Treatments to restore function, integrity, and morphology of teeth
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Dental restoration, dental fillings, or simply fillings are treatments used to restore the function, integrity, and morphology of missing tooth structure resulting from caries or external trauma as well as to the replacement of such structure supported by dental implants.[1] They are of two broad types—direct and indirect—and are further classified by location and size. A root canal filling, for example, is a restorative technique used to fill the space where the dental pulp normally resides.
Tooth #3, the upper right first molar, with the beginning of a preparation. Looking into the preparation, the white, outer enamel appears intact, while the yellow, underlying dentin appears recessed. This is because the dentin was decayed and was thus removed. This portion of the enamel is now unsupported, and should be removed to prevent future fracture.
Restoring a tooth to good form and function requires two steps:
preparing the tooth for placement of restorative material or materials, and
placement of these materials.
The process of preparation usually involves cutting the tooth with a rotary dental handpiece and dental burrs, a dental laser, or through air abrasion (or in the case of atraumatic restorative treatment, hand instruments), to make space for the planned restorative materials and to remove any dental decay or portions of the tooth that are structurally unsound. If permanent restoration cannot be carried out immediately after tooth preparation, temporary restoration may be performed.
Preparations may be intracoronal or extracoronal. Intracoronal preparations are those which serve to hold restorative material within the confines of the structure of the crown of a tooth. Examples include all classes of cavity preparations for composite or amalgam as well as those for gold and porcelain inlays. Intracoronal preparations are also made as female recipients to receive the male components of removable partial dentures. Extracoronal preparations provide a core or base upon which restorative material will be placed to bring the tooth back into a functional and aesthetic structure. Examples include crowns and onlays, as well as veneers.
In preparing a tooth for a restoration, a number of considerations will determine the type and extent of the preparation. The most important factor to consider is decay. For the most part, the extent of the decay will define the extent of the preparation, and in turn, the subsequent method and appropriate materials for restoration.
Another consideration is unsupported tooth structure. When preparing the tooth to receive a restoration, unsupported enamel is removed to allow for a more predictable restoration. While enamel is the hardest substance in the human body, it is particularly brittle, and unsupported enamel fractures easily.
A systematic review concluded that for decayed baby (primary) teeth, putting an off‐the‐shelf metal crown over the tooth (Hall technique) or only partially removing decay (also referred to as "selective removal"[2]) before placing a filling may be better than the conventional treatment of removing all decay before filling.[3] For decayed adult (permanent) teeth, partial removal (also referred to as "selective removal"[2]) of decay before filling the tooth, or adding a second stage to this treatment where more decay is removed after several months, may be better than conventional treatment.[4]
Direct restorations
This technique involves placing a soft or malleable filling into the prepared tooth and building up the tooth. The material is then set hard and the tooth is restored. Where a wall of the tooth is missing and needs to be rebuilt, a matrix should be used before placing the material to recreate the shape of the tooth, so it is cleansable and to prevent the teeth from sticking together. Sectional matrices are generally preferred to circumferential matrices when placing composite restorations in that they favour the formation of a contact point. This is important to reduce patient complaints of food impaction between the teeth. However, sectional matrices can be more technique sensitive to use, so care and skill is required to prevent problems occurring in the final restoration.[5] The advantage of direct restorations is that they are usually set quickly and can be placed in a single procedure. The dentist has a variety of different filling options to choose from. A decision is usually made based on the location and severity of the associated cavity. Since the material is required to set while in contact with the tooth, limited energy (heat) is passed to the tooth from the setting process.
Indirect restorations
An indirect restoration fabricated on model from Ips emax ceramic ready to be cemented on natural tooth structure
In this technique the restoration is fabricated outside of the mouth using the dental impressions of the prepared tooth. Common indirect restorations include inlays and onlays, crowns, bridges, and veneers. Usually a dental technician fabricates the indirect restoration from records the dentist has provided. The finished restoration is usually bonded permanently with a dental cement. It is often done in two separate visits to the dentist. Common indirect restorations are done using gold or ceramics.
While the indirect restoration is being prepared, a provisory/temporary restoration is sometimes used to cover the prepared tooth to help maintain the surrounding dental tissues.
