Dental material

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Dental products are specially fabricated materials, designed for use in dentistry. There are many different types of dental products, and their characteristics vary according to their intended purpose.

Contents

Temporary dressings

A temporary dressing is a dental filling which is not intended to last in the long term. They are interim materials which may have therapeutic properties. A common use of temporary dressing occurs if root canal therapy is carried out over more than one appointment. In between each visit, the pulp canal system must be protected from contamination from the oral cavity, and a temporary filling is placed in the access cavity. Examples include:

Cements

Dental cements are used most often to bond indirect restorations such as crowns to the natural tooth surface. Examples include:

Impression materials

Dental impressions are negative imprints of teeth and oral soft tissues from which a positive representation can be cast. They are used in prosthodontics (to make dentures), orthodontics, restorative dentistry, dental implantology and oral and maxillofacial surgery. [3] :136–137

Because patients' soft-tissue undercuts may be shallow or deep, impression materials vary in their rigidity in order to obtain an accurate impression. Rigid materials are used with patients with shallow undercuts, while elastic materials are used with patients with deep undercuts, as the material must be flexible enough to reach the end-point of the undercut.

Impression materials are designed to be liquid or semi-solid when first mixed, then set hard in a few minutes, leaving imprints of oral structures.

Common dental impression materials include sodium alginate, polyether and silicones. Historically, plaster of Paris, zinc oxide eugenol and agar were used.

Lining materials

Dental lining materials are used during restorations of large cavities, and are placed between the remaining tooth structure and the restoration material. The purpose of this is to protect the dentinal tubules and the sensitive pulp, forming a barrier-like structure. After drilling the caries out of the tooth, the dentist applies a thin layer (approximately 1/2mm) to the base of the tooth, followed by light curing. [4] Another layer might be applied if the cavity is very large and deep.

There are many functions to dental lining materials, some of which are listed below:

Types

Calcium hydroxide

Calcium hydroxide is a relatively low compressive strength and a viscous consistency, making it difficult to apply to cavities in thick sections. A common technique to overcome this issue is to apply a thin sub-lining of calcium hydroxide, then build up with zinc phosphate prior to amalgam condensation. This generates a relatively high pH environment around the area surrounding the cement due to calcium hydroxide leaking out, thus making it bactericidal.

It also has a unique effect of initiating calcification and stimulating the formation of secondary dentine, due to an irritation effect of the pulp tissues by the cement.

Calcium hydroxide is radio-opaque and acts as a good thermal and electrical insulation. However, due to its low compressive strength it is unable to withstand amalgam packing; a strong cement base material should be placed above it to counter this. [3] [6]

Calcium silicate-based liners have become alternatives to calcium hydroxide and are preferred by practitioners for their bioactive and sealing properties; [7] [8] the material triggers a biological response and results in formation of bonding with the tissue. [9] They are commonly used as pulp capping agents and lining materials for silicate and resin-based filling materials. [3]

Calcium-silicate liner used as a pulp capping material Calcium silicate liner.jpg
Calcium-silicate liner used as a pulp capping material

It is usually supplied as two pastes, a glycol salicylate and another paste containing zinc oxide with calcium hydroxide. On mixing, a chelate compound is formed. Light-activated versions are also available; these contain polymerization activators, hydroexyethyl methacrylate, dimethacrylate which when light activated will result in a polymerization reaction of a modified methacrylate monomer. [3]

Polycarboxylate cement

Polycarboxylate cement has the compressive strength to resist amalgam condensation. It is acidic, but less acidic than phosphate cements due to it having a higher molecular weight and polyacrylic acid being weaker than phosphoric acid. It forms a strong bond with dentine and enamel, allowing it to form a coronal seal. In addition, it is an electrical and thermal insulator while also releasing fluoride, rendering it bacteriostatic. It is also radio-opaque, making it an excellent lining material. [3]

Care has to be taken in handling such material, as it has a strong bond with stainless steel instruments once it sets. [3]

Polycarboxylate cement is commonly used as a luting agents or as a cavity base material. However, it tends to be rubbery during its setting reaction and adheres to stainless steel instruments, so most operators prefer not to use it in deep cavities.

It is usually supplied as a power containing zinc oxide and a liquid containing aqueous polyacrylic acid. The reaction consists of an acid base reaction with zinc oxide reacting with the acid groups in polyacid. This forms a reaction product of unreacted zinc oxide cores bound by a salt matrix, with polyacrylic acid chains cross linking with zinc ions. [3]

Glass ionomer

Glass ionomer (GI) has the strongest compressive and tensile strength of all linings, so it can withstand amalgam condensation in high stress bearing areas such as class II cavities. GI is used as a lining material as it is very compatible with most restorative materials, insulates thermally and electrically, and adheres to enamel and dentine. GI lining contains glass of smaller particle sizes compared to its adhesive restorative mix, to allow formation of a thinner film. Some variations are also radiopaque, making them good for X-ray cavity detection. In addition, GI is bacteriostatic due to its fluoride release from un-reacted glass cores. [3]

GIs are usually used as a lining material for composite resins or as luting agents for orthodontic bands. [3]

The reaction is an acid-base reaction between calcium-aluminum-silicate glass powder and polyacrylic acid. They come in a powder and liquid which are mixed on a pad or in capsules which are for single usage. Resin-modified GIs contain a photoinitiator (usually camphorquinone) and an amide, [3] and are light cured with a LED light curing unit. Setting takes place by a combination of acid-base reaction and chemically activated polymerization.

