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

CASTING: casting is the process by which the wax pattern of a restoration is converted to a replicate in a dental alloy. The casting process is used to make dental restorations such as inlays, onlays, crowns, bridges and removable partial dentures.

Objectives of casting

1) To heat the alloy as quickly as possible to a completely molten condition.
2) To prevent oxidation by heating the metal with awell adjusted torch .
3) To produce a casting with sharp details by having adequate pressure to the well melted metal to force into the mold.

STEPS IN MAKING A CAST RESTORATION
1. TOOTH PREPARATION
2. IMPRESSION
3. DIE PREPARATION
4. WAX PATTERN FABRICATION
5. SPRUING

The Sprue :

Its a channel through which molten alloy can reach the mold in an invested ring after the wax has been eliminated. Role of a Sprue: Create a channel to allow the molten wax to escape from the mold. Enable the molten alloy to flow into the mold which was previously occupied by the wax pattern.

FUNCTIONS OF SPRUE

1 . Forms a mount for the wax pattern .
2 . Creates a channel for elimination of wax .
3 .Forms a channel for entry of molten metal
4 . Provides a reservoir of molten metal to compensate for the alloy shrinkage .

SELECTION OF SPRUE

Sprue former gauge selection is often empirical, is yet based on the following five general principles:
1.   Select the gauge sprue former with a diameter that is approximately the same size as the thickest area of the wax pattern. If the pattern is small, the sprue former must also be small because a large sprue former attached to a thin delicate pattern could cause distortion. However if the sprue former diameter is too small this area will solidify before the casting itself and localized shrinkage porosity may result.
2.   If possible the sprue former should be attached to the portion of the pattern with the largest cross-sectional area. It is best for the molten alloy to flow from the thick section to the surrounding thin areas. This design minimizes the risk of turbulence.
3.   The length of the sprue former should be long enough to properly position the pattern in the casting ring within 6mm of the trailing end and yet short enough so the molten alloy does not solidify before it fills the mold.
4.   The type of sprue former selected influences the burnout technique used. It is advisable to use a two-stage burnout technique whenever plastic sprue formers or patterns are involved to ensure complete carbon elimination, because plastic sprues soften at temperatures above the melting point of the inlay waxes.
5.   Patterns may be sprued directly or indirectly. For direct sprueing the sprue former provides the direct connection between the pattern area and the sprue base or crucible former area. With indirect spruing a connector or reservoir bar is positioned between the pattern and the crucible former. It is common to use indirect spruing for multiple stage units and fixed partial dentures.

Acrylic Appliances

Use - space maintenance  or tooth movement for orthodontics and pediatric dentistry

1. Components

a. Powder-PMMA powder. peroxide initiator, and pigments

b. Liquid-MMA monomer, hydroquinone inhibitor, cross-linking agents, and chemical accelerators (N, N-dimethyl-p-toluidine)

2. Reaction

 PMMA powder makes mixture viscous for manipulation before curing . Chemical accelerators cause decomposition of benzoyl peroxide into free radicals that initiate polymerization of monomer .  New PMMA is formed into a matrix that surrounds PMMA powder. Linear shrinkage of 5% to 7% during setting. but dimensions of appliances are not critical

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 .