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MATERIALS IN
PEDIATRIC
PATIENTS
Submitted by :
Dushyant Chopra
Varsha Bihani
B.D.S final prof.
INTRODUCTION
At least 1/3rd of the current dental research effort is
directly concerned with the development of better materials
and improved techniques for their manipulation.
The oral cavity is a formidable obstacle to the
maintenance of the integrity of the tooth structure and the
materials used in its restoration or replacement. Biting
stress on the cusp of the molar tooth may be as great as
207MPa. The pH of dental plaque, food and beverages
fluctuates daily from ranges of low acidity to high
alkalinity.The temperature during the course of a normal
meal may vary as much as 150*F. The warm , moist oral
cavity contains a variety of enzymes and debris providing
optimum conditions for the accumulation of surface
deposits that can tarnish or corrode metallic restorations.
For these and other reasons restorative materials are
readily subject to fracture, solubility, dimensional change
and discoloration.
CLASSIFICATION
METALLIC RESTORATION
Silver amalgam
TOOTH COLORED
Glass Ionomer Cement
Composites
Silicate cement
TEMPORARY RESTORATIVE MATERIALS
Zinc Oxide Eugenol
Zinc Polycarboxylate
BASES AND LINERS
Calcium Hydroxide
Zinc Phosphate
Glass Ionomer Cement
SILVER AMALGAM
Introduction
Amalgam is a special type of alloy that
contains mercury as one of its
constituents. Dental amalgam is an alloy
made by mixing mercury with a silver-tin
alloy powder.
It is most common material used for
class 1 and class 2 cavities.
COMPOSITION
Ag(68.5%) - It whitens the alloy and increases the
strength.
Sn(25.5%) - It controls the reaction b/w Ag and Hg
and reduces strength and resistance to corrosion.
Cu(5%) - It increases strength and hardness.
Zn(1%) - It acts as deoxidizer and causes delayed
expansion.
Pt and Pd – It hardens the alloy.
Hg is added to produce rapid reaction.
Classificatio
n
DEPENDING ON ALLOY PARTICLE
SIZE AND SHAPE
Lathe cut alloys
Spherical alloys
Admixed alloys
DEPENDING ON COPPER/ZINC
CONTENT
Low copper (contains Cu upto 2-5%)
High copper (contains Cu upto 13%)
Zinc containing
Zinc free
Depending on addition of
nobel metal
1ST generation: 3 parts Ag + 1 part Sn
2nd generation: Original alloy + Cu upto 4%+ Zn
upto 1%
3rd generation: Ag-Cu eutectic alloy
4th generation: Alloying of Cu + Ag + Sn upto
29%
5th generation: Pd + Ag + Cu
Manipulation
Proportioning: Recommended alloy: mercury ratio is 5:7or 5:8.In
EAMES Technique equal parts by wt of alloy and mercury is taken.
Tarnish and corrosion: High Cu show less tarnish and corrosion than low
Cu
Mechanism of action:
If a free radical has been formed by a brief exposure
to light when material was dispensed the inhibitor
reacts with the free radical. This inhibits chain
propagation by terminating the ability of the free
radical to initiate polymerization process. When all
inhibitors have been consumed chain propagation will
occur.
Indications
# Classes I, II, IV, V, VI restoration
# Foundations or core buildups
# Sealants and conservative composite restorations
# Esthetic enhancement procedures
# Partial veneers
# Full veneers
# Tooth contour modifications
# Diastema closures
# Cements
# Temporary restorations
# Periodontal splinting
Contraindications
Patients who do not maintain oral hygiene.
Uncooperative patients.
Teeth broken down to the extent that inadequate tooth
tissues remain to create adequate resistance and
retention forms for the purposes of bonding.
Teeth in which outline form includes marked undercuts.
Teeth which show excessive wear.
Situations where moisture control for appropriate
bonding of inlays and onlays cannot be secured and
maintained.
Teeth that experience heavy occlusal forces like in
bruxism, clenching etc.
Teeth in which there are deep gingival margins that
have insufficient enamel for bonding.
3M Filtek P60
Heliomolar HB
Bright Light
C-Fill MH
PRODIGY condensar
CALCIUM HYDROXIDE
Introduction
Calcium hydroxide is mainly used as pulp
protecting agent. It is used as liners in deep
cavities. It provides pulp protection in
preparations very close to pulp. It performs
two main functions :-
1) Sedation of existing pulpal inflammation.
2) Prevention of further irritation by sudden
temperature change.
AVAILABLE AS
2 paste system containing base and
catalyst paste in collapsible tubes.
Light cured system.
Single paste in syringe form.
Powder form mixed with distilled water.
