Dental materials / dental implant courses

DENTAL MATERIALS IN PEDIATRICDENTAL MATERIALS IN PEDIATRIC
DENTISTRYDENTISTRY
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing Dental EducationLeader in continuing Dental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

ContentsContents
» IntroductionIntroduction
» CementsCements
- Zinc phosphate- Zinc phosphate
- Zinc oxide eugenol- Zinc oxide eugenol
- Glass ionomer- Glass ionomer
- Calcium hydroxide- Calcium hydroxide
» Cavity linersCavity liners
» Cavity varnishCavity varnish
» AmalgamAmalgam
» CompositeComposite
» ConclusionConclusion
» ReferencesReferences

Zinc phosphate cementZinc phosphate cement
Applications:Applications:
» Luting of restorationLuting of restoration
» High strength basesHigh strength bases
» Temporary restorationsTemporary restorations
» Luting of orthodontic bands & bracketsLuting of orthodontic bands & brackets
Classification:Classification:
Type I: Fine grainedType I: Fine grained
- Luting- Luting
Type II: Medium grainedType II: Medium grained
- Luting & filling- Luting & filling
Oldest cement used in dentistry

Indian Dental academy
• www.indiandentalacademy.com
• Leader continuing dental education
• Offer both online and offline dental
courses

Mode of supply:Mode of supply:
» Powder & liquid systemPowder & liquid system
» Capsule of prepropotioned P & LCapsule of prepropotioned P & L

CompositionComposition
PowderPowder
» Zinc oxide – 90%Zinc oxide – 90%
» Magnesium oxide - 8.2%Magnesium oxide - 8.2%
» Bismuth trioxide, calciumBismuth trioxide, calcium
oxide & barium oxide –oxide & barium oxide –
0.2%0.2%
» Silica – 1.4%Silica – 1.4%
LiquidLiquid
» Phosphoric acid – 38.2%Phosphoric acid – 38.2%
» Water – 36%Water – 36%
» Aluminium or zincAluminium or zinc
phosphate – 16.2%phosphate – 16.2%
» Aluminium – 2.5%Aluminium – 2.5%
» Zinc – 7.1%Zinc – 7.1%

Setting reactionSetting reaction
» Phosphoric acid attacks zinc oxide – acid zincPhosphoric acid attacks zinc oxide – acid zinc
phosphatephosphate
» Aluminium of liquid is essential for cementAluminium of liquid is essential for cement
formationformation
» Aluminium complexes with phosphoric acid toAluminium complexes with phosphoric acid to
form zinc aluminosilicate gelform zinc aluminosilicate gel
Working timeWorking time –– Upto 11 minUpto 11 min
Setting timeSetting time – 5 to 9 min– 5 to 9 min

PropertiesProperties
Compressive strength:Compressive strength:
» Stronger than zinc oxide eugenolStronger than zinc oxide eugenol
» 103.5 MPa (15000 psi)103.5 MPa (15000 psi)
» Cement gains 75% of its strength in 1 hr & maximumCement gains 75% of its strength in 1 hr & maximum
strength in first daystrength in first day
Factors affectingFactors affecting
-- More powder greater strengthMore powder greater strength
- Any change in water content reduces strength- Any change in water content reduces strength
Tensile strength:Tensile strength:
» 5.5 MPA (800 psi)5.5 MPA (800 psi)
Modulus of elasticity:Modulus of elasticity:13.5 Gpa13.5 Gpa

Solubility & disintegration:Solubility & disintegration: 0.06% wt0.06% wt
Factors affecting:Factors affecting:
» Thicker mix – less solubilityThicker mix – less solubility
» Any change in water content – increased solubilityAny change in water content – increased solubility
Film thickness:Film thickness: ADA – sp 8ADA – sp 8
For type I: Not more than 25 umFor type I: Not more than 25 um
For type II: Not more than 40 umFor type II: Not more than 40 um
- Better cementing action- Better cementing action
- Helps in complete seating of casting- Helps in complete seating of casting
- Minimizes air spaces & other structural defect- Minimizes air spaces & other structural defect
present in bulk of cementpresent in bulk of cement

Thermal properties:Thermal properties:
» Good thermal insulator & effective in reducingGood thermal insulator & effective in reducing
galvanic effectgalvanic effect
Adhesive properties:Adhesive properties:
» Do not form any chemical bond with enamel or dentineDo not form any chemical bond with enamel or dentine
Biological propertiesBiological properties
» Initially acidity of cement is quite high due to theInitially acidity of cement is quite high due to the
presence of phosphoric acidpresence of phosphoric acid
» Three min after start of mixing pH 3.5 and later rapidlyThree min after start of mixing pH 3.5 and later rapidly
comes to neutral in 24 to 48 hrscomes to neutral in 24 to 48 hrs
Optical propertiesOptical properties
» Set cement is opaqueSet cement is opaque

ManipulationManipulation
» Cool glass lab is usedCool glass lab is used
» P/L ratio 1.4 gm/0.5 mlP/L ratio 1.4 gm/0.5 ml
» Liquid should be dispensed just before mixingLiquid should be dispensed just before mixing
» Powder is added in small incrementsPowder is added in small increments
» Large area is covered during mixingLarge area is covered during mixing
» Maximum amount of P should be incorporated inMaximum amount of P should be incorporated in
L to ensure minimum solubility & maximumL to ensure minimum solubility & maximum
strengthstrength

Adv:Adv:
» High strengthHigh strength
» Can be used as temporary restorationCan be used as temporary restoration
» Luting of orthodontic bandsLuting of orthodontic bands
» Good thermal insulatorsGood thermal insulators
Disadv:Disadv:
» Donot form chemical bond with toothDonot form chemical bond with tooth
» Solubility highSolubility high

Zinc oxide eugenol cementZinc oxide eugenol cement
Application:Application:
» Lining cavitiesLining cavities
» Cementing restorationsCementing restorations
» As basesAs bases
» Root canal sealantsRoot canal sealants
» Periodontal dressingPeriodontal dressing
» Temporary & intermediate restorationsTemporary & intermediate restorations
CLASSIFICATION:CLASSIFICATION:
Type I: Temporary restorationType I: Temporary restoration
Type II: Permanent restorationType II: Permanent restoration
Type III: Temporary filling material & thermal insulatorType III: Temporary filling material & thermal insulator
Type IV: Cavity linersType IV: Cavity liners

Mode of supply:Mode of supply:
-- Powder & liquidPowder & liquid
- Two paste system- Two paste system
Composition:Composition:
POWDERPOWDER
Zinc oxide – 69.0% - Principle ingredientZinc oxide – 69.0% - Principle ingredient
White rosin – 29.3% - Reduces brittleness of set cementWhite rosin – 29.3% - Reduces brittleness of set cement
Zinc sterate – 1.0% - Accelerator & plasticizerZinc sterate – 1.0% - Accelerator & plasticizer
Zinc acetate – 0,7% - Accelerator & improves strengthZinc acetate – 0,7% - Accelerator & improves strength
Magnesium oxideMagnesium oxide
LIQUIDLIQUID
Eugenol – 85% - React with zinc oxideEugenol – 85% - React with zinc oxide
Olive oil – 15.0% - PlasticizerOlive oil – 15.0% - Plasticizer

