NEET MDS Lessons
Dental Materials
Suspension liners
Applications
o Dentin lining under amalgam restorations
o Stimulation of reparative dentin formation
Components
-Calcium hydroxide powder
-Water
-Modifiers
Manipulation
Used as W/P or pastes Paint thin film on dentin → Use forced air for 15 to 30 seconds to dry → Film is thicker (15 µm) than varnishes → Do not use on enamel or cavosurface margins
Properties
Physical
-Electrically insulating barrier
-Too thin to be thermally insulating
Chemical
-High basicity for calcium hydroxide (pH is II)
-Dissolves readily in water and should not be used at exposed cavosurface margins or gaps may form
Mechanical - weak film
Biologic - calcium hydroxide dissolves, diffuses, and stimulates odontoblasts to occlude dentin tubules below cavity preparation
Casting of glass or ceramic
A castable ceramic is prepared in a similar manner as metal cast preparation .
Glass is heated to 1360 degrees & then cast.
Phosphate bonded investments are used for this purpose .
Components
a. Fillers added to most to control shrinkage
b. Matrix
CASTING DEFECTS
Classification :
1) Distortion.
2) Surface roughness .
3) Porosity .
4)Incomplete casting .
5) Oxidation .
6) Sulfur contamination .
Distortion
It is usually due to the distortion of wax pattern.
To avoid this :
Manipulation of the wax at its softening temp
Invest the pattern at the earliest .
If storage is necessary store it in a refrigerator .
Surface roughness
May be due to :
Air bubbles on the wax pattern .
Cracks due to rapid heating of the investment .
High W/P ratio .
Prolonged heating of the mold cavity .
Overheating of the gold alloy .
Too high or too low casting pressure .
Composition of the investment .
Foreign body inclusion.
POROSITY
May be internal or external .
External porosity causes discolouration .
Internal porosity weakens the restoration .
Classification of porosity .
I .Those caused by solidification shrinkage :
a) Localised shrinkage porosity .
b) Suck back porosity .
c) Microporosity .
They are usually irregular in shape .
II ) Those caused by gas :
a) Pin hole porosity .
b) Gas inclusions .
c) Subsurface porosity .
Usually they are spherical in shape .
III ) Those caused by air trapped in the mold :
Back pressure porosity .
Localised shrinkage porosity
Large irregular voids found near sprue casting junction.
Occurs when cooling sequence is incorrect .
If the sprue solidifies before the rest of the casting , no more molten metal is supplied from the sprue which can cause voids or pits (shrink pot porosity )
This can be avoided by -
- using asprue of correct thickness .
- Attach the sprue to the thickest portion of the pattern .
-Flaring of the sprue at the point of atttachment .
-Placing a reservoir close to the pattern .
Suck back porosity
It is an external void seen in the inside of a crown opposite the sprue .
Hot spot is created which freezes last .
It is avoided by :
Reducing the temp difference between the mold & molten alloy .
Microporosity :
Fine irregular voids within the casting .
Occurs when casting freezes rapidly .
Also when mold or casting temp is too low .
Pin hole porosity :
Upon solidification the dissolved gases are expelled from the metal causing tiny voids .
Pt & Pd absorb Hydrogen .
Cu & Ag absorb oxygen .
Gas inclusion porosities
Larger than pin hole porosities .
May be due to dissolved gases or due to gases Carried in or trapped by molten metal .
Apoorly adjusted blow torech can also occlude gases .
Back pressure porosity
This is caused by inadequate venting of the mold .The sprue pattern length should be adjusted so that there is not more than ¼” thickness of the investmentbetween the bottom of the casting .
This can be prevented by :
- using adequate casting force .
-use investment of adequate porosity .
-place the pattern not more than 6-8 mm away from tne end of the casting .
Casting with gas blow holes
This is due to any wax residue in the mold .
To eliminate this the burnout should be done with the sprue hol facing downwards for the wax pattern to run down.
Incomplete casting
This is due to :
- insufficient alloy .
-Alloy not able to enter thin parts of the mold .
-When the mold is not heated to the casting temp .
-Premature solidification of the alloy .
