NEET MDS Lessons
Dental Materials
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)
WETTABILITY
To minimise the irregularities on the investment & the casting a wetting agent can be used .
FUNCTIONS OF A WETTING AGENT
1 . Reduce contact angle between liquid & wax surface .
2 .Remove any oily film left on wax pattern .
Denture Teeth
Use-complete or partial dentures
Type
a. Porcelain teeth
b. Acrylic resin teeth
c. Abrasion-resistant teeth (microfilled composite)
Structure and properties
1. Porcelain teeth (high-fusing porcelain)
Only bonded into denture base mechanically. Harder than natural teeth or other restorations and abrades those surfaces. Good aesthetics.Used when patients have good ridge support and sufficient room between the arches
2. Acrylic resin teeth (PMMA [polymethyl methacrylate])
Bonded pseudochemically into the denture base. Soft and easily worn by abrasive foods . Good initial aesthetics
Used with patients with poor ridges and in cases where they oppose natural teeth
3. Abrasion-resistant teeth (microfilled resins)
Bonded pseudochemically into the denture base.Better abrasion resistance then acrylic resin teeth
METALLURGICAL TERMS
a. Cold Working. This is the process of changing the shape of a metal by rolling, pounding, bending, or twisting at normal room temperature.
b. Strain Hardening. This occurs when a metal becomes stiffer and harder because of continued or repeated application of a load or force. At this point, no further slippage of the atoms of the metal can occur without fracture.
c. Heat Softening Treatment (Annealing). This treatment is necessary in order to continue manipulating a metal after strain hardening to prevent it from fracturing. The process of annealing consists of heating the metal to the proper temperature (as indicated by the manufacturer's instructions) and cooling it rapidly by immersing in cold water. Annealing relieves stresses and strains caused by cold working and restores slipped atoms within the metal to their regular arrangement.
d. Heat Hardening Treatment (Tempering). This treatment is necessary to restore to metals properties that are decreased by annealing and cold working. Metals to be heat hardened should first be heat softened (annealed) so that all strain hardening is relieved and the hardening process can be properly controlled. Heat hardening is accomplished in dental gold alloy by heating to 840o Fahrenheit, allowing it to cool slowly over a 15-minute period to 480o Fahrenheit, and then immersing it in water.
Stages of manipulation
Definitions of intervals
- Mixing interval-length of time of the mixing stage.
- Working interval-length of time of the working stage
- Setting interval-length of time of the setting stage
Definitions of times
- Mixing time-the elapsed time from the onset to the completion of mixing
- Working time-the elapsed time from the onset of mixing until the onset of the initial setting time
- Initial setting time-time at which sufficient reaction has occurred to cause the materials to be resistant to further manipulation
- Final setting time-time at which the material practically is set as defined by its resistance to indentation
[All water-based materials lose their gloss at the time of setting]
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 .
Manipulation
Selection
o Microfilled composites or hybrids for anterior class III, IV, V
o Hybrids or midifills for posterior class I, II, III, V
Conditioning of enamel and / or dentin
Do not apply fluorides before etching.-->Acid-etch --> Rinse for 20 seconds with water --> Air-dry etched area for 20 seconds but do not desiccate or dehydrate --> Apply bonding agent and polymerize
Mixing (if required)--> mix two pastes for 20 to 30 seconds
o Self-cured composite-working time is 60 to 120 seconds after mixing
o Light-cured composite-working time is unlimited (used for most anterior and some posterior composite restorations)
o Dual-cured composite-working time is > 10 minutes
o Two-stage cured composite-working time is >5 minutes
Placement
use plastic instrument or syringe --> Light curing --> Cure incrementally in <2 mm thick layers. Use matrix strip where possible to produce smooth surface and contour composite .Postcure to improve hardness
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.