Setting reactionSetting reaction
ZnO + HZnO + H22O --------------------Zn(OH)O --------------------Zn(OH)22
Zn(OH)Zn(OH)22 + 2HE -----------------------ZnE+ 2HE -----------------------ZnE22 + 2H+ 2H22OO
» Set cement cosist of particles of zinc oxideSet cement cosist of particles of zinc oxide
embedded in matrix of particle of zincembedded in matrix of particle of zinc
eugenolateeugenolate
Setting time:Setting time: 4 to 10 min4 to 10 min

Factors affecting setting timeFactors affecting setting time
» Smaller the particle size zinc oxide -cement setSmaller the particle size zinc oxide -cement set
fasterfaster
» Alcohol, glacial acetic acid & small amount ofAlcohol, glacial acetic acid & small amount of
water accelerates the reactionwater accelerates the reaction
» Glycol & glycerin retards reactionGlycol & glycerin retards reaction
» Higher temp accelerates reactionHigher temp accelerates reaction
» Lower temp slows the reactionLower temp slows the reaction
» Higher the P & L ratio faster the setHigher the P & L ratio faster the set

propertiesproperties
» They are relatively weak cementThey are relatively weak cement
» 3 to 4 MPa to 50 to 55 MPa3 to 4 MPa to 50 to 55 MPa
» 0.32 to 5.8 MPa0.32 to 5.8 MPa
Modulus of elasticity:Modulus of elasticity:
» 0.22 to 5.5 Gpa0.22 to 5.5 Gpa
Thermal conductivity:Thermal conductivity:
» Insulating properties are excellent & apprx same asInsulating properties are excellent & apprx same as
human dentinehuman dentine
» 3.98 X 103.98 X 10-4-4
Solubility & Disintegration:Solubility & Disintegration:
» Solubility of set cement is highSolubility of set cement is high
» Disintegrate in oral fluidsDisintegrate in oral fluids
» 0.04% wt0.04% wt www.indiandentalacademy.comwww.indiandentalacademy.com

Film thickness:Film thickness:
» Imp for cement used for cementation of restorations( 25Imp for cement used for cementation of restorations( 25
um)um)
Adhesion:Adhesion:
» These cements do not form any chemical bond withThese cements do not form any chemical bond with
enamel or dentineenamel or dentine
Biological properties:Biological properties:
» Least irritating of all dental cementsLeast irritating of all dental cements
» Have soothing effect on pulpHave soothing effect on pulp
» pH 6.6 to 8.0pH 6.6 to 8.0
Optical properties:Optical properties:
» Set cement is radiopaqueSet cement is radiopaquewww.indiandentalacademy.comwww.indiandentalacademy.com

» P/L ratio 4:1 to 6:1 by wtP/L ratio 4:1 to 6:1 by wt
» Measured quantity of P & L dispensed onMeasured quantity of P & L dispensed on
cool glass slab or paper padcool glass slab or paper pad
» Bulk of powder is incorporated into liquid &Bulk of powder is incorporated into liquid &
spatulated thoroughly in a circular motionspatulated thoroughly in a circular motion
with a stiff bladed stainless steel spatulawith a stiff bladed stainless steel spatula
» Oil of orange can be used to cleanOil of orange can be used to clean
eugenol cement from instrumentseugenol cement from instruments

Adv:Adv:
» Temporary & intermediate restorationTemporary & intermediate restoration
» Root canal filling materialRoot canal filling material
» Periodontal dressingPeriodontal dressing
» Good thermal insulatersGood thermal insulaters
» Least irritatingLeast irritating
» Soothing effectSoothing effect
Disadv:Disadv:
» Low strengthLow strength
» Disintegrates in oral fluidsDisintegrates in oral fluids
» Do not form chemical bondDo not form chemical bond

Modified zinc oxide eugenolModified zinc oxide eugenol
cementscements
EBA - Alumina modified cements:EBA - Alumina modified cements:
Improved mechanical propertiesImproved mechanical properties
COMPOSITION:COMPOSITION:
POWDERPOWDER LIQUIDLIQUID
Zinc oxide – 70% EBA – 62.5%Zinc oxide – 70% EBA – 62.5%
Alumina – 30% Eugenol -37.5%Alumina – 30% Eugenol -37.5%

Compressive StrengthCompressive Strength ::
» 55 MPa (8000 Psi)55 MPa (8000 Psi)
» 4.1 MPa4.1 MPa
Modulus Of ElasticityModulus Of Elasticity ::
» 2.5 GPa2.5 GPa
Solubility & disintegration:Solubility & disintegration:
» 0.O5% wt0.O5% wt

Polymer Reinforced CementPolymer Reinforced Cement
Have superior mechanical properties & longer working timeHave superior mechanical properties & longer working time
USES:USES:
» Luting agentLuting agent
» As basesAs bases
» As temporary filling materialAs temporary filling material
» As cavity linerAs cavity liner
POWDER LIQUIDPOWDER LIQUID
-Zinc oxide - Eugenol-Zinc oxide - Eugenol
-Natural or synthetic - Acetic acid-Natural or synthetic - Acetic acid
resin - Thymolresin - Thymol

Compressive StrengthCompressive Strength:: 48 MPa (7000 psi)48 MPa (7000 psi)
Tensile StrengthTensile Strength:: 4.1 MPa(600 psi)4.1 MPa(600 psi)
Modulus Of Elasticity:Modulus Of Elasticity: 2.5 GPa2.5 GPa
Film Thickness:Film Thickness: 32 um32 um
Solubility & Disintegration:Solubility & Disintegration: 0.03% wt0.03% wt
Pulp ResponsePulp Response:: Similar to conventionalSimilar to conventionalwww.indiandentalacademy.comwww.indiandentalacademy.com

SPECIAL ZINC OXIDE EUGENOLSPECIAL ZINC OXIDE EUGENOL
PRODUCTSPRODUCTS
Antibiotics & steroids – anti-inflammatory agentsAntibiotics & steroids – anti-inflammatory agents
- Pulp capping- Pulp capping
- Root canal therapy- Root canal therapy

Glass Ionomer CementGlass Ionomer Cement
» Wilson & kent -- 1972Wilson & kent -- 1972
» Poly alkenoate cementPoly alkenoate cement
» ASPA (ASPA ( Alumino Silicate Polyacrylic AcidAlumino Silicate Polyacrylic Acid ))
» Silicate cement + polycarboxylate cementSilicate cement + polycarboxylate cement
“Man made Dentin” “Dentin substitute”

ApplicationsApplications
» Ant esthetic restorative material for cl IIIAnt esthetic restorative material for cl III
cavitiescavities
» For eroded areas & Cl V restorationsFor eroded areas & Cl V restorations
» As luting agentAs luting agent
» As liners & basesAs liners & bases
» For core build upFor core build up
» Pit & fissure sealantPit & fissure sealant

ClassificationClassification
According to Wilson & McLean in 1988According to Wilson & McLean in 1988
Type I – Luting cementsType I – Luting cements
Type II – RestorationType II – Restoration
Restorative aestheticRestorative aesthetic
Restorative reinforcedRestorative reinforced

According to application:According to application:
Type I - Luting cementsType I - Luting cements
Type II – Restorative cementsType II – Restorative cements
Aesthetic filling materialsAesthetic filling materials
Reinforced material (Fuji IX, Fuji II LC)Reinforced material (Fuji IX, Fuji II LC)
Type III – Lining cementType III – Lining cement
Type IV – Fissure sealantType IV – Fissure sealant
Type V – Orthodontic cementType V – Orthodontic cement
Type VI – Core build upType VI – Core build up