Removable dental prostheses (mainly dentures) are sometimes considered a form of indirect dental restoration, as they are made to replace missing teeth. There are numerous types of precision attachments (also known as combined restorations) to aid removable prosthetic attachment to teeth, including magnets, clips, hooks, and implants which may themselves be seen as a form of dental restoration.
The CEREC method is a chairside CAD/CAM restorative procedure. An optical impression of the prepared tooth is taken using a camera. Next, the specific software takes the digital picture and converts it into a 3D virtual model on the computer screen. A ceramic block that matches the tooth shade is placed in the milling machine. An all-ceramic, tooth-colored restoration is finished and ready to bond in place.
Another fabrication method is to import STL and native dental CAD files into CAD/CAM software products that guide the user through the manufacturing process. The software can select the tools, machining sequences and cutting conditions optimized for particular types of materials, such as titanium and zirconium, and for particular prostheses, such as copings and bridges. In some cases, the intricate nature of some implants requires the use of 5-axis machining methods to reach every part of the job.[6]
G.V. Black classified the cavities depending on their site: [7]
Class I Caries affecting pit and fissure, on occlusal, buccal, and lingual surfaces of molars and premolars, and palatal of maxillary incisors.
Class II Caries affecting proximal surfaces of molars and premolars.
Class III Caries affecting proximal surfaces of centrals, laterals, and cuspids.
Class IV Caries affecting proximal including incisal edges of anterior teeth.
Class V Caries affecting gingival 1/3 of facial or lingual surfaces of anterior or posterior teeth.
Class VI Caries affecting cusp tips of molars, premolars, and cuspids.
Graham J. Mount's classification:
Mount classified cavities depending on their site and size.[8] The proposed classification was designed to simplify the identification of lesions and to define their complexity as they enlarge.
The following casting alloys are mostly used for making crowns, bridges and dentures. Titanium, usually commercially pure but sometimes a 90% alloy, is used as the anchor for dental implants as it is biocompatible and can integrate into bone.
Amalgams are alloys formed by a reaction between two or more metals, one of which is mercury. It is a hard restorative material and is silvery-grey in colour. One of the oldest direct restorative materials still in use, dental amalgam was widely used in the past with a high degree of success, although recently its popularity has declined due to a number of reasons, including the development of alternative bonded restorative materials, increase in demand for more aesthetic restorations and public perceptions concerning the potential health risks of the material.
The composition of dental amalgam is controlled by the ISO Standard for dental amalgam alloy (ISO 1559).[9] The major components of amalgam are silver, tin and copper.[9] Other metals and small amounts of minor elements such as zinc, mercury, palladium, platinum and indium are also present.[9] Earlier versions of dental amalgams, known as 'conventional' amalgams consisted of at least 65 wt% silver, 29 wt% tin, and less than 6 wt% copper.[9] Improvements in the understanding of the structure of amalgam post-1986 gave rise to copper-enriched amalgam alloys, which contain between 12 wt% and 30 wt% copper and at least 40 wt% silver.[9] The higher level of copper improved the setting reaction of amalgam, giving greater corrosion resistance and early strength after setting.
Possible indications for amalgam are for load-bearing restorations in medium to large sized cavities in posterior teeth, and in core build-ups when a definitive restoration will be an indirect cast restoration such as a crown or bridge retainer. Contraindications for amalgam are if aesthetics are paramount to patient due to the colour of the material. Amalgams should be avoided if the patient has a history of sensitivity to mercury or other amalgam components. Besides that, amalgam is avoided if there is extensive loss of tooth substance such that a retentive cavity cannot be produced, or if excessive removal of health tooth substance would be required to produce a retentive cavity.
Advantages of amalgam include durability - if placed under ideal conditions, there is evidence of good long term clinical performance of the restorations. Placement time of amalgam is shorter compared to that of composites and the restoration can be completed in a single appointment. The material is also more technique-forgiving compared to composite restorations used for that purpose. Dental amalgam is also radiopaque which is beneficial for differentiating the material between tooth tissues on radiographs for diagnosing secondary caries. The cost of the restoration is typically cheaper than composite restorations.
