Dr. Hala A. Bahgat: Restorative Dental Materials

MSA University
Faculty of Dentistry
Dental Biomaterials Department
Restorative Dental Materials

Course Code: (PRS 241)
Edited by:
Dr. Hala A. Bahgat

Professor of Dental Materials Science
Faculty of Oral and Dental Medicine
Cairo University
Dr. Dina H. Mostafa

Professor of Dental Materials Science
Faculty of Oral and Dental Medicine
Cairo University
&
Dr. Ahmed Zaki Zidan
Lecturer of Dental Materials Science
Faculty of Dentistry MSA University
2012-2013
List of contents
Chapter 1: Dental Amalgam 3
Chapter 2: Non Metallic Denture Base Materials 13
Chapter 3: Dental Cements 21
Chapter 4: Direct Esthetic Restorative Materials 35
Chapter 5: Dental Ceramics 46
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Chapter I Dental Amalgam
Dental Amalgam
Introduction
Dental amalgam is a direct posterior restorative material (figure 1) widely used

around the world since 1870’s
Figure 1 Dental amalgam

Advantages
1. Ease of manipulation
2. High compressive strength
3. Marginal leakage decreases with time [self seal restoration]
4. Low cost
5. Long clinical service life
Disadvantages:
1. Metallic color
2. Thermally irritant
3. Concern about mercury toxicity
4. Brittle
5. Subjected to creep
6. Subjected to corrosion
7. Non-adhesive bond to the tooth structure
Definitions
Amalgam Mixture of any metal or alloy with mercury

Dental amalgam alloy It is a special dental alloy powder that will be mixed with
mercury at room temperature
Special dental alloy is Ag3Sn [γ phase] which is an
intermetallic compound formed below 480oC during
solidification of sliver and tin alloy where Ag 73wt% and
Sn 27wt%
Dental amalgam It is the mixture of special dental alloy with mercury at
room temperature giving a plastic mass which is packed
into the prepared cavity to harden
Amalgamation reaction It is the chemical reaction between the special dental alloy
and mercury at room temperature
Indications
1. Posterior filling for Class I and II cavities (figure 1)
2. Core material for crown buildup (figure 2)
3
Figure 2 Amalgam core
Chemical Composition:
Effect of different element on the properties:
a. Dental amalgam alloy consists of the following elements
1. Silver (Ag)
 It increases strength, setting expansion, tarnish and corrosion resistance
and reactivity with mercury
 It decreases setting time and creep
2. Tin (Sn)
 It is added mainly to improve reactivity with mercury
 It increases creep
 It decreases strength, setting expansion, setting time, and tarnish and
corrosion resistance
3. Copper (Cu)
 It increases strength, setting expansion and tarnish and corrosion resistance
 It decreases creep
4. Zinc
 It is added mainly to act as scavenger for oxides during alloy
manufacturing
 It improves plasticity of amalgam mix during mixing
b. Mercury
 Mercury is mixed with the dental amalgam alloy to promote amalgamation
reaction giving a plastic mass ready to be condensed in a prepared cavity
 It increases setting expansion, setting time and creep
 It decreases strength and tarnish and corrosion resistance
Classification of dental amalgam:
I. According to zinc content
1. Zinc free dental amalgam alloy

It contains less than 0.01% Zinc
2. Zinc containing dental amalgam alloy
- It contains more than 0.01% zinc
- Moisture contamination of zinc containing amalgam during trituration or
condensation will cause the following

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 Delayed [secondary] expansion: the hydrogen gas will collect within the
restoration increasing the internal pressure producing: expansion [≈ 400 µm],
which starts 3-5 days after insertion.
 Postoperative pain
 Blistering
When the hydrogen bubbles are formed near the surface, blisters [elevations] are
developed and will open later forming rough surface which is susceptible to the
tarnish and corrosion
N.B. When the isolation of the prepared cavity is difficult (e.g. in children,
uncooperative patient, mentally retarded patient…..etc), zinc free dental amalgam
should be used rather than zinc containing amalgam
II- According to particle shape:
Dental amalgam alloy powder particles can be:
1. Lathe cut [irregular] powder particles

The constituent elements are melted and cast into ingot, which is lathe cut into
irregular powder.
2. Spherical powder particles

- The constituent elements are melted, atomized and allowed to solidify in an
inert gas [e.g. argon] spherical, or in water spheroidal.
- Advantages of spherical particles compared to lathe cut:
 They have lower surface area/volume.
 They take less mercury to obtain a homogenous mix
lower Hg/alloy.
 They need less condensation pressure, because they move readily from
under the condenser, but they require the use of larger condensers to achieve
the proper adaptation.
 Fast setting.
 They produce a smoother surface during carving and finishing.
 They produce amalgam restorations with superior strength properties [1 hr
compressive strength and final strength].
III- According to particle size:

The dental amalgam alloy particle size can be categorized into:
1. Coarse cut [large particle size]:
The average particle size ranges between 100-200 µm
2. Fine cut [small particle size]:

- The average particle size ranges between 15-35µm
- Advantages [compared to coarse cut]:
 Optimum surface area/volume, leading to consumption of some residual Hg.
 Accelerated amalgamation reaction rate i.e. Fast setting.
 A more plastic mix can be obtained better adaptation to cavity walls and
margins.
 A smoother surface can be obtained during carving and finishing.
5
 Greater strength properties [1hr compressive strength and final strength].
N.B. The use of microfine alloy powder less than 3µm, will have negative
effect on the amalgam such as:
• Increased total area/volume requires more mercury to complete the wetting of
alloy particles
• Increased mercury content decreases the amount of the strong γ particles and
increases the weaker γ1 and γ2 phases, which will result in an amalgam with
inferior properties.
IV- According to copper content (table 1)

1- Low copper conventional types.
2- High copper addmixed types.
3- High copper unicompositional types.
N.B. Steps of the amalgamation reactions of all dental amalgam types are:
a- Wetting of the mercury to the powder.
b- Diffusion of the mercury inside the powder.
c- Surface reaction between mercury and the surface of the powder, this is why the dental
amalgam is a cored structure and there is always unreacted particles.
1- Low copper conventional types.

. Composition: Silver 65%, Tin 29%, Copper max. 6% and zinc max. 2%
. The amounts of copper and zinc are too small to enter the reaction so the reaction will be
between Ag3Sn (γ) and mercury:
Ag 3Sn (γ ) + Hg → Ag 2Hg 3 (γ1 ) + Sn 7Hg (γ 2 ) + unreacted Ag 3Sn (γ ) + voids

54 − 56% by.volume 11−13% 27-35%
Microstructure:
€
Unreacted γ Ag3Sn
γ2 Sn7-8Hg
γ1 Ag2Hg3
Voids
Figure 3 Microstructure of the set low-copper conventional amalgam.
N.B. The strength of amalgam phases is in the following order: γ > γ1 > γ2
The resistance to tarnish and corrosion is in the following order: γ > γ1 > γ2
η is more stronger and more corrosion resistant than γ2
6
2- High copper admixed types:
. They are addition mixture of two types of powder (the intermetallic conventional Ag3Sn + the
eutectic AgCu).
. The amount of copper is increased to 13% so it enters the reaction with mercury.
a- Diffusion reaction:
Ag3Sn[γ ]+ AgCu[eutectic]+ Hg →Ag2Hg3 (γ1) + unreacted Ag3Sn(γ )+ AgCu[eutectic]+Sn 7Hg (γ 2 )
b- Ellimination of γ 2
Sn7Hg (γ 2 ) + AgCu[eutectic] →Cu 6Sn 5 (η) + Ag2Hg 3 (γ1)+voids
Microstructure:
€
€ Unreacted γ Ag3Sn
Voids
Eta η Cu6Sn5
γ1 Ag2Hg3
Eutectic
Figure 4 Microstructure of the set high copper admixed amalgam.
2- High copper unicompositional types:
Ag − Sn − Cu + Hg →Ag2Hg3 (γ1) + Cu6Sn5 (η)+ unreacted Ag3Sn(γ )+voids

Microstructure:
η Cu6Sn5
€
γ1 Ag2Hg3
Voids
Unreacted γ Ag3Sn
Figure 5 Microstructure of the set high-copper unicompositional amalgam.
7
Table 1 Classification of dental amalgam according to copper content

Difference Conventional low copper High copper dental amalgam alloy
dental amalgam alloy [Since 1960’s]
[Traditional low copper dental
amalgam alloy] Admixed [blended] Unicompositional
Copper Below 6% 13 – 30%
concentration Copper content is Copper content is
increased in the form of increased in the form of
AgCu eutectic Cu3Sn (ε)
[mechanical mixture of [Ag3Sn () and Cu3Sn (ε)
Ag3Sn and AgCu into single composition]
powder]
Phases in the One phase Ag3Sn [intermetallic Mechanical mixture of Melting all components
alloy powder compound] two phases: of high copper system
 Ag3Sn [γ] intermetallic creating a single
compound composition.
 AgCu eutectic
Shape of the Lathe cut [irregular] or AgsSn lathe cut Lathe cut [irregular] or
particles of the spherical [irregular] spherical
alloy powder AgCu [spherical]
Advantages Elimination of Sn7Hg Elimination of Sn7Hg
(γ2) which is the weakest (γ2) which is the weakest
and most corrodible and most corrodible
phase phase
This occurs by two This occurs by one
reactions reaction
Disadvantages Presence of γ2 phase which is 1. Sedimentation of one
the weakest and the most type of the particles
corrodible phase in the bottom of the
container affect the
powder particles
distribution
2. Surface oxidation of
the AgCu eutectic
during storage
Properties of dental amalgam
1. Dimensional changes during setting
The dimensional changes between 5 minutes and 24 hours after amalgam insertion
must be ±20µm/cm [ANSI/ADA specification].
After mixing the alloy powder with mercury, the following will take place:
• Initial contraction in the first 20 minutes
It is due to:
o Diffusion of mercury between the alloy particles.
• Then expansion will take place
It is due to:
o The reaction of mercury with the alloy particles.
o Formation of new phases [reaction products].
o Crystal growth of these new phases.
• The dimensions become nearly constant after 6-8 hours.
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• The net total dimensional change remains negative i.e. contraction

This is due to the use of:
o Spherical dental amalgam alloy.
o Low mercury/alloy.
o Mechanical amalgamators during trituration [over trituration].
• However marginal adaptation and seal can be obtained by:
o Good condensation.
o Application of cavity varnish along the cavity walls and margins.
o Formation of corrosion products at the amalgam tooth interface (crevice
corrosion). This is known as "self seal property" in 3-2 months.
o Application of amalgam bonded system.
N.B.
• Expansion will take place with high mercury/alloy, as more new phases [reaction
products] will be formed, followed by their crystal growth.
• Delayed [secondary] expansion will occur due to moisture contamination of zinc
containing amalgam.
Clinical Significance:
o Over expansion may lead to:
 Protrusion of amalgam
 Marginal breakdown [ditching]
 Post-operative pain
o Over contraction may lead to:

 Marginal leakage
 Hyper sensitivity
 Recurrent carries
2. Flow and creep

• Flow is a time dependant plastic deformation due to stress application below the
yield stress before complete setting of amalgam.
• Creep is a time dependant plastic deformation due to stress application below the
yield stress after complete setting of amalgam.
• The maximum accepted creep is 3% after 7 days [ANSI/ADA specifications]
• Creep is decreased by the use of:
o High copper unicomposiotnal dental amalgam alloy
o Low mercury/alloy
• The viscoelastic nature of dental amalgam is responsible for flow and creep
i.e. flow and creep are unavoidable in all dental amalgam.
The mercury containing phases Ag2Hg3 (γ1) and Sn7Hg (γ2) represent the viscous
portion.
The presence of γ2 at the grain boundaries of γ1 allows the matrix to slide under load,
therefore creep is very high in conventional low copper amalgam.
The mercury free phases Ag3Sn (γ) and Cu6Sn5 ( ) represent the elastic portion.
Clinical significance
Creep may lead to:
o Marginal break down (ditching)
o Gingival overhangs
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3. Strength
• As dental amalgam alloys are intermetallic compounds, they are characterized by

being brittle restorative material
i.e. Dental amalgam is strong in compression but weak in tension or shear
• Dental amalgam develops its strength slowly.
It takes 7 days to reach its final strength.
The possibility of early fracture by biting force is high in the first hour.
Therefore the one hour compressive strength is more important than the final
strength.
It must be at least 80% of the final strength [ANSI/ADA specifications].
• Dental amalgam is viscoelastic in nature
This makes the measure strength and modulus of elasticity sensitive to the rate of
loading
Higher rate of loading increases both:
o The compressive strength.
o The modulus of elasticity.
Therefore these properties must be tested at the same rate of loading, when
comparing different amalgam samples.
• In order to maximize the strength of dental amalgam, the following must be taken
into consideration:
 Cavity preparation with:

o Adequate depth
o Round line and point angles
o Cavosurface angle 90o
 Use high copper unicompositional dental amalgam alloy.