According to McLean in 1994According to McLean in 1994
» Glass ionomer cements (traditional)Glass ionomer cements (traditional)
» Resin modified GICResin modified GIC
» Polyacid modified composite resinsPolyacid modified composite resins
According to SkinnerAccording to Skinner
» Type I ---- LutingType I ---- Luting
» Type II ---- RestorationsType II ---- Restorations
» Type III ---- Liners & BasesType III ---- Liners & Bases

Newer classification:Newer classification:
» Traditional glass ionomerTraditional glass ionomer
Type I – Luting cementType I – Luting cement
Type II – Restorative cementType II – Restorative cement
Type III – Liners & basesType III – Liners & bases
» Metal modified glass ionomerMetal modified glass ionomer
Miracle mixMiracle mix
CermetCermet
» Light cured glass ionomerLight cured glass ionomer
» Hybrid ionomerHybrid ionomer
Composite resins in which fillers substituted withComposite resins in which fillers substituted with
glass ionomer particlesglass ionomer particles
Pre-cured glasses blended into compositesPre-cured glasses blended into composites

Mode Of SupplyMode Of Supply
» Powder/Liquid in bottlePowder/Liquid in bottle
» Prepropotioned P/L in capsulePrepropotioned P/L in capsule
» Light cure systemLight cure system
POWDERPOWDER
» Silica (SiOSilica (SiO22) --- 41.9%) --- 41.9%
» Alumina (AlAlumina (Al22OO33) --- 28.6%) --- 28.6%
» Aluminium Fluoride (Aluminium Fluoride ( AlFAlF33)) --- 1.6%--- 1.6%
» CalciumCalcium Fluoride (CaFFluoride (CaF22) ---15.7%) ---15.7%
» Sod Fluoride (NaF) --- 9.3%Sod Fluoride (NaF) --- 9.3%
» Aluminium phosphate (AlPOAluminium phosphate (AlPO44) --- 3.8%) --- 3.8%
Calcium-fluro-alumino-silicat glass – ion leachable glassCalcium-fluro-alumino-silicat glass – ion leachable glass

LiquidLiquid
» Polyacrylic acid ---Polyacrylic acid --- 4545 % --- Iticonic acid;% --- Iticonic acid;
maleic acid ; tricarboxillic acidmaleic acid ; tricarboxillic acid
» Tartaric acidTartaric acid
» waterwater

Ca polysalt first and Al polysalt
Adsjjkd;ljfpjapdopka;k
kjjjj

» Set cement consist of unreacted powder particleSet cement consist of unreacted powder particle
surrounded by silica gel & embedded insurrounded by silica gel & embedded in
amorphous matrix of hydrated Ca & Al poly saltsamorphous matrix of hydrated Ca & Al poly salts
Working time:Working time: 60-90 sec60-90 sec
Setting time:Setting time:
Type I: 4-5 minType I: 4-5 min
Type II: 7 minType II: 7 min

Compressive Strength:Compressive Strength: 150 MPa (26000 psi)150 MPa (26000 psi)
Tensile Strength:Tensile Strength: 6.6 MPa (960 psi)6.6 MPa (960 psi)
Hardness:Hardness: 48 KHN48 KHN
Solubility & Disintegration:Solubility & Disintegration:
» Initial solubility is high, it should be protected inInitial solubility is high, it should be protected in
mouth during this periodmouth during this period
Adhesion:Adhesion:
» Bond to enamel is greater than dentineBond to enamel is greater than dentinewww.indiandentalacademy.comwww.indiandentalacademy.com

Esthetic:Esthetic:
» Inferior than silicate & compositesInferior than silicate & composites
» Lacks translucency & have rough surfaceLacks translucency & have rough surface
Biocompatibility:Biocompatibility:
» Pulpal response may be classified as mildPulpal response may be classified as mild
» Pulpal reaction is greater than ZnoE but lessPulpal reaction is greater than ZnoE but less
than Znpo4than Znpo4
AnticariogenicAnticariogenic :: F realiseF realise

For successful restoration of GI rules should be fallowedFor successful restoration of GI rules should be fallowed
1) Conditioning of tooth surface1) Conditioning of tooth surface
2) Proper manipulation2) Proper manipulation
3) Protection of cement during setting3) Protection of cement during setting
4) Finishing4) Finishing
Conditioning of tooth surface:Conditioning of tooth surface:
» Surface of tooth should be clean for effectiveSurface of tooth should be clean for effective
adhesionadhesion
» Smear layer should be removedSmear layer should be removed
-pumice wash-pumice wash
- polyacrylic acid solution- polyacrylic acid solutionwww.indiandentalacademy.comwww.indiandentalacademy.com

Manipulation:Manipulation:
Hand mixing:Hand mixing:
» P/L ratio 3:1 by wtP/L ratio 3:1 by wt
» P & L dispensed on paper pad or glass slab justP & L dispensed on paper pad or glass slab just
prior to mixingprior to mixing
» P divided into two equal incrementsP divided into two equal increments
» First increment incorporated into liquid rapidlyFirst increment incorporated into liquid rapidly
with plastic or agate spatula to producewith plastic or agate spatula to produce
homogeneous milky consistencyhomogeneous milky consistency
» Remainder of powder is added( folding method)Remainder of powder is added( folding method)
» Mixing time 45 secMixing time 45 sec

Mechanical mixing:Mechanical mixing:
AmalgamatorAmalgamator
Adv:Adv:
» Better properties due to controlled P/L ratioBetter properties due to controlled P/L ratio
» Less mixing timeLess mixing time
» Convenient delivery systemConvenient delivery system
Disadv:Disadv:
» Amount of cement needed is limited by manufactureAmount of cement needed is limited by manufacture
» Number of shades provided is limitedNumber of shades provided is limited
Protection of cement during setting:Protection of cement during setting:
i)i) Special varnish supplied by manufactureSpecial varnish supplied by manufacture
ii)ii) An unfilled light cured resin bonding agentAn unfilled light cured resin bonding agent
iii)iii) Cocoa butterCocoa butter
Finishing:Finishing:
» It should be done after 24 hrsIt should be done after 24 hrswww.indiandentalacademy.comwww.indiandentalacademy.com

Advantages & DisadvantagesAdvantages & Disadvantages
Advantages :Advantages :
» Adhesive aestheticAdhesive aesthetic
resto matresto mat
» Liberates F ---Liberates F ---
AnticariogenicAnticariogenic
» BiocompatibleBiocompatible
» Low oral solubilityLow oral solubility
Disadvantages :Disadvantages :
» White & crazedWhite & crazed
surfacesurface
» Clinically poorClinically poor
aestheticsaesthetics
» Technique sensitiveTechnique sensitive
» Poor strengthPoor strength

Resin Modified GlassResin Modified Glass
ionomer Cementionomer Cement
Available as ---- Fuji II LC; Vitremer Restorative;Available as ---- Fuji II LC; Vitremer Restorative;
Vitremer Luting; Fuji plus; Vitrebond (3M)Vitremer Luting; Fuji plus; Vitrebond (3M)
Consists of GIC, modified by inclusion of smallConsists of GIC, modified by inclusion of small
quantity of resin – HEMA (quantity of resin – HEMA ( hydroxyethylhydroxyethyl
methacrylatemethacrylate ).).
Set partly by --- Acid-base reaction,Set partly by --- Acid-base reaction,
Photochemical polymerizationPhotochemical polymerization

