Filling materials in the treatment of carious lesions :
Ministry of education and science of the Russian Federation
“Penza State University”
Department of Dentistry
Course paper in discipline
Cariology and diseases of hard tooth tissues.
Topic :
The use of filling materials in the treatment of caries and non-carious lesions of hard tissues of teeth. Cements. Amalgams.
Educational program-31.05.03 Dentistry
Educational program specialization – specialist's degree
Done by Student:
Ben khalifa Aymen
Group : 16lc3a
Controlled by: ass. Of dentistry department
Uldaltsova E.V
The course paper defended with
Mark: ……………………………...
Teachers : ……………………..…..
Defense date : ……………….……
Penza 2018
Content :
Introduction
Filling materials in the treatment of non carious lesions
Filling materials in the treatment of carious lesions
Benefits of dental filling
Disadvantages and risks of dental filling
Conclusion
1-Introduction
Several dental filling materials are available. Teeth can be filled with gold;
porcelain; silver amalgam (which consists of mercury mixed with silver, tin, zinc,
and copper); or tooth-colored, plastic, and materials called composite resin fillings.
There is also a material that contains glass particles and is known as glass ionomer.
This material is used in ways similar to the use of composite resin fillings.
The location and extent of the decay, cost of filling material, your insurance
coverage, and your dentist's recommendation assist in determining the type of
filling best for you.[1]
2- Filling materials in the treatment of non carious lesions :
Non-carious cervical lesions are defined as the pathological loss of tooth
substance at the cementoenamel junction by a disease process other than dental
caries.
The restorative management of non-carious cervical lesions presents a special
challenge due to their histological and structural features. [4]
Although the creation of these lesions is complexed, the main etiological factors are erosion, abrasion and abfraction.
Erosion describes loss of hard dental tissue due to chemical acids, such as
vinegar beverages, and abrasion due to mechanical factors, such as tooth
brushing.
The abfraction theory is used to describe the breakdown of hard dental tissue in
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the cervical area caused by the accumulation of tensile forces during heavy non-
axial occlusal loading. [3]
The margins of may be located in enamel, cementum or dentin and often have a
subgingival position in an aqueous environment. In some cases, part of the
cavity is not reachable or cannot be isolated properly.
Although many studies have evaluated the use of resin composites for the
restoration of glass ionomer cements are also promising materials for the management of these lesions . [2]
NCCLs are as follows: · Composites and adhesive systems · Flowable composites · Compomers · GIC · Giomers
*Composites And Adhesive :
Systems Composites as a restorative material are well known for their superior
esthetic properties. However, the challenge has always been the availability of a
reliable and predictable dentin bonding adhesive that can convincingly replace
GIC as a restorative material in NCCLs.
With the advent of advanced adhesives and dentin bonding agents exhibiting
improved adhesion to the tooth with higher abrasive resistance, composites are
being used as an alternative to GIC, especially in NCCLs . [8]
*Flowable Composites:
The polymerization shrinkage of the composites is the main cause for
microleakage, poor marginal adaptation, and low retention rates.
The flowable composites have low quantities of filler, low modulus of elasticity, and more flexible to dislodging forces.
The rationale of using flowable composites in NCCLs is the low elasticity
module that exhibits more flexibility under occlusal stress in the cervical areas.
They are hypothesized to better absorb the stresses during polymerization
shrinkage, and its viscous-elastic properties allow for the material to be more
flexible to occlusal stress and prevent dislodgement in comparison to
conventional and hybrid composites that are susceptible to chipping under
flexure stresses.
Despite this sound rationale, clinical studies have found little or no influence on
the differences in modulus of elasticity on retention rate. [10]
*Compomers :
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Compomers are a new class of dental materials developed to provide the
combined benefits of composites and glass ionomers.
The main aim of using compomers is to avoid the use of acid etching of enamel
while retaining the elasticity of composites, hydrophilic, and fluoride-releasing
properties of the GICs.
The increased elasticity in comparison to GICs has suggested a better
performance in stress-bearing cervical areas. [9]
*Giomers And Ormocers:
These are a new class of dental materials developed for the restoration of
NCCLs. Giomers are fluoride-releasing resin materials with “prereacted glass,”
a hybrid of glass-ionomer and resin-based composite. They are claimed to have
a better color match, decreased microleakage, and increased fluoride release.
