18. Biocompatibility of Dental materials.pptx

1
Dr Aayushi shah
I MDS
BIOCOMPATIBILITY
OF DENTAL
MATERIALS

CONTENTS
• Introduction
• Definitions
• Requirements for dental material biocompatibility
• Measuring biocompatibility
• Adverse effects of dental materials
• Key principles effecting biocompatibility
• Current biocompatibility issues
• Clinical guidelines for selecting biocompatible materials
• Conclusion
2

INTRODUCTION
• Although the concept of the ethical treatment of patients extends
back to the time of Hippocrates, the idea that new dental materials
must be tested for safety and efficacy before their clinical use is very
recent.
• As late as the mid 1800’s, dentists tried new materials for the first
time in the patient’s mouth. This included the renowned G.V.Black.
• The concept of protecting the patient is only 30-40 years old, and
since then using humans as research subjects is considered unethical
and illegal.
• Therefore, many alternative tests have been developed to try to
minimize the risk to humans
Phillip’s Science of Dental Materials 11th Edition
3

■The oversight for such testing rests largely with the
⮚Food and Drug Administration (FDA)
⮚American National Standards Institute (ANSI)
⮚American Dental Association (ADA)
⮚International Organization for Standardization(ISO)
Phillips Science of Dental Materials 11th Edition
4

“It is the capability of a material to exist in
harmony with the surrounding biological
environment”
GPT 8
5
Restorative dental materials- CRAIG 12th edition

HOW IS BIOCOMPATIBILITY RELEVANT TO
DENTISTS?
• Dentist’s potential concerns about biocompatibility can be
organized into 4 areas:
A. Safety of the patient,
B. Safety of the dental staff,
C. Regulatory compliance issues, and
D. Legal liability.
J Prosthet Dent 2001;86:203-9
6

SAFETY OF THE PATIENT
• Classically, this concern has focused on allergy
to materials such as nickel or methacrylate's.
• There is also growing concern about the
hypersensitivity of patients to resin-based
materials and to latex
• However, the evidence about harmful effects
from materials is, more often than not,
equivocal or incomplete.
• It therefore is every practitioner’s responsibility
to decide whether the existing evidence has
merit and to assess the risks of these issues in
his or her own practice, taking into account each
patient’s unique history
7

SAFETY OF THE DENTAL STAFF
• In many situations, the risk of adverse
effects of biomaterials is much higher for
the dental staff than for the patient. The staff
may be chronically exposed to materials
when they are being manipulated or setting.
• Hence the required precautions need to be
taken and the staff must be made aware of
the harmful effects of various biomaterials 8

9
✔ The location of the material
✔ It’s duration in the body
✔ The properties of the material
✔ The health of the host

BIOLOGIC RESPONSE IN THE DENTAL
ENVIRONMENT
• Factors that have a profound effect on biologic response :
✧The tooth anatomy
✧The periodontal attachment
✧The mucosa
10

THE ENAMEL DENTIN AND PULP
ENVIRONMENT
• It represents a unique symbiosis of mineralized
tissues and cells
11

PERIODONTAL ATTACHMENT
• Dental restorations are near or in the periodontal attachment area
hence the biocompatibility of these material may influence:
12
✔ the normal architecture
✔ Periodontal disease
process
✔ Body’s ability to defend
against bacteria that
cause periodontal
disease.

THE ORAL IMMUNE SYSTEM
• Dental material can cause immune
hypersensitivity reactions in oral
mucosa and gingiva.
• When exposed to the oral
environment materials may have
different reactions as compared to
their exposure to other parts of the
body ( GI Tract, skin etc)
13

SPECIAL BIOLOGICAL INTERFACES WITH
DENTAL MATERIALS
• The use of dental materials to restore damages or lost tooth
structure creates a specific environment where the
biocompatibility of the material is of great importance.
• The two specialized interfaces being:
✧Dentin-resin interface
✧Bone-implant interface
14

A. DENTIN RESIN INTERFACE
15

B. BONE-IMPLANT INTERFACE
• The ability of a material to osseointegrate is closely related to
its biocompatibility
16

BIOMATERIAL
⮚Any substance, other than a drug, that can be used for any period as a
part of a system that treats, augments, or replaces any tissue, organ or
function of the body.
(G.P.T. 8th edn.-2005)
17
BIOACTIVE MATERIAL
Surface of the material is specifically pre-treated
“BIOFUNCTIONALIZED”
(Gottfried Schmalz & Dorthe arenholt-bindslev)