Powder :Powder : Fluoroaluminosilicate glassFluoroaluminosilicate glass
Initiator for light /chem curing or bothInitiator for light /chem curing or both
LiquidLiquid : Water: Water
Polyacrylic acid modified with HEMAPolyacrylic acid modified with HEMA

AdvantagesAdvantages
» Improved physical propertiesImproved physical properties
» Extended working timeExtended working time
» F release = con GICF release = con GIC
» Improved Translucency --- better aestheticImproved Translucency --- better aesthetic
» More resistance to dehydration & crackingMore resistance to dehydration & cracking
» Chemical & micro-mechanical bonding to tooth strChemical & micro-mechanical bonding to tooth str
DisadvantageDisadvantage
» >> shrinkage on setting --- Microleakageshrinkage on setting --- Microleakage
» Poor color stabilityPoor color stability

UsesUses
» LinersLiners
» Fissure sealantsFissure sealants
» BasesBases
» Core buildupsCore buildups
» RestorationsRestorations
» Ortho bracketOrtho bracket
» Repair mat for damaged amalgam cores or cuspsRepair mat for damaged amalgam cores or cusps
» Retrograde root-filing matRetrograde root-filing mat

CompomerCompomer
» Composites + Glass ionomersComposites + Glass ionomers
» polyacid modified composite resinpolyacid modified composite resin
» Filler is glass( aluminofluorosilicate glass)Filler is glass( aluminofluorosilicate glass)
» Variable amount of polyalkenoic acidVariable amount of polyalkenoic acid
Adv:Adv:
» Good estheticsGood esthetics
» Bonding to tooth structureBonding to tooth structure
» Fluoride releaseFluoride release
» Acceptable mechanical & physical propertiesAcceptable mechanical & physical properties
» Good surface finishGood surface finish

METAL MODIFIED GICMETAL MODIFIED GIC
Introduced to in an attempt to improve strength,Introduced to in an attempt to improve strength,
fracture toughness & resistance to wearfracture toughness & resistance to wear
1) Silver alloy admixed1) Silver alloy admixed
2) Cerment2) Cerment

Silver alloy admixSilver alloy admix oror Miracle mixMiracle mix
Simmons --- 1983Simmons --- 1983
Spherical amalm + type IISpherical amalm + type II
GICGIC
PropertiesProperties: Strength: Strength
SolubilitySolubility
# toughness# toughness
Wear resisWear resis

Adv:Adv:
» Restoration is radiopaqueRestoration is radiopaque
» Greater resistant to wear thanGreater resistant to wear than
conventional GIconventional GI
» They can be finished soon after settingThey can be finished soon after setting
» F release makes material cariostaticF release makes material cariostatic
» Mixture donot use mercuryMixture donot use mercury
Disadv:Disadv:
» UnaestheticUnaesthetic

CermentCerment
» McLean & Gasser --- 1985McLean & Gasser --- 1985
» Involves bonding of silver particles by fusing to theInvolves bonding of silver particles by fusing to the
glass pow particles thru high temp sinteringglass pow particles thru high temp sintering
UsesUses
Small Class I cavitiesSmall Class I cavities
Resto of deciduous teethResto of deciduous teeth
Core build upCore build up
Base under compositesBase under composites
» Available as : Ketac-Silver (3M)Available as : Ketac-Silver (3M)

Calcium hydroxideCalcium hydroxide
Applications:Applications:
» DPC & IPCDPC & IPC
» Low strength bases under composite resinLow strength bases under composite resin
Mode of supplyMode of supply
» Two paste systemTwo paste system
» Light cured systemLight cured system
Commersial names:Commersial names:
Self cured:Self cured:
- Dycal/Life/Care- Dycal/Life/Care
Light cured:Light cured:
- Prisma VLC Dycal- Prisma VLC Dycalwww.indiandentalacademy.comwww.indiandentalacademy.com

Base pasteBase paste
» Glycol salicylate – reactGlycol salicylate – react
with CA(OH)with CA(OH)22 & Zno& Zno
» Calcium sulphateCalcium sulphate
» Titanium dioxideTitanium dioxide
» Calcium tungstate orCalcium tungstate or
barium sulphate -barium sulphate -
radiopacityradiopacity
Catalyst pasteCatalyst paste
» Calcium hydroxideCalcium hydroxide
» Zinc oxideZinc oxide
» Zinc sterateZinc sterate
» Ethylene tolueneEthylene toluene
» Sulphonamide – carrierSulphonamide – carrier
Setting reaction:
Ca(OH)2 reacts with salicylate ester to form chelate
amorphous calcium disalicylatewww.indiandentalacademy.comwww.indiandentalacademy.com

Properties:Properties:
» Low strengthLow strength
» Increases with settingIncreases with setting
» 10 to 27 MPa10 to 27 MPa
» 1 MPa1 MPa
Modulus of elasticityModulus of elasticity
» 0.37 Gpa/m0.37 Gpa/m22
Thermal properties:Thermal properties:
» If they use in sufficiently thick layer – some thermalIf they use in sufficiently thick layer – some thermal
insulationinsulation

Solubility & disintegration:Solubility & disintegration:
» Achieve its therapeutic effectsAchieve its therapeutic effects
» 0.4 to 7.8%0.4 to 7.8%
Biological properties:Biological properties:
» Alkaline in natureAlkaline in nature
» 9.2 to 11.79.2 to 11.7
» High alkalinity & its consequent antibacterial &High alkalinity & its consequent antibacterial &
protein-lysing effects helps in formation ofprotein-lysing effects helps in formation of
reparative dentinereparative dentine
Manipulation: Equal length of two paste are
dispensed on paper pad & mixed until uniform color iswww.indiandentalacademy.comwww.indiandentalacademy.com

Light activated calcium hydroxideLight activated calcium hydroxide
» Calcium hydroxide & barium sulphateCalcium hydroxide & barium sulphate
dispersed in a urethane dimethacrylatedispersed in a urethane dimethacrylate
resinresin
» HEMA & polymerization activatorHEMA & polymerization activator
Adv:Adv:
- Long working time- Long working time
- Less brittle- Less brittle

Cavity linersCavity liners
» Used to provide barrier against the passage of irritantsUsed to provide barrier against the passage of irritants
from cement or other restorative materialsfrom cement or other restorative materials
» To reduce sensitivity of freshly cut dentineTo reduce sensitivity of freshly cut dentine
» GI or suspension of Ca(OH)GI or suspension of Ca(OH)22 in an organic liquid such asin an organic liquid such as
methyl ethyl ketone or ethyl alcoholmethyl ethyl ketone or ethyl alcohol
» They are fluid in consistency can be easily painted overThey are fluid in consistency can be easily painted over
dentinal surfacedentinal surface
» The solvent evaporates to leave a thin film residue thatThe solvent evaporates to leave a thin film residue that
protect the pulpprotect the pulp
» Ca(OH)Ca(OH)22 liners are soluble & should not be applied atliners are soluble & should not be applied at
the margins of restorationsthe margins of restorations

Glass ionomer cavity linerGlass ionomer cavity liner
Fast setting radio opaque versions of conventional GIFast setting radio opaque versions of conventional GI
Adv:Adv:
» Chemically bond to dentineChemically bond to dentine
» Release of F – AnticariogenicRelease of F – Anticariogenic
» Nearly insoluble in oral fluidsNearly insoluble in oral fluids
» High compressive strengthHigh compressive strength
» Injectable liners are availableInjectable liners are available
Disadv:Disadv:
» Sensitive to moisture during application & hardeningSensitive to moisture during application & hardening
processprocess
» Time consumingTime consuming

