Metals in dentistry

Dental material

General information
Alloy: a mixture of two or more metals

Pure metals are rarely used in dentistry because they are weaker than they are when mixed with other metals.

All metal casting

Classification of cast restorations:
Intra-coronal (e.g. inlay) Extra-coronal (e.g. crown)

Cast metal alloys can be used for bridges, partial dentures

Cast metal restorations

Classification of dental casting alloy (ADA)

High noble alloys: Gold-platinum Gold-palladium Gold-copper-silver Noble alloys: Silver-gold-copper Palladium-copper Silver-palladium Base metal alloys Ni-based Co-based Ti-based What does noble mean? Does not corrode readily
High noble: at least 60% noble (Au, Pd, Pt). 40% of which is gold. The remaining 40% is base metal (precious metals) Noble: at least 25% noble (no gold requirements). 75% base metal (semiprecious)

Gold alloys (Au)

Most corrosion resistant Pure gold is 24 karat, 100%, or 1000 fine (percentage * 10) Gold alloys classified:
Hardness (resistance to penetration) Malleability (ability to be shaped by tapping) Ductility (ability to be elongated)
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Platinum is not used much because:

Too expensive High melting point Difficult to mix with gold

Palladium is used more widely because:

Good corrosion resistance Increases hardness of alloy

Silver is precious but not noble because it corrodes.

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Base metal alloys

< 25% noble metal Primary base metals (non-precious):
Copper Added to gold alloy to increase hardness Silver Nickel Tin Zinc: added to decrease oxidation Titanium

Stiffer than gold alloys, higher stress resistance

Base metal alloys

Drawbacks:
Difficult to finish and cut More equipment to manufacture Higher casting temperature Biocompatibility issues

Crystal formation
Alloys start to form crystals as they cool down after being poured into molds. Small crystals produce better qualities than larger ones Some alloys such as gold maybe reheated (annealing) to improve properties Reheating base metal alloys is not recommended.
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Porcelain bonded alloys

High noble Noble Base metal Composition is slightly modified to make them more compatible with porcelain. How?
Blended and mixed to withstand high temperature when porcelain is fired (850-1350 C) Small amounts of indium and tin are added to form oxides on metal surface to which porcelain is bonded Silver and copper is not used to avoid green staining of porcelain
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Porcelain fused to metal

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Porcelain bonding alloy

When PFM restorations are constructed, layers of porcelain are fired in an oven on the metal base to cover the metals dark color Body and incisal porcelain are added in layers to simulate enamel and dentine colors and translucency. Porcelain and metal should have compatible rates of thermal expansion or porcelain will crack.
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Removable prosthetic casting alloys

Base metals used Cobalt Titanium *Chromium *Nickel Aluminium Vanadium
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Iron Beryllium Gallium Carbon molybdenum

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Components are attached to prosthesis (precision and non precision attachments, bars) made from metal alloys :
High noble Noble Base metal

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Biocompatibility
Noble metals are more biocompatible than base metals because they corrode less (corrosion products can cause allergy):
Nickel is associated with allergy (9-12% of population), especially in women
Seen on free gingival tissue in contact with metal Mostly more sever with fixed prosthesis Skin response may occur

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Beryllium, added to Ni-Cr to reduce fusion temperature and create smaller crystals:
Can also cause allergy. Inhalation can cause lung disease called berylliosis

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Solders
Alloys that are used to join metals together or repair cast restorations

Gold solders
Join bridge units Add contacts

Silver solders
Used in ortho., paedo. Solder fixed space maintainer components

Correct marginal deficiencies Solder wire components to removable ortho. appliances Close holes from occlusal adjustment
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Solders
The solder alloy should have a lower melting temperature than the cast restoration. For gold solders, the higher the gold content the lower the melting range. For silver solders, tin is added to lower melting temperature and improve flow.
Solder joint
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Welding
Process of fusing two or more metal parts through the application of heat, pressure, or both, to produce a localized union across an interface between the parts. The welded point is susceptible to corrosion
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Wrought metal alloys

Are alloys that have been mechanically changed into another form (can be shaped as a flat plate, or wire). The resulting alloy, is harder and has a greater yield strength (point at which a force produces permanent deformation). Resistance to deformity can be modified by heating, annealing.