Disadvantages of amalgam include poor aesthetic qualities due to its colour. Amalgam does not bond to tooth easily, hence it relies on mechanical forms of retention. Examples of this are undercuts, slots/grooves or root canal posts. In some cases this may necessitate excessive amounts of healthy tooth structure to be removed. Hence, alternative resin-based or glass-ionomer cement-based materials are used instead for smaller restorations including pit and small fissure caries. There is also a risk of marginal breakdown in the restorations. This could be due to corrosion which may result in "creep" and "ditching" of the restoration. Creep can be defined as the slow internal stressing and deformation of amalgam under stress. This effect is reduced by incorporating copper into amalgam alloys. Some patients may experience local sensitivity reactions to amalgam.
Although the mercury in cured amalgam is not available as free mercury, concern of its toxicity has existed since the invention of amalgam as a dental material. It is banned or restricted in Norway, Sweden and Finland. See dental amalgam controversy.
Direct gold
Direct gold fillings were practiced during the times of the Civil War in America. Although rarely used today, due to expense and specialized training requirements, gold foil can be used for direct dental restorations.
Dental composites, commonly described to patients as "tooth-colored fillings", are a group of restorative materials used in dentistry. They can be used in direct restorations to fill in the cavities created by dental caries and trauma, minor buildup for restoring tooth wear (non-carious tooth surface loss) and filling in small gaps between teeth (labial veneer). Dental composites are also used as indirect restoration to make crowns and inlays in the laboratory.
These materials are similar to those used in direct fillings and are tooth-colored. Their strength and durability is not as high as porcelain or metal restorations and they are more prone to wear and discolouration. As with other composite materials, a dental composite typically consists of a resin-based matrix, which contains a modified methacrylate or acrylate. Two examples of such commonly used monomers include bisphenol A-glycidyl methacrylate (BISMA) and urethane dimethacrylate (UDMA), together with tri-ethylene glycol dimethacrylate (TEGMA). TEGMA is a comonomer which can be used to control viscosity, as Bis GMA is a large molecule with high viscosity, for easier clinical handling.[9] Inorganic filler such as silica, quartz or various glasses, are added to reduce polymerization shrinkage by occupying volume and to confirm radio-opacity of products due to translucency in property,[clarification needed] which can be helpful in diagnosis of dental caries around dental restorations. The filler particles give the composites wear resistance as well. Compositions vary widely, with proprietary mixes of resins forming the matrix, as well as engineered filler glasses and glass ceramics. A coupling agent such as silane is used to enhance the bond between resin matrix and filler particles. An initiator package[clarification needed] begins the polymerization reaction of the resins when external energy (light/heat, etc.) is applied. For example, camphorquinone can be excited by visible blue light with critical wavelength of 460-480nm to yield necessary free radicals to start the process.
After tooth preparation, a thin primer or bonding agent is used. Modern photo-polymerised composites are applied and cured in relatively thin layers as determined by their opacity.[10] After some curing, the final surface will be shaped and polished.
A glass ionomer cement (GIC) is a class of materials commonly used in dentistry as direct filling materials and/or for luting indirect restorations. GIC can also be placed as a lining material in some restorations for extra protection. These tooth-coloured materials were introduced in 1972 for use as restorative materials for anterior teeth (particularly for eroded areas).[9]
The material consists of two main components: Liquid and powder. The liquid is the acidic component containing of polyacrylic acid and tartaric acid (added to control the setting characteristics). The powder is the basic component consisting of sodium alumino-silicate glass.[11] The desirable properties of glass ionomer cements make them useful materials in the restoration of carious lesions in low-stress areas such as smooth-surface and small anterior proximal cavities in primary teeth.
The addition of tartaric acid to GIC leads to a shortened setting time, hence providing better handling properties. This makes it easier for the operator to use the material in clinic.
GIC does not require bond, it can bond to enamel and dentine without the need for use of an intermediate material. Conventional GIC also has a good sealing ability providing little leakage around restoration margins and reducing the risk of secondary caries.
GIC contains and releases fluoride after being placed therefore it helps in preventing carious lesions in teeth.
It has good thermal properties as the expansion under stimulus is similar to dentine.
The material does not contract on setting meaning it is not subject to shrinkage and microleakage.
GIC is also less susceptible to staining and colour change than composite.
GIC have poor wear resistance, they are usually weak after setting and are not stable in water however this improves when time goes on and progression reactions take place. Due to their low strength GICs are not appropriate to be placed in cavities in areas which bear an increase amount of occlusal load or wear.