 Use low mercury alloy.
 Proper trituration [avoid under trituration].
 Proper condensation [avoid poor or delayed condensation].
 Use stiff insulating base:
• To distribute the load applied from masticatory forces
over the whole area of the restorative material.
• To prevent development of tensile stresses at the
amalgam cement interface causing its fracture.
• Clinical significance:
Inadequate strength may lead to:
o Marginal break down [ditching].
o Bulk fracture.
4. Bond to tooth structure

• There is no adhesive bond between amalgam and tooth structure, there is only
mechanical retention.
• Recently amalgam bonded system containing 4META (Methacryloxy Ethyl
Trimellitic Anhydride) has been introduced to bond:
o Amalgam to tooth structure.
o Amalgam to amalgam [repair].
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Advantages
1. Restored tooth is strengthened.
2. Reduction of postoperative sensitivity.
3. Conservative cavity preparation.
Disadvantages
1. It is time consuming.
2. It is very technique sensitive.
3. It is expensive.
5. Biological properties
A. Thermal irritation
As amalgam is a metallic restoration, the cavity must be lined by an insulating
base to prevent thermal irritation to the pulp. The base must also be rigid to
distribute the load over the whole area during mastication.
B. Corrosion
Dental amalgam always corrodes more of the following ways:
i) Composition cell corrosion
Heterogeneous structure of dental amalgam is the main cause for its corrosion
ii) Galvanic corrosion
Contact between
• Amalgam and cast gold.
• Amalgam and prosthodontic alloy.
• Fresh amalgam and old amalgam.
iii) Crevice corrosion

A differential oxygen concentration cell may arise between the surface
of restoration facing the tooth and the outer surface of the restoration, causing
corrosion of the first surface. The corrosion products will become lodged in
the crevice producing the so called self-sealing of the amalgam to the tooth (3-
12 months after amalgam insertion)
A differential oxygen concentration cell may arise on a rough non-
finished and non-polished dental amalgam restoration
Excessive corrosion may lead to:

• Increased porosity
• Marginal breakdown (ditching)
• Loss of strength
• The release of metallic products into the oral environment
Reduction of corrosion is achieved by:

1. The use of low mercury alloy ratio to reduce the reaction products
especially γ2 phase.
2. The use of high copper amalgam alloys to be free of γ2 phase
N.B. η is more corrosion resistant than γ2 it is not an interconnected phase
as γ2 its corrosion does not liberate mercury as γ2
3. Finishing and polishing of amalgam restoration to produce smooth surface.
This prevents accumulation of food, which helps in concentration cell
corrosion.
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C. Mercury Toxicity
From the toxic logical view of point, there are 3 forms of mercury:
• Elemental mercury [liquid or vapor]
Liquid mercury is absorbed poorly via skin or mucosa into the blood
Most of it is excreted through the kidney into the urine
Mercury vapor is absorbed rapidly via the lungs into the blood
Most of it is accumulated into the brain causing its damage
• Inorganic compound
Dental amalgam contains different inorganic mercury compounds, which
are of very low toxicity
• Organic compound
Dental amalgam does not contain any organic mercury compounds, which
are of very high toxicity
The main sources of mercury exposure in the dental clinic arise from:
• Accidental spills.
• Direct contact with mercury.
• Amalgamators.
• Removing old restorations.
Mercury hygiene procedures include:

• The use of no touch technique.
• The cleaning up of spilled mercury immediately.
The dental staff is most at risk from mercury contamination.

Patients are less at risk from mercury contamination.
There is some ingestion of mercury after insertion; wear and corrosion of
amalgam. The ingested amounts are insignificant.
Rarely allergic reaction to mercury may occur. The dentist should be aware to
such possibility.
N.B.
The mercury used in the preparation of amalgam needs to be very pure,
otherwise a surface layer of contaminants is formed interfering with the setting
reaction. Therefore, the mercury is triple distilled. The purity can be checked
by highly reflective surface of mercury.
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Chapter II Non Metallic Denture Base
Chapter II
Non Metallic Denture Base Materials
Non-metallic denture base
Artificial teeth
Figure 6 Complete denture restoration (non metallic denture base + artificial teeth)
Denture base is that part of the denture that retains the artificial teeth and rests
on the soft tissues.
Various materials have been used to construct dentures, including phenol
formaldehyde, vinyl resins and vulcanite; however they suffered from a variety of
problems such as difficult processing, low resistance to fracture and bad esthetics.
Since 1935, acrylic resins were introduced as denture base material. They are till now
the material of choice: They have the required esthetic quality, cheap and are easy to
process.
Requirements for an ideal denture base material:

1. It should be non-toxic and non-irritant.
2. It should be insoluble and non-absorbent.
3. It should be aesthetically satisfactory; the material should be transparent or
translucent, and easily pigmented.
4. It should have adequate mechanical properties, that is:
a. High modulus of elasticity:
1. Great rigidity can be achieved, so that any masticatory load will be
distributed over the denture base area, in order to decrease the amount
of bone resorption occurring by time.
2. With high modulus of elasticity the denture base materials can be used
in thin section, so that the upper denture will be light in weight for
better retention to the tissues.
b. High proportional limit, to avoid permanent deformation when stressed.
c. Adequate strength to resist high stresses and fracture.
d. Adequate resilience to absorb energy without permanent deformation.
e. High impact strength so that the denture will not fracture if accidentally
dropped.
f. High fatigue strength to resist cyclic loading below the proportional limit.
g. Hard and with good abrasion resistance, so that the material will not wear
appreciably, but will take and retain a high polish.
5. It should have adequate physical properties, that is:
a. The thermal expansion of the denture base should match that of the artificial
tooth material.
13
b. The softening temperature should be higher than the temperature of liquids

and foods in the mouth.
c. The density should be low, to assist in the retention of an upper denture.
d. The thermal conductivity should be high, in order to stimulate the underlying
tissues through activating its blood circulation.
6. Other considerations for denture base materials are:
a. There should be no dimensional changes; expansion, contraction, or warpage,
either on processing the denture or while it is in service.
b. Denture base material should be easy to process with the minimum of expense
and equipments.
c. It should be easy to repair if fractured.
d. It should be easy to clean.
e. It should be radio-opaque, so that if a denture or a fragment of a broken
denture is accidentally inhaled or ingested, it could be detected by x-rays.
No denture base material fulfills all these requirements.
Acrylic resin denture base materials

An acrylic resin denture is made by the process of free radical addition
polymerization involving the normal sequence of activation, initiation, propagation
and termination.
The resins are available in either heat-cured or cold-cured forms. Recently, a
light-activated form is introduced. They are commonly supplied in powder/ liquid or
gel form.
I. Composition of Acrylic Resin:
1. Composition of heat cured resins:
These materials consist of powder and liquid, which upon mixing and
subsequent heating form a rigid solid.
Powder:
a. Beads or granules: Of polymethyl methacrylate (pre-polymerized P.M.M.A.
polymer).
b. Initiator (benzoyl peroxide) 0.5-1.5%: To initiate the polymerization of the liquid
monomer when added to the powder.
c. Pigments 1%: To give the natural tissue-like appearance
d. Plasticizers: (Dibutyl phthalate) to give a more resilient and softer polymer.
The following consistency may also be present:
- Opacifier: To give radio-opacity.
- Dyed organic fibers: To simulate blood vessels.
Liquid:
a. Liquid monomer: Methyl methacrylate (M.M.A.).
b. Inhibitor hydroquinone (0.006%): To prevent the polymerization of the monomer
by heat or light during storage.
c. Gross-linking agent: (Glycol dimethacrylate) in order to improve the mechanical
properties by providing polymer with greater resistance to minute surface cracks.
d. Plasticizers: Sometimes added to either the powder or the liquid.
2. Composition of chemically cured resin: (cold cured or self cured or auto-

polymerized resins).
14
The chemistry is identical to that of the heat cured resins, except that the cold
cured resin is initiated by an activator (N, N dihydroxy ethyl para toluidine), which is
added to the liquid, rather than heat activation as in the heat cured resins.
II. Polymerization reaction:

1. Heat curing:
Polymer + Peroxide initiator + Monomer + Inhibitor ⎯
⎯→ Polymer + Heat
Powder + Liquid (exothermic reaction)
2. Self Curing:
€
Polymer + Peroxide initiator + Monomer + Inhibitor + Chemical activator ⎯
⎯→ Polymer + Heat
Powder + Liquid (exothermic reaction)
€ N.B.
- It is a free radical addition polymerization.
- The polymerization process is exothermic and accompanied by shrinkage.
- There is always a residual monomer remains after polymerization. Its amount
depends on the degree of polymerization. The amount of residual monomer is greater
in self-cured resin.
III. Manipulation and processing of denture resins:

1. Proportioning: P/L ratio 3:1 by volume or 2.5:1 by weight:
- The quantity of liquid should completely wet the polymer powder.
A high P/L ratio will lead to granular cured acrylic i.e. insufficient wetting of
the powder.
A low ratio will lead to increase shrinkage and porosity of the finished
denture.
2. Mixing:
- Mixing is done with a stainless steel spatula.
- Allow the monomer to react physically with polymer in a sealed jar to avoid
monomer evaporation.
The mixture of the heat cured acrylic resin goes through the following physical
stages:
1. Sandy stage.
2. Sticky stage.
3. Dough stage.
4. Rubbery stage.
The mixture of the self cured acrylic resin goes through the following physical
stages:
1. Sandy stage.
2. Sticky stage.
3. Dough stage.
4. Rubbery stage.
5. Stiff stage.
The dough stage is the desirable consistency for packing into the denture flask.
15
3. Separating medium:
- Before packing the dough a separating medium should be applied (sodium alginate).
- All parts of the gypsum cast in the flask should be painted by separating medium
except the occlusal surface of the teeth.
Role of separating medium:

a. Prevent the passage of water from gypsum to the resin because it may cause
crazing.
b. Minimize the passage of the monomer to the plaster.
c. Decrease surface porosity.
d. Facilitate separation of the flasks.
4. Packing:
The powder-liquid mixture should be packed in the dough stage.
Too early packing (packing at sandy or sticky stage):

a. Too low viscosity of the material, which will easily flow out of the flask.
b. Possibility of denture porosity.
Delayed packing (packing at rubbery or stiff stage):

a. Too viscous to flow under pressure, cannot obtain metal contacts of the flask
halves.
b. Movement or fracture of teeth.
The mould should be over filled and sufficient pressure should be applied on
the mould, because on polymerization contraction a decrease in pressure inside the
mould occurs. Therefore an under-packing and/or insufficient pressure will lead to
shrinkage porosity.
5. Processing:
- Heat is applied to cure the polymer usually in a water bath.
- The temperature and time should be controlled:
a. Decrease in curing time produces an under-cured denture i.e. high residual
monomer.
b. An increase in the temperature rate (rapid curing) will lead to accumulated
temperature (because of the low thermal conductivity of the gypsum): curing
temperature plus the exothermic reaction temperature will be built up inside the bulk
of the acrylic resin. This might reach the boiling temperature of the monomer
(100.3ºC) before it is polymerized consequently the monomer boils and vaporizes;
this results into gaseous porosity in the finished denture.
Curing Cycles:
1. A satisfactory processing procedure is to cure the plastic in a constant temperature
water bath at 74ºC for 8 hours (long cycle).
OR
2. To heat at 74ºC for one hour and half, then increasing the temperature of water bath
to boiling for an additional hour (short cycle).
16
6. Deflasking and Finishing:

After polymerization, the flask is removed from the water bath and allowed to
cool to room temperature.
- Premature opening before cooling may cause warpage.

