NEET MDS Lessons
Dental Materials
Cement Bases
Applications
• Thermal insulation below a restoration
• Mechanical protection where there is inadequate dentin to support amalgam condensation pressures
Types
• Zinc phosphate cement bases
• Polycarboxylate cement bases
• Glass ionomer cement bases (self-curing and light-curing)
Components
o Reactive powder (chemically basic)
o Reactive liquid (chemically acidic)
Reaction
o Acid-base reaction that forms salts or cross linked matrix
o Reaction may be exothermic
Manipulation-consistency for basing includes more powders, which improves all of the cement properties
Properties
Physical-excellent thermal and electrical insulation
Chemical-much more resistant to dissolution than cement liners
Polycarboxylate and glass ionomer cements are mechanically and chemically adhesive to tooth structure
Solubility of all cement bases is lower than cement liners if they are mixed at higher powder- to-liquid ratios
Mechanical- much higher compressive strengths (12,000 to 30,000 psi)
Light-cured hybrid glass ionomer cements are the strongest
Zinc oxide-eugenol cements are the weakest
Biologic (see section on luting cements for details)
Zinc oxide-eugenol cements are obtundent to the pulp
Polycarboxylate and glass ionomer cements are kind to the pulp
Components
a. Fillers added to most to control shrinkage
b. Matrix
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
Manipulation
1. Selection-based on strength for models, casts, or dies
2. Mixing
(1)Proportion the water and powder
(2) Sift powder into water in rubber mixing bowl
(3) Use stiff blade spatula to mix mass on side of bowl
(4) Complete mixing in 60 seconds
3. Placement
(1) Use vibration to remove air bubbles acquired through mixing
(2) Use vibration during placement to help mixture wet and flow into the impression
Mercury hygiene
- Do not contact mercury with skin
- Clean up spills to minimize mercury vaporization
- Store mercury or precapsulated products in tight containers
- Only triturate amalgam components-in tightly- sealed capsules
- Use amalgam with covers
- Store spent amalgam under water or fixer in a tightly sealed jar
- Use high vacuum suction during amalgam alloy placement, setting, or removal when mercury may be vaporized
- Polishing amalgams generally causes localized melting of silver-mercury phase with release of mercury vapor, so water cooling and evacuation must be used
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
Classification of Dental amalgam
1. By powder particle shape .
- Irregular (comminuted, filing, or lathecut)
- Spherical (spherodized)
- Blends (e.g., irregular-irregular, irregularspherical, or spherical-spherical)
2. By total amount of copper
- Low-copper alloys (e.g., conventional, traditional); <5% copper
- High-copper alloys (e,g. corrosion resistant); 12% to 28% copper
3.By presence of zinc
Examples
- Low-copper, irregular-particle alloy-silver (70%)-tin (26%)-copper (4%)
- High-copper, blended-particles alloy-irregular particles, silver (70%) –tin (26%) -Copper (4%); spherical particles, silver (72%)-copper (28%)
- High-copper, spherical-particles alloy-silver (60%) - tin (27%)-copper (13%)