Comparisons of Direct Restorative Dental Materials
Types of Direct Restorative Dental Materials |
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|---|---|---|---|---|
| comparative factors | amalgam | composite resin (direct and indirect restorations) | glass ionomer cement | resin-ionomer cement |
| General Description | Self-hardening mixture in varying percentages of a liquid mercury and silver-tin alloy powder. | Mixture of powdered glass and plastic resin; self-hardening or hardened by exposure to blue light. | Self-hardening mixture of glass and organic acid. | Mixture of glass and resin polymer and organic acid; self hardening by exposure to blue light. |
| principal Uses | Fillings; sometimes for replacing portions of broken teeth. | Fillings, inlays, veneers, partial and complete crowns; sometimes for replacing portions of broken teeth. | Small fillings; cementing metal & porcelain/metal crowns, liners, temporary restorations. | Small fillings; cementing metal & porcelain/metal crowns, and liners. |
| Resistance to Further Decay | High; self-sealing characteristic helps resist recurrent decay; 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 may be imparted through fluoride release. | Low-Moderate; some resistance to decay may be imparted through fluoride release. |
| Estimated Durability (permanent teeth) | Durable | Strong, durable. | Non-stress bearing crown cement. | Non-stress bearing crown cement. |
| Relative Amount of Tooth Preserved | Fair; Requires removal of healthy tooth to be mechanically retained; No adhesive bond of amalgam to the tooth. | 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 the 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 by surface corrosion; margins may chip over time. | Good if 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, dentine/ post-insertion expansion may help seal the 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. However amalgams contain mercury. Mercury in its elemental form is toxic and as such is listed on prop 65. | Concerns about trace chemical release are not supported by research studies. Safe; no known toxicity documented. Contains some compounds listed on prop 65. | 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 for allergic reactions was found. | No documentation for allergic reactions was found. Progressive roughening of the surface may predispose to plaque accumulation and periodontal disease. | No known documented allergic reactions; Surface may roughen slightly over time; predisposing to plaque accumulation and periodontal disease if the material contacts the gingival tissue. |
| Susceptibility to Post-Operative Sensitivity | Minimal; High thermal conductivity may promote temporary sensitivity to hot and cold; Contact with other metals may cause occasional and transient galvanic response. | Moderate; Material is sensitive to dentist's technique; Material shrinks slightly when hardened, and a poor seal may lead to bacterial leakage, recurrent decay and tooth hypersensitivity. | Low; material seals well and does not irritate pulp. | Low; material seals well and does not irritate pulp. |
| Esthetics (Appearance) | Very poor. Not tooth colored: initially silver-gray, gets darker, becoming black as it corrodes. May stain teeth dark brown or 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; some composite materials show 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 Costs to Patient | Low, relatively inexpensive; actual cost of fillings depends upon their size. | Moderate; higher than amalgam fillings; actual cost of fillings depends upon their size; veneers & crowns cost more. | Moderate; similar to composite resin (not used for veneers and crowns). | Moderate; similar to composite resin (not used for veneers and crowns). |
| Number of Visits Required | Single visit (polishing may require a second visit) | Single visit for fillings; 2+ visits for indirect inlays, veneers and crowns. | Single visit. | Single visit. |
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