Zinc oxide eugenol

Zinc oxide eugenol has the lowest compressive and tensile strength of the liners, so its use is limited to small or non-stress-bearing areas such as Class V cavities. This cavity lining is often used with a high strength base to provide strength, rigidity and thermal insulation. Zinc oxide eugenol can be used as linings in deep cavities without causing harm to the pulp, due to its obtundant effect on the pulp as well as its bactericidal properties due to zinc. However, eugenol may have an effect on resin-based filling materials, as it interferes with polymerization and occasionally causes discoloration. Caution could therefore be exercised when using both in tandem. It is also radio-opaque, allowing fillings to be visible by X-rays. [3]

Zinc oxide eugenol is usually used as a temporary filling/luting agent due to its low compressive strength making it easily removed, or as a lining for amalgam as it is incompatible with composites resins. [3]

It is supplied as a two paste system. Equal length of two pastes are dispensed into a paper pad and mixed. [3]

AgentAdvantagesDisadvantages
Calcium hydroxide
  • Alkaline nature promotes anti-bacterial atmosphere
  • Therapeutic effect for dentinal tubules
  • Low thermal conductivity can provide thermal insulation [3]
  • Radiopaque
  • Thermal and electrical insulator
  • Good restorative material compatibility [3]
  • Soluble for oral fluids thus restricted to dentine coverage only [3]
  • Viscous consistency makes it difficult to apply to cavities in thick sections
  • Low compressive strength, requiring a second layer of strong cement base above it
Polycarboxylate cement
  • Decent compressive and tensile strength [3]
  • Radiopaque
  • Bacteriostatic due to fluoride release
  • Adhesive thus coronal seal
  • Compatible with most restorative materials
  • Thermal and electrical insulator
  • Mildly acidic thus a mild irritant [3]
  • Hard to handle due to strong bond with stainless steel instruments
  • Rubbery during setting reaction thus hard to manipulate in deep cavities
Zinc oxide eugenol
  • Can be used as a temporary filling or lining as it is easy to remove even after set [10]
  • Bactericidal due to zinc
  • Thermal and electrical insulator
  • Radiopaque due to zinc
  • Obtundant
  • Lowest compressive and tensile strength of all linings; can only be used on areas with little or no stress [10]
  • Incompatible with resin composites due to polymerization interference
  • Non adhesive thus no coronal seal
Glass ionomer
  • Relatively high compressive and tensile strength [10]
  • Radiopaque
  • Very adhesive to enamel and dentine thus don't need a bonding agent
  • Bacteriosatic due to fluoride release
  • Adhesive thus coronal seal
  • Good compatibility with restorative materials
  • Thermal and electrical insulator
  • Mildly acidic thus a mild irritant [3]
  • Remains acidic for some time after mixing
  • Not an obtundant

Restorative materials

Glass ionomer cement - composite resin spectrum of restorative materials used in dentistry. Towards the GIC end of the spectrum, there is increasing fluoride release and increasing acid-base content; towards the composite resin end of the spectrum, there is increasing light cure percentage and increased flexural strength. Restorative materials.png
Glass ionomer cement - composite resin spectrum of restorative materials used in dentistry. Towards the GIC end of the spectrum, there is increasing fluoride release and increasing acid-base content; towards the composite resin end of the spectrum, there is increasing light cure percentage and increased flexural strength.

Dental restorative materials are used to replace tooth structure loss, usually due to dental caries (cavities), but also tooth wear and dental trauma. On other occasions, such materials may be used for cosmetic purposes to alter the appearance of an individual's teeth.

There are many challenges for the physical properties of the ideal dental restorative material. The ideal material would be identical to natural tooth structure in strength, adherence, and appearance. The properties of such material can be divided into four categories: physical properties, biocompatibility, aesthetics and application.

Direct restorative materials

Direct restorations are ones which are placed directly into a cavity on a tooth, and shaped to fit. The chemistry of the setting reaction for direct restorative materials is designed to be more biologically compatible. Heat and byproducts generated cannot damage the tooth or patient, since the reaction needs to take place while in contact with the tooth during restoration. This ultimately limits the strength of the materials, since harder materials need more energy to manipulate. The type of filling material used has a minor effect on how long they last. The majority of clinical studies indicate the annual failure rates (AFRs) are between 1% and 3% with tooth colored fillings on back teeth. Root canaled (endodontically) treated teeth have AFRs between 2% and 12%. The main reasons for failure are cavities that occur around the filling and fracture of the real tooth. These are related to personal cavity risk and factors like grinding teeth (bruxism). [15]

Amalgam

Amalgam is a metallic filling material composed from a mixture of mercury (from 43% to 54%) and a powdered alloy made mostly of silver, tin, zinc and copper, commonly called the amalgam alloy. [16] Amalgam does not adhere to tooth structure without the aid of cements or use of techniques which lock in the filling, using the same principles as a dovetail joint.