- Rapid cooling will increase internal stresses (thermal stresses) in the
denture.
- After cooling, the denture is ejected from the flask and stone is
removed.
- Stone adhering to plastic is removed by shell blasting.
- Denture is trimmed with acrylic burs to remove any excesses of plastic.
- Polishing is performed by a wet polishing wheel and slurry of pumice
in water.
- After finishing and polishing, the denture should be stored in water.
IV. Properties of denture resins:

1. Polymerization shrinkage:
The polymerization of the monomer results in a 21% volumetric shrinkage.
Mixing the polymer with the monomer with a ratio 3:1 by volume or 2.5:1 by weight
results in a free volumetric shrinkage about 6%. This reduction is because the powder
used (the beads of PMMA) is pre-polymerized.
2. Residual monomer:
Even in properly cured acrylic resin 0.2 to 0.5% of the monomer remains
unpolymerized, excess free monomer may be released from denture and irritate the
oral tissue.
Free monomer act as a plasticizer and make the resin flexible and weak. It also
decreases mechanical properties and increases surface porosity.
3. Water sorption:
Immediately after processing, a denture absorbs some water. Further water
absorption can occur up to an equilibrium value of about 2%. It has been claimed that
each 1% increase in weight of the resin due to water absorption causes a linear
expansion of 0.23%. Similarly, drying out of the resin is associated with shrinkage.
For this reason, dentures should at all times be kept wet when not in service. It should
be noted that there is thermal shrinkage of the resin on cooling from the processing
temperature 75ºC to 20ºC room temperature of about 0.44%. This will be
compensated by the expansion caused by water absorption.
4. Solubility:
Although PMMA is soluble in most solvents (e.g. chloroform), it is insoluble
in most fluids that may come into contact with it in the mouth. Some weight loss will
occur due to leaching out of the monomer.
5. Mechanical properties:
a. Tensile strength: About 50MPa.
b. Elastic modulus: About 2.8-3.8 X l03MPa.
c. Transverse strength: Varies from 78 to 92MPa for various types.
17
d. Impact strength: Ideally a denture base plastic should have sufficiently high impact
strength to prevent breakage on accidental dropping.
For patients who fracture their dentures frequently, it is possible to consider a high-
impact strength denture base resin.
e. Hardness: The low Knoop hardness number indicates that these materials could be
scratched and abraded easily.
6. Thermal properties:
a. Thermal conductivity: Very low thermal conductivity this may cause:
i. Problems during denture processing since the heat produced cannot escape leading
to temperature rise.
ii. Denture isolates the oral soft tissues from any sensation of temperature.
b. Coefficient of thermal expansion: About 80 X l0-6/ºC, which is quite high. This

may lead to gradual loosening of porcelain teeth attached to a denture base due to the
difference in contraction and expansion.
7. Porosity:
This may have undesirable effects on the strength and optical properties of the
acrylic.
a. Contraction or shrinkage porosity (surface porosity):
This porosity appears as irregular voids throughout on the surface of the denture due
to:
i. Under-packing (insufficient packing).
ii. Packing at sandy or sticky stage.
iii. Use of excessive monomer.
iv. Lack of separating medium.
b. Gaseous porosity (internal porosity):

This porosity appears as fine uniform bubbles particularly in thicker sections of
the denture remote from the external heating source.
8. Crazing:
Cracks may appear on the surface of the resin. This is believed to be due to
tensile stresses causing separation of the polymer molecules. Crazing has a weakening
effect on the denture. Cross-linked resins are less likely to craze. Crazing may result
from:
a. Mechanical stresses on repeated drying and wetting of the denture, causing
alternate contraction and expansion.
b. Solvent action e.g. when a denture is being repaired, some monomer comes in
contact with the resin and may cause crazing.
c. Stresses due to differences in coefficient of thermal expansion between acrylic
resin and artificial teeth.
d. Cleaning the denture by bleaching agent or alcohol.
e. Allowing water to pass from gypsum to acrylic resin during curing (failure to use
appropriate separating medium).
18
Modified Denture Base Resins
1. Pour type denture resin (fluid resin):

- Their chemical composition is similar to the self-cured polymethyl methacrylate.
- Principal difference is in the size of the polymer beads, these are much smaller and
when mixed with the monomer, the resulting mix is very fluid (fluid resin).
- They are poured in a hydrocolloid mold.
- They give excellent reproduction of surface details.
2. High impact strength resins:

They are similar to the heat-cured polymethyl methacrylate with the exception of the
following:
- They are reinforced with butadiene styrene rubber.
- They have much higher impact strength. Here the rubbery inclusions will stop the
crack growth showing a higher degree of resistance to fracture.
3. Rapid heat-polymerized resins:

- These are hybrid acrylics. They are polymerized in boiling water immediately after
being packed into the denture flask for 20 minutes.
- Initiator is formulated from both chemical and heat initiators to allow rapid
polymerization without porosity.
4. Microwave cured acrylic resin:

- This technique involves a specially formulated resin and a special flask.
- The major advantage of this technique is speed.
5. Visible light-cured resins:

This is a relatively recent innovation. The material consists of urethane
dimethacrylate matrix with an acrylic copolymer, microfine silica fillers and a photo-
initiator system.
It is supplied in premixed sheets, which are adapted to the cast then taken to be
polymerized in a light chamber with blue light of 400-500nm.
6. Gel form acrylic resin:

It has the same composition as the powder and liquid type used for heat cured
acrylic resin except that the powder and the liquid have been mixed to form a gel and
shaped into a form of a thick sheet. The gel type is heat cured only.
19
Tissue Conditioners and Resilient Lining for Dentures
These are polymers, which are soft at mouth temperature; in other words, their
glass transition temperature (G.T.T) is below mouth temperature.
An acrylic denture may have a soft lining either for temporary or permanent
use
I. Tissue conditioners:
These are soft polymers, applied temporarily to the fitting surface of the denture for:
a. Treatment of irritated mucosa under the denture as they distribute the occlusal
forces throughout the mucosa, thus allowing the tissues to return to a healthier state.
b. Stabilization of immediate dentures.
c. Use as a functional impression material.
1. Composition:
Powder: Polyethyl methacrylate (PEMA), because it has a low G.T.T.
Liquid: Mixture of:
- Ethyl alcohol as a solvent.
- Aromatic ester as a plasticizer.
On mixing, the liquid penetrates between the polymer and a gel is formed
therefore it is a physical process not a chemical reaction.
N.B.
- These materials are not irritant (they do not contain monomer).
- These materials are not permanent and must be replaced every three
days because alcohol evaporates and the plasticizer is leached out and
so it hardens.
II. Resilient Lining:
These are soft polymers, which can be applied permanently to the denture for the
following uses:
1. In cases of very sensitive mucosa.
2. For patient's comfort with old denture while new denture is
constructed.
3. To improve the fit of an old denture.
4. For the (problem denture patient) who has difficulty to wear dentures.
1. Types:
a. Self or mouth cured: Heat or lab-cured:
Powder: PEMA + initiator. Powder: PEMA + initiator.
Liquid: MMA + Activator + plasticizer. Liquid: MMA + plasticizer.
OR
b. Self cured silicone: Heat cured silicone:
Similar in composition and reaction to the silicone impression materials.
2. Limitations of resilient linings:

a. They lose their resilience and become hard due to the leaching out of the
plasticizers into saliva.
b. May become rough leading to food stagnation.
c. May peel away from the denture base.
d. May change in color due staining and calculus deposition.
e. Have poor abrasion resistance.
20
Chapter III Dental Cements
Chapter III
Dental Cements
Introduction:
Dental cements are widely used for a variety of applications as: cavity lining,
luting, filling. endodontic, pedodontic and surgical fields of dentistry.
Requirements of dental cements:
Generally the properties of dental cements are influenced by:
1. Composition.
2. Powder/ liquid ratio.
3. Handling of the mix.
I. Biological properties:
1. They should be non-toxic and non-irritant to the pulp and other dental tissues, i.e.
obtundent effect.
2. They should be bacteriostatic if inserted in a cavity with residual caries.
3. Protection of the pulp from effects of their restorative materials.
4. Thermal insulation, i.e. to protect the pulp from temperature changes under large
metallic restoration.
5. Chemical protection, i.e. to prevent penetration of harmful chemicals from the
restorative materials.
6. Electrical insulation, i.e. to protect the pulp from galvanic effects under a metallic
restoration.
II. Solubility:
They should be insoluble in saliva because solubility leads to marginal leakage
around the restoration, loosing of the restoration and recurrent caries.
III. Mechanical properties:
These must meet the requirements for the applications of dental cements, e.g.
for cavity lining a cement should develop sufficient strength rapidly to enable a filling
material to be packed on it.
IV. Optical properties:
These also must meet the requirements for the cements, e.g. for cementation of
a translucent restoration, properties of the cement should be paralleled those of tooth
substance.
V. Bonding:
A dental cement should ideally be adhesive to tooth structure and restorations but not
to dental instruments.
Bond strength of dental cement depends on:
- Strength of the cement.
- Film thickness of the cement.
- Surface texture of tooth and restorations.
- Design of the restoration.
VI. Rheological properties:
Dental cement should be mixed in the proper proportion that film thickness
suitable for its application. e.g. thin mix for cementation and thicker mix for
temporary fillings.
N.B. Film thickness of dental cement depends on:
- Powder particle size.
- Powder/ liquid ratio.
- Viscosity of the mix
21
Classification of dental cements:

Dental cements are generally classified according to their chief chemical ingredients
into:
I. Cements based on zinc oxide.
II. Cements based on aluminosilicate glasses (ion leachable glasses).
III. Resin cements.
IV. Others.
I. Cements based on Zinc oxide:

Zinc oxide with:
1. Eugenol.
2. Phosphoric acid.
3. Polyacrylic acid
Zinc Oxide
+ + +
Eugenol Phosphoric acid Polyacrylic
acid
Zinc oxide-eugenol Zinc phosphate Zinc polycarboxylate

cement cement cement
II. Cements Based on Aluminosilicate glasses (ion leachable glasses):
Alumino-silicate Glass
Phosphoric acid Polyacrylic acid
Silicate cement (historical) Glass ionomer cement
III. Resin cements:

Resin cement as luting.
IV. Others:
- Varnishes and liners.
- Calcium hydroxide as liner and pulp capping.
22
1. Zinc oxide-eugenol cements:

Zinc oxide-eugenol cements have been widely used, they are available in
powder-liquid form or in a ready-made paste of zinc oxide and eugenol.
Composition:
Powder: Mainly zinc oxide and contains 10% magnesium oxide to reduce
temperature for calcinations process, and small quantities of zinc acetate to improve
strength of the cement, and zinc stearate as accelerator.
Liquid: Eugenol and about 15% olive oil. A glass slab and a stainless steel spatula are
used for mixing. The cement is mixed by adding the powder to the liquid in small
increments until a thin or thick consistency is obtained.
Setting reaction (chelation reaction):

The zinc oxide absorbs some eugenol and reacts in the presence of water,
which is essential for setting to form zinc eugenolate on the surface of the powder,
this bind the unreacted particles of the powder with each other. The set material
contains both unreacted zinc oxide and free eugenol in zinc eugenolate matrix.
Properties:
1. Biological properties:
The set cement has a pH of about 7 (neutral) and has little or no effect on the pulp
when used in deep cavities. It has an obtundent, sedative and palliative effect on the
pulp due to the presence of eugenol. It has bacteriostatic action due the eugenol
content.
2. Consistency and film thickness:

Film thickness is an important factor in the complete sealing of restorations.
Consistency and film thickness are dependent on the powder particle size,
powder/liquid ratio and viscosity of the mix. It gives a film thickness of about 40µm.
3. Solubility and disintegration:

One of the main disadvantages of zinc oxide eugenol is their high solubility in the
oral conditions due to leaching out of free eugenol from the set mass. Leached
eugenol is then, replaced by water which can cause hydrolysis of' zinc eugenolate
matrix and disintegration of the cement structure (higher solubility of all cements).
4. Strength:
Zinc oxide-eugenol cement has poor mechanical properties with compressive strength
of about 15MPa for the luting cements. Tensile strength is 5MPa.
5. Bonding: By mechanical interlocking.
6. Optical properties: Opaque due to the presence of unreacted zinc oxide particles
23
Modifications:
1. Reinforced zinc oxide-eugenol cements:
One of the main disadvantages of zinc oxide eugenol cements is their high solubility
and low mechanical properties. Additives have been added to the powder and to the
liquid to improve the mechanical properties. The modified zinc oxide and eugenol
cements which are available:
a. Polymer reinforced cement (resin bonded cement):
Powder composed of 80% zinc oxide and 20% polymethyl methacrylate and
about 10% polystyrene dissolved in the eugenol. The compressive strength of resin-
bonded cement is about 38MPa and is used final cementation, as cement base and
temporary restoration.
b. Ethoxy benzoic acid cement (E.B.A. cement):

Powder: Composed of zinc oxide about 30% by weight alumina and about 6%
resin and copolymers to reduce brittleness and film thickness.
Liquid: Contains 37.5% eugenol and 62.5% by weight EBA (ethoxy benzoic
acid).
The compressive strength of E.B.A. cement is about 85MPa and is used as

base under amalgam restorations, as luting cement and as a temporary filing.
2. Non-eugenol cements:
Non-eugenol zinc oxide cements have become available and are suitable for
patients sensitive to eugenol (aromatic oil, olive oil or oleic acid may be used).
3. Rapid set zinc oxide eugenol cements:

