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SEMINAR ON
BIOCOMPATIBILITY OF
DENTAL MATERIALS
Presented By : -
CONTENTS
INTRODUCTION
REQUIREMENTS
TESTS FOR EVALUATION
ALLERGIC RESPONSE TO DENTAL MATERIALS
PULPAL REACTIONS TO RESTORATIONS
o ZINC PHOSPHATE CEMENT
o ZINC POLYCARBOXYLATE CEMENT
o ZINC OXIDE EUGENOL CEMENT
o GLASS IONOMER CEMENTS
o SILICATE CEMENTS
o CALCIUM HYDROXIDE CEMENTS
o VARNISHES
o FILLED AND UNFILLED RESINS
o AMALGAM
PULPAL RESPONSE TO VARIOUS STIMULI / CARIES
CONCLUSION
In general,
and
mucosal
response),
systemic
responses,
allergenicity
and
carcinogenicity.
REQUIREMENTS :
1) It should not be harmful to the pulp and soft tissues.
2) It should not contain toxic diffusible substances that can be released and
absorbed into the circulatory system to cause a systemic toxic response.
3) It should be free of potentially sensitizing agents that are likely to cause
an allergic response.
4) It should have no carcinogenic potential.
Tests for evaluation :
Group I tests consist of cytotoxic evaluation in which dental material in a
fresh or cured state are placed directly on tissue culture cells or on membranes
that leach through the barriers.
Eg. Genotoxicity test : Mammalian and non mammalian cells. Bacteria, yeast,
fungi cells are used to determine whether change in chromosome structure,
gene mutation are caused by test materials.
Group II : Secondary tests : The product is evaluated for its potential to create
systemic toxicity.
Eg. Oral median lethal dose, irritation, implantation tests. Dermal toxicity.
Group III : Preclinical usage tests : Approval of the product after it has
successfully pass the primary and secondary tests on the basis that the product
would not be harmful to humans.
Eg.
a) Pulp and dentin usage test : This test is designed to assess the
biocompatibility of dental materials placed in dentin adjacent to the
dental pulp (Class V is prepared to leave 1 mm or less of tubular dentin
between the floor of cavity preparation anterior the pulp).
b) Pulp capping and pulpotomy usage test (pulp is partially removed / pulp
is merely exposed).
c) Endodontic usage test (Pulp is partially or completely removed and
replaced by the obtaining material.
evaluated).
Allergic Responses to Dental Materials :
a) Allergic contact dermatitis :
Seen commonly first by primary physicians. It is a skin condition caused
by simple chemical insult to the skin. An allergic contact dermatitis associated
with monomers of bonding agent frequently involves the distal parts of the
fingers and patman aspects of finger tips.
Allergy to Latex Products :
Hypersensitivity to latex containing products may represent a true latex
allergy or a reaction to accelerates and an antioxidants used in latex processing.
Thiuram is a chemical used in the fabrication of latex articles that has also been
reported to cause allergic reactions.
Polyether component : Allergy. Localized rashes, Wheezing, Anaphylaxis.
Allergy Contact Stomatitis :
It is the most common adverse reaction to dental material.
It may be local or at distant site.
Dental material contain many components known to be common
allergens, such as chromium cobalt, mercury, eugenol, components of resin
The
The incomplete
Gingival reactions.
Lichenoid reactions.
products that can diffuse through the dentinal tubules that evoke an
inflammatory reaction. This has been found to be a major cause in pulpal
injury.
Watts A. (1979) showed that materials such as composite resins,
silicates produced only a localized tissue reaction when placed directly on
exposed pulp in germ free animals.
Brannstrom (1979) found that bacteria did not grow when the outer
portion of restorations were replaced with ZnO eugenol.
When bacterial
Pathogenicity of microorganisms.
: 1- 15 ppm/oC
Metals
: 10-30 ppm/oC
Polymers
: 30-600 ppm/oC
Amalgam
: 25 ppm/oC
Tooth
: 9-11 ppm/oC
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Zinc Oxide Eugenol : Used as temporary and permanent luting agent, root
canal sealer, thermal insulating base, temporary restorative material,
periodontal pack.