Amalgam is still used extensively in many parts of the world because of its cost effectiveness, superior strength and longevity. However, the metallic colour is not aesthetically pleasing and tooth coloured alternatives are continually emerging with increasingly comparable properties. Due to the known toxicity of mercury, there is some controversy about the use of amalgams. The Swedish government banned the use of mercury amalgam in June 2009. [17] Research has shown that, while amalgam use is controversial and may increase mercury levels in the human body, these levels are below safety threshold levels established by the World Health Organization and the U.S. Environmental Protection Agency. However, there are certain subpopulations who, due to inherited genetic variabilities, are more sensitive to mercury than these threshold levels. They may experience adverse effects caused by amalgam restoration, including neural defects caused by impaired neurotransmitter processing. [18]

Composite resin

Enamel and dentin shades of composite. Other A2 universal shade for direct and indirect restorations, and flowable composite. Composite material.jpg
Enamel and dentin shades of composite. Other A2 universal shade for direct and indirect restorations, and flowable composite.

Composite resin fillings (also called white fillings) are a mixture of nanoparticles [19] [20] [21] or powdered glass and plastic resin, and can be made to resemble the appearance of the natural tooth. Although cosmetically superior to amalgam fillings, composite resin fillings are usually more expensive. Bis-GMA based resins contain Bisphenol A, a known endocrine disrupter chemical, and may contribute to the development of breast cancer. However, there is no added risk of kidney or endocrine injury in choosing composite restorations over amalgams. [18] PEX-based materials do not contain Bisphenol A and are the least cytotoxic material available.

Most modern composite resins are light-cured photopolymers, meaning that they harden with light exposure. They can then be polished to achieve maximum aesthetic results. Composite resins experience a very small amount of shrinkage upon curing, causing the material to pull away from the walls of the cavity preparation. This makes the tooth slightly more vulnerable to microleakage and recurrent decay. Microleakage can be minimized or eliminated with proper handling techniques and appropriate material selection.

In some circumstances, using composite resin allows less of the tooth structure to be removed compared to other dental materials such as amalgam and indirect methods of restoration. This is because composite resins bind to enamel (and dentin too, although not as well) via a micromechanical bond. As conservation of tooth structure is a key ingredient in tooth preservation, many dentists prefer placing materials like composite instead of amalgam fillings whenever possible.

Generally, composite fillings are used to fill a carious lesion involving highly visible areas (such as the central incisors or any other teeth that can be seen when smiling) or when conservation of tooth structure is a top priority.

The bond of composite resin to tooth is especially affected by moisture contamination and the cleanliness of the prepared surface. Other materials can be selected when restoring teeth where moisture control techniques are not effective.

Glass ionomer cement

The concept of using "smart" materials in dentistry has attracted a lot of attention in recent years. Conventional glass ionomer cements (GICs) have many applications in dentistry. They are biocompatible with the dental pulp to some extent. Clinically, this material was initially used as a biomaterial to replace the lost osseous tissues in the human body.

GIC fillings are a mixture of glass and an organic acid.

The cavity preparation of a GIC filling is the same as a composite resin. GICs are chemically set via an acid-base reaction. Upon mixing of the material components, no light cure is needed to harden the material once placed in the cavity preparation. After the initial set, GICs still need time to fully set and harden.

An advantage of GICs compared to other restorative materials is that they can be placed in cavities without any need for bonding agents. Another advantage is that they are not subject to shrinkage and microleakage, as the bonding mechanism is an acid-base reaction and not a polymerization reaction. Additionally, GICs contain and release fluoride, which is important to prevent carious lesions. As GICs release their fluoride, they can be "recharged" by the use of fluoride-containing toothpaste; this means they can be used to treat patients at high risk of caries.

Although they are tooth-colored, GICs vary in translucency, and their aesthetic potential is not as great as that of composite resins. Newer formulations that contain light-cured resins can achieve a greater aesthetic result, but do not release fluoride as well as conventional GICs.

The most important disadvantage of GICs is lack of adequate strength and toughness. To improve the mechanical properties of the conventional GIC, resin-modified ionomers have been marketed. GICs are usually weak after setting and are not stable in water; however, they become stronger with the progression of reactions and become more resistant to moisture.

New generations of GICs aim to regenerate tissues; they use bioactive materials in the form of a powder or solution to induce local tissue repair. These materials release chemical agents in the form of dissolved ions or growth factors such as bone morphogenetic protein, which stimulates activate cells.

GICs are about as expensive as composite resin. The fillings do not wear as well as composite resin fillings, but they are generally considered good materials to use for root caries and for sealants.

Resin modified glass-ionomer cement (RMGIC)

A combination of glass-ionomer and composite resin, these fillings are a mixture of glass, an organic acid, and resin monomers that harden when light cured (light-activated polymerization besides the acid-base reaction of conventional GICs). The cost is similar to composite resin. It holds up better than GIC, but not as well as composite resin, and is not recommended for biting surfaces of adult teeth, [22] or when control of moisture cannot be achieved. [23] [24]

Generally, RMGICs can achieve a better aesthetic result than conventional GICs, but not as good as pure composites.