Cavity VarnishCavity Varnish
APPLICATIONS:APPLICATIONS:
» Reduces Microleakage around newly placedReduces Microleakage around newly placed
amalgam restorationamalgam restoration
» Reduces passage of irritants into dentinal tubulesReduces passage of irritants into dentinal tubules
from overlying restoration or basefrom overlying restoration or base
» In case of amgm prevents penetration of corrosionIn case of amgm prevents penetration of corrosion
products into dentinal tubule thus reduces toothproducts into dentinal tubule thus reduces tooth
discolorationdiscoloration
» Used as surface coating over certain restoration toUsed as surface coating over certain restoration to
protect from dehydration or contact with oral fluidsprotect from dehydration or contact with oral fluids
» Can be applied over metallic restorations to reduceCan be applied over metallic restorations to reduce
galvanic shockgalvanic shock www.indiandentalacademy.comwww.indiandentalacademy.com

» Natural gum like copal, rosin or synthetic resinNatural gum like copal, rosin or synthetic resin
dissolved in organic solvent such as alcohol,dissolved in organic solvent such as alcohol,
acetone or ether.acetone or ether.
» Chlorbutanol, Thymol & eugenol, some containsChlorbutanol, Thymol & eugenol, some contains
fluoridesfluorides
Properties:Properties:
» Film thickness – 2 to 40 umFilm thickness – 2 to 40 um
» They neither provide mechanical strength norThey neither provide mechanical strength nor
thermal insulationthermal insulation
» Nearly insoluble in oral fluidsNearly insoluble in oral fluids

Manipulation:Manipulation:
» It can be applied using brush or small plellet ofIt can be applied using brush or small plellet of
cottoncotton
» Several thin layers must be appliedSeveral thin layers must be applied
» Each layer is allowed to dry before applying nextEach layer is allowed to dry before applying next
oneone
Contraindications:Contraindications:
» Composite resins restorationsComposite resins restorations
» Glass ionomer restorationsGlass ionomer restorations
» Therapeutic action is expected from theTherapeutic action is expected from the
overlying cement. eg zinc oxide eugenol &overlying cement. eg zinc oxide eugenol &
CA(OH)CA(OH)22

AMALGAMAMALGAM
AmalgamAmalgam
Technically means alloy ofTechnically means alloy of
mercury with any other metalmercury with any other metal
Dental AmalgamDental Amalgam
Is an alloy made byIs an alloy made by
mixing Hg with dental amalgam alloy ( Ag – Sn )mixing Hg with dental amalgam alloy ( Ag – Sn )
Amalgam alloyAmalgam alloy
Is a silver – tin alloy to whichIs a silver – tin alloy to which
varying amts of copper (Cu) and small amts zincvarying amts of copper (Cu) and small amts zinc
(Zn) have been added(Zn) have been added

» Amalgam was introduced in 1830Amalgam was introduced in 1830
» Initially, amalgam restorations were madeInitially, amalgam restorations were made
by filing silver coins & mixing with Hgby filing silver coins & mixing with Hg
» G. V. Black 1896G. V. Black 1896
65 wt % Silver65 wt % Silver
29 wt % Tin29 wt % Tin
<< 6 wt % Copper6 wt % Copper

FUNCTION OF EACH CONSTITUENTFUNCTION OF EACH CONSTITUENT
SilverSilver
»
Whitens alloyWhitens alloy
»
strengthstrength
»
Decreases flow and creepDecreases flow and creep
»
Increases expansion on settingIncreases expansion on setting
»
Gives resistance to tarnishGives resistance to tarnish
»
Regulates setting timeRegulates setting time
TinTin
»
Control reaction betn silver & mercuryControl reaction betn silver & mercury
»
Reduces the strength & hardnessReduces the strength & hardness
»
Increases the flowIncreases the flow
»
Reduces resistance to tarnish & corrosionReduces resistance to tarnish & corrosion

CopperCopper
» Increases strength and hardnessIncreases strength and hardness
» Increases the setting expansionIncreases the setting expansion
ZincZinc
» Acts as a scavenger or deoxidizer ---- removes oxidesActs as a scavenger or deoxidizer ---- removes oxides
and other impurities.and other impurities.
» Causes delayed expansion ---- in presence of moistureCauses delayed expansion ---- in presence of moisture
PLATINUM:PLATINUM:
» Hardens alloyHardens alloy
» Increases resistance to corrosionIncreases resistance to corrosion
PALLADIUM:PALLADIUM:
» Hardens & whitens alloyHardens & whitens alloy

CLASSIFICATIONCLASSIFICATION
I) BASED ON COPPER CONTENTI) BASED ON COPPER CONTENT ::
Low copper - < 6%Low copper - < 6%
High copper - > 6%High copper - > 6%
- admixed or blended alloysadmixed or blended alloys
- single composition or unicomposition alloys- single composition or unicomposition alloys
II) BASED ON ZINC CONTENTII) BASED ON ZINC CONTENT ::
Zinc containing alloys - > 0.01% ZnZinc containing alloys - > 0.01% Zn
Zinc free alloys - < 0.01% ZnZinc free alloys - < 0.01% Zn

III) BASED ON SHAPE OF ALLOY:III) BASED ON SHAPE OF ALLOY:
Lathe cut alloysLathe cut alloys
Spherical alloysSpherical alloys
Admixed alloysAdmixed alloys
IV) BASED ON NUMBER OF ALLOYEDIV) BASED ON NUMBER OF ALLOYED
PARTICLES:PARTICLES:
Binary alloy (silver-tin)Binary alloy (silver-tin)
Ternary alloy (silver-tin-copper)Ternary alloy (silver-tin-copper)
Quaternary alloy (silver-tin-copper-indium)Quaternary alloy (silver-tin-copper-indium)

MODE OF SUPPLY:MODE OF SUPPLY:
» Bulk powderBulk powder
» Alloy & mercury in disposable capsuleAlloy & mercury in disposable capsule
» Preweighed alloy as tablet/pellet & mercury inPreweighed alloy as tablet/pellet & mercury in
sachetssachets

Setting reactionsSetting reactions
Low copper alloysLow copper alloys
AgAg33Sn + Hg AgSn + Hg Ag22HgHg33 + Sn+ Sn88Hg + AgHg + Ag33Sn(unreacted)Sn(unreacted)
ýý ýý11 ýý22 ýý
» Silver - Tin comp ( unreacted ) -----Silver - Tin comp ( unreacted ) ----- ýý
» Silver – Hg ----Silver – Hg ---- ýý11
» Tin – Hg ----Tin – Hg ---- ýý22

High copper alloysHigh copper alloys
Ag – Cu ---- eutecticAg – Cu ---- eutectic
AgAg33Sn + Ag-Cu + Hg AgSn + Ag-Cu + Hg Ag22HgHg33 + Sn+ Sn88Hg + AgHg + Ag33Sn + Ag - CuSn + Ag - Cu
ýý eutecticeutectic ýý11 ýý22 ýý eutecticeutectic
SnSn66Hg + Ag – Cu CuHg + Ag – Cu Cu66SnSn55 + Ag+ Ag22HgHg33
ýý22 eutecticeutectic ŋŋ ýý11