The reason that ZnO eugenol is a good temporary cement and causes
only a mild reaction in pulp is that ;
a) pH is approximately 7 at the time, they are inserted into the tooth.
b) It adapts very close to dentin, thus providing a good marginal seal.
c) Its antibacterial properties inhibits bacterial growth on cavity walls.
When ZnO eugenol comes in direct control with the pulp tissues,
following reaction takes place.
1) Chronic inflammation may remain limited, the area will be walled off by
fibrous tissues followed by matrix formation, mineralization and
bridging of the exposure.
2) Chronic inflammation may propogate to involve all pulp and root canal
tissues with slow, symptomless necrosis.
3) Chronic inflammation may lead to complete fibrosis of pulp and root
canal tissues leaving pulp dentin organ susceptible to any irritation and
with little or no defense.
4) Chronic inflammation may change to acute inflammation leading to
necrosis of pulp and root canal tissues.
Eugenol is slightly acidic and produces palliative or obtundant actions
on the pulp in low concentration. Since eugenol injures cells, one must use
Ca(OH)2 cavity liner in very deep cavity preparation where there is risk of pulp
exposure.
Glass Ionomer Cements :
Used both as luting agent and as a restorative material. They elicit
greater pulp reaction than ZnO eugenol but less than ZnPO 4.
It contains
polyacrylic acids which are weaker than phosphoric acid and possess higher
molecular weight that may limit their diffusion through the dentinal tubules.
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persons are more likely to react severely to these cements than the pulp of older
persons.
A non-irritating base, such as ZnO eugenol should be used under
silicates.
Ca(OH)2 can be an irritant to the pulp if it comes in contact with it. The
irritating ingredients and characteristics could be the forces with which the
material is introduced into the pulp tissue and high alkalinity of the material. If
the effective depth is 100 micrometer or more, a healthy reparative reaction can
be expected.
When Ca(OH)2 comes in contact with the pulp tissues, the layer of tissue
that its contacts directly will undergo chemical necrosis (Coagulation). To
anticipate a favourable pulpal reaction, the following criteria must be met ;
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It prevents
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Irritant contact
Dermatitis
Contact
Urticaria
Itchy, dry,
fissured skin
and chapping
Immediate
type reaction
Itching, odema
and wheal
within 1 hour
Check handcare
regimen
Check gloves
Frequently
Try alternative
Brand
If Dermatitis persist
Consult dermatologist
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Immediate
referral and
avoid contact
with rubber
(Emergency
Treatment
needed)
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Therefore use of
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It
presents with pinkish hue which is irreversible. However dark purplish color
indicates thrombosis.
Effect of Lasers on the Pulp :
Lasers can remove caries, modify the dentin surface for stronger
bonding, eliminate pits and fissures, anaesthetize and treat hypersensitive teeth.
Two requirements critical for effectiveness of cases is laser must
provide superior results over traditional procedures and it must not damage the
vital pulp in the process.
The interaction between laser light and substrate is expressed in terms
of reflection, absorption and transmission which are wavelength dependent.
Clinically CO2 laser and Gr:Yag will do less harm to pulp than Nd:YAG and
diode laser system.
CO2 Laser : Is known for cutting soft tissue without bleeding used in
periodontal and oral surgery procedures. It is not applicable for hard tissue
procedures.
Nd:YAG : has wavelength of 1.06 mm. They have beneficial effect on dentin
but not on the pulp. The pulp damage includes nerve injury and haemorrhage
leading to irreversible damage. Identifying an energy level at given dentin
thickness that provides desired effect on dentin without harming the pulp is an
important step in laser research.
Er :YAG : Can ablate dental hard tissue with minimal damage to dental pulp.
The mechanism is based on its high absorption into the water
component of hard tissue. This may cause a quick temperature increase within
a small volume of the tissue. Thus both enamel and dentin are partly removed
by continuous vaporization process and partly by microexplosion.
Hypersensitive Teeth :
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Mechanism : The enamel and cementum covers the dentin when these
protective layer is removed, dentinal tubules are exposed (eg, scaling, caries,
#), the teeth often become hypersensitive. Dentin sensitivity is due to a fibres
present in dentinal tubules.
It is characterized by sharp, transient and well localized pain to cold, air
and heat. It can be confused with pulpal pathology. In the latter, it is because
of excitation of C fibres.
Management of Hypersensitive Dentin :
-
Oxalate Salts :
-
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