Waxes

Many different waxes are used in dentistry. The composition, form, and color of each wax are designed to facilitate its use and to produce the best possible results.

Applications

o    Making impressions
o    Registering of tooth or soft tissue positions
o    Creating restorative patterns for lab fabrication
o    Aiding in laboratory procedures

Classification

a. Pattern waxes-inlay, casting, and baseplate waxes
b. Impression waxes-corrective and biteplate waxes
c. Processing waxes-boxing, utility, and sticky waxes

Types

1) Inlay wax-used to create a pattern for inlay, onlay or crown for subsequent investing and casting in a metal alloy.
2) Casting wax-used to create a pattern for metallic framework for a removable partial denture
3) Baseplate wax-used to establish the vertical dimension. plane of occlusion. and  initial arch form of a complete denture
4) Corrective impression wax-used to form a registry pattern of soft tissues on an impression
5) Bite registration wax-used to form a registry pattern for the occlusion of opposing models or casts
6) Boxing wax-used to form a box around an impression before pouring a  model or cast
7) Utility wax -soft pliable adhesive wax for modifying appliances, such as alginate impression trays
8) Sticky  wax-sticky when melted and used to temporarily adhere pieces of metal or resin in laboratory procedures

Components

a. Base waxes-hydrocarbon (paraffin) ester waxes    
b. Modifier waxes-carnauba, ceresin, bees wax, rosin, gum dammar, or microcrystalline waxes
c. Additives-colorants

Reaction-waxes are thermoplastic

Properties

Physical

a. High coefficients of thermal expansion and contraction
b. Insulators and so, cool unevenly; should be waxed in increments to allow heat dissipation

Chemical

a. Degrade prematurely if overheated
b. Designed to degrade into CO2and H2Oduring burnout

Mechanical-stiffness, hardness, and strength depend on modifier waxes used
 

Cement liners

Applications (if remaining dentin thickness is <0.5 mm)

o    Used for thermal insulation where cavity preparation is close to the pulp
o    Used for delivering medicaments to the pulp

•    Calcium hydroxide stimulates reparative dentin or
•    Eugenol relieves pain by desensitizing nerves
•    Used to deliver F ion to enamel and dentin

Components

o    Paste of calcium hydroxide reactant powder, ethyl toluene sulfonamide dispersant, zinc oxide filler, and zinc stearate radiopacifier
o    Paste of glycol salicylate reactant liquid, titanium dioxide filler powder, and calcium tungstenate radiopacifier

Reaction

Chemical reaction of calcium ions with salicylate to form methylsalicylate salts Moisture absorbed to allow calcium hydroxide to dissociate into ions to react with salicylate Mixture sets from outside surface to inside as water diffuses

Manipulation

Dentin should not be dehydrated or material will not setMix drop of each paste together for 5 secondsApply material to dentin and allow I to 2 minutes to set

Properties

o    Physical-good thermal and electrical insulator
o    Chemical-poor resistance to water solubility and may dissolve
o    Mechanical-low compressive strength (100 to 500 psi)
o    Biologic-releases calcium hydroxide constituents, which diffuse toward the pulp and stimulate
o    reparative dentin formation

Glass Ionomer Cements

Applications

a. Class V restorations-resin-modified glass ionomers for geriatric dentistry
b. Class II restorations-resin-modified glass ionomers, metal-modified glass ionomers in pediatric dentistry
c. Class III restorations-resin-modified glass ionomers
d. permanent cementing of inlays, crowns, bridges, and/or orthodontic band/brackets. In addition, it can be used as a cavity liner and as a base.

