operative dentistry 4th year lectures lecture 2 wed 8-4-2020 · factors related to the condition of...
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Operative dentistry 4TH YEAR LECTURES
Lecture 2 WED 8-4-2020
Objective of the Chapter
(1) Types of available restorative materials.
(2) Requirements of ideal restorative materials.
(3) Assessment of restorative material behavior.
(4) Factors influencing selection of the suitable
restorative materials.
Factors related to the condition of the oral cavity
a. Oral hygiene: 1. Patients with good oral hygiene should be instructed to maintain this condition. Any restoration can be used. 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.
Factors related to the condition of the oral cavity
b. Caries incidence: 1. Patients with high caries incidence need full coverage restorations, otherwise, short-term regular check up is imp. to discover any progress of caries to be treated early. 2. Teeth with rampant caries are better to be treated with temporary restorations until the condition subside.
Rampant caries
Factors related to the condition of the oral cavity
c. Condition of occlusion: 1. Normal occlusion has no troubles in the selection of the suitable restorations. 2. Conditions of malocclusion such as cross bite, sever overlap, plunger cusp and tilted teeth need restorations of high strength
Edge to edge Cross bite
Normal occlusion
Factors related to the condition of the oral cavity
d. Presence of metallic restoration: 1. The present metallic restoration is leading for the selection of the future metallic restoratives. Presence of different metallic restorations may cause tarnish and corrosion and/ or may cause pain due to galvanic shocks. 2. Non metallic restoration can be used with any type of metallic restoratives without any side effect.
Amalgam Gold
Factors related to the tooth to be restored
a. Position of the tooth: 1. Anterior teeth restored with esthetic R.M. such as castable ceramics, or resin composite. 2. Smiling teeth restored with esthetic materials few patients prefer gold color. 3. Abutment teeth restored with amalgam or composite restorations. However, those used with removable partial denture should be restored with cast gold restoration. 4. Wisdom teeth restored with zinc free amalgam or cast restorations.
Factors related to the tooth to be restored
b. Form of the tooth: 1. Hutchinson teeth or peg-shaped lateral incisors should be restored with full coverage restorations. 2. Mulberry molars should be corrected occlusally with cast gold restorations or full coverage restorations. 3. Normal teeth should be restored with the suitable restorative material.
Mulberry molar
Hutchinson teeth
Beg shaped lateral
Factors related to the tooth to be restored
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.
Decalcified anterior teeth Decalcified posterior teeth
Factors related to the tooth to be restored
d. 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 cannot confine the restoration
Pin retained restoration Large cavity indicated for Post retained restoration
Factors related to the tooth to be restored
e. Vitality of the pulp: 1- Teeth with hyperemia should be restored with a suitable temporary R.M. until the irritational condition is relieved and then
restored permanently with a suitable restoration. 2- In deep cavities, apply base 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.
Custom made post
Ready made post
Factors related to the cavity to be restored
a. Size of the cavity: 1. Small cavities can be restored with gold foil, amalgam, composite, or glass ionomer R. M. 2. Medium size cavities are better restored with amalgam, cast gold, composite or glass ionomer R.M.
3. Large cavities should be restored with cast gold, ceramics, amalgam or full coverage restorations.
Factors related to the cavity to be restored
b. Location of the cavity: Anterior teeth:
- Mesial cavities restored with esthetic restoratives. - Distal cavities of cuspids restored with amalgam or R.C. - Cervical cavities restored with resin composite. Posterior teeth:
- Occlusal cavities restored with metallic or esthetic R.M. - Cervical cavities restored with amalgam, R.C. or G.I.
C. Accessibility to the cavity: 1. 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.
Factors related to the cavity to be restored
Factors concerning the operator
He should have sufficient information’s about available restorative materials.
He should have sufficient skill for manipulation and handling of restoratives.
He should use the material within its indications. He should provide patient with sufficient post-
restorative instructions. Successful dentist should satisfy his patients.
Selection of a Suitable Restorative Material
Chapter outline:
- Available restorative materials
a) Permanent restorative materials
b) Temporary restorative materials
-Requirements for an ideal restoration
-Assessment of restorative material behavior
-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
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B- Factors related to the condition of the oral cavity:
a. Oral hygiene: 1. Patients with good oral hygiene should instruct to
maintain this condition. Any restorative material
can be used.
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 and regular check up to
discover any progress of caries to be treated early.
2. Teeth with rampant caries are better to be treated
with temporary restorations until the condition
subside.
c. Condition of occlusion: 1. Normal occlusion has no troubles in the selection of
the suitable restorations.
2. Conditions of malocclusion such as cross bite,
sever overlap, plunger cusp and tilted teeth need
restorations of high strength properties.
d. Presence of metallic restoration: 1. The present metallic restoration is leading for the
selection of the future metallic restoratives.
Presence of different metallic restorations may
cause tarnish and corrosion and/or may cause pain
due to galvanic shocks.
2. No metallic restoration can be used with any type of
metallic restoratives without any dangerous effect.
C- Factors concerning the tooth to be restored:
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a. Position of the tooth: 1. Anterior teeth are better to be restored with
esthetic restorative materials such as castable
ceramics or resin composite.
2. Teeth that appear during smiling should be
restored with esthetic materials. However, few
patients prefer gold color to appear during smiling.
3. 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 facilitate
preparation of occlusal rest seat.
4. Wisdom teeth are difficult to be isolated by rubber
dam application. It is advisable to restore them
with zinc free amalgam or cast restorations.
b. Teeth with slight mobility: It is advisable to fix these teeth together with
soldered cast gold restorations.
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.
d. Condition of calcification: Hypocalcified tooth or teeth with friable enamel
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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 cannot confine
the restoration, pin retained type is advisable.
3. Post-retained gold, ceramic, or composite
restoration can be fabricated in non-vital teeth
when pin retained restorations are contraindicated.
4. Post-retained restorations can be used in root canal
treated teeth.
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. The space of the vital pulp can be used for
retention of the missing coronal portion if
necessary.
4. Post-retained restorations are indicated in non vital
teeth.
5. 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.
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D- Factors related to the cavity to be restored:
a. Size of the cavity: 1. Small cavities can be restored with direct gold,
amalgam, composite, or glass ionomer restorative
materials.
2. 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 resin composite.
6. Cervical cavities of posterior teeth may be restored
with metallic, composite or glass ionomer
restorations.
7. Sub-gingival cavities are better to be restored with
cast gold restorations.
C. Accessibility to the cavity: 1. Wide mouth opening provides sufficient
accessibility. However, small mouth opening
creates difficult in cavity preparation and
restoration.
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2. Anterior teeth, premolars and first molars are more
accessible than second and third molars.
III- Factors related to the dentist (operator):
a. Dentist should know full information’s about
population needs.
b. He should have sufficient information’s about available restorative materials.
c. He should have sufficient skill for manipulation
and handling of restoratives.
d. He should use the material within its indications.
e. He should provide his patients with sufficient
post-restorative instructions.
f. Successful dentist should satisfy his patients'
needs.