REQUIREMENTS FOR DENTAL MATERIAL
BIOCOMPATIBILITY
✧Should not be harmful to pulp and soft tissues.
✧Should not contain toxic, diffusible substances that can be
released and absorbed into the circulatory system to cause a
systemic toxic response.
✧Should be free from potentially sensitizing agents that are likely
to cause an allergic response.
✧Should have no carcinogenic potential
18

CLASSIFICATION OF BIOMATERIALS FROM
PERSPECTIVE OF BIOCOMPATIBILITY
⮚Those which contact soft tissues within the oral cavity
eg. Acrylic resin
⮚Those which could affect health or vitality of pulp
eg. Liner, bases
⮚Those which are used as root canal filling materials
eg. Gutta percha
19

⮚Those which affect hard tissues of oral cavity
eg. Implants
⮚Those used in dental laboratory
eg. Nickel, chromium, cobalt
20

ASSESSING BIOCOMPATIBILITY
• Purpose of different tests used is to
eliminate any potential
product/component of a product that
can cause harm/damage to oral
tissues.
• Several varieties of tests are
currently used to ensure that new
materials are biocompatible.
21

THE TESTS ARE CLASSIFIED AS:
In-vitro
or
primary
In-vivo or animal or
secondary tests
Preclinical usage tests
22

23
TEST ADVANTAGES DISADVANTAGES
In vitro tests quick to perform, least
expensive, can be
standardized, good
experimental control.
relevance to in vivo is
questionable
In vivo tests allows complex systemic
interactions, response more
comprehensive than in
vitro tests
relevance to use of material
is questionable, expensive,
time consuming,
legal/ethical concerns.
Usage tests relevance to use of
material is assured
very expensive, time
consuming, major
legal/ethical issues, difficult
to interpret & quantify.

PRIMARY TESTS
• In vitro tests for biocompatibility are done in a test tube or in a cell-
culture dish.
• These tests can be subdivided into
24
Cytotoxicity
Tests
Genotoxicity
Tests

CYTOTOXICITY TESTS
Asses cell death caused by a material measuring cell number
or growth before and after exposure to the material.
A. Zone of inhibited cell growth
B. Change in Membrane Permeability
25

GENOTOXICITY TESTS
⮚Determines carcinogenic/mutagenic
potential
⮚Carried out on mammalian or non-
mammalian cells, bacteria, yeasts, or fungi.
⮚Evaluates gene mutations, changes in
chromosomal structure & other DNA or
genetic changes caused by dental materials.
26

AMES TEST :-
⮚ Material is tested with mutant histidine dependent bacteria
⮚ Agent is added to culture medium consisting salmonella typhimurium
mutant gene which cannot produce histidine
⮚ If carcinogenic :- salmonella species reversed to original state, i.e....
start producing histidine again
27

SECONDARY TESTS
At this level the product is evaluated for
a. Systemic toxicity
b. Inhalation toxicity
c. Skin irritation and sensitization
d. Implantation responses
28

A. SYSTEMIC TOXICITY TESTS:
⮚Oral median lethal dose (LD50)
test is carried out.
⮚Test sample is administered
daily to rats for 15 days.
⮚If 50% of the animals survive,
the product has passed the test.
29

B. INHALATION TOXICITY TESTS
Performed on rabbits, rats or guinea pigs.
Carried out in an inhalation chamber with aerosol preparations,
by releasing the spray materials around the head and upper trunk
of the animals
30 seconds of continuous spray at 30 minute intervals
After 10 consecutive exposures, the animals are observed over a 4
day period
If animal dies within 2-3 minutes, the agent is considered very toxic
If none of the animals die, the agent is not likely to be harmful to
humans.
30

C. DERMAL TOXICITY TESTS
This is important because of the large
no. of dental products we contact
daily.
✔Primary irritant🡪 capable of
producing an inflammatory response
in most susceptible people after the
first exposure.
✔Once the toxic
material/product/component is
identified, it can be replaced, diluted,
neutralized and chelated to reduce the
risk of toxicity.
31