Classification by composition

a. Glass ionomer-limited use
b. Metal-modified glass ionomer-limited use
c. Resin-modified glass ionomer-popular use

Components

a. Powder-aluminosilicate glass
b. Liquid-water solution of copolymers (or acrylic acid with maleic, tartaric, or itaconic acids) and water-soluble monomers (e.g., HEMA)

Reaction (may involve several reactions and stages of setting)

a. Glass ionomer reaction (acid-base reaction of polyacid and ions released from aluminosilicate glass particles)
- Calcium, aluminum, fluoride, and other ions released by outside of powder particle dissolving in acidic liquid
- Calcium ions initially cross-link acid functional copolymer molecules
- Calcium cross-links are replaced in 24 to 48 hours by aluminum ion cross-links, with increased hardening of system
- If there are no other reactants in the cement (e.g., resin modification), then protection from saliva is required during the first 24 hours

b. Polymerization reaction (polymerization of double bonds from water-soluble monomers and/or pendant groups on copolymer to form cross-linked matrix)
- Polymerization reaction can be initiated with chemical (self-curing) or light-curing steps
- Cross-linked polymer matrix ultimately interpenetrates glass ionomer matrix 

Manipulation

a. Mixing-powder and liquid components may be manually mixed or may be precapsulated for mechanical mixing
b. Placement-mixture is normally syringed into place
c. Finishing-can be immediate if system is resin-modified (but otherwise must be delayed 24 to 72 hours until aluminum ion replacement reaction is complete)
d. Sealing-sealer is applied to smoothen the surface (and to protect against moisture affecting the glass ionomer reaction)

Properties

1. Physical

-Good thermal and electrical insulation
-Better radiopacity than most composites
-Linear coefficient of thermal expansion and contraction is closer to tooth structure than for composites (but is less well matched for resin-modified systems)
-Aesthetics of resin-modified systems are competitive with composites

2. Chemical

-Reactive acid side groups of copolymer molecules may produce chemical bonding to tooth structure
-Fluoride ions are released
(1) Rapid release at first due to excess fluoride ions in matrix
(2) Slow release after 7  to 30 days because of slow diffusion of fluoride ions out of aluminosilicate particles

-Solubility resistance of resin-modified systems is close to that of composites

3. Mechanical properties

-Compressive strength of resin-modified systems is much better than that of traditional glass ionomers but not quite as strong as composites
- Glass ionomers are more brittle than composites

4. Biologic properties

- Ingredients are biologically kind to the pulp
- Fluoride ion release discourages secondary canes
 

Zinc Phoshate Cement

Uses. Zinc phosphate cement is used both as an intermediate base and as a cementing medium. 

(1) Intermediate base. A thick mix  is used under permanent metallic restoration. This layer of cement protects the pulp from sudden temperature changes that may be transmitted by the metallic restoration. 

(2) Cementing medium. Zinc phosphate cement is used to permanently cement crowns, inlays, and fixed partial dentures upon the remaining tooth structure. A creamy mix of cement is used to seat the restoration or appliance completely into place. The cementing medium does not cement two objects together. Instead, the cement holds the objects together by mechanical interlocking, filling the space between the irregularities of the tooth preparation and the cemented restoration

c. Chemical Composition. 

(1) Powder. primary ingredients - zinc oxide and magnesium oxide. 
(2) Liquid. Phosphoric acid and water in the ratio of two parts acid to one part water. The solution may also contain aluminum phosphate and zinc phosphate Liquids exposed in open bottles will absorb moisture from the air in high humidity. The liquids will lose moisture if humidity is low. Water gain hastens setting; water loss lengthens setting time.
 
PROPERTIES OF ZINC PHOSPHATE CEMENT

a. Advantages. Some advantages of zinc phosphate cement as a cementing medium are:

o    Inconspicuous appearance. 
o    Speed and ease of usage. 
o    Sufficient flow to form a thin layer for the cementing of closely adapted crowns, fixed partial dentures, and inlays. 
o    Low thermal conductivity beneath a metallic restoration.

b. Disadvantages. Some disadvantages of zinc phosphate cement as a cementing medium are:

o    Low crushing strength that varies between 12,000 and 19,000 psi. 
o    Slight solubility in mouth fluids. 
o    Opaque material not suitable for visible surfaces. 

c. Strength. The ratio of powder to liquid increases the strength of phosphate cements to a certain point. For this reason, the dental specialist must use as thick a mix as practical for the work being performed. 

