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Dental materials
Pulpal protection
Pulpal irritation can result from:
Dental caries Chemicals in restorative material Cutting of tooth structure Thermal conductivity of metal restorations
Pulpal protection
Cavity varnish: a thin layer placed on the floor and wall of the cavity to seal dentinal tubules and minimize microleakage. Composition:
Natural resin (copal) Synthetic resin dissolved in solvent such as alcohol or chloroform.
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Cavity varnish
Application method:
The varnish is applied in a thin layer The solvent evaporates within 5 15 seconds A second layer is applied The resin component protects pulp by:
Sealing dentinal tubules Reducing microleakage Reduce staining
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Cavity Varnish
Varnishes have been largely replaced by bonding agents since varnishes wash out quickly
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Light cured cement: UDMA + Ca hydroxide + barium sulfate filler and low viscosity monomer
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Properties:
Weak Sedative effect Little thermal insulation since its used in thin layers
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Mixing: mixed into a thick putty like consistency (secondary consistency) that can be rolled into a ball or rope.
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Dental cements
Glass ionomer cements Resin cements ZnO cements Compomer cements Hybrid ionomers Zinc phosphate Zinc polycarboxylate
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Luting cements
Desirable features:
Good wettability Good flow Thin film thickness: 25 m or less to fill the space between tooth structure and restoration.
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Restorations
Permanent: cements are rarely used as restorations due to:
Low strength Low wear resistance High solubility
The exception is GIC, used for class V cavities and primary teeth.
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Restorations
Temporary and intermediate restorations:
Cements are mixed to secondary consistency Uses: If time is insufficient to place permanent restoration In symptomatic teeth, a sedative provisional restoration can be placed Between visits in cases of Endodontic treatment, crowns, inlays
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Surgical dressing
Purpose for using cements as dressing:
Protection and support of surgery site Help to control bleeding Provide comfort for patient
Material used: non eugenol dressing, mixed to soft putty like consistency. A good dressing should be:
Smooth and not too bulky Covers surgery site with minimal overextension Interlocks interdentally to provide retention
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Manipulation
Mixing Loading the restoration Removal of excess cement Cleanup, disinfection and sterilization Consideration during instrumentation
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Mixing
Follow manufacturer instruction Consider working time of the cement according to clinical application. Example:
Long span bridge VS. one crown Areas of difficult isolation Patient consideration Mixing skills of dentist or dental assistance
Removal of excess
Some cements should be removed when rubbery others need to be removed when tacky
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Newer cements are eugenol free Dispensed as powder & liquid, and two paste system
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Properties:
Sedative effect on pulp and antibacterial Alkaline pH (=7), biocompatible Can be irritant if in direct contact with pulp Eugenol interferes with setting of resin Moderate strength Retention is mechanical Water and temperature increase accelerate setting
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Manipulation
Type I: two paste system, mixed until uniform color Solvent: oil of orange Type II: powder and liquid, powder in immediately incorporated into liquid ad mixed (30 seconds) yielding putty consistency, additional 30 sec. mixing provide fluid consistency.
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Zinc phosphate
Used to be used as a permanent luting agent Composition:
Powder: zinc oxide Liquid: phosphoric acid and water buffered by Al + Zn to slow setting
Setting reaction: 5-9 minutes, exothermic, controlled by incremental incorporation of powder into liquid. Cement is porous.
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Properties
Initial acidity with pH of 4.2, becomes neutral after 48 hours. Retentive by mechanical retention sandblasting of crowns or inlays Similar strength to GIC, high CS, low tensile strength. Low solubility once set
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Manipulation
Powder is dispensed and divided into 4-6 portions Liquid is dispensed according to manufacturer Mixing is gradual at 15 seconds intervals for 60-120seconds Large strokes over a large area
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Zinc polycarboxylate
Uses:
High strength base Final cementation of indirect restorations
Composition:
Powder: zinc oxide Liquid: polyacrylic acid
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Properties:
Lower compressive strength than other cements Mild acidity Higher viscosity when mixed but reasonable flow Liquid should not be dispensed before needed, to avoid water evaporation and viscosity Retention is chemical and mechanical To increase working time use a cold slab
Manipulation: powder liquid systems, 90% of powder added first then the rest is mixed with liquid to adjust consistency
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Manipulation?
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GIC
Luting
Filling
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Resin modified-GIC
Uses:
Permanent cementation of crowns and bridges Core build up Liners Bonding of orthodontic brackets
Properties:
Fluoride release Low solubility once set Early low pH then increases High fracture toughness but lower than resin cements Problem of water sorption (contraindicated for all-ceramic restorations, may cause cracking due to expansion)
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Resin-based cements
They are modified composites used for:
Bond ceramic indirect restorations Bond conventional crowns and bridges Bonding of orthodontic bands Temporary cementation
Setting:
Chemical cure Light cure Dual cure: most versatile
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Cementation
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Compomer cements
Uses: PFM bridges and crowns Composition and reaction:
Powder: fluorosilicate glass, sodium fluoride, selfcured and light-cured initiators Liquid: polymerized-methacrylate-carboxylic acid monomer, water, acrylate-phosphate monomer, diacrylate monomer
Properties:
Fluoride release, low solubility, high bond strength, high fracture toughness and strength
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Manipulation
Paste-paste system Powder-liquid system: rapid mixing is needed Dry but not desiccated tooth surface Gelation after 1 minutes, here excess is removed Margins are light-cured
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Root canal sealers: zinc/O based or Ca hydroxide. Should be biocompatible, radiopaque, long working time
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Reference: Dental Materials, properties and manipulation chapter 7 Dental Materials, clinical applications for dental assistants and dental hygienists Chapter 10, page 175-180
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