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A Peer-Reviewed Publication
Abstract
The posterior restorative material of choice depends on the individual clinical situation and patient. Amalgam has a long history of use and clinical success. Esthetic restorations are increasingly in demand, and include glass ionomers, compomers and composite resins. Fluoride release is a desirable attribute in a restorative material, as are wear resistance, low polymerization shrinkage and low polymerization stress. Recently, technologies have been incorporated into composite resins that lower polymerization shrinkage and stress.
Educational Objectives
The overall goal of this article is to provide dental professionals with information on the options available for posterior esthetic restorations. Upon completion of this course, the participant will be able to do the following:
1. List and describe the considerations involved in the selection of posterior restorative materials
2. List and describe the history and safety profile of amalgam, its advantages and disadvantages
3. List and describe how polymerization stress occurs and its relevance to restoration failure
4. List and describe the technologies that can now be incorporated into posterior composite restoratives to combat polymerization shrinkage and/or polymerization stress
Introduction
Material selection for restoring posterior teeth depends upon the patient's age, caries risk, esthetic requirements, ability to isolate the tooth and functional demands placed on the restoration. Although amalgam has been an effective restorative material for Class I and II cavity preparations, patient expectations are varied and range from high functional requirements to high esthetic demands. Each material used to restore posterior teeth has specific advantages and disadvantages and these should be carefully weighed before selecting a restorative material. Compomers, glass ionomers and composite resins bond to tooth structure and may reinforce weakened tooth structure. They have proven longevity in minimally invasive preparations, are excellent thermal insulators, esthetic, and produce varying levels of fluoride release, which may inhibit recurrent caries. However, esthetic restorative materials have disadvantages. Composite resin, while the most durable of the esthetic direct restorative materials, has clinical limitations that restrict its use as a posterior restorative material, especially in areas where isolation is poor and wear is high. Resin restorations require greater attention to detail during adhesive placement, increased placement time and are technically more difficult than a similar- sized amalgam restoration. Postoperatively, sensitivity to cold is a frequent...