-sprues blocked with foreign bodies .
-Back pressure of gases .
-low casting pressure .
-Alloy not sufficiently molten .
Too bright & shiny casting with short & rounded margins :
occurs when wax is eliminated completely ,it combines with oxygen or air to form carbon monoxide .
Small casting :
occurs when proper expansion is not obtained & due to the shrinkage of the impression .
Contamination of the casting
1) Due to overheating there is oxidation of metal .
2) Use of oxidising zone of the flame .
3) Failure to use a flux .
4) Due to formation sulfur compounds .
Black casting
It is due to :
1) Overheating of the investment .
2) Incomplete elimination of the wax .
Bonding Agents
Applications-composites, resin-modified gIass ionomers, ceramic bonded to enamel restorations, veneers, orthodontic brackets, and desensitizing dentin by covering exposed tubules (Maryland bridges, composite and ceramic repair systems, amalgams and amalgam repair, and pinned amalgams)
Definitions;-
Smear layer - Layer of compacted debris on enamel and/or dentin from the cavity preparation process that is weakly held to the surface (6 to 7 MPa) , and that limits bonding agent strength if not removed
Etching (or, conditioning)- smear layer removal and production of microspaces for micromechanical bonding by dissolving –minor amounts of surface hydroxyapatite crystals
Priming..- micromechanical (and chemical) bonding to the microspaces created by conditioning step.
Conditioning/priming agent-agent that accomplishes both actions
Bonding- formation of resin layer that connect the primed surface to the overlying restoration (e.g., composite) .. –
Enamel bonding System-for bonding to enamel (although dentin bonding may be a Second step)
Dentin bonding system for bonding to dentin (although enamel bonding may have been a first step)
• First-generation dentin bonding system for bonding to smear layer
• New-generation dentin bonding system- for removing smear layer and etching intertubular dentin to allow primer and/or bonding agent to diffuse into spaces between collagen and form hybrid zone
Enamel and dentin bonding system-for bonding to enamel and dentin surfaces with the same procedures
Amalgam bonding system for bonding to enamel, dentin, and amalgam, dentin and amalgam during an amalgam placement procedure or for amalgam repair
Universal bonding system-for bonding to enamel, dentin, amalgam, porcelain , or any other substrate intraorally that may be necessary for a restorative procedure using the same set of procedures and materials
Types
Enamel bonding systems
Dentin bonding systems
Amalgam bonding systems
Universal bonding systems
Structure
o Components of bonding systems
o Conditioning agent-mineral or organic acid
Enamel only 37% phosphoric acid
Dentin only or enamel and .dentin---37% phosphoric acid, citric acid, maleic acid, or nitric acid
o Priming agent
Hydrophobic-solvent-soluble, light cured monomer system
Hydrophilic-water-soluble, light-cured monomer system
Bonding agent
BIS-GMA-type monomer system
UDMA-type monomer system
Reaction
Bonding occurs primarily by intimate micromechanical retention with the relief created by the conditioning step
Chemical bonding is possible but is not recognized as contributing significantly to the overall bond strength
Manipulation-follow manufacturer's directions
Properties
Physical-thermal expansion and contraction may create fatigue stresses that debond the interface and permit micro leakage
Chemical-water absorption into the bonding agent may chemically alter the bonding
Mechanical-mechanical stresses may produce fatigue that debonds the interface and permits microleakage
Enamel bonding-adhesion occurs by macrotags (between enamel prisms) and microtags (into enamel prisms) to produce micromechanical retention
Dentin bonding-adhesion occurs by penetration of smear layer and formation of microtags into intertubular dentin to produce a hybrid zone (interpenetration zone or diffusion zone) that microscopically intertwines collagen bundles and bonding agent polymer
Biologic
Conditioning agents may be locally irritating if they come into contact with soft tissue
Priming agents (uncured), particularly those based on HEMA, may be skin sensitizers after several contacts with dental personnel
Protect skin on hands and face from inadvertent contact with unset materials and/ or their vapors
HEMA and other priming monomers may penetrate through rubber gloves in relatively short times (60 to 90 seconds)
Dental Implants
Applications/Use
Single-tooth implants
Abutments for bridges (freestanding, attached to natural teeth)