Compomers

[25] Another combination of composite resin and GIC technology, compomers are essentially made up of filler, dimethacrylate monomer, difunctional resin, photo-activator and initiator, and hydrophilic monomers. The filler decreases the proportion of resin and increases the mechanical strength, as well as improving the material's appearance.

Although compomers have better mechanical and aesthetic properties than RMGIC, they have some disadvantages which limit their applications:

  • Compomers have weaker wear properties.
  • They cannot adhere to tooth tissue due to the presence of resin, which can make it shrink on polymerisation. They therefore require bonding materials.
  • They release low levels of fluoride, so cannot act as a fluoride reservoir.
  • They have high staining susceptibility; uptake of oral fluid causes them to show staining soon after placement.

Due to its relatively weaker mechanical properties, Compomers are unfit for stress-bearing restorations but can be used in the deciduous dentition where lower loads are anticipated.

Cermets

Dental cermets, also known as silver cermets, were created to improve the wear resistance and hardness of glass ionomer cements by adding silver. Their other advantages are that they adhere directly to tooth tissue, and are radio-opaque, which helps with identification of secondary caries when future radiographs are taken.

However, cermets have poorer aesthetics, appearing metallic rather than white. They also have a similar compressive strength, flexural strength, and solubility as GICs, some of the main limiting factors for both materials. In addition, their fluoride release is poorer than that of GICs. Clinical studies have shown cermets perform poorly. All these disadvantages led to the decline in the use of this restorative material. [26]

Indirect restorative materials

A fabricated indirect restoration (inlay) made of porcelain Before and after cementation of inlay.jpg
A fabricated indirect restoration (inlay) made of porcelain

An indirect restoration is one where the teeth are first prepared, then an impression is taken and sent to a dental technician who fabricates the restoration according to the dentist's prescription.

Porcelain

Porcelain fillings are hard, but can cause wear on opposing teeth. Their hardness and rigidity enables them to resist abrasion forces, and are good aesthetically as they mimic the appearance of natural teeth. [3] :91–92 However, they are also brittle and not always recommended for molar fillings. [3] :91–92 Porcelain materials can be strengthened by soaking fired material in molten salt to allow exchange of sodium and potassium ions on the surface; this successfully creates compressive stresses on the outer layer, by controlling cooling after firing, and by the use of pure alumina inserts, a core of alumina or alumina powder, as they act as crack stoppers and are highly compatible to porcelain.[ clarification needed ] [3] :91–92

Dental composite materials

Tooth colored dental composite materials are either used as a direct filling or as the construction material for an indirect inlay. They are usually cured by light. [27]

Nano-ceramic particles

Nano-ceramic particles embedded in a resin matrix are less brittle and therefore less likely to crack, or chip, than all-ceramic indirect fillings. They absorb the shock of chewing more like natural teeth, and more like resin or gold fillings, than do ceramic fillings; at the same time they are more resistant to wear than all-resin indirect fillings. They are available in blocks for use with CAD/CAM systems.[ medical citation needed ]

Gold fillings

Gold fillings have excellent durability, wear well, and do not cause excessive wear to the opposing teeth, but they do conduct heat and cold, which can be irritating. There are two categories: cast gold fillings (gold inlays and onlays) made with 14 or 18 kt gold, and gold foil made with pure 24 kt gold that is burnished layer by layer. For years, they have been considered the benchmark of restorative dental materials. However, recent advances in dental porcelains and a consumer focus on aesthetic results have caused the demand for gold fillings to drop. Gold fillings are sometimes quite expensive, but they last a very long time, meaning that gold restorations are less costly and painful in the long run. It is not uncommon for a gold crown to last 30 years.[ medical citation needed ]

Other historical fillings

Lead fillings were used in the 18th century, but became unpopular in the 19th century because of their softness. This was before lead poisoning was understood.

According to American Civil War-era dental handbooks, since the early 19th century metallic fillings had been made of lead, gold, tin, platinum, silver, aluminum, or amalgam. A pellet was rolled slightly larger than the cavity, condensed into place with instruments, then shaped and polished in the patient's mouth. The filling was usually left "high", with final condensation—"tamping down"—occurring while the patient chewed food. Gold foil was the most popular filling material during the Civil War. Tin and amalgam were also popular due to lower cost, but were held in lower regard.

One survey[ citation needed ] of dental practices in the mid-19th century catalogued dental fillings found in the remains of seven Confederate soldiers from the Civil War. They were made of:

Acrylic polymers

Acrylics are used in the fabrication of dentures, artificial teeth, impression trays, maxillofacial / orthodontic appliances and temporary (provisional) restorations. They cannot be used as tooth filling materials because they can lead to pulpitis and periodontitis, as they may generate heat and acids during setting, and in addition they shrink. [28]

Failure of dental restorations

Fillings have a finite lifespan; composites appear to have a higher failure rate than amalgam over five to seven years. [29] How well people keep their teeth clean and avoid cavities is probably a more important factor than the material chosen for the restoration. [30]

Evaluation and regulation of dental materials

The Nordic Institute of Dental Materials (NIOM) performs several tests to evaluate dental products in the Nordic countries. In the European Union, dental materials are classified as medical devices according to the Medical Devices Directive. In USA, the Food and Drug Administration is the regulatory body for dental products.