PROPERTIESPROPERTIES
Dimensional changes:Dimensional changes:
» Amalgam may expand or contract depending on its manipulationAmalgam may expand or contract depending on its manipulation
» Excessive contraction can lead to microleakage & secondary cariesExcessive contraction can lead to microleakage & secondary caries
» Excessive expansion can produce pressure on pulp & postExcessive expansion can produce pressure on pulp & post
operative sensitivityoperative sensitivity
» According to ADA sp.1, Amalgam should neither contract norAccording to ADA sp.1, Amalgam should neither contract nor
expand more than 20expand more than 20µµm/cm at 37m/cm at 37oo
bet 5min & 24hrs after beginningbet 5min & 24hrs after beginning
of triturationof trituration
EFFECT OF MOISTURE CONTAMINATION:EFFECT OF MOISTURE CONTAMINATION:
» Zinc containing amalgam is contaminated by moister duringZinc containing amalgam is contaminated by moister during
trituration or condensation – delayed expansiontrituration or condensation – delayed expansion
» Starts after 3 to 5 days & continues for months, reaching valueStarts after 3 to 5 days & continues for months, reaching value
greater than 400 umgreater than 400 um
Complications:Complications:
» Protrusion of restoration out of cavityProtrusion of restoration out of cavity
» Increased creep & microleakageIncreased creep & microleakage
» Pitted surface & corrosionPitted surface & corrosion
» Fracture of restorationFracture of restoration

Strength:Strength:
» Amalgam has high compressive strength & low tensile strengthAmalgam has high compressive strength & low tensile strength
1 hour 7 day1 hour 7 day
Low copper 145 MPa 343 MPaLow copper 145 MPa 343 MPa
Admixed 137 MPa 431 MPaAdmixed 137 MPa 431 MPa
Single composition 262 MPa 510 MPaSingle composition 262 MPa 510 MPa
» Tensile strength -- 48 to 70 MPaTensile strength -- 48 to 70 MPa
Factors affecting strength:Factors affecting strength:
» Under or over Trituration -- strengthUnder or over Trituration -- strength
» Lower Hg – strength, Higher Hg -- strengthLower Hg – strength, Higher Hg -- strength
» Greater Condensation pressure -- strengthGreater Condensation pressure -- strength
» Voids & Porosity -- strengthVoids & Porosity -- strength

CreepCreep
» Is a time dependent plastic deformation of crystallineIs a time dependent plastic deformation of crystalline
material under the influence of a static or dynamicmaterial under the influence of a static or dynamic
stress.stress.
Creep rate: 1) Low Cu --- 0.8 to 8.0%Creep rate: 1) Low Cu --- 0.8 to 8.0%
2) High Cu --- 0.4 to 1%2) High Cu --- 0.4 to 1%
Factors affecting creep:Factors affecting creep:
» Higher condensation forcesHigher condensation forces
» Elimination ofElimination of ýý2 phase Creep2 phase Creep
» Excess Hg CreepExcess Hg Creep
» Under or over triturationUnder or over trituration

Tarnish & corrosionTarnish & corrosion
» Tarnish: surface discoloration of metal or slight loss orTarnish: surface discoloration of metal or slight loss or
alteration of the surface finish or lusteralteration of the surface finish or luster
» Corrosion: actual deterioration of a metal by reaction withCorrosion: actual deterioration of a metal by reaction with
its environmentits environment
» Corrosion between restoration & tooth interface -- reducesCorrosion between restoration & tooth interface -- reduces
microleakagemicroleakage

Microleakage:Microleakage:
» Small amount of leakage under amalgamSmall amount of leakage under amalgam
restoration is uniquerestoration is unique
» Leakage decreases as the restoration ages inLeakage decreases as the restoration ages in
the mouth due to the accumulation of corrosionthe mouth due to the accumulation of corrosion
products in the interface between tooth &products in the interface between tooth &
restorationrestoration

MANIPULATIONMANIPULATION
I) Selection of material:I) Selection of material:
» If restoration subjected to heavy occlusal forces – matIf restoration subjected to heavy occlusal forces – mat
highly resistant to marginal fracture is desirablehighly resistant to marginal fracture is desirable
» If quick attainment of strength is necessary – sphericalIf quick attainment of strength is necessary – spherical
alloys are preferredalloys are preferred
» Isolation is problematic – non zinc containing alloysIsolation is problematic – non zinc containing alloys
Eg: - Pt with excessive salivationEg: - Pt with excessive salivation
- Retrograde root canal filling- Retrograde root canal filling
- Very subgingival lesions- Very subgingival lesions

Mercury alloy ratio:Mercury alloy ratio:
» Earlier days excess mercury was used toEarlier days excess mercury was used to
achieve smooth & plastic mixachieve smooth & plastic mix
» Minimum mercury (Eames technique) M/A =Minimum mercury (Eames technique) M/A =1:11:1
Trituration:Trituration:
» Objective is to wet all alloy particles with mercuryObjective is to wet all alloy particles with mercury
» Either done by hand or mechanical amalgamatorEither done by hand or mechanical amalgamator

Under triturated mix:Under triturated mix:
» Rough & grainyRough & grainy
» Gives rough surface after carving & offers leastGives rough surface after carving & offers least
resistance to tarnish & corrosionresistance to tarnish & corrosion
» Mix will harden to rapidlyMix will harden to rapidly
Normal mix:Normal mix:
» Smooth & soft in consistencySmooth & soft in consistency
» Shiny surfaceShiny surface
Over triturated mix:Over triturated mix:
» Mix is soupyMix is soupy
» Too plastic to manipulateToo plastic to manipulate
» Working time is decreased

AdvantagesAdvantages
» Easy to useEasy to use
» Not technique sensitiveNot technique sensitive
» Maintains anatomic forms wellMaintains anatomic forms well
» Have adequate resistance to fractureHave adequate resistance to fracture
» After a period of time prevents marginal leakageAfter a period of time prevents marginal leakage
» Have long service lifeHave long service life
» Lower costLower cost
DisadvantagesDisadvantages
» Color does not match tooth structureColor does not match tooth structure
» More brittleMore brittle
» Subjected to corrosion & galvanic actionSubjected to corrosion & galvanic action
» Eventually shows marginal breakdownEventually shows marginal breakdown
» Do not bond to tooth structureDo not bond to tooth structure
» Less conservative ( more removal of tooth str during toothLess conservative ( more removal of tooth str during tooth
preparation )preparation )
» Oral lichen planus is reported with some amalgam restoOral lichen planus is reported with some amalgam resto

Amalgam bonding systemAmalgam bonding system
» To seal underlying tooth structure & bondTo seal underlying tooth structure & bond
amalgam to enamel & dentinamalgam to enamel & dentin
» 4 – methyloxyethyl trimellitic anhydride4 – methyloxyethyl trimellitic anhydride
( 4-META )( 4-META )

Advantages:Advantages:
» Conservation of tooth structureConservation of tooth structure
» Improved retentionImproved retention
» Decreased micro leakageDecreased micro leakage
» Improved resistance formImproved resistance form
» Decreased post-operative sensitivityDecreased post-operative sensitivity
Disadvantages:Disadvantages:
» Time consumingTime consuming
» Technique sensitiveTechnique sensitive
» Increases cost of amalgam restorationIncreases cost of amalgam restoration

Mercury toxicityMercury toxicity
Sources of Hg contamination:Sources of Hg contamination:
» Hg spillsHg spills
» Leakage from dispensersLeakage from dispensers
» Improper storage of scarp amalgamImproper storage of scarp amalgam
» Contaminated instruments placed in sterilizersContaminated instruments placed in sterilizers
» Removal of old restorationRemoval of old restoration
Hg absorption:Hg absorption:
» As vapor from lungsAs vapor from lungs
» Skin, mucous membraneSkin, mucous membrane
» As ions from tooth into pulpAs ions from tooth into pulp
» Hg ion may be released from corrosion of amalgam resto &Hg ion may be released from corrosion of amalgam resto &
absorbed into G.I.Tabsorbed into G.I.T