They have a better surface finish and esthetic properties comparable to
composites. Ormocers are organically modified ceramics consisting of a
polycondensed three-dimensional cross-linked organic/inorganic network
(polysiloxanes), organic polymers, and glass/ceramic filler particles. They are
available as fully polymerized materials and undergo less polymerization
shrinkage. The coefficient of thermal expansion approximates that of natural
tooth structure, both results in better marginal adaptation and integrity. [5]
Filling materials in the treatment of carious lesions :
Dental caries (more commonly known as tooth decay) develops when bacteria
from food debris and sugar in the mouth release acids that demineralise and
soften the tooth surface .
The condition initially appears as white spot lesions of demineralised enamel.
If the demineralisation process is not interrupted or reversed, carious lesions
can progress further into the tooth structure and form cavities. Ultimately,
untreated caries can lead to infection and tooth loss. Children who require
extraction of decayed primary teeth also face an increased risk of developing
orthodontic problems due to premature primary dentition loss . [13]
Dental caries is a chronic disease that is almost entirely preventable, and usually
manifests from a combination of the following risk factors: poor oral hygiene,
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frequent sugar consumption, and lack of exposure to topical sources of fluoride,
which is understood to have a cariostatic effect .
The most commonly used restorative materials in carious lesion are as follows :
Amalgam , resin based , glass ionomer cement . [16]
*Amalgam : Dental amalgam is a liquid mercury and metal alloy mixture used
in dentistry to fill cavities caused by tooth decay.[1] Low-copper amalgam
commonly consists
of mercury (50%), silver (~22,32%), tin (~14%), copper (~8%) and other trace
metals.
When placing dental amalgam, the dentist first drills the tooth to remove the
decay and then shapes the tooth cavity for placement of the amalgam filling.
Next, under appropriate safety conditions, the dentist mixes the powdered alloy
with the liquid mercury to form an amalgam putty. (These components are
provided to the dentist in a capsule as shown in the graphic.) This softened
amalgam putty is placed and shaped in the prepared cavity, where it rapidly
hardens into a solid filling. [15]
*Resin based : At one end of the aesthetic restoration spectrum, resin
composites (RC), which are made from a mix of plastic resin and powdered
glass, are strong and resemble the natural colour of teeth, but they are more
expensive to produce than amalgam, and require more time and greater expertise
to fit (for example, ensuring moisture control) . [14]
*Glass ionomer cement :
An alternative is glass ionomer cement (GIC), which is made from a
combination of acid and powdered glass. GIC also resembles tooth colour
(although the appearance is reduced because it is more translucent than RC), but
is more biocompatible as a material and claims to be able to release fluoride for
up to a year after placement, although this is . It is thought that the GIC
fluoride‐release function also provides a mechanism whereby use of topical
fluoride 'recharges' the GIC to maintain ongoing fluoride release .
Different filling materials require different techniques for restoration placement
and retention: amalgam requires preparation of retentive undercuts (known as
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macro‐retention) to mitigate the material's inability to adhere; RC use an
adhesive system to forge a micro‐retentive bond with the tooth's structure,
although the choice of bonding agent may require additional tooth surface
pretreatment before placement; and GIC’s chemical adhesion bonds the material
to the tooth structure without requiring additional adhesive or cavity pretreatment . [17]
4-Benefits of dental fillings :
The dental filling treatment consists of two stages: first, your dentist will clean
out the infected tooth, removing all signs of decay and damage; next, your
dentist will bond the filling material to the tooth to provide additional strength
and support.
Patients can choose to have a silver amalgram filling or tooth-colored composite
filling placed during treatment.
The dental fillings treatment is ideal because it can generally be completed in one dentist appointment, is relatively inexpensive, and results in few side effects.
The dental fillings treatment offers a number of benefits, including:
*Quick procedure: When only one tooth is affected by decay, the fillings
treatment can be completed in as little as one hour
*Long lasting: Tooth-colored fillings tend to last about five to seven years, while silver fillings tend to last about 12 years
*Cost: Treatment is typically covered by dental insurance
*Appearance: Tooth-colored filling restorations produce a natural appearance;
often used to replace old silver amalgram fillings . [18]
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