Related Research Articles

Zinc oxide eugenol (ZOE) is a material created by the combination of zinc oxide and eugenol contained in clove oil. An acid–base reaction takes place with the formation of zinc eugenolate chelate. The reaction is catalysed by water and is accelerated by the presence of metal salts. ZOE can be used as a dental filling material or dental cement in dentistry. It is often used in dentistry when the decay is very deep or very close to the nerve or pulp chamber. Because the tissue inside the tooth, i.e. the pulp, reacts badly to the drilling stimulus, it frequently becomes severely inflamed and precipitates a condition called acute or chronic pulpitis. This condition usually leads to severe chronic tooth sensitivity or actual toothache and can then only be treated with the removal of the nerve (pulp) called root canal therapy. For persons with a dry socket as a complication of tooth extraction, packing the dry socket with a eugenol-zinc oxide paste on iodoform gauze is effective for reducing acute pain. The placement of a ZOE "temporary" for a few to several days prior to the placement of the final filling can help to sedate the pulp. But, ZOE had in vitro cytotoxicity majorly due to release of Zn ions, not eugenol. In spite of severe in vitro cytotoxicity, ZOE showed relatively good biocompatibility in animal study when ZOE was applied on dentin. When ZOE was used as dentin-protective based materials, use of dental composite resin on ZOE was strongly prevented due to its inhibition of resin polymerization through radical scavenging effect. It is classified as an intermediate restorative material and has anaesthetic and antibacterial properties. The exact mechanism of anesthetic effect from ZOE was not revealed perfectly, but possibly through anti-inflammatory effect, modulating immune cells to less inflamed status.

Dental restoration, dental fillings, or simply fillings are treatments used to restore the function, integrity, and morphology of missing tooth structure resulting from caries or external trauma as well as to the replacement of such structure supported by dental implants. They are of two broad types—direct and indirect—and are further classified by location and size. A root canal filling, for example, is a restorative technique used to fill the space where the dental pulp normally resides.

Dental sealants are a dental treatment intended to prevent tooth decay. Teeth have recesses on their biting surfaces; the back teeth have fissures (grooves) and some front teeth have cingulum pits. It is these pits and fissures that are most vulnerable to tooth decay because food and bacteria stick in them and because they are hard-to-clean areas. Dental sealants are materials placed in these pits and fissures to fill them in, creating a smooth surface which is easy to clean. Dental sealants are mainly used in children who are at higher risk of tooth decay, and are usually placed as soon as the adult molar teeth come through.

<span class="mw-page-title-main">Crown (dental restoration)</span> Dental prosthetic that recreates the visible portion of a tooth

In dentistry, a crown or a dental cap is a type of dental restoration that completely caps or encircles a tooth or dental implant. A crown may be needed when a large dental cavity threatens the health of a tooth. Some dentists will also finish root canal treatment by covering the exposed tooth with a crown. A crown is typically bonded to the tooth by dental cement. They can be made from various materials, which are usually fabricated using indirect methods. Crowns are used to improve the strength or appearance of teeth and to halt deterioration. While beneficial to dental health, the procedure and materials can be costly.

<span class="mw-page-title-main">Dental composite</span> Substance used to fill cavities in teeth

Dental composite resins are dental cements made of synthetic resins. Synthetic resins evolved as restorative materials since they were insoluble, of good tooth-like appearance, insensitive to dehydration, easy to manipulate and inexpensive. Composite resins are most commonly composed of Bis-GMA and other dimethacrylate monomers, a filler material such as silica and in most applications, a photoinitiator. Dimethylglyoxime is also commonly added to achieve certain physical properties such as flow-ability. Further tailoring of physical properties is achieved by formulating unique concentrations of each constituent.

<span class="mw-page-title-main">Dental abrasion</span> Medical condition

Abrasion is the non-carious, mechanical wear of tooth from interaction with objects other than tooth-tooth contact. It most commonly affects the premolars and canines, usually along the cervical margins. Based on clinical surveys, studies have shown that abrasion is the most common but not the sole aetiological factor for development of non-carious cervical lesions (NCCL) and is most frequently caused by incorrect toothbrushing technique.

<span class="mw-page-title-main">Inlays and onlays</span> Restoration procedure in dentistry

In dentistry, inlays and onlays are used to fill cavities, and then cemented in place in the tooth. This is an alternative to a direct restoration, made out of composite, amalgam or glass ionomer, that is built up within the mouth.

<span class="mw-page-title-main">Temporary crown</span>

A temporary crown is a temporary (short-term) crown used in dentistry. Like other interim restorations, it serves until a final (definitive) restoration can be inserted. Usually the temporary crown is constructed from acrylic resins (monomethacrylate-based/polymethacrylate-based) or, chemical-cure/light cure composite (dimethacrylate-based), although alternative systems using aluminium crown forms are occasionally used. Temporary crowns function to protect the tooth, prevent teeth shifting, provide cosmetics, shape the gum tissue properly, and prevent sensitivity.