OCCUPATIONAL EXPOSURE TOOCCUPATIONAL EXPOSURE TO
MERCURY CAN BE MINIMZEDMERCURY CAN BE MINIMZED
BY(ADA1991)BY(ADA1991)
1) Be aware of hazards & symptoms of mercury1) Be aware of hazards & symptoms of mercury
exposureexposure
2) Know the potential sources of mercury spills2) Know the potential sources of mercury spills
3) Provides proper ventilation in the office3) Provides proper ventilation in the office
4) Periodically monitor mercury vapor level in office4) Periodically monitor mercury vapor level in office
5) Use precapsulated alloy5) Use precapsulated alloy
6) Use amalgamated fitted with cover6) Use amalgamated fitted with cover
7) Avoid skin contact with mercury7) Avoid skin contact with mercury
8) Change face mask after procedure8) Change face mask after procedure
9) Store amalgam scrape under radiographic fixer9) Store amalgam scrape under radiographic fixer
solutionsolution
10) Dispose amalgam scrape according to appropriate10) Dispose amalgam scrape according to appropriate
regulationsregulations
11) Wear professional clothing in the dental operatory11) Wear professional clothing in the dental operatorywww.indiandentalacademy.comwww.indiandentalacademy.com

CompositesComposites
The term composite refers to a three dimensionalThe term composite refers to a three dimensional
combination of at least 2 chemically different materialscombination of at least 2 chemically different materials
with a distinct interface separating the components.with a distinct interface separating the components.
““A compound of 2 or more distinctly differentA compound of 2 or more distinctly different
materials with properties that are superior ormaterials with properties that are superior or
intermediate to those of the individualintermediate to those of the individual
constituents”constituents” ((Anusavice)Anusavice)

Resin matrix:Resin matrix:
» BIS-GMA (Bisphenol glycidyl methacrylate):-BIS-GMA (Bisphenol glycidyl methacrylate):-
» Urethane dimethacrylate (UDMA) :-Urethane dimethacrylate (UDMA) :-
» TEGDMA (triethylene glycol dimethacrylate)TEGDMA (triethylene glycol dimethacrylate)
Filler Particle:Filler Particle:
» StrengthStrength
» RigidityRigidity
» HardnessHardness
» Increases modulus of elasticityIncreases modulus of elasticity
» Decreases coefficient of expansionDecreases coefficient of expansion
» Decreases contractionDecreases contractionwww.indiandentalacademy.comwww.indiandentalacademy.com

» Ground quartzGround quartz
» Colloidal silicaColloidal silica
» Glasses or ceramic containing heavy metal.Glasses or ceramic containing heavy metal.
» Yittrium trifluoride & yitterbiumtrifluorideYittrium trifluoride & yitterbiumtrifluoride
Coupling agent:Coupling agent:
produce a bond between the filler particles andproduce a bond between the filler particles and
the resin matrix.the resin matrix.
» OrganosilaneOrganosilane
» ZirconatesZirconates
» TitanatesTitanates
Coloring agent:Coloring agent:
» Aluminum oxide & titanium dioxide in 0.001-0.007%Aluminum oxide & titanium dioxide in 0.001-0.007%
by wtby wt

Classification:Classification:
According to SturdevantAccording to Sturdevant
I) On the basis of matrix compositionI) On the basis of matrix composition
-Bis-GMA-Bis-GMA
-UDMA-UDMA
II) On the basis of polymerization methodII) On the basis of polymerization method
-Self curing/chemically cured-Self curing/chemically cured
-Ultraviolet light cured-Ultraviolet light cured
-Visible light cured-Visible light cured
-Dual cured-Dual cured
-Staged cured-Staged cured

Based on filler particle size range:Based on filler particle size range:
I. Megafill - contains megafillers- very largeI. Megafill - contains megafillers- very large
individual filler particle.individual filler particle.
2. Macrofill- contains macro fillers (10-1002. Macrofill- contains macro fillers (10-100 µµm)m)
3. Midifill- contains midi fillers (1-103. Midifill- contains midi fillers (1-10 µµm)m)
4. Minifill - contains minifillers (0.1-14. Minifill - contains minifillers (0.1-1 µµm)m)
5. Microfill - contains micro fillers (0.01-0.15. Microfill - contains micro fillers (0.01-0.1 µµm)m)
6. Nanofill - contains nanofillers (0.005-0.016. Nanofill - contains nanofillers (0.005-0.01 µµm)m)

According to MARZOUK:According to MARZOUK:
A) First generation compositesA) First generation composites
Consists of macro ceramic reinforcing phasesConsists of macro ceramic reinforcing phases
in an appropriate resin matrixin an appropriate resin matrix
B) Second generation compositesB) Second generation composites
Colloidal and micro ceramic phases in aColloidal and micro ceramic phases in a
continuous resin phasecontinuous resin phase
C) Third generation compositeC) Third generation composite
Hybrid composite in which there is aHybrid composite in which there is a
combination of macro and micro (colloidal)combination of macro and micro (colloidal)
ceramics as reinforcers, exists in a ratio ofceramics as reinforcers, exists in a ratio of
75:25 in a suitable continuous phase resin.75:25 in a suitable continuous phase resin.

D) Fourth generation composites:D) Fourth generation composites:
These contain heat-cured, irregularly shaped, highlyThese contain heat-cured, irregularly shaped, highly
reinforced composite macro-particles with a reinforcingreinforced composite macro-particles with a reinforcing
phase of micro (colloidal) ceramics.phase of micro (colloidal) ceramics.
E) Fifth generation composites:E) Fifth generation composites:
Hybrid composite in which the continuous resin phase isHybrid composite in which the continuous resin phase is
reinforced with microceramics (colloidal) and macro,reinforced with microceramics (colloidal) and macro,
spherical, highly reinforced, heat cured compositespherical, highly reinforced, heat cured composite
particles.particles.
F) Sixth generation:F) Sixth generation:
Hybrid types in which the continuous phase is reinforcedHybrid types in which the continuous phase is reinforced
with a combination of micro (colloidal) ceramics andwith a combination of micro (colloidal) ceramics and
agglomerates of sintered micro (colloidal) ceramicsagglomerates of sintered micro (colloidal) ceramics

According to particle size by PHILIPSAccording to particle size by PHILIPS
CategoryCategory
AverageAverage
particle size (particle size ( µµmm))
Traditional compositeTraditional composite 8 - 128 - 12
Small particle compositeSmall particle composite 1 - 51 - 5
Microfilled compositeMicrofilled composite 0.04 - 0.50.04 - 0.5
Hybrid compositeHybrid composite 0.6 -1.00.6 -1.0

DifferencesDifferences
Chemically curedChemically cured
» Act – Tertiary amineAct – Tertiary amine
» Init – Benzoyl peroxideInit – Benzoyl peroxide
» Polymerization is centralPolymerization is central
» Curing is in one phaseCuring is in one phase
» Sets within 45 secSets within 45 sec
» No time for manipulationNo time for manipulation
» Not properly finishedNot properly finished
Light curedLight cured
» Act – diketonesAct – diketones
» Ini – Benzoyl methyl etherIni – Benzoyl methyl ether
» Polymerization is peripheralPolymerization is peripheral
» Curing is in incrementsCuring is in increments
» Sets only after light activationSets only after light activation
» Working time is under controlWorking time is under control
of operatorof operator
» Takes better finishTakes better finish