Composition
BASE PASTE:
1) Glycol Salicylate 40%
2) CaSO4
3) Titanium dioxide
4) Calcium tungstate or BaSO4
CATALYST PASTE:
1) Ca (OH)2 50%
2) ZnO 10%
3) Zinc Stearate 0.5%
4) Ethylene toluene
5) Sulfonamide 39.5%
PROPERTIES
Poor mechanical property but better than zinc
oxide eugenol.
Compressive strength is 10 to 27 MPa after 24
hr. strength continue to increase with time.
Tensile strength is 1 MPa.
If used in thick layer provide good thermal
insulation.
High solubility and increases when exposed to
pgospheric acid and esters.
It is highly alkaline and kills bacteria by
breakdown of proteins.
MANIPULATION
Equal length of two pastes are
dispensed on a paper and
mixed to a uniform color.
Material carried and applied
using an applicator.
SETTING
REACTION
Calcium hydroxide reacts with
salicylate ester to form chelate
i.e. calcium disalicylate.
SETTING TIME
2.5 to 5.5 mins. Reaction is
accelerated by moisture
therefore sets faster in cavity.
USES
Cavity liner :- It helps in formation of reparative dentine
and used in deep cavity preparations.
Pulp capping :- It is an excellent dressing for exposed
pulp for maintaining the pulp vitality due to formation of
secondary dentine.
Root canal filling :- It is used as intra-canal
medicaments for killing bacteria in root canal. But rarely
used in primary dentition.
Perforation repair :- It causes hemostasis so used for
controlling bleeding in case of perforation.
Apexification :- It is defined as process of creating
environment within which root canal and periapical tissue
after pulp death is formed that allow calcific barrier to
form across open apex. Calcium hydroxide is the material
of choice. But is is mainly used in young permanent teeth
in which root apex is not formed.
Bosworth Hydrox
Pulpdent Paste
PULPDENT Root Canal
Sealer
CALCIDOR
ZINC PHOPSHATE
CEMENT
Introduction
Zinc phosphate cement the one of the oldest and
widely used cements, and is commonly used for
luting permanent metal restorations and as a
base. It is a high-strength cement base, mixed
from zinc oxide powder and phosphoric acid
liquid. Due to its low initial pH, it may cause
pulpal irritation, especially where only a thin layer
of dentin exists between the cement and the
pulp; thus is especially important to follow the
correct procedures and precautions when using
zinc phosphate cement.
APPLICATIONS
Luting of restoration
High strength base
Temporary restorations
Luting or orthodontic bands and brackets.
COMPOSITION
Powder Liquid
Zinc oxide – 90.2% Phosphoric acid –
Magnesium oxide - 8.2 38.2%
% Water – 36%
Other oxide - 0.2 % Aluminum phosphate
Silica - 1.4 % – 16.2%
Aluminum – 2.5%
Zinc – 7.1%
CLASSIFICATION
Type I – Fine grained for luting.
Type II – Medium grained for luting and
filling.
MANIPULATION
Cool glass slab is used.
Powder added in increments.
Mixing done with stainless steel spatula in circular
motion.
Large area covered while mixing to dissipate
heat.
Material inserted immediately.
Area should be dry.
Powder:liquid ratio -1.4gm/0.5ml
SETTING TIME :- 5-9 mins.
MIXING TIME :- 1.5 mins.
SETTING REACTION
Phosphoric acid attacks the surface of
the particle, dissolving zinc oxide and
forming zinc phosphate. The aluminium
complexes with the phosphoric acid to
form zinc aluminophosphate gel. This
reaction is exothermic.
PROPERTIES
1) Compressive strength: It gains 75% of its max strength
in 1st hour
2) Tensile strength: It is less so making it brittle (5.5 MPa).
3) Modulus of elasticity: Comparatively high so makes it
stiff and resistant to elastic deformation (13.5GPa).
4) Solubility and disintegration: In mouth shows more
disintegration. Solubility is more in dilute organic acid.
5) Film Thickness:
For luting: thickness should be 25microns or less.
For filling: thickness should not be more than 40microns.
6) Thermal properties: Good thermal insulator.
7) Adhesion: Mechanical interlocking.
8) Biological properties: At the time of insertion, high
acidity ‘coz of phosphoric acid so thin mixes are
avoided.
9) Pulp protection: Lining is provided of Zinc oxide eugenol, calcium
hydroxide, or varnish.
Bosworth
ZINC PHOSPHATE
CEMENT
tgzincem
Conclusions
# GICs are favourable for Class I cavities and in
uncooperative children.
# Compomers show best long-term performance
in primary teeth. The cooperation has to be
sufficient, at least during bonding and layering.
# The biggest effort is needed for resin
composites. After rubber dam application and
correct establishment of technique-sensitive
adhesion, resin composites reach the level of
compomers.