✔The test material is held in contact with shaved skin of the
lab animals for 24-90 days. (Animal must receive an
occlusive covering to prevent mechanical loss of
contacting agent, even by evaporation.)
✔After removal of the dressing, at 24, 48 and 72 hours, the
skin reactions at the challenged sites are evaluated and
graded.
32

D. IMPLANTATION TESTS
Physical characteristics :
- form
- density
- hardness
- surface finish
have to be taken into account as they can influence the character of the tissue
response.
Animal species are selected according to the size of the implant test specimen
and the intended duration of the test with respect to the life span of the
animal. 33

Short Term Tests
Less than 12 weeks
Given in s.c. tissue and muscle
Mice, rats, hamsters, guinea pigs.
Long Term Tests
More than 12 weeks
Given in muscle or bone
Rabbits, dogs, sheep, goats &
sub-human primates.

PRECLINICAL USAGE TESTS
This group of tests is the most important with regard to the use of
drugs.
Pulp and Dentin Usage Tests: Used to assess the biocompatibility
of dental materials placed in dentin, adjacent to the dental pulp.
Conducted on non rodent mammals (i.e. subhuman primates, dogs
and miniature pigs.)
35

Class V cavities are cut on buccal/labial surfaces leaving 1mm or
less tubular dentin between the floor of the cavity preparation
and the pulp.
The cavities are restored with test material and some are
retained for control specimens
• Negative control some form of ZOE is used.
• Positive control restorative material that consistently induces
a moderate to severe pulp response.
The animals are sacrificed after 7, 28 and 70 days.
Histopathological examinations are done
36

Specimens are graded for:
❖degree of inflammatory response
❖prevalence of reparative dentin formation in the pulp
❖No of microorganisms (microleakage) entrapped in
surrounding cavity walls and cut dentinal tubules.
37

• Promising test specimens induce the least inflammatory
response in the pulp.
If a response is produced, the time required to disappear is also
measured.
• As a rule, the less the reparative dentin that is subsequently
formed the better.
This is because there is more bulk of vital pulp tissue available
to deal with future episodes of caries and dental treatment.
38

HOW TESTS ARE USED TOGETHER TO MEASURE
BIOCOMPATIBILITY
• The no. of materials tested is
represented by the width of the
triangle.
• Thus all will be tested at the primary
level but many will not have responses
favorable enough to be carried to
secondary tests.
• Likewise only materials that show
favorable responses in the secondary
tests will be evaluated by the usage
tests.
39
Classical progression of
biocompatibility tests in
the assessment of a new
material.

• All three tests may be done
initially but as the testing
progresses the usage tests
predominate.
• The most common progression
is from primary to secondary
to usage tests, but any test can
be performed at any time in
the development of a material.
40
These diagrams show several
newer schemes for the
progression of biocompatibility
tests in the assessment of a
new material.

ADVERSE EFFECTS OF DENTAL MATERIALS
❖ Localized toxicity
❖ Systemic response
❖ Allergic reactions
❖ Carcinogenicity
41

TOXICITY:
✔Earliest response studied.
✔The first screening test used for almost all
materials is the
“Toxicity Test”
✔Eg: Early dental materials containing lead
posed a real risk to the patient because of
the toxic properties of the lead that
leached into the patient’s body.
42

INFLAMMATION:
⮚It involves the activation of the body’s immune system to ward off
some threat.
⮚May result from toxicity or allergy.
⮚Histologically it is characterized by:
Edema of the tissues
Infiltration of inflammatory cells
*neutrophils=short term
*monocytes and other lymphocytic cells=long term
⮚Eg. Animal test used for material biocompatibility
43

ALLERGIC RESPONSE
⮚Occurs when the body specifically recognizes a material
as foreign and reacts disproportionately to the amount of
material present.
⮚Involves all dimensions of the immune system including T
& B lymphocytes and monocytes or macrophages
⮚Histologically it results in an inflammatory response that
can be difficult to differentiate from
Non allergic inflammation
Low grade toxicity
44

⮚Types:
I - Immediate atopic or anaphylactic
reaction.
II - Cytotoxic hypersensitivity
response.
III- Immune complex hypersensitivity
response.
IV- Delayed or cell mediated
hypersensitivity.
V- Stimulating antibody reaction.
VI- Antibody-dependant, cell
mediated
cytotoxicity reaction. 45