MaterialMaterial ComprCompr
essiveessive
stre(Mstre(M
Pa)Pa)
TensileTensile
stre(MPastre(MPa
))
Hadness(Hadness(
KHN)KHN)
ModulusModulus
ofof
elasticity(elasticity(
GPa)GPa)
ThermalThermal
expansiexpansi
on(X10on(X10--
66
//oo
CC
ClinicalClinical
consideratioconsideratio
nn
ConventionalConventional 250-250-
300300
50-6550-65 55-6055-60 8-158-15 25-3525-35 Polishing isPolishing is
difficultdifficult
Poor resitPoor resit
occl wearoccl wear
DiscolorDiscolor
MicrofilledMicrofilled 250-250-
350350
30-5030-50 25-3025-30 3-63-6 50-6050-60 Ant teethAnt teeth
Not stressNot stress
bearingbearing
areasareas
SmallSmall
particleparticle
350-350-
400400
75-9075-90 50-6050-60 15-2015-20 19-2619-26 Cl II & IVCl II & IV
HybridHybrid 300-300-
350350
70-9070-90 50-6050-60 7-127-12 30-4030-40 Ant restorAnt restor
Post restorPost restor

Indications:Indications:
» For esthetically pleasing restorations, class III, IV and V.For esthetically pleasing restorations, class III, IV and V.
» Areas of minimal masticatory loading.Areas of minimal masticatory loading.
» Only used for supra gingival lesions.Only used for supra gingival lesions.
» Used in areas of erosion and abrasions lesions, where teeth are veryUsed in areas of erosion and abrasions lesions, where teeth are very
sensitive and cavity preparation may increase that sensitivity.sensitive and cavity preparation may increase that sensitivity.
» In a badly broken down tooth prior to end/ortho/perio treatment.In a badly broken down tooth prior to end/ortho/perio treatment.
» For provisional splintingFor provisional splinting
» In case of midline diastema closureIn case of midline diastema closure
» As a core materialAs a core material

ContraindicationsContraindications
Composites are generally not recommended underComposites are generally not recommended under
the following conditions.the following conditions.
» Improper isolation of operating site.Improper isolation of operating site.
» Heavy occlusal stressesHeavy occlusal stresses
» Deep sub gingival areas that are difficult toDeep sub gingival areas that are difficult to
prepared or restore.prepared or restore.
» Poor oral hygiene.Poor oral hygiene.

Advantages Of CompositesAdvantages Of Composites
» Good esthetics.Good esthetics.
» Conservation of tooth structure.Conservation of tooth structure.
» Improved resistance to microleakage.Improved resistance to microleakage.
» Strengthening of remaining tooth structure.Strengthening of remaining tooth structure.
» Low thermal conductivity.Low thermal conductivity.
» Elimination of mercury in dental environmentElimination of mercury in dental environment
» Economic - less expensive compared to gold orEconomic - less expensive compared to gold or
porcelain.porcelain.

Disadvantages:Disadvantages:
» Highly technique sensitive.Highly technique sensitive.
» Shrinkage during polymerization affects marginalShrinkage during polymerization affects marginal
adaptationadaptation
» Possible open Interproximal contactsPossible open Interproximal contacts
» Limited wear resistance in high stress areas.Limited wear resistance in high stress areas.

Flowable compositeFlowable composite
Similar to traditional composite but filler content isSimilar to traditional composite but filler content is
reduced – decrease the viscosityreduced – decrease the viscosity
APPLICATIONS:APPLICATIONS:
» Filling mat in low stress areasFilling mat in low stress areas
» Repairing amalgam, composite or crownRepairing amalgam, composite or crown
marginsmargins
» Pit &fissure sealingPit &fissure sealing
» Liners in proximal box cl IILiners in proximal box cl II
» Core build upCore build up
» Veneer materialVeneer material
» Cementing agent for porcelain restorationCementing agent for porcelain restoration

Anti bacterial compositeAnti bacterial composite
Chlorhexidine has been tried to reduceChlorhexidine has been tried to reduce
plaque accumulationplaque accumulation
Disadv:Disadv:
» Toxic effect of released materialToxic effect of released material
» Population shift of the micro organismPopulation shift of the micro organism
» Anti bacterial activity is short livedAnti bacterial activity is short lived
» Deterioration of the physical & mechanicalDeterioration of the physical & mechanical
propertiesproperties

Dentine Bonding AgentDentine Bonding Agent
First generation:First generation:
» Bowen early1950Bowen early1950
» Surface active co monomer – N-phenyl-glycine-Surface active co monomer – N-phenyl-glycine-
glycidyl methacrylateglycidyl methacrylate
Second Generation:Second Generation:
» Early 1980Early 1980
» Holophospheric esters of unfilled resin(BISGMA &Holophospheric esters of unfilled resin(BISGMA &
HEMA)HEMA)
» Improved surface wetting and ionic interactionImproved surface wetting and ionic interaction
between phosphate group & calcium in dentinalbetween phosphate group & calcium in dentinal
smear layersmear layer

Drawbacks:Drawbacks:
» Lack of adequate bond strengthLack of adequate bond strength
» Poor adaptation to dentinePoor adaptation to dentine
» Lack of sufficient knowledge about presence & nature of smearLack of sufficient knowledge about presence & nature of smear
layerlayer
Third generation:Third generation:
» Late 1980Late 1980
» Either mdify or remove the smear layer to allow resin penetrationEither mdify or remove the smear layer to allow resin penetration
into underlying dentineinto underlying dentine
Fourth generation:Fourth generation:
» Early 1990Early 1990
» Total etch techniqueTotal etch technique
- Conditioning- Conditioning
-Priming-Priming
-bonding-bonding

Fifth generation:Fifth generation:
» Simplified versionSimplified version
» Priming + bonding agentPriming + bonding agent
» Single system adhesivesSingle system adhesives
Adv:Adv:
» Bond strength is moreBond strength is more
» Post oper sensitivity is rarePost oper sensitivity is rare
» Some agents contains FSome agents contains F
» Time saving & simple to useTime saving & simple to use
Sixth generation:Sixth generation:
» Etchent+bonding agentEtchent+bonding agent
» Self etchent primerSelf etchent primer

ConclusionConclusion

ReferencesReferences
» Pediatric Dentistry : Total Patient care --- Stephen H.Y. WeiPediatric Dentistry : Total Patient care --- Stephen H.Y. Wei
» Pediatric Dentistry --- Ray E. StewartPediatric Dentistry --- Ray E. Stewart
» Fundamentals of pediatric dent. --- R.MathewsonFundamentals of pediatric dent. --- R.Mathewson
» Art & science of Operative Dentistry --- SturdevantArt & science of Operative Dentistry --- Sturdevant
» Pediatric Dentistry : Infancy through Adolescence --- PinkhamPediatric Dentistry : Infancy through Adolescence --- Pinkham
» Dentistry for child and adolescent – Mc DonaldDentistry for child and adolescent – Mc Donald
» Restoration & Prevention of Tooth Structure --- Graham J.Restoration & Prevention of Tooth Structure --- Graham J.
mountmount
» Textbook of Operative Dentistry ---- Vimal K. SikriTextbook of Operative Dentistry ---- Vimal K. Sikri

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