Abutments for over dentures
Terms
Subperiosteal- below the periosteum -but above the bone (second most frequently used types)
Intramucosal-within the mucosa
Endosseous into the bone (80%of all current types)
Endodontics-through the root canal space and into the periapical bone
Transosteal-through the bone
Bone substitutes -replace. Long bone
Classification by geometric form
Blades
Root forms
Screws
Cylinders
Staples
Circumferential
Others
Classification by materials type
Metallic-titanium, stainless steel, and .chromium cobalt
Polymeric-PMMA
Ceramic hydroxyapatite, carbon, and sapphire
Classification by attachment design
Bioactive surface retention by osseointegration
Nonative porous surfaces for micromechanical retention by osseointegration
Nonactive, nonporous surface for ankylosis. By osseointegration
Gross mechanical retention designs (e.g.. threads, screws, channels, or transverse holes)
Fibrointegration by formation of fibrous tissue capsule
Combinations of the above
Components
a. Root (for. osseointegration)
b. Neck (for epithelial attachment and percutancaus sealing)
c. Intramobile elements (for shock absorption)
d. Prosthesis (for dental form and function)
Manipulation
a. Selection-based on remaining bone architecture and dimensions
b. Sterilization-radiofrequency glow discharge leaves biomaterial surface uncontaminated and sterile; autoclaving or chemical sterilization is contraindicated for some designs
Properties
1. Physical-should have low thermal and electrical conductivity
2. Chemical
a. Should be resistant to electrochemical corrosion
b. Do not expose surfaces to acids (e.g.. APF fluorides).
c. Keep in mind the effects of adjunctive therapies (e.g., Peridex)
3. Mechanical
a. Should be abrasion resistant and have a high modulus
b. Do not abrade during scaling operations (e.g.with metal scalers or air-power abrasion systems like Prophy iet)
4. Biologic-depend on osseointegration and epithelial attachment
INVESTING
Mixing investment with distilled water is done according to the manufacturers ratio in a clean dry bowl without entrapment of the air into the mix.
Mixing methods:
a. Hand mixing and the use of the vibrator to remove air bubbles.
b. Vacuum mixing- This is the better method because it removes air bubbles as well as gases that are produced and thus produces a smoother mix.
Methods of investing:
a. Hand investing
b. Vacuum investing
Hand investing:
First the mixed investment is applied on all the surfaces of the pattern with a soft brush. Blow off any excess investment gently, thus leaving a thin film of investment over the pattern, then apply again.
Then the coated pattern can be invested by two methods;
1. Placing the pattern in the ring first and then filling the ring full with investment.
2. Filling the ring with the investment first and then force the pattern through into it.
Vacuum investing :
Vacuum investing unit: This consists of the chamber of small cubic capacity from which air can be evacuated quickly and in which casting ring can be placed.
Evacuation of air can be done by electrically or water driven vacuum pump.
Procedure:
The ring filled with investment is placed in the vacuum chamber. Air entry tube is closed. Then the vacuum is applied. The investment will rise with froth vigorously for about 10-15 sec and then settles back. This indicates that air has been extracted from the ring. The pressure is now restored to atmospheric by opening the air entry tap gradually at first and then more rapidly as the investment settles back around the pattern. Then the ring is removed from the chamber and the investment is allowed to set. Modern investing unit does both mixing and investing under vacuum and is considered better than hand mixing and pouring.
Then there are two alternatives to be followed depending upon what type of expansion is to be achieved in order to compensate for metal shrinkage. They are:
1. If hygroscopic expansion of the investment is to be achieved then immediately immerse the filled ring in water at the temperature of 37C.
Or “under controlled water adding technique”. A soft flexible rubber ring is used instead of usual lined metal ring. Pattern is invested as usual. Then specified amount of water is added on top of the investment in the rubber ring and the investment is allowed to set at room temperature. In this way only enough water is added to the investment to provide the desired expansion.
2. If thermal expansion of the investment is to be achieved, then investment is allowed to set by placing the ring on the bench for 1 hour or as recommended by the manufacturer.