lies with in matrix.
Fluoride can be released out without affecting the physical properties of cement.

ADVANTAGE DISADVANTAGE

Instrument Function
Barbed Broaches Remove pulp tissue from the canal; thin and flexible with barbed projections
Files Shape and clean the canal walls; available in various designs (K-files, H-files)
Reamers Enlarge the canal by cutting dentin; fewer spirals than files
Spreaders Used during lateral condensation of gutta-percha
Pluggers Compact filling material vertically into the canal
Gates-Glidden Drills Enlarge coronal portion of canal; used with slow-speed handpiece
Endodontic Explorers Locate canal orifices; long, sharp tips for precision

Materials Used

  • Stainless Steel: Durable but less flexible

  • Nickel-Titanium (NiTi): Highly flexible, ideal for curved canals

Bases in Restorative Dentistry

Bases are an essential component in restorative dentistry, serving as a thicker layer of material placed beneath restorations to provide additional protection and support to the dental pulp and surrounding structures. Below is an overview of the characteristics, objectives, and types of bases used in dental practice.

1. Characteristics of Bases

A. Thickness

  • Typical Thickness: Bases are generally thicker than liners, typically ranging from 1 to 2 mm. Some bases may be around 0.5 to 0.75 mm thick.

B. Functions

  • Thermal Protection: Bases provide thermal insulation to protect the pulp from temperature changes that can occur during and after the placement of restorations.
  • Mechanical Support: They offer supplemental mechanical support for the restoration by distributing stress on the underlying dentin surface. This is particularly important during procedures such as amalgam condensation, where forces can be applied to the restoration.

2. Objectives of Using Bases

The choice of base material and its application depend on the Remaining Dentin Thickness (RDT), which is a critical factor in determining the need for a base:

  • RDT > 2 mm: No base is required, as there is sufficient dentin to protect the pulp.
  • RDT 0.5 - 2 mm: A base is indicated, and the choice of material depends on the restorative material being used.
  • RDT < 0.5 mm: Calcium hydroxide (Ca(OH)₂) or Mineral Trioxide Aggregate (MTA) should be used to promote the formation of reparative dentin, as the remaining dentin is insufficient to provide adequate protection.

3. Types of Bases

A. Common Base Materials

  • Zinc Phosphate (ZnPO₄): Known for its good mechanical properties and thermal insulation.
  • Glass Ionomer Cement (GIC): Provides thermal protection and releases fluoride, which can help in preventing caries.
  • Zinc Polycarboxylate: Offers good adhesion to tooth structure and provides thermal insulation.

B. Properties

  • Mechanical Protection: Bases distribute stress effectively, reducing the risk of fracture in the restoration and protecting the underlying dentin.
  • Thermal Insulation: Bases are poor conductors of heat and cold, helping to maintain a stable temperature at the pulp level.

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