SETTING REACTIONS OF ZINC PHOSPHATE CEMENT 

a. Chemical Reaction. The chemical reaction that takes place between the powder and liquid of setting phosphate cement produces heat. The amount of heat produced depends upon the rate of reaction, the size of the mix, and the amount of heat extracted by the mixing slab. 

b. Powder to Liquid Ratio. The less powder used in ratio to the liquid, the longer the cement will take to harden. Good technique minimizes the rise in temperature and acidity of the setting cement that can injure the pulp. Generally, for increased strength, decreased shrinkage, and resistance to solubility, it is advisable to blend as much powder as possible to reach the desired consistencies. 

c. Setting Time. The setting time of zinc phosphate cement is normally between 5 and 9 minutes. 
 Lower the temperature of the glass mixing slab to between 65° and 75° F (18° to 24° C), if the glass mixing slab is not already cooled below the temperature at which moisture will condense on it. → Blend the powder slowly. →  Mix the powder over a large area of the cool slab. →  Use a longer mixing time, within optimum limits. 
 
Precautions. The following precautions should be observed. 

o    Prevent loss or gain of moisture in liquid cement by keeping bottles tightly stoppered. 
o    Dispense drops only when ready to mix. 
o    Use a cool, dry glass slab (65° to 75° F). 
o    Use the same brand of powder and liquid. 
o    Add increments of powder slowly. 
o    Use the maximum amount of powder to obtain the desired consistency. 

(To incorporate the most powder, the material should be mixed with a moderate circular motion over a large area of the slab, turning the spatula often.) 

Effects of Amalgam.

(1) The combined effects of the properties of its ingredients should provide the most satisfactory restorative material.

(2) Quantity of mercury. Too little mercury in the mix results in a grainy, weak, readily tarnished, and corroded amalgam. Too much mercury will cause excessive expansion and weakened amalgam.

 (3) Composition of the alloy. Composition of the alloy must include a minimum of 65 percent silver, a maximum of 29 percent tin, a maximum of 6 to 13 percent copper, and a maximum of two percent zinc by weight

 (4) Correct proportion important. Before use, the silver alloy is mixed with pure and uncontaminated mercury. There are some alloys that are completely zinc free. They can therefore be used more successfully in a moisture-contaminated environment.

 (5) Properties of the finished product.

Silver imparts strength, durability, and color, gives the alloy desirable setting expansion, decreases flow, and accelerates (decreases) the setting time.

Tin makes the amalgam easier to work, controls excessive setting expansion, and increases both flow and setting time.

Copper increases hardness, contributes to setting expansion, reduces flow, and decreases setting time.

Zinc increases workability, and unites with oxygen and other "impurities" to produce a clean amalgam.

Mouth Protectors

Use - to protect against effects of blows to chin, top of the head, the face, or grinding of the teeth

Types

o    Stock protectors-least desirable because of poor fit
o    Mouth-formed protectors-improved fit compared with stock type
o    Custom-made protectors-preferred because of durability. low  speech impairment, and comfort

I. Components

a. Stock protectors-thermoplastic copolymer of PYA-PE (polyvinyl acetate-polyethylene copolymer)
b. Mouth-formed protectors-thermoplastic copolymer
c. Custom-made protectors- thermoplastic copolymer, rubber. or polyurethane
2. Reaction-physical reaction of hardening during cooling
3. Fabrication

Alginate impression made of maxillary arch. High-strength stone cast poured immediately. Thermoplastic material is heated in hot water and vacuum-molded to cast .

Mouth protector trimmed to within ½ inch of labial fold, clearance provided at the buccal and labial frena, and edges smoothed by flaming. Gagging, taste, irritation. and impairment of speech are minimized with properly fabricated appliances

4. Instructions for use

a. Rinse before and after use with cold water
b. Clean protector occasionally with soap and cool water
c. Store the protector  in a rigid container
d. Protect from heat and pressure during storage
e. Evaluate protector routinely for evidence of deterioration

Properties

1. Physical-thermal insulators
2. Chemical-absorbs after during use
3. Mechanical-tensile strength, modulus, and hardness decrease after  water absorption, but elongation, tear strength, and resilience increase
4. Biologic-nontoxic as long as no bacterial, fungal, or viral growth occurs on surfaces between uses