❖E.g. Of Type I, II and III: Latex Allergy
❖ *Direct activation of antibodies to the material
❖ *Occur quickly
❖ *Modulated by eosinophils, mast cells or B lymphocytes
❖E.g. of Type IV: Metal Allergy
❖ *Metal ions must first interact with the host molecules
❖ *Delayed reaction
❖ *Modulated primarily by monocytes and T cells
A key difference between a non allergic response and an allergic response is
the fact that in an allergic response, the individual’s immune system
recognizes a substance as foreign.
46

MUTAGENIC REACTIONS
⮚Occur when components of a material alter the base-pair sequences
of the DNA cells. These alterations are called mutations.
⮚Mutations maybe caused by
*direct interactions between a substance and DNA
*indirect alterations in the cellular processes that maintain DNA
integrity
⮚Mutations may result from many factors
*radiation
*chemicals
*errors in DNA replication
47

❖ Metal ions such as
❖ Nickel
❖ Copper
❖ Beryllium
❖ Root canal sealers have been shown to be mutagenic.
❖ Resin based materials have also been shown to have some mutagenic
potential.
❖ It must be clear that mutagenicity does not imply carcinogenicity, because
many mutations are repaired and others are irrelevant.
❖ Eg of materials of interest in prosthodontics- latex gloves, eugenol, MMA
monomer, epoxy resins, cyanoacrylate resilient liners, dust from plaster
models and alginate, metal and porcelain materials.
48

CURRENT BIOCOMPATIBILITY ISSUES IN
DENTISTRY
50

ALLERGIC CONTACT DERMATITIS:
• It occurs where the body surface makes contact with the
allergen.
• most common
• The interval between exposure to the causative agent and
the occurrence of clinical manifestations varies between 12-
48 hours
• Incubation period : 2 days - several years
51

Clinical Features:
✔Itching or burning sensation at
the site of contact
✔Erythema and vesicle formation.
✔After rupture of vesicles, erosions
may become extensive, and if
secondary infections occur, the
lesions may become serious.
✔In chronic contact the skin may
become thickened and dry.
52

ALLERGIC CONTACT STOMATITIS:
✔Maybe -local or contact type
✔ Distant from material site
✔The long term reactions are dependent on
composition of materials, degradation
products, toxic components, concentration
of absorbed and accumulated components.
53

Clinical Features :
✔Mucosa may become
inflamed and edematous,
having a smooth shiny
surface.
✔Severe burning sensation
which may be accompanied
by pruritis.
✔Small vesicles may form
which when rupture lead to
erosions and ulceration.
✔Secondary infection is
particularly common.
54

ALLERGY TESTS
• Patch Test
• Epi mucosal test ( Alternate to Patch Test)
• Prick Test
• RAST ( Alternate to Prick Test)
• Immunotoxicological Test – LTT & MELISA
• Pulp Sensitivity Tests
• Analysis of Intraoral Alloys-
For removable Prosthesis- EDX analysis
For Fixed prosthesis – CHIP TEST
Biocompatibility of dental materials – Gottfried Schmalz & Arenholt
55

• A 55-year-old man with a dental prosthesis for 3 years had a chronic relapsing
cheilitis for more than 1 year. Patch test was performed.
• The test confirmed sensitivity to Ammonium persulfate.
• The adsorption of the persulfate and its progressive release, necessary for
sensitization and the allergic phenomena, were favored by the porosity of the
prosthesis. Chemicals used for dental prosthesis cleaning should be carefully
considered in the etiologic diagnosis of allergic contact cheilitis. Patients with
dental prostheses should be tested for ammonium persulfate.
56
Allergic contact cheilitis due to effervescent dental cleanser:
combined responsibilities of the allergen persulfate and prosthesis
porosity
Le Coz CJ, Bezard M. Allergic contact cheilitis due to effervescent dental cleanser: combined responsibilities of the allergen
persulfate and prosthesis porosity. Contact Dermatitis. 1999 Nov;41(5):268-71.

