Pit-and-Fissure Dental Sealants

Applications/Use

Occlusal surfaces of newly erupted posterior teeth
Labial surfaces of anterior teeth with fissures
Occlusal surfaces of teeth in older patients with reduced saliva flow (because low saliva increases the susceptibility to caries)

Types

Polymerization method

Self-curing (amine accelerated)
Light curing (light accelerated)

Filler content

Unfilled-most systems are unfilled because filler tends to interfere with wear away from self-cleaning occlusal areas(sealants are designed to wear away, except where there is no self-cleaning action a common misconception is that sealants should be wear resistant)

Components

Monomer-BIS-GMA with TEGDM diluent to facilitate flow into pits and fissures prior to cure
Initiator-benzoyl peroxide (in self-cured) and diketone (in light cured)
Accelerator-amine (In light cured)
Opaque filler-I % titanium dioxide. or other colorant to make the material detectable on tooth surfaces
Reinforcing filler-generally not added because wear resistance is not required within pits and fissures

Reaction-free radical reaction 

Manipulation

Preparation

Clean pits and fissures of organic debris. Do not apply fluoride before etching because it will tend to make enamel more acid resistant. Etch occlusal surfaces, pits, and fissures for 30 seconds (gel) or 60 seconds (liquid) with 37% phosphoric acid . Wash occlusal surfaces for 20 seconds. Dry etched area for 20 seconds with clean air spray. Apply sealant and polymerize

Mixing or dispensing

Self-cured-mix equal amounts of liquids in Dappen dish for 5 seconds with brush applicator. Light cured-dispense from syringe tips 
Placement

-pits, fissures, and occlusal surfaces  --> Allow 60 seconds for self-cured materials to set. 

Finishing

Remove unpolymerized and excess material .Examine hardness of sealant. Make occlusal adjustments where necessary in sealant; some sealant materials are self-adjusting

Properties

Physical

Wetting-low-viscosity sealants wet acid etched tooth structure the best

Mechanical

Wear resistance should not be too great because sealant should be able to wear off of  self-cleaning areas of tooth
Be careful to protect sealants during polishing procedures with air abrading units to prevent sealant loss

Clinical efficacy

Effectiveness is 100% if retained in pits and fissures .Requires routine clinical evaluation for resealing of areas of sealant loss attributable to poor retention .
Sealants resist effects of topical fluorides
 

Solution Liners (Varnishes)

Applications 

o    Enamel and dentin lining for amalgam restorations
o    Enamel and dentin lining for cast restorations that are used with non adhesive cements
o    Coating over materials that are moisture sensitive during setting

Components of copal resin varnish

o    90% solvent mixture (e.g., chloroform, acetone, and alcohol)
o    10% dissolved copal resin

Reaction
 
Varnish sets physically by drying → Solvent loss occurs in 5 to 15 seconds (a film forms the same way as drying fingernail polish)

Manipulation

Apply thin coat over dentin. enamel. And margins of the cavity preparation → Dry lightly with air for 5 seconds Apply a second thin coat → Final thickness is 1 to 5 µ.m

Properties

o    Physical 

Electrically insulating barrier that prevents shocks. Too thin to be thermally insulating. Decreases degree of percolation attributable to thermal expansion

o    Chemical

Forms temporary barrier that prevents microleakage into dentinal tubules until secondary dentin formation occurs. Decreases initial tendency for electrochemical corrosion

o     Mechanical

Very weak and brittle film that has limited lifetime 
Film adheres to smear layer

Properties of Amalgam.

The most important physical properties of amalgam are

• Coefficient of thermal expansion = 25-1 >ppm/ C (thus amalgams allow percolation during temperature changes)

• Thermal conductivity-high (therefore, amalgams need insulating liner or base in deep restorations)
• Flow and creep. Flow and creep are characteristics that deal with an amalgam undergoing deformation when stressed. The lower the creep value of an amalgam, the better the marginal integrity of the restoration. Alloys with high copper content usually have lower creep values than the conventional silver-tin alloys.