The material is susceptible to moisture when it is first placed.
GIC varies in translucency therefore it can have poor aesthetics , especially noticeable if placed on anterior teeth.
Resin Modified Glass Ionomer
Resin modified glass ionomer was developed to combine the properties of glass ionomer cement with composite technology. It comes in a powder-liquid form. The powder contains fluro-alumino-silicate glass, barium glass (provides radiopacity), potassium persulphate (a redox catalyst to provide resin cure in the dark) and other components such as pigments. The liquid consists of HEMA (water miscible resin), polyacrylic acid (with pendant methacrylate groups) and tartaric acid. This can undergo both acid base and polymerisation reactions. It also has photoinitiators present which enable light curing.[11]
The ionomer has a number of uses in dentistry. It can be applied as fissure sealant, placed in endodontic access cavity as a temporary filling and a luting agent. It can also be used to restore lesions in both primary and permanent dentition. They are easier to use and are a very popular group of materials.
Polymerisation Contraction can cause microleakage around restoration margins
It has an exothermic setting reaction which can cause potential damage to tooth tissue.
The material swells due to uptake of water as HEMA is extremely hydrophilic.
Monomer leaching: HEMA is toxic to the pulp therefore it must be polymerised completely.
The strength of the material reduces if its not light-cured.
GIC and RMGIC are used in dentistry, there will be times when one of these materials is better than the other but that is dependant upon the clinical situation. However in most cases the ease of use is deciding factor.
Dental compomers are another type of white filling material although their use is not as widespread.[12][13][14]
Compomers were formed by modifying dental composites with poly-acid in an effort to combine the desirable properties of dental composites, namely their good aesthetics, and glass ionomer cements, namely their ability to release fluoride over a long time. Whilst this combination of good aesthetics and fluoride release may seem to give compomers a selective advantage, their poor mechanical properties (detailed below) limits their use.[12][13][14]
Compomers have a lower wear resistance and a lower compressive, flexural and tensile strength than dental composites, although their wear resistance is greater than resin-modified and conventional glass ionomer cements.[12][13] Compomers cannot adhere directly to tooth tissue like glass ionomer cements; they require a bonding agent like dental composites.[12][13][14]
Compomers may be used as a cavity lining material and a restorative material for non-load bearing cavities.[12][13] In Paediatric dentistry, they can also be used as a fissure sealant material.[14]
The luting version of compomer may be used to cement cast alloy and ceramic-metal restorations, and to cement orthodontic bands in Paediatric patients.[13][14] However, compomer luting cement should not be used with all-ceramic crowns.[12][13]
Porcelain (ceramics)
All-ceramic Dental Onlay for a molar tooth
Full-porcelain dental materials include dental porcelain (porcelain meaning a high-firing-temperature ceramic), other ceramics, sintered-glass materials, and glass-ceramics as indirect fillings and crowns or metal-free "jacket crowns". They are also used as inlays, onlays, and aesthetic veneers. A veneer is a very thin shell of porcelain that can replace or cover part of the enamel of the tooth. Full-porcelain restorations are particularly desirable because their color and translucency mimic natural tooth enamel.
Another type is known as porcelain-fused-to-metal, which is used to provide strength to a crown or bridge. These restorations are very strong, durable and resistant to wear, because the combination of porcelain and metal creates a stronger restoration than porcelain used alone.
One of the advantages of computerized dentistry (CAD/CAM technologies) involves the use of machinable ceramics which are sold in a partially sintered, machinable state that is fired again after machining to form a hard ceramic. [15] Some of the materials used are glass-bonded porcelain (Vitablock), lithium disilicateglass-ceramic (a ceramic crystallizing from a glass by special heat treatment), and phase stabilized zirconia (zirconium dioxide, ZrO2). Previous attempts to utilize high-performance ceramics such as zirconium-oxide were thwarted by the fact that this material could not be processed using the traditional methods used in dentistry. Because of its high strength and comparatively much higher fracture toughness, sintered zirconium oxide can be used in posterior crowns and bridges, implant abutments, and root dowel pins. Lithium disilicate (used in the latest Chairside Economical Restoration of Esthetic Ceramics CEREC product) also has the fracture resistance needed for use on molars.[16] Some all-ceramic restorations, such as porcelain-fused-to-alumina set the standard for high aesthetics in dentistry because they are strong and their color and translucency mimic natural tooth enamel.
