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

CLEANING AND PICKLING ALLOYS

The surface oxidation or other contamination of dental alloys is a troublesome occurrence. The oxidation of base metals in most alloys can be kept to a minimum or avoided by using a properly adjusted method of heating the alloy and a suitable amount of flux when melting the alloy . Despite these precautions, as the hot metal enters the mold, certain alloys tend to become contaminated on the surface by combining with the hot mold gases, reacting with investment ingredients, or physically including mold particles in the metal surface. The surface of most cast, soldered, or otherwise heated metal dental appliances is cleaned by warming the structure in suitable solutions, mechanical polishing, or other treatment of the alloy to restore the normal surface condition.

Surface tarnish or oxidation can be removed by the process of pickling. Castings of noble or high-noble metal may be cleaned in this manner by warming them in a 50% sulfuric acid and water solution . . After casting, the alloy (with sprue attached) is placed into the warmed pickling solution for a few seconds. The pickling solution will reduce oxides that have formed during casting. However, pickling will not eliminate a dark color caused by carbon deposition 

The effect of the solution can be seen by comparing the submerged surfaces to those that have still not contacted the solution. the ordinary inorganic acid solutions and do not release poisonous gases on boiling (as sulfuric acid does). In either case, the casting to be cleaned is placed in a suitable porcelain beaker with the pickling solution and warmed gently, but short of the boiling point. After a few moments of heating, the alloy surface normally becomes bright as the oxides are reduced. When the heating is completed, the acid may be poured from the beaker into the original storage container and the casting is thoroughly rinsed with water. Periodically, the pickling solution should be replaced with fresh solution to avoid excessive contamination.

Precautions to be taken while pickling

With the diversity of compositions of casting alloys available today, it is prudent to follow the manufacturer's instructions for pickling precisely, as all pickling solutions may not be compatible with all alloys. Furthermore, the practice of dropping a red-hot casting into the pickling solution should beavoided. This practice may alter the phase structure of the alloy or warp thin castings, and splashing acid may be dangerous to the operator. Finally, steel or stainless steel tweezers should not be used to remove castings from the pickling solutions. The pickling solution may dissolve the tweezers and plate the component metals onto the casting. Rubber-coated or Teflon tweezers are recommended for this purpose.

Physical reaction-cooling causes reversible hardening

Chemical reaction-irreversible reaction during setting

Mechanical properties

1.  Resolution of forces

Uniaxial (one-dimensional) forces-compression, tension, and shear

Complex forces-torsion, flexion. And diametral

2. Normalization of forces and deformatations

Stress

 Applied force (or material’s resistance to force) per unit area

Stress-force/area (MN/m²)

Strain

Change in length per unit of length because of force

Strain-(L- L_o)/(L_o); dimensionless units

3. Stress-strain diagrams

Plot of stress (vertical) versus strain (horizontal)

• Allows convenient comparison of materials
• Different curves for compression, tension, and shear
• Curves depend on rate of testing and temperature

4. Analysis of curves

• Elastic behavior
  • Initial response to stress is elastic strain
  • Elastic modulus-slope of first part of curve and represents stiffness of material or the resistance to deformation under force
  • Elastic limit (proportional limit)- stress above which the material no longer behaves totally elastically
  • Yield strength-stress that is an estimate of the elastic limit at 0.002 permanent strain
  • Hardness-value on a relative scale that estimates the elastic limit in terms of a material’s resistance to indentation (Knoop hardness scale, Diamond pyramid, Brinnell, Rockwell hardness scale, Shore A hardness scale, Mohs hardness scale

• Resilience-area under the stress strain curve up to the elastic limit (and it estimates the total elastic energy that can be absorbed before the onset of plastic deformation)

• Elastic and plastic behavior

• Beyond the stress level of the elastic  limit, there is a combination of elastic  and plastic strain
• Ultimate strength-highest stress  reached before fracture; the ultimate compressive strength is greater than the ultimate shear strength and the ultimate tensile strength
• Elongation (percent elongation)- percent change in length up to the point of fracture = strain x 100%

• Brittle materials-<5% elongation at fracture

• Ductile materials->5% elongation  at fracture
• Toughness-area under the stress strain  curve up to the point of fracture (it estimates the total energy absorbed up to fracture)

• Time-dependent behavior

the faster a stress is applied, the more likely a material is to store the energy elastically and not plastically

• Creep-strain relaxation
• Stress relaxation

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
 

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