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Wire
Is a wrought metal which can be soft and easily shaped or may resist bending as does as spring. Used for clasps in partial dentures
Stainless steel (iron, carbon and traces of Mn, Cr, Ni to resist tarnish and rust) Platinum-gold-palladium (PGP)

Arch wires and ligature used in orthodontic appliances Arch bars and ligature wires used in oral surgery for fracture stabilization

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Wrought wires

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Endodontic files and reamers

Example of wrought metal alloy which have been twisted to produce cutting edges
Stainless steel Nickel-titanium (more flexible)

Reamers are similar to files but with fewer twists and cut faster

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Endodontic files

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Metals used in orthodontics

Wires:
composed of base meta, stainless steel, cobaltchrome-nickel, titanium, titanium-nickel. Able to resist deformity. This resistance creates memory in the wire, so it tries to reassume its original shape. That enables the wire to move teeth. Wires have different diameters (gauge), the thicker the wire the smaller the gauge

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Brackets and bands

Cemented on teeth with bonding resin Retain the arch wire that has been shaped by the orthodontists to guide the teeth into new position. The wire is held to brackets and bands by ligature wire or elastics Made from stainless steel, the bracket has a slot into which the wire fits and 4 wings to hold the ligature or elastics

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Lingual retainer:
Used to maintain the position of teeth after orthodontic treatment Adapted to the lingual surface of anterior teeth and bonded with composite.

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Implant materials
Used as anchors for prosthetic replacement of missing teeth
One or more single units as crowns or bridges Support for dentures

Three main types:

Subperiosteal Transosteal Endosseous

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Subperiosteal
Placed under periosteum (fibrous covering of bone) and rests on the bone. Placed in 3 stages:
Incision and flap reflection Impression and closure of wound & Framework cast with projection on which prosthesis is attached 3rd incision and attachment of framework

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Transosteal (mandibular staple)

In cases of sever resorption of mandible Needs intraoral and extraoral incisions Seldom used due to its invasive nature Consists of a beam attached to metal rods

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Endosseous
Most popular Placed in bone May include surface irregularities, screw like threads, or a hollow core with or without holes on the side These designs help to integrate the implant with bone
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A: Subperiosteal B: Transosteal C: Endosseous

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These implants are made of titanium or titanium alloy, used for its biocompatibility:
Pure titanium is not as rigid as the alloy

These implants are retained by intimate contact with bone (osseointegration) Some implants are coated with Calcium phosphate (hydroxyapatite) or plasma proteins to improve osseointegration

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Placement and restoration

Incision and bone exposure A hole is drilled that is slightly smaller than implant cylinder size so when implant is placed it will have a frictional fit with bone. Excessive heat should be avoided Permanent restoration is attached to implant core with a screw made of gold alloy

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Maintenance

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Maintenance
Home care:
Disclosing agents: to visualize plaque Brushes:
Brushing should b done in different angels Sulcular brushing Toothpaste should b non-abrasive

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Flosses:
For plaque removal Floss threaders are used to remove plaque underneath prosthesis.

Wooden sticks for plaque removal Antibacterial agents:

Chlorhexidine gluconate used for a week (30 seconds) after the second surgical stage when implant is uncovered or if inflammation occurs Phenolic compounds

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Hygiene visit
Patient visit to dentist at 3-4 months intervals for:
Routine examination Questions specific to implants: Soreness Bleeding Looseness Radiographs to check bone level

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Examine soft tissue for edema, erythema, bleeding If scaling needs to be done, and titanium is exposed, plastic or gold and Teflon coated scalers can be used Abrasive paste, steel curettes, ultrasonic scalers are not indicated Regular steel scalers can be used against a porcelain surface

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Implant failure
Early failure is caused by failure of bone to integrate with implant due to:
Poor surgical technique Generation of excess heat Implant infection Poor quality of bone Placing load on implant too soon

Failure occurring after initial integration is due to bacterial infection extending to bone
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Endodontic posts
Posts are metal or nonmetal rods placed in root canal The purpose of a post is to retain the core build up over which the crown is placed Classification:
Active, engages canal surface with threads Passive post, cemented into the canal space

Classification by shape:
Parallel Tapered
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Classification by material:
Metal Nonmetal

Classification by manufacturing method:

Custom made: made from a wax or resin pattern made directly on tooth or indirectly in lab. Using lot wax technique. Core attached Preformed:
They rely for retention on shape, diameter, length, and cementation. Come in kits with drills specific to size of post Core not attached, need to be made from amalgam, composite, hybrid GIC

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End of part one

References: Chapter 8 metals in dentistry Dental materials, clinical applications for dental assistants and dental hygienists

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