The setting time of cement depends on the powder particle size and shape, the
powder/liquid ratio and presence of zinc acetate or acetic acid.
Applications:
According to ADA specifications:
Type I: Used as temporary cementation.
Type II: Used as permanent cementation.
Type III: Used as base.
Type IV: Used as cavity liner.
These cements can also be used as temporary filling, surgical pack,
periodontal pack and root canal filling.
N.B.
- Zinc oxide eugenol is contraindicated to be used under resin-based materials
(e.g. resin composite restorations) because it interferes with their
polymerization and causes their discoloration.
- Conventional ZnO and eugenol (non-reinforced) is contraindicated to be used
under amalgam filling as it cannot withstand forces of condensation of
amalgam, so reinforced types should be used.
24
II. Zinc phosphate cements:

Zinc phosphate cement is the oldest of the luting cements used in dentistry.
Composition:
These materials are generally supplied as a powder and liquid, which are
mixed together by hand on a glass slab using stainless steel spatula.
Powder:
The powder is mainly zinc oxide with small quantities of other oxides such as
magnesium oxide, silica and alumina. The magnesium oxide is added to maintain the
white color of the cement and control the reactivity of the powder, while silica and
alumina have been added to improve the mechanical properties.
Liquid:
The liquid is an aqueous solution of phosphoric acid buffered by adding
small quantities of zinc phosphate or aluminum phosphate to slow the reaction during
mixing. These compounds stabilize the pH of the acid and reduce its reactivity. This
will control working time and will help in adding adequate amounts of the powder to
the liquid.
Setting reaction (acid-base reaction):

On mixing the powder and liquid together a surface reaction occurs, the
powder is partially dissolved in the acid resulting in the formation of zinc phosphate
as follows:
ZnO + 2H3PO4 Zn (H2PO4) + H2O
This reaction is followed by a further reaction resulting in the formation of a

hydrated zinc phosphate matrix, which binds together the unreacted particles of zinc
oxide. The reaction is rapid and exothermic and the result of the reaction is a cored
structure. The set structure is composed of unreacted particles of zinc oxide in a
matrix of phosphates of zinc, magnesium and aluminum.
Properties:
- Zinc phosphate may have an irritant effect on the dental pulp when used as a
cavity lining. The pH of the freshly mixed cement will be about 1.3-3.6, at
the end of one hour this value increases to about 6 and the cement neutral
after 48 hours. The initial acidity of the zinc phosphate cement excite pulpal
response when placed in a deep cavity, therefore a sub-base should be used
under zinc phosphate cement.
- The degree of irritation depends on the depth of the cavity and the thickness
of residual dentin. Also during cementation, the patient may complain of pain
as a result of the low pH of the cement and by the movement of fluid through
dentinal tubules. This pain is usually transient and should subside within few
minutes.
2. Thermal and electrical conductivity:

- The phosphate cement has adequate thermal insulating properties when used
as a base in deep cavities under metallic restorations to protect pulp from
thermal trauma.
25
- This cement is an effective thermal insulator although it is not more effective

than dentin itself. Therefore, zinc phosphate cement base is desirable to
protect the pulp against thermal shocks when a significant amount of dentin
has been lost because of trauma or caries.
3. Consistency and film thickness (least film thickness of all cements):
- The heavier the consistency, the greater the film thickness.
- The consistency of zinc phosphate cement mix depends on the powder/liquid
ratio and on the particle size of the zinc oxide powder.
- In order to achieve adequate seating, it is important that cements with fine
grain zinc oxide powders are used.
- The film thickness of the zinc phosphate cement determines the degree of
seating of the cast restoration to the tooth.
- The bond strength may be influenced by the film thickness.
- The film thickness varies with the amount of load applied to a casting during
cementation.
- The maximum film thickness is 25µ m.
4. Solubility (lower solubility):

- The solubility of cement is an important consideration when the cement is
being used as a luting agent.
- A thicker mix of cement exhibits less solubility than a thinner mix.
- Zinc phosphate luting exhibits solubility of about 0.1-0.2% after 24hours
immersion in water.
- Solubility of the luting cement leads to marginal leakage around the
restoration and cause loosening of the restoration and recurrent caries.
5. Strength:
- The strength of the cement is influenced by the composition of powder and
liquid, powder/liquid ratio, and the handling of the cement during mixing and
during its placement.
- The mixed cement reaching 50% of its final strength within the first
10minutes and reaching its final strength after about 24hours.
- The compressive strength can vary from 95-135MPa, while the tensile
strength is about 3-5MPa.
- The cement is extremely brittle and is influenced by its very low tensile
strength.
6. Bonding:
- Bonding of zinc phosphate cement is based on flow of the cement into the
microscopic irregularities on the tooth and restoration surface. Therefore,
bonding of phosphate cement is based mainly on mechanical interlocking and
on the strength of the cement.
7. Optical properties:
Opaque due to the presence of unreacted zinc oxide particles
Applications:
- Permanent cementation (luting agent).
- Temporary filling.
- Base.
26
III. Zinc polycarboxylate cement (adhesive cement):

Presentation:
- Traditional form: Powder and liquid.
- Proportioned capsules: For mechanical mixing.
- Water settable cement: The polyacrylic acid is freeze-dried and added to the
powder. In such a case the liquid may be distilled water or a diluted solution
of tartaric acid. This method was developed to overcome the problem of
achieving the correct powder/liquid ratio, which was difficult because of the
high viscosity of the liquid.
Composition:
Powder: The cement powder is based on zinc oxide and magnesium oxide. Some
cement powders contain additives such as alumina, silica, fluoride and stainless steel
fibers.
Liquid: The liquid is 30-40% aqueous solution of a copolymer of polyacrylic acid
with other unsaturated carboxylic acids. This co-polymerization increases liquid
reactivity, reduces liquid viscosity and gelation tendency on storage. The pH and
viscosity of the liquid is adjusted by the addition of sodium hydroxide. Tartaric acid is
added to control the setting reaction.
Setting reaction:
The setting reaction is an acid-base reaction between zinc oxide and the
ionized copolymer of acrylic acid. The set cement is a zinc polyacrylate matrix that
holds the unreacted powder particles (cored structure). The setting reaction proceeds
rapidly when compared with that of zinc phosphate cement.
Properties:
The polyocarboxylate cements are acidic but not as irritant as zinc phosphate
cements for the following reasons:
- Polyacrylic acid is a weaker acid than phosphoric acid.
- Polyacid chains are too large and lack the mobility required to penetrate
dentinal tubules.
- Rapid rise of pH of mixed cement on setting to approach 5.5-6.
2. Film thickness:
The variables affecting film thickness of zinc polycarboxylate are as those in
case of zinc phosphate cement. The film thickness of the polycarboxylate cement is
slightly higher than that of zinc phosphate cement; it is about 25-45µm.

Solubility in distilled water after 24hours varies from 0.1% to 0.2% by weight
for zinc polycarboxylate cement, which is less than that of zinc phosphate cement.
4. Strength:
The 24-hour compressive strength of the polycarboxylate cements for luting is
in the range of 55-95 MPa. This strength depends upon the powder/liquid ratio and is
less than that of the zinc phosphate cement while the tensile strength is in the range of
3.5-7.5 MPa, which is slightly higher than that of zinc phosphate cement.
27
5. Bonding:
- One of the most important advantages of polycarboxylate cements is their
ability to bond chemically to enamel and dentine. A chemical reaction takes
place through the reaction of the carboxylic group of polyacrylic acid and the
calcium and phosphate contents of tooth structure.
- The bond strength to enamel has been reported to be about 8 MPa and that to
dentin has been found to be 2 MPa.
- Optimum bonding requires a clean tooth surface.
- Superior bond strengths are obtained with the base metal alloys.
- Bonding of polycarboxylate cements to gold alloys is dependent on surface
preparation and usually results in an adhesive failure of the interface because
the gold surface is highly inert.
- Bonding of polycarboxylate cement to gold alloy surface can be improved by
sandblasting which provides some mechanical interlocking.
Because of the presence of zinc oxide, the material is opaque.
Applications:
- Cementation of crowns and inlays (luting agent).
- Bases under restorations.
28
II. Glass ionomer cement (polyalkenoate) (adhesive cement):

Presentation:
- Traditional form: Powder and liquid.
- Pre-proportioned capsules.
- Water settable cement: The polyacrylic acid is freeze-dried and added to the
powder. In such a case the liquid may be distilled water or a diluted solution
of tartaric acid.
Composition:
Powder: The powder is of the same composition as that of silicate cement.
N.B. Barium is added to give radiopacity.
Liquid: The liquid is the same composition as that of the polycarboxylate cement.
Setting reaction:
The setting reaction is an acid-base reaction that undergoes the following
stages on mixing the powder with liquid:
1. Dissolution.
2. Migration.
3. Reaction and precipitation.
1. Dissolution: Dissolution of the surface glass particles by the acid i.e. H+ attack
to release cations (Ca++, Al+++) and fluoride ions. 20-30% of the glass is
decomposed by the acid attack.
2. Migration: Migration of the surface ions Ca++, Al+++ and fluoride ions
complex into the liquid. The divalent Ca++ ions will migrate first followed by
the trivalent Al+++ ions. The sodium ions form silica gel on the surface of the
particles.
3. Reaction and precipitation: The migrated Ca++ ions will react first with the
carboxylic group of the acid to form the cross-linked carboxylic salt gel
leading to the initial set. This is followed by the reaction of the slowly
migrated trivalent Al+++ ions. The later reaction takes longer time and results
into a stronger cross-linked cement.
The precipitation process of the carboxylic gel salts is a continuous process
and may take 24hours. Therefore, the setting material should be protected
against premature exposure to saliva as it affects the setting and the surface
hardness.
Role of water in the setting process:

Water is an important constituent of the cement liquid. It serves initially as a
reaction medium then it slowly hydrates the cross-linked matrix, thereby increasing
the material strength. During the initial set, it is known as loosely bound water. As the
reaction proceeds, it becomes tightly bound. Thus, if glass ionomer cement is
subjected to dryness during the initial set, the reaction will not go to completion and
the surface will crack. On the other hand, if glass ionomer cement is subjected to
moisture contamination during the initial set, dissolution of the matrix will occur.
Consequently, either the condition yields glass ionomer cement with reduced strength,
increased solubility and poor aesthetics. Therefore, glass ionomer cement must be
protected against water changes in the structure during setting process.
29
Microstructure of the set material:

The material is a composite cored structure consisting of unreacted glass cores
surrounded by silica gel embedded in a matrix of cross-linked poly salt hydrogel of
calcium and aluminum. Aluminum fluorocarboxylate salts constitute the main bulk of
the matrix and provides the final strength.
Types of glass ionomer cement:

There are three types of glass ionomer cement based on their formulations and
their potential uses. These are designated as follows:
- Type I: For luting applications.
- Type II: As a restorative material.
- Type III: For use as a line or base.
N.B. Light-curable versions of glass ionomer cements are also available.
Properties:
a. The glass ionomer cements have a mild effect on the pulp. In case of
deep cavities, calcium hydroxide lining must be used under glass
ionomer cement.
b. Anticariogenic effect: These cements have the potential for inhibiting
secondary caries due to the presence of fluoride.
Glass ionomer cements are susceptible to attack by water during its setting.
Therefore it is necessary to coat the restoration immediately by varnish to protect the
cement from premature exposure to the saliva. Value of solubility and disintegration
of the glass ionomer cements in water after 24hours immersion is about 1.5% by
weight.
3. Film thickness:
The film thickness of the glass ionomer cement is about 25µm, which is
similar to that phosphate cement.
a. Compressive strength properties: The 24-hour compressive strength of
glass ionomer cements ranges from 90 to 240MPa. A glass ionomer
cement as a filling material showed an increase in strength from 160 to
280MPa between 24hours and one year. The strength of the glass
ionomer cements improves more rapidly when the cement is protected
from moisture during the first 24hours after filling.
b. Tensile strength: It is a brittle material. Its tensile strength ranges from
14-24MPa.
5. Bonding: The glass ionomer cements bond chemically to tooth structure by
reaction of carboxylic group of polyacrylic acid with the calcium phosphate content of
tooth structure. The bond strength of glass ionomer cement to tooth structure is lower
than that of the polycarboxylate cements because of the sensitivity of the glass
ionomer cements to moisture during setting. To obtain a good bond to dentin, the
surface must be treated with a conditioner to remove any smear layer, which interferes
with bonding.
They are translucent. Therefore, they can be used in anterior restoration in
low stress-bearing areas.
30
Modifications of glass ionomer cement:

Modifications have been made in order to improve the mechanical properties,
abrasion resistance and optical properties of glass ionomer cements.
1. Metal modified glass ionomer:

Trials have been made to incorporate amalgam alloy powder with the glass
powder in order to increase wear resistance and flexure strength. e.g. Miracle mixture.
Such attempt was not successful because it did not increase the wear resistance.
2. Cermet glass ionomers:

Fine precious metals such as silver, gold, palladium were sintered with the
glass ionomer powder. Silver is the most commonly used and by sintering it adheres
intimately to the glass particles. The strength and wear resistance were improved
markedly.
Glass cermets can be used as:

- Core build up restorations.
- Restorations for class I and II in deciduous teeth.
Properties of cermet glass ionomers:

- They have higher abrasion resistance, higher flexure strength and higher
fracture toughness than the conventional glass ionomers.
- Because of the metal content, they are opaque.
- They have lower fluoride release than conventional glass ionomers.
3. Light cured glass ionomers (resin modified glass ionomer or hybrid ionomer):
They were first used as lining materials under resin composite, and then they
gained a wide acceptance as anterior restoratives, especially class V cavities.
These materials undergo setting reaction through two mechanisms

a. Dual cure:
- The conventional acid-base reaction, which takes place when the
powder and liquid are mixed.
- Polymerization reaction of the resin component i.e. free radical
reaction when light is applied to the cement.
Resin modified glass ionomer is usually supplied as a powder and liquid.

