| Types of Direct Restorative Materials | ||||
| Comparative Factors | Silver Amalgam |
Composite Resin (Direct & Indirect Restorations) |
Glass Ionomer Cement | Resin Reinforced- Glass Ionomer Cement |
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| Number of Visits Requested | Single visit (polishing can be done at next visit) | Single visit for fillings (2+ visits when used for indirect inlays & crowns, etc.) | Single visit | Single visit |
| General Description | Self-hardening alloy of silver-tin-mercury | Light Cured mixture of powdered glass and plastic resin | Self-hardening mixture of organic acid and powdered glass | Self-hardening or Light Cured mixture of composite polymer and organic acid |
| Principle Uses | Fillings; sometimes replacing portions of broken teeth | Fillings,inlays, veneers; sometimes replacing portions of broken teeth | Cementing crowns, temporary fillings, or lining the base of a cavity | Cementing crowns, temporary fillings, or lining the base of a cavity |
| Resistance to Further Decay | High; corrosion of material causes a self-sealing characteristic but recurrent decay around amalgam is difficult to detect in its early stages. | Moderate; recurrent decay is easily detected in early stages. | Low-Moderate; some resistance to decay is due to fluoride release. | Low-Moderate; some resistance to decay is due to fluoride release. |
| Estimated Durability | Durable | Strong, durable. | Low, no-stress bearing crown cement | Low, non-stress bearing crown cement |
| Relative Amount of Tooth Preserved | Fair, requires removal of healthy tooth to be mechanically retained; requires minimal thickness of 2mm for strength. | Excellent; bonds adhesively to healthy enamel and dentin. | Excellent; bonds adhesively to healthy enamel and dentin. | Excellent; bonds adhesively to healthy enamel and dentin. |
| Resistance to Surface Wear | Low, similar to dental enamel; brittle metal. | May wear slightly faster than dental enamel. | Poor in stress-bearing applications. Fair in non-stress bearing applications. | Poor in stress-bearing applications. Good in non-stress bearing applications. |
| Resistance to Fracture | Amalgam may fracture under stress; tooth around filling may fracture before amalgam does. | Good resistance to fracture. | Brittle; low resistance to fracture but not recommended for stress-bearing restorations. | Tougher than glass ionomer, recommended for stress-bearing restorations in adults. |
| Resistance to Leakage | Good; self-sealing due to surface corrosion; margins may chip over time. | Good if properly bonded to enamel; may show leakage over time when bonded to dentin; Does not corrode. | Moderate; tends to crack over time | Good; adhesively bonds to resin, enamel, dentin/post-insertion expansion may help to seal margins. |
| Resistance to Occlusal Stress | High; but lack of adhesion may weaken the remaining tooth. | Good to excellent depending upon product used. | Poor; not recommended for stress-bearing restorations. | Moderate; not recommended to restore biting surfaces of adults; suitable for short-term primary teeth restorations. |
| Toxicity | Generally safe; occasional allergic reactions to metal components. Amalgams contain mercury. Mercury by itself is toxic, although it is chemically inert when bound in amalgam. | Safe; no known toxicity documented. | No known incompatibilities Safe; no known toxicity documented. | No known incompatibilities Safe; no known toxicity documented. |
| Allergic or Adverse Reactions | Rare; recommend that dentist evaluate patient to rule out metal allergies. | No documentation of allergic reactions has been found. | No documentation for allergic reations was found. Progressive roughening of the surface may predispose to plaque accumulation and periodontal disease. | No documentation for allergic reations was found. Progressive roughening of the surface may predispose to plaque accumulation and periodontal disease if the material contacts the gingival tissue. |
| Post-Operative Sensitivity | Minimal; High thermal conductivity may promote temporary sensitivity to hot and cold; Contact to other metals may cause occasional galvanic electrical sensations. | Moderate; Material is sensitive to dentists' proper technique. Material shrinks slightly when hardened, and a poor marginal seal may lead to bacterial leakage, recurrent decay and tooth hyper-sensitivity. | Low; material seals well and does not irritate pulp | Low; material seals well and does not irritate pulp. |
| Esthetics (Appearance) | Very Poor. Initially silver-gray, gets darker & black as it corrodes. May stain tissues black over time. | Excellent; often indistinguishable from natural tooth. | Good; tooth colored, varies in translucency. | Very good; more translucency than glass ionomer. |
| Frequency of Repair or Replacement | Low; replacement is usually due to fracture of the filling or the surrounding tooth. | Low-Moderate; durable material hardens rapidly; More rapid wear than amalgam. Replacement is usually due to marginal leakage. | Moderate; Slowly dissolves in mouth; easily dislodged. | Moderate; more resistant to dissolving than glass ionomer, but less than composite resin. |
| Relative Cost to Patient | Low, relatively inexpensive; actual cost of fillings depends on their size. | Moderate; higher than amalgam; actual cost of fillings depends on their size. | Moderate; similar to composite resin (not used for veneers and crowns). | Moderate; similar to composite resin (not used for veneers and crowns). |
| Silver Amalgam |
Composite Resin (Direct & Indirect Restorations) |
Glass Ionomer Cement | Resin Reinforced- Glass Ionomer Cement | |
| Types of Indirect Restorative Dental Material | |||||
| Comparative Factors |
Gold Alloys (Noble) |
Nickel or Cobalt-Chrome Alloys (Base Metal) |
Porcelain (Ceramic Only) |
Porcelain (Fused to Metal) |
Porcelain (Fused to Ceramic) |