<span class="mw-page-title-main">Glass ionomer cement</span> Material used in dentistry as a filling material and luting cement

A glass ionomer cement (GIC) is a dental restorative material used in dentistry as a filling material and luting cement, including for orthodontic bracket attachment. Glass-ionomer cements are based on the reaction of silicate glass-powder and polyacrylic acid, an ionomer. Occasionally water is used instead of an acid, altering the properties of the material and its uses. This reaction produces a powdered cement of glass particles surrounded by matrix of fluoride elements and is known chemically as glass polyalkenoate. There are other forms of similar reactions which can take place, for example, when using an aqueous solution of acrylic/itaconic copolymer with tartaric acid, this results in a glass-ionomer in liquid form. An aqueous solution of maleic acid polymer or maleic/acrylic copolymer with tartaric acid can also be used to form a glass-ionomer in liquid form. Tartaric acid plays a significant part in controlling the setting characteristics of the material. Glass-ionomer based hybrids incorporate another dental material, for example resin-modified glass ionomer cements (RMGIC) and compomers.

<span class="mw-page-title-main">Luting agent</span>

A luting agent is a dental cement connecting the underlying tooth structure to a fixed prosthesis. To lute means to glue two different structures together. There are two major purposes of luting agents in dentistry – to secure a cast restoration in fixed prosthodontics, and to keep orthodontic bands and appliances in situ.

<span class="mw-page-title-main">Amalgam (dentistry)</span> Material used in dentistry for direct restorative procedures in the tooth

In dentistry, amalgam is an alloy of mercury used to fill teeth cavities. It is made by mixing a combination of liquid mercury and particles of solid metals such as silver, copper or tin. The amalgam is mixed by the dentist just before use. It remains soft for a short while after mixing, which facilitates it being snugly packed into the cavity and shaped before it sets hard.

Dental cements have a wide range of dental and orthodontic applications. Common uses include temporary restoration of teeth, cavity linings to provide pulpal protection, sedation or insulation and cementing fixed prosthodontic appliances. Recent uses of dental cement also include two-photon calcium imaging of neuronal activity in brains of animal models in basic experimental neuroscience.

Mineral trioxide aggregate (MTA) is an alkaline, cementitious dental repair material. MTA is used for creating apical plugs during apexification, repairing root perforations during root canal therapy, and treating internal root resorption. It can be used for root-end filling material and as pulp capping material. It has better pulpotomy outcomes than calcium hydroxide or formocresol, and may be the best known material, as of 2018 data. For pulp capping, it has a success rate higher than calcium hydroxide, and indistinguishable from Biodentin.

<span class="mw-page-title-main">Pulpotomy</span> Dental procedure

Pulpotomy is a minimally invasive procedure performed in children on a primary tooth with extensive caries but without evidence of root pathology. The minimally invasive endodontic techniques of vital pulp therapy (VPT) are based on improved understanding of the capacity of pulp (nerve) tissues to heal and regenerate plus the availability of advanced endodontic materials. During caries (cavity) removal, this results in a carious or mechanical pulp exposure (bleeding) from the cavity. During pulpotomy, the inflamed/diseased pulp tissue is removed from the coronal pulp chamber of the tooth, leaving healthy pulp tissue which is dressed with a long-term clinically successful medicament that maintains the survival of the pulp and promotes repair. There are various types of medicament placed above the vital pulp such as Buckley's Solution of formocresol, ferric sulfate, calcium hydroxide or mineral trioxide aggregate (MTA). MTA is a more recent material used for pulpotomies with a high rate of success, better than formocresol or ferric sulfate. It is also recommended to be the preferred pulpotomy agent in the future. After the coronal pulp chamber is filled, the tooth is restored with a filling material that seals the tooth from microleakage, such as a stainless steel crown which is the most effective long-term restoration. However, if there is sufficient remaining supporting tooth structure, other filling materials such as amalgam or composite resin can provide a functional alternative when the primary tooth has a life span of two years or less. The medium- to long-term treatment outcomes of pulpotomy in symptomatic permanent teeth with caries, especially in young people, indicate that pulpotomy can be a potential alternative to root canal therapy (RCT).

Minimal intervention (MI) dentistry is a modern dental practice designed around the principal aim of preservation of as much of the natural tooth structure as possible. It uses a disease-centric philosophy that directs attention to first control and management of the disease that causes tooth decay—dental caries—and then to relief of the residual symptoms it has left behind—the decayed teeth. The approach uses similar principles for prevention of future caries, and is intended to be a complete management solution for tooth decay.

Dental compomers, also known as polyacid-modified resin composite, are used in dentistry as a filling material. They were introduced in the early 1990s as a hybrid of two other dental materials, dental composites and glass ionomer cement, in an effort to combine their desirable properties: aesthetics for dental composites and the fluoride releasing ability for glass ionomer cements.

