Since in composite tooth prep should be conservative so the design:
a- amalgam in moderate and large cavities
b_beveled amalgam margines...
C- conservative restorations.***
-------------------
Dental restorations:
There are a wide variety of alternatives for dental restorations of decayed, fractured teeth or to replace missing teeth.
The greater the availability of alternatives, the more important it is to know the peculiarities of each material, its technique of use and its advantages and limitations. In addition to the technique and restorative material, in order to discern the limit of indications between a direct and indirect dental restoration, a broad view of the clinical situation to be managed is required.
Direct and indirect dental restorations:
What is better? This is the question that patients do most frequently. This will depend on some factors such as:
- Extent of decay, fracture or existing restoration that needs to be replaced.
- Mechanical resistance of the remnant.
- Location in the archway and possibility of access to the tooth.
- Location of the margin with respect to the gum.
- Specific characteristics of the dentition and periodontal health of the patient.
- Economic cost of the procedure for the patient.
- Evaluate risks and benefits of the procedures for the patient.
- Ability of the professional to evaluate procedures.
- Professional preference for one technique and another.
- Acceptance by the patient of the proposed treatment.
It is very important to be very clear that there is no single solution for all clinical situations and that the individualization of treatments is a crucial process for the success and durability of dental treatment.
The key is to create a personalized treatment, which seeks to restore as few teeth as possible. The restoration project must also be conservative, preserving the dental structure to the maximum. With this there is less risk of failure and greater mechanical resistance of the tooth is achieved. In addition, a conservative project allows other restoration alternatives to be carried out in the future.
Materials for dental reconstruction:
The options for dental reconstruction available are composite resin, ceramics and glass ionomer cements are the materials available to make aesthetic restorations.
The glass ionomer is indicated for direct restorations, composite resins for direct and indirect restorations and ceramics for indirect restorations. The use of glass ionomer is restricted to small and distant lesions from areas of direct occlusal stress.
Composite resins are the most versatile materials. The possibility of adhesion to enamel and dentin structures altered the way of planning cavitary preparation in a more conservative way, whose concept of preparation is limited to the removal of tissue affected by caries and enamel structures that are too fragile.
The negative aspects of the resins are related to the organic nature of these materials. The organic matrix is exposed to an inevitable process of aging and deterioration. The polymerization of the organic matrix produces dimensional alterations (polymerization contraction) that generates stress at the interface between the restoration and the tooth. The effects of polymerization shrinkage are more significant the greater the volume of resin used and the more complex the geometry of the restorative cavity.
The ceramics constitute another alternative of aesthetic material to make indirect restorations. Under the name of ceramic there is a wide range of materials with different properties. Feldspathic porcelains are the most fragile, aesthetic and best ceramic in adhesion to the tooth. At the other end, zirconium oxide is the strongest, least aesthetic (opaque) ceramic and the one that requires the most effort to achieve some adhesion to the tooth and therefore requires more aggressive preparations that allow the mechanical retention of the prosthesis.
a- amalgam in moderate and large cavities
b_beveled amalgam margines...
C- conservative restorations.***
-------------------
Dental restorations:
There are a wide variety of alternatives for dental restorations of decayed, fractured teeth or to replace missing teeth.
The greater the availability of alternatives, the more important it is to know the peculiarities of each material, its technique of use and its advantages and limitations. In addition to the technique and restorative material, in order to discern the limit of indications between a direct and indirect dental restoration, a broad view of the clinical situation to be managed is required.
Direct and indirect dental restorations:
What is better? This is the question that patients do most frequently. This will depend on some factors such as:
- Extent of decay, fracture or existing restoration that needs to be replaced.
- Mechanical resistance of the remnant.
- Location in the archway and possibility of access to the tooth.
- Location of the margin with respect to the gum.
- Specific characteristics of the dentition and periodontal health of the patient.
- Economic cost of the procedure for the patient.
- Evaluate risks and benefits of the procedures for the patient.
- Ability of the professional to evaluate procedures.
- Professional preference for one technique and another.
- Acceptance by the patient of the proposed treatment.
It is very important to be very clear that there is no single solution for all clinical situations and that the individualization of treatments is a crucial process for the success and durability of dental treatment.
The key is to create a personalized treatment, which seeks to restore as few teeth as possible. The restoration project must also be conservative, preserving the dental structure to the maximum. With this there is less risk of failure and greater mechanical resistance of the tooth is achieved. In addition, a conservative project allows other restoration alternatives to be carried out in the future.
Materials for dental reconstruction:
The options for dental reconstruction available are composite resin, ceramics and glass ionomer cements are the materials available to make aesthetic restorations.