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| Number of Visits Requested | 2 Visits (minimum) | 2 Visits (minimum) | 2 Visits (minimum); matching esthetics may require more visits. | 2 Visits (minimum); matching esthetics may require more visits. | 2 Visits (minimum); matching esthetics may require more visits. |
| General Description | Mixture of gold, copper, palladium and other metals used for inlays, onlays, crowns & bridges | Mixture of nickel & chromium | Glass-like material baked into crown forms using models of the prepared teeth | Glass-like material that is baked onto metal shells; used for crowns & bridges | Glass-like material that is baked onto ceramic shells – can be alumina, zirconium or a combination of both, used for crowns & bridges |
| Principle Uses | Cast metal crowns & bridges | Cast metal crowns & bridges; most Removable Partial Denture (RPD) frameworks | Inlays, veneers, crowns and bridges | Crowns & bridges | Crowns, bridges & implant abutments |
| Resistance to Further Decay | Good if the restoration fits well. | Good if the restoration fits well. | Good if the restoration fits well. | Good if the restoration fits well. | Good if the restoration fits well. |
| Estimated Durability | Excellent. Does not fracture under stress; does not corrode in the mouth. Actually gets smoother (burnishes) with time. | Excellent. Does not fracture under stress; does not corrode in the mouth. | Moderate. Brittle material that may fracture under high biting forces. Not recommended for posterior (molar) teeth. | Very Good. Less susceptible to fracture due to the metal substructure. | Good. Porcelain-Ceramic bond is greater than Porcelain Fused to Metal. Brittle substructure is more likely to fail at the onset of a problem than metal, therefore easier to detect problems and recurrent decay. |
| Relative Amount of Tooth Preserved | Good. A strong material that requires removal of a thin outside layer of the tooth. | Good. A strong material that requires removal of a thin outside layer of the tooth. | Good-Moderate. Little removal of natural tooth is necessary for Veneers; more for crowns since porcelain strength is related to its bulk (thickness). | Moderate-High. More tooth must be removed to permit the metal to accompany the porcelain. | Moderate. Less tooth must be removed than metal-porcelain crowns to achieve the same esthetic result. |
| Resistance to Surface Wear | Similar hardness to natural enamel; does not abrade opposing teeth. | Harder than natural enamel but minimally abrasive to opposing natural teeth. | Resistant to surface wear; but abrasive to opposing teeth. | Resistant to surface wear; permists either metal or porcelain on the biting surface of crowns and bridges. | Resistant to surface wear; but abrasive to opposing teeth. Same as all porcelain. |
| Resistance to Fracture | Does not fracture in bulk. | Does not fracture in bulk. | Poor resistance to fracture. | Porcelain surface may fracture. | Moderate resistance to fracture. Will fracture when undermined by decay, does not mask problems. |
| Resistance to Leakage | Very good-Excellent. Can be formed with great precision and can be tightly adapted to the tooth. | Good-Very Good – Stiffer than gold; less adaptable, but can be formed with great precision. | Very Good. Can be fabricated for very accurate fit of the Crown margins. | Good – Very Good depending on the design of the Crown margins. | Good – Very Good depending on the design of the Crown margins. |
| Resistance to Occlusal Stress | Excellent | Excellent | Moderate; brittle material susceptible to catastrophic fracture under biting forces. | Very good. Metal substructure gives high resistance to fracture. | Good. Ceramic substructure gives moderate resistance to fracture. Will fracture when undermined by decay, does not mask problems. |
| Toxicity | None; No known adverse effects. | None; Occasional/ rare allergy to metal alloys used. | None; No known adverse effects. | None; Occasional/ rare allergy to metal alloys used. | None; No known adverse effects. |
| Allergic or Adverse Reactions | Extremely rare; occasional allergic reactions seen in susceptible individuals. | Rare; Nickel allergies are common among women, although rarely manifested in dental restorations. | None. | Rare; Occasional allergy to metal substructures. | None. |
| Post-Operative Sensitivity | Conducts heat and cold; may irritate sensitive teeth. | Conducts heat and cold; may irritate sensitive teeth. | Not due to material, only due to over-preparation of tooth. | Not due to material, only due to over-preparation of tooth. | Not due to material, only due to over-preparation of tooth. |
| Esthetics (Appearance) | Poor- gold colored metal. | Poor- dark silver metal. | Excellent | Good to Excellent | Excellent |
| Frequency of Repair or Replacement | Infrequent; replacement is usually due to recurrent decay around margins. | Infrequent; replacement is usually due to recurrent decay around margins. | Varies; depends on biting forces; fractures of molar teeth are more likely than anterior teeth; porcelain fracture may often be repaired with composite resin. | Infrequent; porcelain fracture can sometimes be repaired with composite resin. | Infrequent; depends on biting forces; fractures of molar teeth are more likely than anterior teeth. In most cases, fracture indicates a problem which ceramic materials will not hide (unlike metal). |
| Relative Cost to Patient | High; requires expensive materials and laboratory services. | High; less expensive than cast gold materials, but laboratory services as well. | High; requires expensive materials and laboratory services. | High; requires expensive materials and laboratory services. | Highest; requires expensive materials and CAD/CAM laboratory services [Computer Aided Design and Manufac-turing] |
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Gold Alloys (Noble) |
Nickel or Cobalt-Chrome Alloys (Base Metal) |
Porcelain (Ceramic Only) |
Porcelain (Fused to Metal) |
Porcelain (Fused to Ceramic) |
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