Cast metals and porcelain-on-metal were the standard material for crowns and bridges for long time. The full ceramic restorations are now the major choice of patients and are of commonly applied by dentists.
Comparison
Composites and amalgam are used mainly for direct restoration. Composites can be made of color matching the tooth, and the surface can be polished after the filling procedure has been completed.
Amalgam fillings expand with age, possibly cracking the tooth and requiring repair and filling replacement, but chance of leakage of filling is less.
Composite fillings shrink with age and may pull away from the tooth allowing leakage. If leakage is not noticed early, recurrent decay may occur.
A 2003 study showed that fillings have a finite lifespan: an average of 12.8 years for amalgam and 7.8 years for composite resins.[17] Fillings fail because of changes in the filling, tooth or the bond between them. Secondary cavity formation can also affect the structural integrity the original filling. Fillings are recommended for small to medium-sized restorations.
Inlays and onlays are more expensive indirect restoration alternative to direct fillings. They are supposed to be more durable, but long-term studies did not always detect a significantly lower failure rate of ceramic[18] or composite[19] inlays compared to composite direct fillings.
Porcelain, cobalt-chrome, and gold are used for indirect restorations like crowns and partial coverage crowns (onlays). Traditional porcelains are brittle and are not always recommended for molar restorations. Some hard porcelains cause excessive wear on opposing teeth.
Experimental
The US National Institute of Dental Research and international organizations as well as commercial suppliers conduct research on new materials. In 2010, researchers reported that they were able to stimulate mineralization of an enamel-like layer of fluorapatitein vivo.[20] Filling material that is compatible with pulp tissue has been developed; it could be used where previously a root canal or extraction was required, according to 2016 reports.[21]
Dental implants are anchors placed in bone, usually made from titanium or titanium alloy. They can support dental restorations which replace missing teeth. Some restorative applications include supporting crowns, bridges, or dental prostheses.
Complications
Irritation of the nerve
When a deep cavity had been filled, there is a possibility that the nerve may have been irritated.[citation needed] This can result in short term sensitivity to cold and hot substances, and pain when biting down on the specific tooth. It may settle down on its own. If not, then alternative treatment such as root canal treatment may be considered to resolve the pain while keeping the tooth.
Weakening of tooth structure
In situations where a relatively larger amount of tooth structure has been lost or replaced with a filling material, the overall strength of the tooth may be affected. This significantly increases the risk of the tooth fracturing off in the future when excess force is placed on the tooth, such as trauma or grinding teeth at night, leading to cracked tooth syndrome.
Dental products are specially fabricated materials, designed for use in dentistry. There are many different types of dental products, and their characteristics vary according to their intended purpose.
Cosmetic dentistry is generally used to refer to any dental work that improves the appearance of teeth, gums and/or bite. It primarily focuses on improvement in dental aesthetics in color, position, shape, size, alignment and overall smile appearance. Many dentists refer to themselves as "cosmetic dentists" regardless of their specific education, specialty, training, and experience in this field. This has been considered unethical with a predominant objective of marketing to patients. The American Dental Association does not recognize cosmetic dentistry as a formal specialty area of dentistry. However, there are still dentists that promote themselves as cosmetic dentists.
A bridge is a fixed dental restoration used to replace one or more missing teeth by joining an artificial tooth definitively to adjacent teeth or dental implants.
Dental sealants are a dental treatment intended to prevent tooth decay. Teeth have recesses on their biting surfaces; the back teeth have fissures (grooves) and some front teeth have cingulum pits. It is these pits and fissures that are most vulnerable to tooth decay because food and bacteria stick in them and because they are hard-to-clean areas. Dental sealants are materials placed in these pits and fissures to fill them in, creating a smooth surface which is easy to clean. Dental sealants are mainly used in children who are at higher risk of tooth decay, and are usually placed as soon as the adult molar teeth come through.
