A dental restoration or dental filling is a dental restorative material used artificially to restore the function, integrity and morphology of missing tooth structure. The structural loss typically results from caries or external trauma. It is also lost intentionally during tooth preparation to improve the aesthetics or the physical integrity of the intended restorative material. Dental restoration also refers to the replacement of missing tooth structure by restoring dental implants.

Dental restorations may be fabricated out of a variety of materials, Common direct restorative materials include dental amalgam, glass ionomer cement and composite resins. Common indirect restorative materials include acrylic, porcelain, zirconia, gold and other metals.

Dental restoration types Dental restorations can be divided into two broad types: direct restorations and indirect restorations. All dental restorations can be further classified by their location and size.

Direct restorations

Direct restorations are placed in the tooth in situ, while indirect restorations are created away from the tooth, traditionally prepared in a laboratory.

Indirect restorations

Common indirect restorations include inlays and onlays, crowns, bridges, and veneers.

Usually a dental technician fabricates the indirect restoration from records the dentist has provided of the prepared tooth. Once a proper fit and bite is confirmed the restoration is usually bonded permanently.

While the indirect restoration is being prepared, a provisory/temporary restoration sometimes is used to cover the prepared part of the tooth, in order to maintain the occlusal space and the contact points, and insulation of the pulpal tissues and maintenance of the periodontal relationship.

Removable dental prostheses (mainly dentures) are considered by some to be a form of indirect dental restoration, as they are made to replace missing teeth. There are numerous types of precision attachments (also known as combined restorations) to aid removable prosthetic attachment to teeth, including magnets, clips, hooks and implants which could be seen as a form of dental restoration.

Restoration classifications

GV Black classified the fillings depending on their size and location. For example, a one surface filling is called "Class I" under Black's system.

Restoration of dental implants

Dental implants are becoming more widely used as the technology and treatment research improves. A dental implant, usually made from titanium or titanium alloy, is a screw which anchors into maxillary or mandibular bone. Some of the uses of dental implants in restorative care are to support an implant crown, bridge, or dental prosthesis. Ideally the bone integrates into the implant screw's roughened surface.

Materials used in dental restorations

Metals (and metallic alloys)

These metals are mostly used for making crowns, bridges and dentures. Pure titanium could be successfully incorporated into bone. It is biocompatible and stable.

    * titanium

Most commonly used precious metallic alloys

The lingual pit of tooth #7 being restored with gold foil. The upper photo shows the decay removed and the tooth preparation just prior to placement of the gold.

The lingual pit of tooth #7 being restored with gold foil. The upper photo shows the decay removed and the tooth preparation just prior to placement of the gold.

    * gold (high purity: 99.7%)

    * gold alloys (with high gold content)

    * gold-platina alloy

    * silver-palladium allo

Most commonly used base metallic alloys 

    * cobalt-chromium alloy

    * nickel-chrome alloy

Porcelain (ceramics) 

Full-porcelain (ceramic) dental materials include porcelain, ceramic or glasslike fillings and crowns (a.k.a jacket crown, as a metal free option). They are used as in-lays, on-lays, crowns and aesthetic veneers. A veneer is a very thin shell of porcelain that can replace or cover part of the enamel of the tooth. Full-porcelain (ceramic) restorations are particularly desirable because their color and translucency mimic natural tooth enamel.

Another type is known as porcelain-fused-to-metal, which is used to provide strength to a crown or bridge. These restorations are very strong, durable and resistant to wear, because the combination of porcelain and metal creates a stronger restoration than porcelain used alone.

One of the blessings of computerized dentistry (CAD/CAM technologies) is that it enabled the application of zirconium-oxide (ZrO2). The introduction of this material in restorative and prosthetic dentistry is most likely the decisive step towards the use of full ceramics without limitation. With the exception of zirconium-oxide, existing ceramics systems lack reliable potential for the various indications for bridges without size limitations. Zirconium-oxide with its high strength and comparatively higher fracture toughness seems to buck this trend. With a three-point bending strength exceeding nine hundred megapascals, zirconium-oxide can be used in virtually every full ceramic prosthetic solution, including bridges, implant supra structures and root dowel pins.

Previous attempts to extend its application to dentistry were thwarted by the fact that this material could not be processed using traditional methods used in dentistry. The arrival of computerized dentistry enables the economically prudent use of zirconium-oxide in such elements as base structures such as copings and bridges and implant supra structures. Special requirements apply to dental materials implanted for longer than a period of thirty days. Several technical requirements include high strength, corrosion resistance and defect-free producability at a reasonable price.

Ever more stringent requirements are being placed on the aesthetics of teeth. Metals and porcelain are currently the materials of choice for crowns and bridges. The demand for full ceramic solutions, however, continues to grow. Consequently, industry and science are increasingly compelled to develop full ceramic systems. In introducing full ceramic restorations, such as base structures made of sintered ceramics, computerized dentistry plays a key role.

Dental restorations made by using computer technology (CAD/CAM)

The CEREC® method (this is the world's first and only chairside CAD/CAM restorative procedure): first of all, the dentist examines the tooth and determines the appropriate treatment. It could be a simple filling, an in-lay or a full crown, depending on how much healthy tooth structure is remaining. Then he/she takes an optical impression of the prepared tooth by using a camera. Next, the specific software takes the digital picture and converts it into a 3D virtual model on the computer screen. After that, the restoration design data is sent to a separate milling machine in the office. A ceramic block that matches your tooth shade is placed in the milling machine. About 10-20 minutes later, your all-ceramic, tooth-colored restoration is finished and ready to bond in place.

The Procera® method uses patented CAD/CAM technology to improve coping production. Traditionally, once a tooth is prepared for a crown, a cast is made and sent to a laboratory, where a coping is produced by manual techniques. With Procera, the cast is scanned in the lab, and the image is then sent electronically to a Procera Sandvik production facility, where a coping is made by computer-directed machines to exacting specifications of the original scanned casting.

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