CHAPTER 8: PART I

types of esthetic restorative materials

ceramic inlays & onlays

silicate cement

acrylic resin

glass ionomer

inlay

fits within the cusps of a tooth

lasts for 10-15 years — good hygiene & bonding

least invasive — only affected area is removed

replacing the central chewing surface (like a large filling)

onlay

moderate tooth reduction

lasts for 10-20 years — stronger due to cusp coverage

a more extensive restoration than an inlay, but less than a crown

covers one or more cusps as well as the central portion of the tooth

crown

covers the entire tooth (all cusps & sides)

most invasive—entire outer layer is removed

lasts for 10-25+ years — v strong and protective

often used when a tooth is significantly damaged or weakened

indications of inlay

replacement of large fillings

esthetic alternative to amalgam

moderate decay or fracture that doesn’t affect cusps

indications of onlay

damage or decay involves one or more cusps

prevents future fracture of weakened cusps

patient desires a conservative alternative to a crown

indications of crown

severe wear or esthetic need

tooth has minimal remaining healthy structure

extensive tooth damage, large fracture, or root canal treatment

advantages ceramic inlays & onlays

highly esthetic

biocompatible & non-reactive

conservative alternative to a crown

strong & durable (lithium disilicate, zirconia)

disadvantages ceramic inlays

not suitable for cusp damage

may fracture if under high force

disadvantages ceramic onlays

technique-sensitive bonding

more expensive than composite fillings

requires two appointments (unless CAD/CAM used)

disadvantages ceramic crowns

more invasive

more expensive

harder to reverse or replace

common materials of inlay

lithium disilicate

composite resin

gold

common materials of onlay

zirconia

composite resin

lithium disilicate

gold

common materials of crown

porcelain-fused-to-metal

gold

metal

zirconia

lithium disilicate

silicate cement

now largely obsolete

sets by acid-base reaction

anterior esthetic restorative material

not suitable for permanent restorations

lasts for 2-5 years (short-term) as it degrades over time due to solubility

once popular for esthetic restorations due to translucency and fluoride release, is now obsolete due to poor durability and pulpal irritation risk

indications of silicate cement

fluoride-releasing needs

anterior restorations (class III, V)

aesthetic, non-load-bearing areas

temporary / transitional restorations

advantages of silicate cement

easy to use

initial adhesion to enamel

good esthetics (translucent)

fluoride release (anti-cariogenic)

disadvantages of silicate cement

discolors over time

high solubility in saliva

brittle; weak mechanical strength

can irritate the pulp due to low pH

acrylic resin

forms a plastic matrix once polymerized

lasts 3-5 years or more for denture bases

lasts weeks-months for temporary restorations

a versatile, cost-effective material used mainly in prostho and temporary restorations

its mechanical limitations and tissue irritations risks make it unsuitable for permanent restorations

indications of acrylic resin

custom trays

denture bases

orthodontic appliances

temporary crowns & bridges

early composite restoration (obsolete)

advantages of acrylic resin

inexpensive

quick-setting

good esthetics (initially)

easy to manipulate and polish

used widely in prosthodontics

disadvantages of acrylic resin

exothermic setting reaction

high polymerization shrinkage

free monomer can irritate soft tissues

poor wear resistance and mechanical strength

prone to discoloration and plaque accumulation

3 types of acrylic composite resin

microfill

nanofill

hybrid (microhybrid / nanohybrid)

microfill

best for anterior esthetic areas

contains very small filler particles (0.04 μm)

offers superior polish and smoothness but lower strength

nanofill

nanosized particles

combines excellent polish with good strength

suitable for both anterior and posterior restorations

hybrid (microhybrid / nanohybrid)

ideal for stress-bearing posterior restorations

provides good strength and wear resistance but less polishable

combines strengths of various fillers for better handling and mechanical properties

flowable composite

lower filler content

lower mechanical strength

lower elastic modulus — more flexible

low viscosity — flows easily into cavity preparations

handled with syringe or needle tips; self-leveling

excellent adaptation to cavity walls due to flowability

higher polymerization shrinkage due to lower filler content

advantages of flowable composite

superior flow and adaptation for conservative or inaccessible areas

disadvantages of flowable composite

higher shrinkage

weak for load-bearing surfaces

shorter lifespan in high-stress areas

indications of flowable composite

small class III & IV

liner under restorations

minimally invasive preps

pediatric restorations — pit and fissure sealants

packable composite

high viscosity — thick and stiff; requires condensation

higher strength, more resistant to occlusal forces

higher elastic modulus — more rigid

lower polymerization shrinkage

good adaptation to cavity walls

better marginal adaptation and less shrinkage

handled with hand instruments for placement; more sculptable

advantages of packable composite

superior strength and durability for bulk restorations

longer-lasting especially in load-bearing posterior restorations

disadvantages of packable composite

more difficult to adapt in fine or irregular areas

may lead to marginal gaps if not handled well

glass ionomer

2-5 years for conventional GIC; 5-7 years for RMGIC

short-to-medium term until tooth exfoliation for pediatric GIC

tooth-colored restorative material that sets via acid-base reaction

chemically bonds to tooth structure and releases fluoride for anti-cariogenic effects

good for pedia patient due to being moisture-resistant—it sets even if there is moisture around the tooth

indications of glass ionomer

base or liner

core build-up

cervical lesions

temporary fillings

pediatric restorations

cementation of crowns / bridges

non-load bearing class III & V restorations

advantages of glass ionomer

biocompatible

fluoride-releasing

thermal expansion similar to tooth

chemical bond to enamel and dentin

moisture tolerance during placement

no need for etching or bonding agent

disadvantages of glass ionomer

esthetic inferior to composites

brittle and lower fracture toughness

susceptible to wear and erosion over time

not ideal for high-stress areas (for occlusal loads)

9 types of glass ionomer cement

type I — luting cement

type II — restorative cement

type III — base / liner

type IV — pit and fissure sealants

type V — orthodontic cementation

type VI — core build-up material

type VII — fluoride releasing light-cured GIC

type VIII — atraumatic restorative treatment (ART)

type IX — pediatric and geriatric restorations

mnemonic for different types of GIC

little

rest

between

fussy

orthodontic

classes

flourishes

artist

children