<span class="mw-page-title-main">Pulp capping</span> Dental restoration technique

Pulp capping is a technique used in dental restorations to protect the dental pulp, after it has been exposed, or nearly exposed during a cavity preparation, from a traumatic injury, or by a deep cavity that reaches the center of the tooth, causing the pulp to die. Exposure of the pulp causes pulpitis. The ultimate goal of pulp capping or stepwise caries removal is to protect a healthy dental pulp, and avoid the need for root canal therapy.

Apexification is a method of dental treatment to induce a calcific barrier in a root with incomplete formation or open apex of a tooth with necrotic pulp. Pulpal involvement usually occurs as a consequence of trauma or caries involvement of young or immature permanent teeth. As a sequelae of untreated pulp involvement, loss of pulp vitality or necrotic pulp took place for the involved teeth.

Dental cermets, or silver cermets, are a type of restorative material dentists use to fill tooth cavities.

Atraumatic restorative treatment (ART) is a method for cleaning out tooth decay from teeth using only hand instruments and placing a filling. It does not use rotary dental instruments to prepare the tooth and can be performed in settings with no access to dental equipment. No drilling or local anaesthetic injections are required. ART is considered a conservative approach, not only because it removes the decayed tissue with hand instruments, avoiding removing more tissue than necessary which preserves as much tooth structure as possible, but also because it avoids pulp irritation and minimises patient discomfort. ART can be used for small, medium and deep cavities caused by dental caries.