The glass ionomer is indicated for direct restorations, composite resins for direct and indirect restorations and ceramics for indirect restorations. The use of glass ionomer is restricted to small and distant lesions from areas of direct occlusal stress.
Composite resins are the most versatile materials. The possibility of adhesion to enamel and dentin structures altered the way of planning cavitary preparation in a more conservative way, whose concept of preparation is limited to the removal of tissue affected by caries and enamel structures that are too fragile.
The negative aspects of the resins are related to the organic nature of these materials. The organic matrix is exposed to an inevitable process of aging and deterioration. The polymerization of the organic matrix produces dimensional alterations (polymerization contraction) that generates stress at the interface between the restoration and the tooth. The effects of polymerization shrinkage are more significant the greater the volume of resin used and the more complex the geometry of the restorative cavity.
The ceramics constitute another alternative of aesthetic material to make indirect restorations. Under the name of ceramic there is a wide range of materials with different properties. Feldspathic porcelains are the most fragile, aesthetic and best ceramic in adhesion to the tooth. At the other end, zirconium oxide is the strongest, least aesthetic (opaque) ceramic and the one that requires the most effort to achieve some adhesion to the tooth and therefore requires more aggressive preparations that allow the mechanical retention of the prosthesis.
Direct versus indirect restorations:
What are the advantages and disadvantages of indirect and direct dental restorations?
The main difference between direct and indirect restorations is related to the need for more aggressive tooth preparation. The basic conditions of the preparation for an indirect restoration is the divergence of the walls, which determine the quality of the marginal adaptation that the restoration provides the tooth. Direct restorations allow a more conservative plan because of the possibility of filling in cavities with irregular and retentive aspects.
The extension of the cavity and the difficulty of access to perform a direct restoration are factors that influence the indication of indirect restorations. The work on the plaster model facilitates obtaining a correct anatomical contour and adequate occlusal and proximal contacts. In addition the quality of polymerization in an indirect restoration is better. The fabrication in the prosthesis laboratory goes through a more intense polymerization process, associated with the application of heat and pressure. There is a greater degree of conversion of the material that provides greater mechanical resistance and resistance to chemical degradation. However, this advantage determines a disadvantage of indirect resin restorations. The more complete polymerization implies unavailability of polymeric radicals on the surface of the material and this causes less bond strength between the restorations and the resinous agent used to cement the restorations to the tooth.
Compared to direct restorations, there is a significant increase in time and resources in the making of indirect restorations. While direct restorations normally require consultation, the indirect ones are performed in two or more sessions.
Despite being less conservative than direct restorations, indirect partial restorations enable viable and interesting clinical solutions for the aesthetic, mechanical and biological recovery of teeth. The advantage of partial restorations lies in the possibility of preserving the structure of the enamel and dentin and of maintaining a smaller portion of the interface between the tooth and the restoration located in the cervical region. This facilitates inspection, sanitation and maintenance of work compared to a total crown with margins located within the gingival groove.
The ceramics that adhere more efficiently to resinous cement (feldspathic, reinforced with leucite and lithium) are the ones of choice for this type of work, since the remnant does not have an obvious mechanical retention aspect. These solutions also follow the principle that less is more. When partial restoration fails, a total crown is a reliable conventional alternative.
It is necessary to know and control the limitations of the substrate present in the tooth. The degree of mineralization and the direction of the dentinal tubules after preparing the preparation affect the efficiency of dentin binding. The choice of adhesive also determines long-term success, since simplified adhesives (5th, 6th and 7th generation) act as permeable membranes that facilitate hydrolytic degradation of the hybrid layer. The comparison between contemporary adhesives reveals that the 3-step alcohol-based adhesives remain the ones that offer the best adhesion and durability.
In the cementation of indirect restorations, the surplus of the resins used as cement causes concern. This surplus is removed to ensure that it does not harm aesthetics and gingival health. Once the surplus is removed, it is necessary to polish the worn surfaces to give a smoothness that facilitates the preservation and hygiene of the restoration and the tooth.
A tooth with a small dental caries of groove and another with complete absence of the clinical crown represents extreme situations. There is no doubt that a direct restoration is sufficient for the needs of the first situation, while an indirect restoration is indicated for the tooth devoid of crown. This accuracy to decide between direct and indirect is less evident when the tooth has intermediate conditions before Two situations described above.The limit in the indication of direct or indirect restorations depends on factors that include the aesthetic demand, the biomechanical characteristics of the tooth, occlusion, the position of the tooth in the arch, the ability of the professional and the availability of time and resources.
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