Powder: Radiopaque ion leachable fluroalumino-silicate glass.
Liquid: Modified polyacid with methacrylate end group, the HEMA (Hydroxyethyl
methacrylate) which is usually added to the liquid. The acid base reaction plays a
significant part of the reaction over the curing reaction.
b. Triple cure:
To ensure effective polymerization of the resin part in deep cavities, the resin
part was modified to allow self-curing reaction. In such case the newly formulated
cement will set through three reactions:
- Conventional acid-base reaction.
- Light-cure polymerization of the resin.
- Chemical-cure polymerization of the resin.
31
4. Compomer (polyacid modified resin composite materials):

- These are supplied as one paste system and not as powder and liquid.
- They are considered as intermediate restoratives between glass ionomer and
resin composite materials.
- They are a mechanical mixture of glass ionomer particles and composite
materials.
- The light curing reaction plays a significant part of reaction over the acid-
base reaction. The later being minimal.
- They are used as anterior restorative materials.
Light curing glass ionomers have the following advantages over conventional types:
- Better optical properties.
- Less sensitivity to moisture after setting.
- Superior mechanical properties.
N.B. Polyacid modified resin composite materials are more related to resin composite
rather than glass ionomer materials.
III. Resin Cements:

Classification of resin cements:
There are two major groups of resin cements:
- Unfilled acrylic cement.
- Resin composite cements.
1. Unfilled acrylic resin cement:

- These are monomer-polymer formulations based on methylmethacrylate and
co-monomers.
- The accelerator-initiator system is typically amine and peroxide.
- Setting occurs as a result of free radical polymerization characterized by
liberation of heat and shrinkage of the polymer.
- They are supplied as powder (polymer) and liquid (monomer).
- They were used for cementation of acrylic jacket crowns.
- Some types are used for cementation of or brackets.
2. Resin composite cements:

These types of filled resin cements replaced the unfilled resin types due to
their superior properties. Resin composite cements may be classified according to
bonding mechanism to tooth structure into:
a. Conventional cements.
b. Adhesive resin cements.
a. Conventional resin composite cements:

These types gain their retention to tooth structure through acid etching in
conjunction with enamel and dentin bonding agents. These may be further divided
into three types according to curing mechanism.
i. Self-cured composite cements: They are typically powder/liquid or two-paste
system. The reaction takes place by peroxide-amine initiator accelerator
system.
32
ii. Light-cured types: They are microfilled or hybrid composites. They are
photoinitiated in the presence of camphorquinone-amine system. They are
provided as a single paste, which requires no mixing.
iii. Dual-cure types: They polymerize by the two mechanisms of setting, the
light and the chemical curing at the same time. They are supplied as base-
catalyst paste and must be mixed before use. After mixing, self-cure chemical
reaction takes place slowly and provides extended working time until the
cement is exposed to light, at which point the cement solidifies rapidly.
b. Adhesive resin cements:

These are self-cured powder/liquid systems formulated with an adhesive
promoter such as 4-methacryloxy ethyl trimellitic anhydride (4-META). These
cements are called phosphonate cements. They are recently reformulated as a two-
paste system that contains Bis-GMA resin and silanated quartz fillers. The phosphate
end of the phosphonate reacts with calcium of the tooth or with a metal oxide. The
phosphonate is very sensitive to oxygen, so a gel is provided to coat the margins of a
restoration until the setting has occurred.
Properties:
There is a wide variation in the range of the properties from one product to
another. These variations are due to compositional differences.
They are irritating to the pulp. Thus, pulp protection via calcium hydroxide or
glass ionomer liner is important when cementing an indirect restoration that involves
bonding to dentin. If the bonding area involves only enamel, or if the remaining
dentin thickness is sufficient, the irritating properties are insignificant.
2. Film thickness:
They may be supplied with different viscosity according to uses from low to
high. So the film thickness varies according to uses.

They are insoluble in the oral fluids.
4. Bonding:
Bonding of conventional types occurs to enamel by acid etching, while
bonding to dentine occurs by dentine bonding agent. On the other hand, bonding of
adhesive type occurs chemically by the help of 4-META.
5. Strength:
The compressive strength ranges from 180-260MPa. Fracture toughness is
high compared to other cements.
They are translucent. Radiopaque types are available to be used in the
posterior region to facilitate protection under inlays.
33
VI. Cavity varnish and liners:

Varnishes and liners are used for coating the freshly cut tooth structure of the
prepared cavity.
The cavity varnish is natural gum such as copal, rosin or a synthetic resin
dissolved in an organic solvent such as acetone, chloroform or ether.
The cavity varnish is applied to the cavity preparation with a brush or cotton
pledge, the solvent is allowed to evaporate leaving a thin coating resin film on the
surface. This process may be repeated two to three times to give a uniform resin layer.
The cavity liner is a liquid in which calcium hydroxide and some zinc oxide
are suspended in a solution of natural or synthetic resins.
Applications:
- To seal the dentinal tubules and prevent penetration of chemicals into the
pulp.
- To act as a temporary protection against the loss of constituents from the
surface of a filling material. Cavity varnishes are used as a surface coat over
glass ionomer restoration.
- To seat the dentinal tubules under amalgam restorations and prevent
penetration of metallic ions into enamel and dentin thus reducing
discoloration of the tooth around amalgam restorations. A film of varnish
under a metallic restoration is not an effective thermal insulator.
Calcium hydroxide cements: (as liner and pulp capping material)

This material is supplied as two pastes in two collapsible tubes. One paste
consists of a mixture of calcium hydroxide, zinc oxide and sulphonamide, the other
paste consists of glycol salicylate, titanium dioxide and calcium sulphate. Light
activated calcium hydroxide cements have become available.
Properties:
- The freshly mixed cement is alkaline with a pH of 11-12.
- It has the ability to stimulate the pulp to lay down secondary dentin. This
characteristic is utilized in very deep carious lesions where calcium hydroxide cement
is used as a pulp capping agent. i.e. it can be placed adjacent to the pulp and it is
capable of destroying micro-organisms found in carious lesions.
2. Solubility and disintegration: The calcium hydroxide is highly soluble since it is

dissolved if left at the cavity wall and margin this will lead to increase marginal
leakage (applied only on the pulpal floor).
3. Compressive strength: The compressive strength of calcium hydroxide liner is very

low (about 5MPa). Therefore in deep cavities, a thin sub-lining of calcium hydroxide
cement and then a base of zinc phosphate cement should be placed before
condensation of amalgam.
34
Chapter IV Direct Esthetic Restorative Materials
Chapter IV
Direct Esthetic Restorative Materials
For a filling material to be used to restore an anterior tooth, it should have the
following Requirements:
1. It should match the tooth in color, translucency and refractive index. It should not
stain or discolor by time.
2. It should not be irritant to the pulp or to the gingiva.
3. It should not dissolve in saliva or in fluids taken into the mouth.
4. It should have adequate mechanical properties to withstand the forces of
mastication:
a. It should have strength and modulus of elasticity similar to those of
enamel and dentin.
b. Good abrasion resistance to dentifrices and constituents of food.
5. It should have coefficient of thermal expansion similar to that of enamel and dentin.
6. It should undergo minimal dimensional changes on setting.
7. It should take and retain a smooth surface finish.
8. It should be radiopaque to enable detection of secondary caries, identification of
overhanging edges and detection of incompletely filled cavities.
9. Ideally, adhesion between the filling material, enamel and dentine should occur.
However, there is no single material that satisfies all these requirements.
Historically, four types of materials have been developed for use as direct
esthetic restorative materials:
I. Silicates.
II. Unfilled acrylic polymers.
III. Composites.
IV. Glass ionomer restorations.
I. Silicate Cements
Silicates were introduced as filling material for anterior teeth since 1903.
Composition:
Powder: Contains 36% by weight SiO2, 28% Al2O3, 8% CaO, 8% Na2O, and 20%
sodium and calcium fluorides.
The mixture is fused at about 1400ºC where fluorides act as fluxes. The fused mass is
quenched in water to form a glass, which is then powdered, to form aluminosilicate
glass particles; this powder is supplied to the dentist. Arsenic is an impurity in some
of the powder constituents, the material should contain less than two parts per million
of arsenic, otherwise pulpal damage can occur.
Liquid: 40% aqueous solution of phosphoric acid.
Setting reaction:
The reaction is an acid base reaction, which takes 24 hours after clinical setting
(10minutes). The surface of the powder particle is attacked by acid liquid, releasing
Ca++, Al+++ and fluoride ions. The metals ions precipitate as hydrated phosphate to
form a gel matrix, while the unreacted glass particles are sheathed by siliceous gel
that arises from removal of cations from the surface of the particle. The set cement
35
has cored structure consisting of unreacted glass particle sheathed by a surface layer
of silicic acid gel imbedded in amorphous hydrated gel matrix.
Properties:
1. Biological effect:
a. Pulpal reactions can occur due to the chemical constituents of the
material (the lower initial pH, the heat evolved during setting, the
arsenic present as impurity, and the silicic acid gel). Pulpal protection
was required to minimize the irritation.
b. The main advantage of silicate as direct restorative materials was the
fluoride release from the fluxes, which provided an anticariogenic
effect. Fluoride uptake by the enamel adjacent the restoration reduces
the enamel solubility.
2. Solubility:
One of the chief disadvantages of silicate cements is that they erode in oral
fluids, as it is highly soluble.
The compressive strength of silicate restorative cements is 200 MPa i.e. it is
stronger than the other cements. Also the silicate cement is harder than any other
type of cement. The hardness of silicates is 80 K.H.N.
4. Dimensional stability:
A slight contraction of the cement takes place during setting. Moreover a
hydrated gel matrix, which is present in set silicate cement, can be subjected to
imbibition under water or syneresis on exposure to air. That is why a silicate filling
should be covered with varnish, wax or Vaseline. This is the reason why silicate
cements are not highly indicated for mouth breathers.
5. Esthetics:
Initially, silicate restorations have excellent aesthetic properties and can
match the tooth color well. This is due to two factors:
a. The refractive index of silicates is similar to that of enamel and dentin.
b. The silicates are translucent, due to the gel-like nature of the matrix
and the fact that the core is a glass.
However, after a period of time, silicates become stained, particularly if the
surface has been roughened by erosion.
6. Bonding:
No true adhesive bond is formed between a silicate cement and enamel and
dentin.
N.B. Early clinical failure of silicate was most frequently related to:
a. Dissolution in oral fluid.
b. Loss of translucency.
c. Surface crazing.
d. Lack of adequate mechanical properties.
e. Poor biological response.
36
These deficiencies caused the demise of this material. However their

advantages lead to development of more biological acceptable materials e.g. glass
ionomer.
II. Unfilled Acrylic Polymers

Acrylic restorative resins were unfilled low molecular weight polymers, less
susceptible to fracture, less soluble in oral fluid and more color stable than silicate
materials.
Composition:
Powder: Polymethyle methacrylate together with initiator (benzoyl peroxide) and
pigments.
Liquid: Methyl methacrylate together with the chemical activator (dimethyl para
toluidine) and an inhibitor (hydroquinone) to prevent polymerization on storage.
Disadvantages:
1. The monomer can penetrate the dentinal tubules and cause pulpal irritation.
2. Mechanical properties are poor so they were only used for classes III and V:
a. The compressive strength is less than that of other restorative
materials (70MPa).
b. Low modulus of elasticity, therefore, they are liable to undergo
considerable deformation under stress.
c. The proportional limit is also low, so that plastic deformation occurs
readily.
d. Their hardness number is lower than other restorative materials
(easily abraded).
3. Esthetics: Initially excellent esthetics can be achieved; however, over a period of

time, staining is evident at the cavity margins due to their thermal properties.
4. Thermal properties: The coefficient of thermal expansion is different from that of

the other structure. With temperature changes in the mouth, acrylics may expand and
contract at least seven to eight times more than enamel and dentin. Thus, on cooling
a gap may be created between the tooth and cavity, into which oral fluids can
penetrate. On subsequent warming up, the fluids can be extruded from the gap. This
process is termed percolation. This will cause staining at the cavity margins and
recurrent caries.
N.B. Early clinical failure of this material was related directly to dimensional
instability (high polymerization shrinkage and thermal dimensional changes).
III. Composite Filling Materials

