NEET MDS Lessons
Dental Materials
CAD/CAM Restorations
Applications-inlays, onlays, veneers, crowns, bridges, implants, and implant prostheses
Stages of fabrication
CSD-computerized surface digitization
CAD-computer-aided (assisted) design
CAM-computer-aided (assisted) machining
CAE-computer-aided esthetics (currently theoretic)
CAF-computer-aided finishing or polishing (which are currently theoretic steps)
Classification
Chairside or in-office systems
(1) Cerec (Siemens system)-inlays, onlays, veneers
(2) Sopha (Duret system)-inlays, onlays (and Crowns)
Laboratory systems
(1) DentiCAD (Rekow system)-inlay, onlays, veneers, crowns
(2) Cicero (Elephant system)-porcelain fused-to-metal crowns
Materials
a. Feldspathic oorcelains (Vita)
b. Machinable ceramics (Dicor MGC)
c. Metal alloys limited use)
Cementing
- Etching enamel and/or dentin for micromechanical retention
- Bonding agent for retention to etched surface
- Composite as a luting cement for reacting chemically with bonding agent and with silanated surface of restoration
- Silane for bonding to etched ceramic (or metal) restorations and to provide chemical reaction
- Hydrofluoric acid etching to create spaces for micromechanical retention on surface or restoration
Properties
1. Physical properties
a. Thermal expansion coefficient well matched to tooth structure
b. Good resistance to plaque adsorption or retention
2. Chemical properties-not resistant to acids and should be protected from APF
3. Mechanical properties
a. Excellent wear resistance (but may abrade opponent teeth)
b. Some wear of luting cements but self-limiting
c. Excellent toothbrush abrasion
4. Biologic properties-excellent properties
Introduction
The science of dental materials involves a study of the composition and properties of materials and the way in which they interact with the environment in which they are placed
Selection of Dental materials
The process of materials selection should ideally follow a logical sequence involving
(1) analysis of the problem,
(2) consideration of requirements,
(3) consideration of available materials and their properties, leading to
(4) choice of material.
Evaluation of the success or failure of a material may be used to influence future decisions on materials selection.
POLISHING MATERIALS
1 Tin Oxide. Tin oxide is used in polishing teeth and metal restorations. Tin oxide is a fine, white powder that is made into a paste by adding water or glycerin.
2. Pumice. Pumice is used as an abrasive and polishing agent for acrylic resins, amalgams, and gold. It consists mainly of complex silicates of aluminum, potassium, and sodium. Two grades--flour of pumice and coarse pumice--are listed in the Federal Supply Catalog.
3. Chalk (Whiting). Chalk is used for polishing acrylic resins and metals. It is composed primarily of calcium carbonate.
4.Tripoli. Tripoli is usually used for polishing gold and other metals. It is made from certain porous rocks.
5. Rouge (Jeweler's). Rouge is used for polishing gold and is composed of iron oxide. It is usually in cake or stick form.
6. Zirconium Silicate. Zirconium silicate is used for cleaning and polishing teeth. It may be mixed with water or with fluoride solution for caries prevention treatment. For full effectiveness, instructions must be followed exactly to obtain the proper proportions of powder to liquid.
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.
Investment Materials
Investment is mold-making material
Applications
a. Mold-making materials for casting alloys
b. Mold-making materials for denture production
Classification
a. Gypsum-bonded investments (based on gypsum products for matrix)
b. Phosphate-bonded investments
c. Silicate-bonded investments
Components
a. Liquid-water or other reactant starts formation of matrix binder by reacting with reactant powder
b. Powder-reactant powder, filler, or modifiers
Manipulation
a. P/L mixed and placed in container around wax pattern
b. After setting, the investment is heated to eliminate the wax pattern in preparation for casting
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
POLYCARBOXYLATE CEMENT
Use:. The primary use of polycarboxylate cement is as a cementing medium of cast alloy and porcelain restorations. In addition, it can be used as a cavity liner, as a base under metallic restorations, or as a temporary restorative material.
Clinical Uses
Polycarboxylate cement is used in the same way as zinc phosphate cement, both as an intermediate base and as a cementing medium.
c. Chemical Composition.
(1) Powder:. It generally contains zinc oxide, 1 to 5 percent magnesium oxide, and 10 to 40 percent aluminum oxide or other reinforcing fillers. A small percentage of fluoride may be included.
(2) Liquid. Polycarboxylate cement liquid is approximately a 40 percent aqueous solution of polyacrylic acid copolymer with other organic acids such as itaconic acid. Due to its high molecular weight, the solution is rather thick (viscous).
d. Properties.
The properties of polycarboxylate cement are identical to those of zinc phosphate cement with one exception. Polycarboxylate cement has lower compressive strength.
e. Setting Reactions:
The setting reaction of polycarboxylate cement produces little heat. This has made it a material of choice. Manipulation is simpler, and trauma due to thermal shock to the pulp is reduced. The rate of setting is affected by the powder-liquid ratio, the reactivity of the zinc oxide, the particle size, the presence of additives, and the molecular weight and concentration of the polyacrylic acid. The strength can be increased by additives such as alumina and fluoride. The zinc oxide reacts with the polyacrylic acid forming a cross-linked structure of zinc polyacrylate. The set cement consists of residual zinc oxide bonded together by a gel-like matrix.
Precautions.
The following precautions should be observed.
o The interior of restorations and tooth surfaces must be free of saliva.
o The mix should be used while it is still glossy, before the onset of cobwebbing.
o The powder and liquid should be stored in stoppered containers under cool conditions. Loss of moisture from the liquid will lead to thickening.