 Dimensional change. An amalgam can expand or contract depending upon its usage. Dimensional change can be minimized by proper usage of alloy and mercury. Dimensional change on setting, less than ± 20 (excessive expansion can produce post operative pain)

•  Compression strength. Sufficient strength to resist fracture is an important requirement for any restorative material. At a 50 percent mercury content, the compression strength is approximately 52,000 psi. In comparison, the compressive strength of dentin and enamel is 30,000 psi and 100,000 psi, respectively. The strength of an amalgam is determined primarily by the composition of the alloy, the amount of residual mercury remaining after condensation, and the degree of porosity in the amalgam restoration.
• Electrochemical corrosion produces penetrating corrosion of low-copper amalgams but only produces superficial corrosion of high copper amalgams, so they last longer

• Because of low tensile strength, enamel support is needed at margins

• Spherical high-copper alloys develop high tensile strength faster and can be polished sooner
• Excessive creep is associated with silver mercury phase of low-copper amalgams and contributes to early marginal fracture
• Marginal fracture correlated with creep and electrochemical corrosion in low-copper amalgams
• Bulk fracture (isthmus fracture) occurs across thinnest portions of amalgam restorations because  of high stresses during traumatic occlusion and/or the accumulated effects of fatigue
• Dental amalgam is very resistant to abrasion

CRUCIBLE FORMER

It serves as a base for the casting ring during investing .Usually convex in shape.
May be metal , plastic or rubber .
Shape depends on casting machine used .
Modern machines use tall crucible to enable the pattern to be positioned near the end of the casting machine .

PHYSICAL PROPERTIES OF MATERIALS

Definite and precise terms are used to describe the physical properties of dental materials.

a. Hardness. Hardness is the measure of the resistance of a metal to indentation or scratching. It is an indication of the strength and wearability of an alloy or metal.

b. Ductility. Ductility is the measure of the capacity of a metal to be stretched or drawn by a pulling or tensile force without fracturing. This property permits a metal to be drawn into a thin wire.

c. Malleability. Malleability is the measure of the capacity of a metal to be extended in all directions by a compressive force, such as rolling or hammering. This property permits a metal to be shaped into a thin sheet or plate.

d. Flexibility and Elasticity. These terms differ in their technical definition but they are very closely related. Flexibility is the characteristic of a metal, which allows it to deform temporarily. The elasticity of a metal is used when it returns to its original shape when the load or force is removed.

e. Fatigue. Fatigue is the property of a metal to tire and to fracture after repeated stressing at loads below its proportional limit.

f. Structure (Crystalline or Grain Structure). Metals are crystalline and many of their physical properties depend largely upon the size and arrangement of their minute crystals called grains.

(1) Grain size. The size of the grains in a solidified metal depends upon the number of nuclei of crystallization present and the rate of crystal growth. In the practical sense, the faster a molten is cooled to solidification, the greater will be the number of nuclei and the smaller will be the grain size. Generally speaking, small grains arranged in an orderly fashion give the most desirable properties.

(2) Grain shape. The shape of the grains is also formed at the time of crystallization. If the metal is poured or forced into a mold before cooling, the grains will be in a flattened state. Metal formed by this method is known as cast metal. If the metal is shaped by rolling, bending, or twisting, the grains are elongated and the metal becomes a wrought wire.

g. Crushing Strength. Crushing strength is the amount of resistance of a material to fracture under compression.

h. Thermal Conductivity. Thermal conductivity is defined as the ability of a material to transmit heat or cold. A low thermal conductivity is desired in restorative materials used on the tooth whereas a high thermal conductivity is desirable where the material covers soft tissue.

COMPOSITE RESINS

Types

• Amount of filler-25% to 65% volume, 45% to 85% weight
• Filler particle size (diameter in microns)
  • Macrofill 10 to 100 µm (traditional composites)
  • Midi fill- 1 to 10 µm(small particle composites)
  • Minifill— 0.l to 1 µm
  • Microfill-: 0.01 to  0.1 µm (fine particle composites)
  • Hybrid--blend (usually or  microfill and midifill or minifill and microfill)
• Polymerization method
  • Auto-cured (self-cured)
  • Visible light cured
  • Dual cured
  • Staged cure
• Matrix chemistry
  • BIS-GMA type
  • Urethane dimethacrylate (UDM or UDMA) type
  • TEGDMA-diluent monomer to reduce  viscosity