Direct restorative materials are what patients normally call fillings. Direct composite restorations are placed at the time that the cavity preparation is cut. Indirect composite restorations are built in a laboratory from a model made from an impression that the dentist takes on the day of the cavity preparation. They are then inserted on a subsequent visit.
Comparison of Direct Restorative Dental
Factors
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Amalgam (silver)
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Composites Direct and Indirect
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Glass lonomers
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Resin lonomers (compomeres)
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General Description
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A mixture of mercury and silver alloy powder that forms a hard solid metal filling, Self-hardening at mouth temperature,
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A mixture of submicron glass filler and acrylic resin that forms a solid tooth-colored restoration. Self- or light-hardening at mouth temperature.
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Self-hardening mixture of fluoride containing glass powder and organic acid that forms a solid tooth-colored restoration able to release fluoride.
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Self- or light-hardening mixture of sub-micron glass filler with fluoride containing glass powder and acrylic resin that forms a solid tooth-colored restoration able to release fluoride.
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Principal Uses
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Dental fillings and heavily loaded back tooth restorations.
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Esthetic dental fillings and veneers,
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Small nonload-bearing fillings, cavity liners and cements for crowns and bridges.
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Leakage and Recurrent Decay
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Leakage is moderate, but recurrent decay is no more prevalent than other materials.
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Leakage low when properly bonded to underlying tooth; recurrent decay depends on maintenance of the tooth-material bond.
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Leakage is generally low; recurrent decay is comparable to other direct materials, fluoride release may be beneficial for patients at high risk for decay.
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Leakage is low when properly bonded to the underlying tooth; recurrent decay is comparable to other direct materials, fluoride release may be beneficial for patients at high risk for decay.
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Overall Durability
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Good to excellent in large load-bearing restorations.
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Good in small-to-moderate size restorations.
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Moderate to good in nonload-bearing restorations; poor in load-bearing.
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Cavity Preparation Considerations
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Requires removal of tooth structure for adequate retention and thickness of the filling.
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Adhesive bonding permits removing less tooth structure.
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Clinical Considerations
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Tolerant to a wide range of clinical placement conditions, moderately tolerant to the presence of moisture during placement.
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Must be placed in a well-controlled field of operation; very little tolerance to presence of moisture during placement.
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Resistance to Wear
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Highly resistant to wear. Brittle, subject to chipping on filling edges, but good bulk strength in larger high-load restorations.
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Moderately resistant, but less so than amalgam.
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High wear when placed on chewing surfaces.
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Resistance to Fracture
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Brittle, subject to chipping on filling edges, but good bulk strength in larger high-load restorations.
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Moderate resistance to fracture in high-load restorations.
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Low resistance to fracture.
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Low to moderate resistance to fracture.
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Biocompatibility
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Well-tolerated with rare occurrences of allergenic response
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Post-Placement Sensitivity
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Early sensitivity to hot and cold possible.
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Occurrence of sensitivity highly dependent on ability to adequately bond the restoration to the underlying tooth.
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Low
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Occurrence of sensitivity highly dependent on ability to adequately bond the restoration to the underlying tooth.
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Esthetics
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Silver or gray metallic color does not mimic tooth color.
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Mimics natural tooth color and translucency, but can be subject to staining and discoloration over time.
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Mimics natural tooth color, but lacks natural translucency of enamel.
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Relative Cost to Patient
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Generally lower; actual cost of fillings depends on size.
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Moderate; actual cost of fillings depends on size and technique.
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Average Number of Visits to Complete
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One
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One for direct fillings; 2+ for indirect inlays, veneers and crowns.
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One
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One
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