Pit-and-Fissure Dental Sealants

Applications/Use

Occlusal surfaces of newly erupted posterior teeth
Labial surfaces of anterior teeth with fissures
Occlusal surfaces of teeth in older patients with reduced saliva flow (because low saliva increases the susceptibility to caries)

Types

Polymerization method

Self-curing (amine accelerated)
Light curing (light accelerated)

Filler content

Unfilled-most systems are unfilled because filler tends to interfere with wear away from self-cleaning occlusal areas(sealants are designed to wear away, except where there is no self-cleaning action a common misconception is that sealants should be wear resistant)

Components

Monomer-BIS-GMA with TEGDM diluent to facilitate flow into pits and fissures prior to cure
Initiator-benzoyl peroxide (in self-cured) and diketone (in light cured)
Accelerator-amine (In light cured)
Opaque filler-I % titanium dioxide. or other colorant to make the material detectable on tooth surfaces
Reinforcing filler-generally not added because wear resistance is not required within pits and fissures

Reaction-free radical reaction 

Manipulation

Preparation

Clean pits and fissures of organic debris. Do not apply fluoride before etching because it will tend to make enamel more acid resistant. Etch occlusal surfaces, pits, and fissures for 30 seconds (gel) or 60 seconds (liquid) with 37% phosphoric acid . Wash occlusal surfaces for 20 seconds. Dry etched area for 20 seconds with clean air spray. Apply sealant and polymerize

Mixing or dispensing

Self-cured-mix equal amounts of liquids in Dappen dish for 5 seconds with brush applicator. Light cured-dispense from syringe tips 
Placement

-pits, fissures, and occlusal surfaces  --> Allow 60 seconds for self-cured materials to set. 

Finishing

Remove unpolymerized and excess material .Examine hardness of sealant. Make occlusal adjustments where necessary in sealant; some sealant materials are self-adjusting

Properties

Physical

Wetting-low-viscosity sealants wet acid etched tooth structure the best

Mechanical

Wear resistance should not be too great because sealant should be able to wear off of  self-cleaning areas of tooth
Be careful to protect sealants during polishing procedures with air abrading units to prevent sealant loss

Clinical efficacy

Effectiveness is 100% if retained in pits and fissures .Requires routine clinical evaluation for resealing of areas of sealant loss attributable to poor retention .
Sealants resist effects of topical fluorides
 

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

Chromium Alloys for Partial Dentures

Applications - Casting partial denture metal frameworks

Classification

a. Cobalt-chromium
b. Nickel-chromium
c. Cobalt-chromium-nickel

Composition

a. Chromium-produces a passivating oxide film for corrosion resistance
b. Cobalt-increase~ the rigidity of the alloy
c. Nickel-increases the ductility of the alloy
d. Other elements-increase strength and castability

Manipulation

a. Requires higher temperature investment materials
b. More difficult to cast because less dense than gold alloys usually requires special casting equipment
c. Much more difficult to finish and polish because of higher strength and hardness

Properties

a. Physical-less dense_than gold alloys
b. Chemical-passivating corrosion behavior
c. Mechanical-stronger. stiffer. and harder than gold alloys
d. Biologic

-Nickel may cause sensitivity in some individuals (I % of men and 11 % of women)
-Beryllium in some alloys forms oxide that  is toxic to lab technicians

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
 

CRUCIBLE FORMER

It serves as a base for the casting ring during investing .Usually convex in shape.
May be metal , plastic or rubber .
Shape depends on casting machine used .
Modern machines use tall crucible to enable the pattern to be positioned near the end of the casting machine .

COMPOSITE RESINS

Types

• Amount of filler-25% to 65% volume, 45% to 85% weight
• Filler particle size (diameter in microns)
  • Macrofill 10 to 100 µm (traditional composites)
  • Midi fill- 1 to 10 µm(small particle composites)
  • Minifill— 0.l to 1 µm
  • Microfill-: 0.01 to  0.1 µm (fine particle composites)
  • Hybrid--blend (usually or  microfill and midifill or minifill and microfill)
• Polymerization method
  • Auto-cured (self-cured)
  • Visible light cured
  • Dual cured
  • Staged cure
• Matrix chemistry
  • BIS-GMA type
  • Urethane dimethacrylate (UDM or UDMA) type
  • TEGDMA-diluent monomer to reduce  viscosity