In attempt to overcome the drawbacks of the silicate and acrylic resin materials,
composite restorative materials come out in the early 1970s.
A composite is a combination of two or more chemically different materials
with a distinct interface separating the components and having properties, which
could not be achieved by any of the components alone.
37
In dentistry the term composite initially referred to a restorative material,

usually in paste form, consisting of two principal phases, an inorganic filler dispersed
in a continuous resin matrix system that would induce polymerization.
Composites were initially developed for anterior class III and V restorations,
in which esthetics were crucial, however, modifications of materials and techniques
have extended their application to class II posterior restorations.
Composition:
The broad composition of any composite material may be stated as:
1. Organic matrix phase.
2. Inorganic filler phase.
3. Coupling agent, which binds the inorganic fillers to the organic matrix.
4. Initiator activator systems.
5. Inhibitors.
6. Ultraviolet stabilizers.
7. Pigments.
1. Organic matrix phase:

a. Principal high molecular weight monomer (oligomer):
The majority of the materials are based on either Bisphenol A-glycidyl
methacrylate (BIS-GMA), which is called Bowen's resin, or urethane dimethacrylates
(UDMA). In some products mixture of the two oligomers is present.
These oligomer products are superior to methyl methacrylate monomers by:

i. Lower polymerization shrinkage (due to higher molecular size and less
double bond available).
ii. Lower volatility (due to its chemical structure).
iii. More rapid hardening.
iv. Production of stiffer and stronger resin due to higher molecular weight
and more cross-linkage.
The urethane dimethacrylates are superior to BIS-GMA by:
i. Lower viscosity.
ii. Lower water sorption.
iii. Greater toughness.
iv. Greater susceptibility to visible light curing.
These oligomers, which contain reactive carbon double bonds at each end, can
undergo free radical addition polymerization to give a rigid cross-linked polymer.
On the other hand these oligomers are viscous and the incorporation of the
inorganic fillers is difficult. The viscosity is reduced to a useful clinical level by the
addition of lower molecular weight monomers called diluents.
b. Diluent (lower molecular weight monomers):

These monomers are included in composite formulations to reduce the
viscosity of the material to enable proper blending with the inorganic constituents,
and to facilitate clinical manipulation. The monomer of choice may be diethylene
glycol dimethacrylate or trietheylene glycol dimethacrylate.
38
N.B: Ormocers (organically modified ceramic):

In an attempts to minimize polymerization shrinkage of resin composite which
may affect the bonding to tooth structure Ormocer composite materials were
developed. They are polymeric inorganic-organic hybride materials in which an
inorganic polysiloxane polymer network has been selectively modified by chemically
bonded organic methacrylate group. The presence of inorganic network builders
fundamentaly distinguishs them from the matrix molecules previously used in dental
composite.
Advantages of Ormocers:
i. Biocompatibility: the experimental data on biological tolerance
has been reduced compared to Bis-GMA and other composites.
ii. Less polymerization shrinkage compared to other composite.
iii. More depth of polymerization was claimed.
2. Inorganic fillers (reinforcing fillers):

The dispersed inorganic phase may consist of several inorganic materials such as
quartz, borosilicate glass, lithium aluminum silicate, barium aluminum silicate,
strontium or zinc glass, or colloidal silica. The heavy elements contribute to
radiopacity. Recently calcium fluoride has also been used as filler.
Role of inorganic fillers:
a. Improvement in mechanical properties such as compressive strength,
modulus of elasticity and hardness. The filler in a composite must be in high
concentration to achieve good mechanical properties.
b. Reduction in coefficient of thermal expansion and contraction.
c. Glass is able to reflect the color of the surrounding tooth material so the filler
contributes to the esthetics. The refractive index should match that of the
organic matrix to secure translucency.
d. Reduction in the polymerization shrinkage.
e. Less heat evolved in polymerization.
f. The composite is radiopaque if barium or strontium glasses are used.
Filler particle size and shape:

The filler particle size, shape and distribution have an important effect on the
properties.
Historically early composite (conventional) contained large (20-30µm)
spherical particles then products containing large irregular particles come out.
Irregular particles have better mechanical retention to the resin. The disadvantage of
conventional composites with large filler particles are:
1. Discoloration and staining tendencies as wear of the organic matrix occurred
and particles were dislodged leaving a rough surface.
2. There was difficulty in finishing and polishing such composites.
Due to the drawbacks of the early conventional macrofilled composites, current

composites are:
1. Fine composites: with smaller filler particles (0.5-3µm). They have good
mechanical properties and can be finished and polished to a smooth surface.
39
2. Microfine composites: (0.04-0.2µm). They have a perfect surface quality but

they have poor mechanical properties.
3. Blend (hybrid) composites: Containing mixture of fine and microfine fillers.
They have high mechanical properties as fine composites and perfect surface
finish as microfine composites.
N.B. In micro filled composite, it is technically difficult to add large quantities of

microfine fillers to a fluid oligomer, because they have high surface area and act as
thickening agents (maximum 25% by volume can be added). To overcome this, the
microfine filler is added first to the oligomer of lower viscosity then polymerized and
ground into particles 10-20µm in diameter. These ground pre-polymerized polymer
particles containing the reinforcing fillers are then added to the oligomer matrix,
which is already containing microfine fillers. In this way the inorganic filler in the
microfine composite was increased up to 32-50% by volume. The ground polymer
particles containing the reinforcing fillers are commonly referred as organic fillers.
The microfine particles may be smaller than the wavelength of light and thus give
lustrous surfaces on finishing.
Attempts to combine the advantage of fine-microfine particles (high mechanical

properties with good surface finish) led to the development of hybrid composite
containing significant amounts of microfine fillers and major amount of fine silica or
glasses with fine particles (1-5µm). Filler loading up to 70% by volume (88% by
weight) was achieved.
3. Coupling agents:
For reinforcement of the polymer by the inorganic filler to occur, it is important that
the two constituents should be bonded together. To achieve this, the filler is usually
treated with a vinyl silane compound. This compound has two functional groups, an
inorganic group that react with the filler and an organic group that react with the
organic matrix; thus the filler and matrix are coupled.
The use of a coupling agent:
a. Improves the mechanical properties of composite by transferring the
stresses from the weak resin to the stronger filler.
b. Reduces early loss of the filler particles caused by penetration of
water between the resin and filler.
4. Initiator activator systems:

Polymerization of composites is achieved by chemical or light activation, with the
latter being more common.
a. Chemical activation (two pastes system):

In the two component chemically polymerized materials; one paste
contain the initiator usually benzoyl peroxide. The other paste contains the
activator usually a tertiary amine, which leads to better color stability than
dimethyl- P-toluidine.
Once the two pastes are mixed, chemical activation is accomplished by
the reaction of the organic amine with the organic peroxide to produce free
radicals, which in turn attack the carbon double bonds, causing
polymerization.
40
b. Light activation (light curing or photo-initiated composites):

By the use of ultra-violet or visible light radiations. Visible light
waves (blue light wave of about 470nm) are used now instead of ultra-
violet because light has:
i. Limited depth of polymerization than the visible light.
ii. Potential harmful effects such as skin cancer and eye damage.
iii. The visible-light cured materials are supplied as one paste system. They
usually contain a diketone such as benzyl or camphorquinone and an
amine activator. On application of intense visible (blue) light of
wavelength around 470nm, free radicals are generated as follows:
Visible light Amine
Diketone Excited state Free radical generated
advantages of light cured materials over chemically cured resin:

i. The light activated materials are single component pastes that required
no mixing, thus eliminating human variables.
ii. Command setting time.
However the depth of cure is dependent on several variables such as:

i. The characteristics of the light source e.g. a new bulb would give the
highest intensity.
ii. The distance between source and resin composite surface (note that light
intensity varies as the inverse square of the distance).
iii. The time of exposure.
iv. The initiator system absorption characteristics. With the development of
light sources of improved intensity at least a 2mm depth of material can be
polymerized in 10 to 20 seconds.
N.B. Care should be taken to avoid unpolymerized material in the base of cavities or
undercuts. Therefore, directing the light from both sides of an anterior restoration or
building up by layers may be advisable. Resin composite, which is not fully
polymerized, will show reduced mechanical properties, poorer color stability and
greater susceptibility to stain.
5. Polymerization inhibitors:
Since dimethacrylate monomers will polymerize on storage, an inhibitor is
necessary to prevent hardening on storage.
Hydroquinone had been widely used, but was responsible for causing discoloration of
the material. The monomethyl ether of hydroquinone is now used. Only few parts per
million of this product is required.
6. Ultraviolet stabilizers:
To prevent discoloration with age of composites (e.g. yellowing of the set
composite filling from the amine and its by-products) ultraviolet stabilizers are
incorporated to absorb electromagnetic radiation and improve color stability. Most
composites contain a small amount of such materials together with fluorescent agent.
41
7. Pigments:
Inorganic pigments are added in small amounts so that the color of the
composite matches the natural tooth structure.
Classification of composites:
Current composites may be classified according to particle size, shape and
distribution or according to the methods of activation.
1. Classification according to particle size, shape and distribution (figure 7):

a. Fine composite.
b. Microfine composite.
c. Hybrid composite products.
Figure 7 Schematic sketch of cross section of (A) fine, (B) microfine and (C) hybrid composite.
42
Table 2 Different types of resin composite according to fillers particle size and distribution
Range of % of filler
Type particle size (by General comments
(µm) weight)
Difficult to polish, surface roughness on
Large particle
20-35 78 abrasion of resin matrix may attract plaque,
(conventional)
good mechanical properties.
Good mechanical properties with superior
Fine particle 0.5-3 70-86 finishing and polishing characteristics than
the above.
Easy to obtain and maintain smooth surface
finish, which does not attract plaque.
However mechanical properties are poorer;
Microfilled 0.04-0.2 25-63
wear resistance may be poor; also greater
shrinkage on setting and more absorption of
water owing to lower filler content.
Developed in an attempt to obtain the
Hybrid 0.04 and 1-5 77-88
benefits of both types of filler.
N.B. The conventional early types, which are not manufactured nowadays, are
mentioned only for comparative reasons.
2. Classification according to the method of activation:

a. Chemically cured materials.
b. Light cured materials.
c. Some types of resin composite polymerize by both mechanisms and
are termed dual cure resin.
Properties:
1. Biological considerations:
Composites are superior to silicate cements and unfilled acrylics in terms of
pulpal irritation. However, plaque can accumulate on a rough composite surface.
2. Solubility:
Composites have a very low solubility. It is markedly lower than the solubility
of unfilled acrylic due to loss of residual monomer from acrylics. In composites,
polymerization leads to a more cross-linked structure with less residual monomer.
3. Water sorption:
Is less than that of unfilled acrylics due to the higher molecular weight and
more cross linkage of the BIS-GMA, or UDMA and good adhesion between the
polymer matrix and the inorganic filler. Water sorption of the fine and hybrid
composite is less than microfine types.
4. Thermal properties:
a. Thermal conductivity: The thermal conductivity values are lower than those
for metallic restorations and closely match those of enamel and dentin.
Therefore, composites provide good thermal insulation for the dental pulp.
b. Coefficient of thermal expansion: The higher the amount of organic matrix,
the higher the linear coefficient of thermal expansion since the polymer has a
higher value than the filler. As a result, the microfilled composites have the
highest values for thermal expansion (55-68X10-6/°C). Consequently,
43
restorations from these composites will have a greater change in dimensions