In dentistry, a crown or a dental cap is a type of dental restoration that completely caps or encircles a tooth or dental implant. A crown may be needed when a large dental cavity threatens the health of a tooth. Some dentists will also finish root canal treatment by covering the exposed tooth with a crown. A crown is typically bonded to the tooth by dental cement. They can be made from various materials, which are usually fabricated using indirect methods. Crowns are used to improve the strength or appearance of teeth and to halt deterioration. While beneficial to dental health, the procedure and materials can be costly.
Dental composite resins are dental cements made of synthetic resins. Synthetic resins evolved as restorative materials since they were insoluble, of good tooth-like appearance, insensitive to dehydration, easy to manipulate and inexpensive. Composite resins are most commonly composed of Bis-GMA and other dimethacrylate monomers, a filler material such as silica and in most applications, a photoinitiator. Dimethylglyoxime is also commonly added to achieve certain physical properties such as flow-ability. Further tailoring of physical properties is achieved by formulating unique concentrations of each constituent.
Abrasion is the non-carious, mechanical wear of tooth from interaction with objects other than tooth-tooth contact. It most commonly affects the premolars and canines, usually along the cervical margins. Based on clinical surveys, studies have shown that abrasion is the most common but not the sole aetiological factor for development of non-carious cervical lesions (NCCL) and is most frequently caused by incorrect toothbrushing technique.
In dentistry, inlays and onlays are used to fill cavities, and then cemented in place in the tooth. This is an alternative to a direct restoration, made out of composite, amalgam or glass ionomer, that is built up within the mouth.
A glass ionomer cement (GIC) is a dental restorative material used in dentistry as a filling material and luting cement, including for orthodontic bracket attachment. Glass-ionomer cements are based on the reaction of silicate glass-powder and polyacrylic acid, an ionomer. Occasionally water is used instead of an acid, altering the properties of the material and its uses. This reaction produces a powdered cement of glass particles surrounded by matrix of fluoride elements and is known chemically as glass polyalkenoate. There are other forms of similar reactions which can take place, for example, when using an aqueous solution of acrylic/itaconic copolymer with tartaric acid, this results in a glass-ionomer in liquid form. An aqueous solution of maleic acid polymer or maleic/acrylic copolymer with tartaric acid can also be used to form a glass-ionomer in liquid form. Tartaric acid plays a significant part in controlling the setting characteristics of the material. Glass-ionomer based hybrids incorporate another dental material, for example resin-modified glass ionomer cements (RMGIC) and compomers.
A luting agent is a dental cement connecting the underlying tooth structure to a fixed prosthesis. To lute means to glue two different structures together. There are two major purposes of luting agents in dentistry – to secure a cast restoration in fixed prosthodontics, and to keep orthodontic bands and appliances in situ.
In dentistry, amalgam is an alloy of mercury used to fill teeth cavities. It is made by mixing a combination of liquid mercury and particles of solid metals such a silver, copper or tin. The amalgam is mixed by the dentist just before use. It remains soft for a short while after mixing, which facilitates it being snuggly packed into the cavity and shaped before it sets hard.
A resin-retained bridge is a bridge replacing a missing tooth that relies for its retention on a composite resin cement. It is one of many available dental restoration methods which is considered minimally invasive and conservative of tooth tissue. The resin-retained-bridge has gone through a number of iterations. Perhaps the best known is the Maryland bridge and other designs used in the past include the Rochette bridge. The five-year survival rate is around 83.6% and the ten-year rate at 64.9%. The case selection is important and as with any dental prosthesis, good oral hygiene is paramount for success. In recent years, the indications for the use of resin-retained-bridges have diminished significantly and there have been changes in the principles underpinning their design. Resin-retained-bridges should be considered when a fixed prosthesis retained by natural teeth is required. The use has been driven by the advent of evidence-based dentistry showing the benefits to patients of reduced tooth preparation and the importance of an intact enamel structure for the long-term health of the teeth. The bridge is currently in favour in the United Kingdom for these reasons. Indeed, recent contemporary research shows resin retained bridges have better success rates than implants and are a cheaper alternative.
Dental cements have a wide range of dental and orthodontic applications. Common uses include temporary restoration of teeth, cavity linings to provide pulpal protection, sedation or insulation and cementing fixed prosthodontic appliances. Recent uses of dental cement also include two-photon calcium imaging of neuronal activity in brains of animal models in basic experimental neuroscience.