References

  1. Gulabivala K, Ng YL (2014). Endodontics (Fourth ed.). London: Mosby-Wolfe. ISBN   978-0-7020-3155-7.
  2. Qureshi A, Soujanya E, Nandakumar, Pratapkumar, Sambashivarao (January 2014). "Recent advances in pulp capping materials: an overview". Journal of Clinical and Diagnostic Research. 8 (1): 316–21. doi:10.7860/JCDR/2014/7719.3980. PMC   3939574 . PMID   24596805.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 McCabe JF, Walls AW (2008). Applied dental materials (9th ed.). Oxford, UK: Blackwell Pub. ISBN   978-1-4051-3961-8. OCLC   180080871.
  4. Schenkel, Andrew B.; Veitz-Keenan, Analia (5 March 2019). "Dental cavity liners for Class I and Class II resin-based composite restorations". The Cochrane Database of Systematic Reviews. 3 (3): CD010526. doi:10.1002/14651858.CD010526.pub3. ISSN   1469-493X. PMC   6399099 . PMID   30834516.
  5. 1 2 Dail K (22 June 2012). "When and why you should use a liner/base". Dentistry IQ. Retrieved 14 November 2017.
  6. Arandi NZ (2017-07-01). "Calcium hydroxide liners: a literature review". Clinical, Cosmetic and Investigational Dentistry. 9: 67–72. doi: 10.2147/CCIDE.S141381 . PMC   5516779 . PMID   28761378.
  7. Karadas M, Cantekin K, Gumus H, Ateş SM, Duymuş ZY (September 2016). "Evaluation of the bond strength of different adhesive agents to a resin-modified calcium silicate material (TheraCal LC)". Scanning. 38 (5): 403–411. doi:10.1002/sca.21284. PMID   26553783.
  8. Corral-Núñez C, Fernández-Godoy E, Casielles JM, Estay J, Bersezio-Miranda C, Cisternas-Pinto P, Batista-de Oliveira O (January 2016). "The Current State of Calcium Silicate Cements in Restorative Dentistry: A Review". Revista Facultad de Odontología Universidad de Antioquia. 27 (2): 425–41. doi: 10.17533/udea.rfo.v27n2a10 .
  9. Karabucak B, Li D, Lim J, Iqbal M (August 2005). "Vital pulp therapy with mineral trioxide aggregate". Dental Traumatology. 21 (4): 240–3. doi:10.1111/j.1600-9657.2005.00306.x. PMID   16026533.
  10. 1 2 3 Powers JM, Wataha JC (2013). Dental materials : properties and manipulation (10th ed.). St. Louis, Mo.: Elsevier/Mosby. ISBN   978-0-323-07836-8. OCLC   768071631.
  11. Collares, F. M; Klein, M; Santos, P. D; Portella, F. F; Ogliari, F; Leitune, V. C; Samuel, S. M (2013). "Influence of radiopaque fillers on physicochemical properties of a model epoxy resin-based root canal sealer". Journal of Applied Oral Science. 21 (6): 533–9. doi:10.1590/1679-775720130334. PMC   3891277 . PMID   24473719.>
  12. Collares, F. M.; Ogliari, F. A.; Lima, G. S.; Fontanella, V. R.; Piva, E.; Samuel, S. M. (2010). "Ytterbium trifluoride as a radiopaque agent for dental cements". International Endodontic Journal. 43 (9): 792–7. doi:10.1111/j.1365-2591.2010.01746.x. PMID   20579134.
  13. "Dentistry". American Elements. Retrieved 2018-07-16.
  14. Kastyl, Jaroslav; Chlup, Zdenek; Stastny, Premysl; Trunec, Martin (2020-08-17). "Machinability and properties of zirconia ceramics prepared by gelcasting method". Advances in Applied Ceramics. 119 (5–6): 252–260. Bibcode:2020AdApC.119..252K. doi:10.1080/17436753.2019.1675402. hdl: 11012/181089 . ISSN   1743-6753. S2CID   210795876.
  15. Demarco FF, Corrêa MB, Cenci MS, Moraes RR, Opdam NJ (January 2012). "Longevity of posterior composite restorations: not only a matter of materials". Dental Materials. 28 (1): 87–101. doi:10.1016/j.dental.2011.09.003. PMID   22192253.
  16. WHO - Mercury in Health Care :Amalgam is a mixture of mercury and a metal alloy page 1 item # 2, third paragraph.
  17. "Sweden will ban the use of mercury on 1 juni 2009". Regeringskansliet. 29 January 2009.
  18. 1 2 Woods JS, Heyer NJ, Russo JE, Martin MD, Pillai PB, Bammler TK, Farin FM (2014). "Genetic polymorphisms of catechol-O-methyltransferase modify the neurobehavioral effects of mercury in children". Journal of Toxicology and Environmental Health. Part A. 77 (6): 293–312. doi:10.1080/15287394.2014.867210. PMC   3967503 . PMID   24593143.
  19. Sonal, Sonal; Kumar, Shiv Ranjan; Patnaik, Amar; Meena, Anoj; Godara, Manish (2017). "Effect of adding nanosilica particulate filler on the wear behavior of dental composite". Polymer Composites. 39 (S1): 332–341. doi:10.1002/pc.24436.
  20. Sonal, Sonal; Patnaik, Amar; Kumar, Shiv Ranjan; Godara, Manish (2019). "Investigating influence of low fraction of polytetrafluoroethylene filler on mechanical and wear behavior of light-cured dental composite". Materials Research Express. 6 (8): 085403. Bibcode:2019MRE.....6h5403S. doi:10.1088/2053-1591/ab209a. S2CID   164705598.
  21. Porto, Thiago Soares; Medeiros da Silva, Italo Guimaraes; de Freitas Vallerini, Bruna; Fernando de Goes, Mario (November 2023). "Different surface treatment strategies on etchable CAD-CAM materials: Part 1—Effect on the surface morphology". The Journal of Prosthetic Dentistry. 130 (5): 761–769. doi:10.1016/j.prosdent.2021.10.020.
  22. Cho SY, Cheng AC (October 1999). "A review of glass ionomer restorations in the primary dentition". Journal (Canadian Dental Association). 65 (9): 491–5. PMID   10560209.
  23. Mickenautsch S, Yengopal V (2013-08-23). "Retention loss of resin based fissure sealants - a valid predictor for clinical outcome?". The Open Dentistry Journal. 7: 102–8. doi: 10.2174/18742106201305130001 . PMC   3785037 . PMID   24078856.
  24. Smallridge J (June 2010). "UK National Clinical Guidelines in Paediatric Dentistry: Use of fissure sealants including management of the stained fissure in first permanent molars". International Journal of Paediatric Dentistry: no. doi:10.1111/j.1365-263x.2009.01035.x. PMID   20545793.
  25. Bonsor SJ, Pearson GJ (2013). A clinical guide to applied dental materials. Amsterdam: Elsevier/Churchill Livingstone. pp. 99–104. ISBN   9780702046964. OCLC   824491168.
  26. Noort, Richard van. (2013). Introduction to dental materials (4th ed.). Edinburgh: Mosby Elsevier. ISBN   978-0-7234-3659-1. OCLC   821697096.
  27. Pallesen U, Qvist V (June 2003). "Composite resin fillings and inlays. An 11-year evaluation". Clinical Oral Investigations. 7 (2): 71–9. doi:10.1007/s00784-003-0201-z. PMID   12740693. S2CID   157974.
  28. Sakaguchi, Ronald L.; Powers, John M. (2012). Craig's Restorative Dental Materials. Elsevier/Mosby. ISBN   978-0-323-08108-5.
  29. Worthington, Helen V.; Khangura, Sara; Seal, Kelsey; Mierzwinski-Urban, Monika; Veitz-Keenan, Analia; Sahrmann, Philipp; Schmidlin, Patrick Roger; Davis, Dell; Iheozor-Ejiofor, Zipporah; Rasines Alcaraz, María Graciela (2021-08-13). "Direct composite resin fillings versus amalgam fillings for permanent posterior teeth". The Cochrane Database of Systematic Reviews. 2021 (8): CD005620. doi:10.1002/14651858.CD005620.pub3. ISSN   1469-493X. PMC   8407050 . PMID   34387873.
  30. Opdam NJ, van de Sande FH, Bronkhorst E, Cenci MS, Bottenberg P, Pallesen U, Gaengler P, Lindberg A, Huysmans MC, van Dijken JW (October 2014). "Longevity of posterior composite restorations: a systematic review and meta-analysis". Journal of Dental Research. 93 (10): 943–9. doi:10.1177/0022034514544217. PMC   4293707 . PMID   25048250.