with changes in oral temperatures and probably will have more marginal
leakage than fine and hybrid (25-38X10-6/°C) composites. Also, thermal
stresses, which are cyclic in nature, are more in microfilled because of the
higher coefficient of thermal expansion. These stresses may cause fatigue of
the material and early bond failure.
5. Polymerization shrinkage:
Composite materials undergo shrinkage during polymerization. Shrinkage is a
direct function of the amount of organic matrix therefore the polymerization
shrinkage of fine particles composite is lower than that of microfine types. This
shrinkage creates polymerization stresses between the composite and the cavity of the
tooth.
These stresses, may reach 130 Kg/cm2, can lead to failure of the interfacial
bond between the composite and the tooth leading to very small gap that can allow
marginal leakage of saliva.
The net effect of setting contraction (due to polymerization) can be reduced by:
a. Incremental addition of light cure material and polymerization of each
increment independently, which allows for some contraction within each
increment before successive additions.
b. Obtaining strong bond between the composite filling and the enamel and
dentin of the cavity.
c. Composite inlay: Composite inlay systems are polymerized outside or inside
the patient mouth and then removed from the prepared cavity by the help of
separating medium. The inlay is then subjected to post-curing by additional
light (6minutes) or heat (about 100ºC for 7minutes), after which the
preparation is etched. The inlay is then cemented to the prepared cavity with a
dual cure resin and is then polished. By this technique the polymerization
shrinkage does not occur in the tooth, so the induced stresses and the bond
failure are reduced.
a. Compressive strength: Ranged from 200-340MPa. The compressive strength
of the microfine composite is lower than that of fine and hybrid types.
b. Tensile strength: Of microfine composite 26-33MPa is only about half those
of fine composites (34-62 MPa).
c. Modulus of elasticity: Of fine composite (from 9000-10.000 MPa) is two to
three times the value for microfine composites.
d. Hardness: Of the fine and hybrid composites (KHN 55-88 kg/mm2) is higher
than that of the microfine types indicating more resistance for penetration or
indentation under functional stress. This difference in hardness is not an
indication of resisting functional wear.
e. Wear: Wear of composite is a complex phenomenon involving abrasion,
attrition, and erosion. As a result, no single mechanical property has been
predictive of clinical wear.
44
7. Esthetic and optical properties:

a. Composite materials are translucent materials, which can match the color of
teeth and have good esthetics.
b. The materials can be radiopaque by the addition of glasses having high
atomic numbers such as barium, strontium and zirconium. Radiopacity helps
in diagnosis.
c. Abrasive wear may lead to surface roughness of the material, because the
polymer phase wears more rapidly than harder ceramic fillers. This may lead
to discoloration with time. However, microfine and hybrid types can take and
retain smooth surface finish for long periods in the mouth.
d. Stress cracks within the polymer matrix and partial debonding of the fillers as
a result of hydrolysis tend to change the color.
8. Bonding and retention to tooth structure:

a. Bonding to enamel:
- Bonding is obtained by mechanical retention to acid-etched enamel.
- After acid etching and washing of enamel, bonding agent is applied to
penetrate sufficiently into the etched areas, to produce a good bond.
- Bonding agents usually consist of BIS-GMA or UDMA systems that
have been diluted to lower molecular weight monomers to decrease the
viscosity thus help penetration.
b. Bonding to dentine:
- Resin dentin bonding agents are now available; they are used like
enamel bonding agents to provide micromechanical retention resulting
from good wetting and penetration of the bonding agent into dentin.
Bonding agents usually consist of a bi-functional monomer with
hydrophilic groups to improve wetting to dentin, and hydrophobic
groups to polymerize with the composite.
- The bond strength of composite to dentin is less than that for enamel.
- Recently single component bonding agents have been introduced to be
used for both enamel and dentin.
Applications of composites:
1. The most widely used materials for anterior restorations.
2. Posterior restorations, as substitutes for dental amalgam when esthetics is of
primary importance. In such case the hybrid types must be used.
3. Laminate veneers in anterior teeth.
4. The lower viscosity types are used as resin cements or fissure sealant.
Recent composite “Silorane chemistry”:

Low Shrink Posterior Restorative is the first direct posterior composite that
shrinks less than 1%. This scientific breakthrough reduces polymerization stress by up
to 80% and leads to excellent marginal integrity. The ring-opening step in the
polymerization of the silorane resin compensates a significant amount of the
polymerization shrinkage which occurs in the curing process.
IV. Glass Ionomer Restorative Materials

(See dental cements)
45
Chapter V Dental Ceramics Restorative Materials
Chapter V
Dental Ceramics: Dental Porcelain
Dental porcelain consists basically of fine ceramic powder that can be mixed
with water to form a paste. The paste is formed into the desired shape, and then fused
at a high temperature to form a ceramic body, which is relatively strong, insoluble in
oral fluids and exhibits excellent esthetic qualities.
Uses:
1. Denture teeth.
2. Jacket crown.
3. Porcelain-metal crown and bridge work.
4. Simple inlays.
Advantages and disadvantages:

Advantages:
1. Esthetic appearance quite satisfactory.
2. Glazed surface produces a restoration that is color stable, compatible with the
soft tissues.
3. Resistant to sudden thermal changes.
4. Strength is normally adequate.
Disadvantages:
1. It has no matching of the exact color and texture of the teeth because the
optical properties of porcelain are different from those of enamel and dentine.
2. Porcelain restoration involves removal of additional tooth structure.
3. Porcelain has a high resistance to abrasion this may result in excessive wear of
the teeth in the opposing arch.
4. Low tensile strength (brittleness is a major defect in ceramics).
Composition:
All ceramics are composed of essentially the same ingredients, the principle
difference being in their degree of purity, their proportions, their grain composition
and the firing procedures.
Generally conventional dental porcelain is a vitreous ceramic based on silica
network and feldspar. Other additives like pigments, opacifiers and glasses are added
in smaller concentrations.
Figure 8 Silica tetrahedra
1. Feldspars:
They are anhydrated aluminum silicate, they are mixtures of potassium aluminum
silicate (K2O.A12O3.6SiO2) also known as orthoclase and sodium aluminum silicate
46
(Na2O.A12O3.6SiO2) also known as albite. Upon heating, it fuses at about 1290ºC,

becomes glassy, and unless overheated, retains its form without rounding. This is
important because it is necessary to retain the form of porcelain restorations while
they are fusing.
Potassium feldspar when mixed with various metal oxides and fired to high
temperature can form leucite and a glass phase. (Leucite is a crystalline mineral:
potassium-aluminum-silicate with high coefficient of thermal expansion (20-25 X10-6ºC).
2. Silica:
(Quartz) remains unchanged during the firing process and acts as a strengthening
agent. It is present as a fine crystalline dispersion throughout, the glassy phase that is
produced by the melting of the feldspar and the kaolin.
3. Kaolin:
Kaolin is a hydrated aluminum silicate (A12O.2SiO2.2H2O) acts as a binder
increases the mouldability of the unfired porcelain. When mixed with water it
becomes sticky and helps in forming a workable mass of the porcelain during
molding. When subjected to high heat it adheres to the framework of quartz particles
and shrinks considerably. It gives porcelain its properties of opaqueness.
N.B. Modern dental porcelain does not contain kaolin thus can be considered
feldspathic glass with crystalline inclusions.
4. Other ingredients:
a. Glass modifiers:
Metal ions: Like Na+, K+ or Ca++ can associate with oxygen atoms at the
corners of the silica tetrahedra and interrupt the oxygen silica bond, thereby lowering
the softening temperature.
Manufactures employ glass modifiers to produce dental porcelains with different
firing temperatures.
Effect of glass modifiers:
- Increase fluidity of the glass (decreased viscosity).
- Lower softening temperature.
- Increased thermal expansion.
Effect too high a modifier concentration:
- Reduces the chemical durability (resistance to attack by water, acids
and alkalis) of the glass.
- The glass may crystallize during porcelain firing.
b. Fluxes:
Low fusing glasses: Often added to reduce the temperature required to sinter the
porcelain powder particles together.
c. Coloring pigments:
They give the required color e.g. metal oxides.
d. Sugar and starch:

They may be present to help in the manipulation of the powder.
47
The porcelain components can be in about the following proportions:

Feldspar 75-85 %
Quartz 12-22%
Kaolin 3-5%
Metallic pigments < 1%
Lanthamide earth used to provide fluorescence instead of uranium oxide
because the later has a small amount of radiation.
Manufacture:
The various components of the porcelain are blended together by the manufacture.
Then, they are melted on a refractory crucible, during which the fluxes partially
combine with the silica (these high temperature reaction is termed pyrochemical
reaction.) The material is then quenched while red hot to break it up, FRITS are
obtained which is the powdered material supplied to the dental lab.
The components blended together by the manufacture result in two principle
phases:
a. Vitreous phase or glass phase: Is the glass phase formed during the firing process.
b. Crystalline phase or mineral phase: Includes the silica and certain metallic oxides
added as coloring agents or opacifiers, such as iron, tin, or titanium oxides.
Classification:
Porcelain restorations can be classified according to their use, to their application,
to their processing methods, to the method of firing, to their fusing temperature etc...
In this text a general classification is given and a classification according to their
fusion temperature.
Classification of ceramic restorations:

1. General classification:
Porcelain Restorations
All ceramic restorations: Porcelain fused to metal:
2. According to their fusion temperatures:

1. High fusing 1300ºC
2. Medium fusing 1100-1300ºC
3. Low fusing 850-1100ºC
4. Ultra-Low fusing < 850ºC
The principle advantage of high-fusing porcelain is its ability to be repaired
without distortion. The medium-fusing and high-fusing types are used for the
production of denture teeth. The low-fusing and ultra-low-fusing porcelains are used
for crown and bridge construction.
48
I- All Ceramic Restorations:

Porcelain technique (conventional condensation and sintering): Porcelain Jacket
Crown (PJC)
After the tooth has been prepared, an impression of it is made, and a working
model or die is formed of a suitable die material. The portion of the die to be
contacted with porcelain is carefully covered with a thin layer of platinum foil
approximately 0.025mm thick. This platinum form or matrix retains the porcelain mix
in the shape of the tooth preparation during firing and determines to a great extent, the
accuracy of fit of the restoration. A porcelain jacket crown is made from a number of
porcelain powders because it is impossible to recreate all of the esthetic features of a
tooth by the use of single porcelain. Conventionally, three basic types of porcelain
powder are used:
- Opaque shade masks the color of the underlying structure.
- Dentin shade.
- Enamel shade.
Figure 9 Cross sectional view of aluminous porcelain jacket crown.
The production of a porcelain jacket crown involves three technical stages:

1. Compaction.
2. Firing procedure.
3. Glazing.
4. Cooling.
1. Compaction:
The porcelain powder in the color selected for the body or dentin portion is
mixed with distilled water to a creamy consistency and is applied in the correct
proportion to the platinum matrix with allowance made for shrinkage i.e. about 13%
oversized. To produce minimum shrinkage and less porosity in the fired porcelain
thorough condensation must be achieved by one of the following methods:
49
- First method: Uses mild vibration to pack the wet powder densely on the
underlying framework. The excess water is blotted away with a clean tissue, and
condensation occurs toward the blotted area.
- Second method: A small spatula is used to apply and smooth the wet porcelain.
The smoothing action brings the excess water to the surface, where it is removed.
- Third method: Employs the addition of dry porcelain powder to the surface to
absorb the water. The dry powder is placed by a brush to the side opposite from an
increment of wet porcelain. As the water is drawn toward the dry powder, the wet
particles are pulled together.
2. Firing procedure:
The thermo-chemical reactions between the porcelain powder components are
virtually completed during the original manufacturing process. Therefore, the purpose
of firing is simply to sinter the particles of powder. Firing takes place in a muffle i.e.
an electric oven with a pyrometer.
During firing, the porcelain undergoes several changes:

1. The first change: Involves the loss of water, which was added to the powder to
form a workable mass.
2. The second change: Occurs as the temperature is raised and the particles of
porcelain fuse together by sintering.
N.B. Sintering: Is the process responsible for the fusion of the powder particles to
form a continuous mass.
3. Glazing:
The glazing stage is reached in the last firing. It is done either by flow of the glass
at the surface from the ceramic restoration known as self-glaze porcelain, or a low
fusing glass is added to it.
Self-glaze porcelain is preferred to an applied glaze because the later contains
more glass modifiers and thus has a lower firing temperature and has a lower
resistance to oral fluids.
Glazing is done to produce a smooth shiny and impervious surface.
4. Cooling:
Slow cooling or annealing should be done to avoid surface crazing.
Properties:
1. Shrinkage on firing:
Loss of water leads to voids. Residual water is lost from the material
accompanied by loss of any binder if present. Due to the elimination of voids during
sintering magnitude of shrinkage occurs:
- Linear: 14% for low-fusing and 11.5% for high-fusing.
- Volumetric: 32-37% for low-fusing and 28-34% for high-fusing.
It should be compensated for.
A precise control of the condensation and firing technique is required to
compensate for such shrinkage values during the construction of the porcelain
restoration.
2. Porosity:
Internal voids decrease the strength and opacify the porcelain even in a relatively
low concentration.
50
Sintered dental ceramics contain sealed pores (1.3-4.8%). Inevitably there are
numerous air bubbles in fired porcelain. Porosities can be reduced by firing under
vacuum; also the powder particle size has an effect on porosity. The use of small and
large particle sizes blended together reduce the voids and achieve greater degree of
compaction. The vacuum firing and the optimum particle sizes can reduce the
porosity to 1.3 %.
3. Chemical properties:
It is chemically indestructible in most environments. To dissolve ceramic, strong
chemicals such as hydrofluoric acid (HF) is required.
- Porcelain is a brittle material
- Elongation percent 0.1%
- Shear strength 110 MPa
- Tensile strength (Diametral compression test) 34 MPa
- Transverse strength 62-90 MPa
- Compressive strength 172 MPa
- Modulus of elasticity 69 GPa
- Hardness (KHN) 460 Kg/mm2
5. Specific gravity:
The apparent specific gravity is 2.2-2.3.
6. Esthetics and color:

Excellent but not perfect. The color and shades can match natural teeth. It is
essential that the matching of shades be done under lighting conditions similar to the
every day environment of the patient, color and appearance are highly influenced by
the nature of the incident light. Appearance properties of importance are:
translucency, surface reflectance and fluorescence.
Fluorescent materials glow under ultraviolet light. Since natural enamel is
fluorescent, oxides are added to dental porcelains to simulate this effect.
7. Biological effect:
Dental porcelain is very inert and no adverse tissue reactions have been
reported. However porcelain crowns that are too bulky place surrounding gingival
tissues under mechanical stress, and clinical changes in the tissues may occur.
High strength ceramic:

Methods of strengthening of porcelain:
Porcelain ceramics are brittle materials, their strength values are much lower than
the predicted values based on the strength of their primary interatomic bond. This is
because the scratches and other defects present at their surface act as cracks. These
cracks lead to a phenomenon known as (stress concentration). i.e. they cause the
localized stress to increase to the theoretical strength of the material at a relatively low
average stress. The crack then propagates and leads to failure of the material.
Strengthening of ceramics can be done in several ways:

1. Designing components of the restoration to minimize stress concentrations and
tensile stresses.
51
2. Reducing the size or the number of the surface flaws (stress raisers) can produce a
large increase in strength. This is one of the reasons for glazing dental porcelain.
3. Interruption of crack propagation in the material is one way of strengthening the

material. This is done by reinforcing them with a different phase of a different
material that is capable of hindering a crack from propagating through the material.
There are two different types of dispersion:
a. Relies on the toughness of particle to absorb energy from the crack and deplete its
driving force for propagation. e.g. Alumina dispersion, magnesia-core, mica crystals
in Dicor, injection-molded glass-ceramic.
b. Relies on the crystal structural changes under stress to absorb energy from the
crack. e.g. transformation toughening of zirconia (called Partially Stabilized Zirconia
PSZ) since the energy required for transformation is taken from the energy that
allows the crack to propagate. The disadvantage is that the refractive index is much
higher than that of the surrounding glass matrix, so, scatters light leading to
opacifying effect.
4. Development of residual compressive stresses within the surface of the material,

because the material is weak in tension.
Strengthening is gained by virtue of the fact that these residual stresses must
first be negated by developing tensile stresses before any net tensile stress develops.
e.g. If the compressive strength within the surface of ceramic A is -40MPa and the
normal tensile strength of the stress free ceramic is 60 MPa it would take a total
induced tensile stress of +100MPa in this region to fracture of the material.
a. Ion exchange:
It involves the exchange of larger potassium ions for the smaller sodium ions,
which is a common constituent of a variety of glasses.
The potassium ion is about 35% larger than the sodium ion. The forcing of the
potassium ion into the place formerly occupied by the sodium ion creates large
residual compressive stresses (roughly 700MPa) in the surface subjected to this
chemical treatment.
b. Thermal tempering:
The most common method. It creates residual surface compressive stresses by
rapidly cooling, while it is hot and in the softened state.
This rapid cooling produces a skin of rigid glass surrounding a soft core. As
the molten core solidifies, it tends to shrink but the outer skin remains rigid the pull of
the solidifying molten core, as it shrinks, creates residual tensile stresses in the core
and residual compressive stresses within the outer surface.
c. Thermal compatibility:
e.g. Ceramo-metal system. Consists of metal coping and fired ceramic veneer
if a good bond is achieved between them the restoration is three times stronger than
the ceramic alone.
The crack is stopped because the system acquired high fracture toughness. The
objective is accomplished by selecting an alloy that contracts slightly more than the
porcelain on cooling from firing to room temperature i.e. slight mismatch in their
thermal coefficient of expansion (metal > porcelain). This mismatch leaves the
porcelain in residual compression and provides additional strength for the restoration.
52
II. Ceramo-Metallic restorations:

Introduction:
Generally, the restoration consists of an alloy substructure with bonded
porcelain veneers. These restorations combine the good mechanical properties of the
cast dental alloys and the excellent esthetic properties of porcelain. They were
introduced in the late 1960.
Requirements:
1. Requirements of the alloy used to form the substructure:
a. The alloy, having been previously cast into the desired shape, should be
capable of withstanding porcelain firing without melting or suffering from sag
(creep at high temperature). Hence the alloy must have a higher melting range
than the firing temperature of porcelain by 100ºC-150ºC.
b. The alloy should have a value of coefficient of thermal expansion and
contraction similar to that for the porcelain to which it is bonded. Since this is
impossible, the alloy should contract slightly more than porcelain giving a degree
of compressive bonding.
∴ α of metal slight > α of porcelain by 0.5 X 10-6/ºC.
c. The alloy should be of high modulus of elasticity (rigid) and high yield
strength to provide a rigid metallic support because if any small strain occurs in
the metal portion, the porcelain veneer will craze or fracture.
2. Requirements of porcelain used to form the veneer:

a. The addition of greater quantities of soda potash (alkali content) and leucite
(crystalline phase) increases the coefficient of thermal expansion of the porcelain
to a value closer to that of metal. This prevents the development of thermal
stresses during cooling from the firing temperature.
b. The addition of leucite also helps to strengthen the ceramic.
c. The addition of large amount of metallic oxide opacifiers to conceal the dark
color of the underlying metal.
3. Practical requirements:
a. Adequate tooth preparation is necessary (1.5mm of tooth structure should be
removed) to allow space for metal coping (0.3-0.5mm) and the porcelain veneer
(1.0mm) to achieve optimal restoration.
b. The use of an appropriate design minimizing stress concentration, which
weakens the porcelain veneer.
c. The use of satisfactory casting techniques gives casting the proper fit.
d. Adequate cleaning of the casting, however strong acids should not be used.
e. Degassing (heating the metal substructure near the firing temperature of
porcelain before porcelain application). This allows the metal elements
incorporated in the alloy to migrate to the surface forming oxide surface layer.
This is necessary in all gold porcelain system.
f. The metal surface is sandblasted to aid mechanical bonding.
g. There are certain agents applied as a thin liquid to the metal surface and then
fired before the condensation of the opaque porcelain layer.
- They improve the metal ceramic bonding by limiting the build up of an oxide
layer on the base metal surface during firing.
- They can improve esthetic by helping to block the color of the dark metal
oxide.
53
h. Opaque porcelain is applied with a thickness of 0.3mm and fired followed by

building the restoration with translucent porcelain. A final glaze is then applied.
Types of alloys bonded to porcelain:

1. Noble metal alloys:
Such as high gold, gold palladium, palladium silver and high palladium alloys.
They must contain the following elements:
• Platinum or palladium:
- To increase the melting temperature of the alloy.
- To decrease the coefficient of thermal expansion and contraction of the alloy.
- To strengthen the alloy by precipitation hardening.
• Tin and indium:

- To provide metallic oxides which are necessary for the ceramo-metallic
bonding.
• No copper:
- Because copper produces a greenish color in porcelain.
- Silver has similar but lesser effect than copper.
2. Base metal alloys:

Such as nickel chromium and titanium alloys discussed before.
Nature of ceramo-metallic bond:

It depends on:
1. Mechanical bonding:
If the fused porcelain is able to wet the metal surface efficiently, it will flow
into the small irregularities on the surface resulting in mechanical interlocking
2. Chemical bonding:
The metallic oxides on the alloy surface can react with porcelain to give a
chemical bond. These are tin and indium oxides in case of noble metal alloys. In base
metal alloys the chromium oxides or titanium oxides serve for chemical bonding.
3. Compressive bonding:
If the porcelain contracts less than the alloy on cooling, the porcelain will have
a residual compressive stress. Consequently, a higher applied stress is necessary to
cause failure of the bond.
Failure of the ceramo-metallic bond:

1. In practice strong bonds can be formed between gold alloys and porcelain. In
testing such bonds, cohesive failure of the porcelain is usually indicating the
presence of good bonding between the two materials.
2. In contrast to the precious metal porcelain bond, failure of base metal porcelain
bond occurs at the interface between metal and porcelain i.e. adhesive failure. This
occurs because of:
- The high degree of compressive residual stress at the bond due to the
excessive shrinkage of the alloy.
- Excessive oxidation of the alloy at the interface.
54
Figure 10 Classification of porcelain enamel failures according to interfaces formed. Type III
represents cohesive failure indicative of a proper bond.
Porcelain teeth:
They are made from high and medium fusing dental porcelains. They are
packed into metal molds and fired. They retain on the denture base by mechanical
interlocking in the form of pins in anterior teeth and diatoric channels in posterior
teeth.
Advantages:
- They are considered to be more esthetic than acrylic teeth.
- Much more resistant to wear.
- They are the only type of denture teeth that allow the denture to be rebased.
Disadvantages:
- They are brittle.
- They make a clicking sound on contact with the opposing teeth.
- They require a greater inter-ridge distance because they cannot be ground
without destroying the diatoric channels that provide their only means of
retention to the denture base.
55

Dr. Hala A. Bahgat: Restorative Dental Materials

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MSA University

Dental Biomaterials Department

Restorative Dental Materials

Dr. Hala A. Bahgat

Dr. Dina H. Mostafa

Chapter 1: Dental Amalgam 3

Chapter 2: Non Metallic Denture Base Materials 13

Chapter 3: Dental Cements 21

Chapter 4: Direct Esthetic Restorative Materials 35

Chapter 5: Dental Ceramics 46

Dental amalgam is a direct posterior restorative material (figure 1) widely used

Figure 1 Dental amalgam

Amalgam Mixture of any metal or alloy with mercury

Figure 2 Amalgam core

Classification of dental amalgam:

I. According to zinc content

1. Zinc free dental amalgam alloy

II- According to particle shape:

Dental amalgam alloy powder particles can be:

1. Lathe cut [irregular] powder particles

2. Spherical powder particles

III- According to particle size:

2. Fine cut [small particle size]:

 Greater strength properties [1hr compressive strength and final strength].

IV- According to copper content (table 1)

1- Low copper conventional types.

Ag 3Sn (γ ) + Hg → Ag 2Hg 3 (γ1 ) + Sn 7Hg (γ 2 ) + unreacted Ag 3Sn (γ ) + voids

Figure 3 Microstructure of the set low-copper conventional amalgam.

2- High copper admixed types:

Figure 4 Microstructure of the set high copper admixed amalgam.

2- High copper unicompositional types:

Ag − Sn − Cu + Hg →Ag2Hg3 (γ1) + Cu6Sn5 (η)+ unreacted Ag3Sn(γ )+voids

Figure 5 Microstructure of the set high-copper unicompositional amalgam.

Table 1 Classification of dental amalgam according to copper content

Properties of dental amalgam

1. Dimensional changes during setting

• The net total dimensional change remains negative i.e. contraction

o Over contraction may lead to:

2. Flow and creep

• As dental amalgam alloys are intermetallic compounds, they are characterized by

 Cavity preparation with:

 Use high copper unicompositional dental amalgam alloy.

4. Bond to tooth structure

iii) Crevice corrosion

Excessive corrosion may lead to:

Reduction of corrosion is achieved by:

Mercury hygiene procedures include:

The dental staff is most at risk from mercury contamination.

Requirements for an ideal denture base material:

b. The softening temperature should be higher than the temperature of liquids

Acrylic resin denture base materials

2. Composition of chemically cured resin: (cold cured or self cured or auto-

II. Polymerization reaction:

III. Manipulation and processing of denture resins:

Role of separating medium:

Too early packing (packing at sandy or sticky stage):

Delayed packing (packing at rubbery or stiff stage):

6. Deflasking and Finishing:

- Premature opening before cooling may cause warpage.

IV. Properties of denture resins:

b. Coefficient of thermal expansion: About 80 X l0-6/ºC, which is quite high. This

b. Gaseous porosity (internal porosity):

Modified Denture Base Resins