Mineral trioxide aggregate (MTA) is an alkaline, cementitious dental repair material. MTA is used for creating apical plugs during apexification, repairing root perforations during root canal therapy, and treating internal root resorption. It can be used for root-end filling material and as pulp capping material. It has better pulpotomy outcomes than calcium hydroxide or formocresol, and may be the best known material, as of 2018 data. For pulp capping, it has a success rate higher than calcium hydroxide, and indistinguishable from Biodentin.
Minimal intervention dentistry is a modern dental practice designed around the principal aim of preservation of as much of the natural tooth structure as possible. It uses a disease-centric philosophy that directs attention to first control and management of the disease that causes tooth decay—dental caries—and then to relief of the residual symptoms it has left behind—the decayed teeth. The approach uses similar principles for prevention of future caries, and is intended to be a complete management solution for tooth decay.
Dental compomers, also known as polyacid-modified resin composite, are used in dentistry as a filling material. They were introduced in the early 1990s as a hybrid of two other dental materials, dental composites and glass ionomer cement, in an effort to combine their desirable properties: aesthetics for dental composites and the fluoride releasing ability for glass ionomer cements.
The Hall Technique is a minimally-invasive treatment for decayed baby back (molar) teeth. Decay is sealed under preformed crowns, avoiding injections and drilling. It is one of a number of biologically orientated strategies for managing dental decay.
Pulp capping is a technique used in dental restorations to protect the dental pulp, after it has been exposed, or nearly exposed during a cavity preparation, from a traumatic injury, or by a deep cavity that reaches the center of the tooth, causing the pulp to die. Exposure of the pulp causes pulpitis. The ultimate goal of pulp capping or stepwise caries removal is to protect a healthy dental pulp, and avoid the need for root canal therapy.
Dental cermets, or silver cermets, are a type of restorative material dentists use to fill tooth cavities.
Atraumatic restorative treatment (ART) is a method for cleaning out tooth decay from teeth using only hand instruments and placing a filling. It does not use rotary dental instruments to prepare the tooth and can be performed in settings with no access to dental equipment. No drilling or local anaesthetic injections are required. ART is considered a conservative approach, not only because it removes the decayed tissue with hand instruments, avoiding removing more tissue necessary which preserves as much tooth structure as possible, but also because it avoids pulp irritation and minimises patient discomfort. ART can be used for small, medium and deep cavities caused by dental caries.
↑ Christian F.J. Stappert, Wael Att, Thomas Gerds, and Joerg R. Strub Fracture resistance of different partial-coverage ceramic molar restorations: An in vitro investigation J Am Dent Assoc 2006 137: 514-522.
↑ Van Nieuwenhuysen JP, D'Hoore W, Carvalho J, Qvist V (2003). "Long-term evaluation of extensive restorations in permanent teeth". Journal of Dentistry. 31 (6): 395–405. doi:10.1016/s0300-5712(03)00084-8. PMID12878022. S2CID24774674. The present prospective, longitudinal study assessed the outcome of posterior extensive restorations and identified risk factors for failure of the restorations. ... The Kaplan–Meier median survival times were 12.8 years for amalgam restorations, 7.8 years for resin restorations, and more than 14.6 years for crowns, considering all retreatment as failures (P=0.002).
↑ Clinical evaluation of ceramic inlays compared to composite restorations.; (2009); RT Lange, P Pfeiffer; Oper Dent. May-Jun;34(3):263-72. doi:10.2341/08-95
↑ Composite resin fillings and inlays. An 11-year evaluation.; U Pallesen, V Qvist; (2003) Clin Oral Invest 7:71–79 doi:10.1007/s00784-003-0201-z Conclusion:.." Considering the more invasive cavity preparation and the higher cost of restorations made by the inlay technique, this study indicates that resin fillings in most cases should be preferred over resin inlays."
↑ Guentsch, Arndt; Busch, Susanne; Seidler, Karin; Kraft, Ulrike; Nietzsche, Sandor; Preshaw, Philip M.; Chromik, Julia N.; Glockmann, Eike; Jandt, Klaus D.; Sigusch, Bernd W. (2010). "Biomimetic Mineralization: Effects on Human Enamel in Vivo". Advanced Engineering Materials. 12 (9): B571–B576. doi:10.1002/adem.201080008. S2CID137647259.
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