GALVANISM
⮚Flow of current when two dissimilar
metallic restorations oppose each other
in oral cavity
⮚Due to different electromotive
potentials of opposing metals
⮚Saliva acts as electrolyte
⮚Contact----- Short-circuit-------current
flows through pulp------Pain &
Discomfort
57

⮚Prevention :-
Placement of insulating base
Applying varnish on cavity walls
Proper planning of restoration
58

LATEX ALLERGY
• sources are gloves and latex rubber dam.
• problem for both the dentist as well as the patient
A true latex allergy A reaction to accelerators &
Antioxidants used in latex
Processing.
Thiuram-Chemical used in
the fabrication of latex
products
Polyether-component in
latex rubber gloves.
59

Clinical features:
localized rashes and swelling
Dermatitis of the hands is the
most common side effect.
systemic allergic reactions occur
when latex containing products
such as gloves and rubber dams,
contact the mucous membrane.
Prevention:
Vinyl gloves or gloves made
from other systemic polymers
maybe used
60

METALLIC ALLERGY
• When metals and alloys are used in dentistry, there is
the opportunity for adverse reactions caused by the
release of metal ions.
• Except for certain noble metals, pure metals and
alloys used in dentistry derive biocompatibility from
the formation of a protective layer on the surface
called a passive film, which is an oxide of one or
more of the components of the alloy.
• These films are products of an oxidative (corrosive)
reaction that reduces the corrosion rate by several
orders of magnitude and essentially prevents further
corrosion once the passive layer is formed.
61
John KR. Biocompatibility of dental materials. Dental Clinics of North America. 2007 Jul 1;51(3):747-60.

ALLERGY TO NICKEL
• used for crowns, FPD’s, RPD’s
• Nickel is the most allergenic metal known
• The reaction is very subtle and resembles a periodontal inflammation
• If an adverse allergic response occurs, little can be done other than to
exchange the metal component for one that does not contain nickel.
62

TOXICITY AND ALLERGENICITY OF
BERYLLIUM
• Used in Ni-Cr alloys in concentrations of 1-2 wt% to increase the
castability of these metals and decrease their melting range.
63
✔Beryllium particles that are inhaled
and reach the lungs may cause a chronic
inflammatory condition called
“berylliosis”. Occurs only in
individuals with a hypersensitivity
towards beryllium and may occur from
inhalation of beryllium dust, fumes or
salts such as those encountered when
casting beryllium containing alloys.
✔Beryllium containing alloys should be
ground only with proper ventilation.

Suspected association of an allergic reaction with titanium
dental implants:A clinical report
• A 50-year-old woman presented with the facial eczema in association
with a titanium dental implant placed for a mandibular overdenture
supported by 2 implants. Complete remission was achieved by the
removal of the titanium material. This clinical report raises the
possibility that in rare circumstances, for some patients, the use of
titanium dental implants may induce an allergic reaction.
Evrard L, Waroquier D, Parent D. Allergies to dental metals. Titanium: a new allergen. Revue médicale de
Bruxelles. 2010;31(1):44-9.
64

• Acrylic monomer is known to be an
irritant. However, residual monomer
levels are normally very low in
properly prepared dentures
(approximately 0.3%) and, therefore,
it is unlikely to produce irritant
contact stomatitis.
• Inadequately short curing cycles or
the use of certain auto polymerizing
resins with excessive residual
monomer content can lead to allergic
contact stomatitis.
65
METHYL METHACRYLATE(MMA)
Koutis D, Freeman S. Allergic contact stomatitis caused by acrylic monomer in a denture. Australasian journal of
dermatology. 2001 Aug 9;42(3):203-6.

MANAGEMENT
66
Methods for decreasing residual
monomer:
1. A method was suggested by Jorge et al,
he said that after polymerization, water
bath at 55 degrees for 1 hr reduces the
toxicity.
2. Sheridan et al said cytotoxic effect of
acrylic was greater in first 24 hours.
Hence longer the resins were soaked-
less cytotoxic effect.
ALLERGY-FREE DENTURES:
1. High impact polystyrene
2. Polycarbonates
3. Polyvinyl chloride-based acrylic
4. Metallic denture base
5. Light activated denture material
6. Flexible denture base (Valplast)
Koutis D, Freeman S. Allergic contact stomatitis caused by acrylic monomer in a denture. Australasian journal of dermatology. 2001 Aug

• This article reported 2 patients who developed an acute onset
hypersensitivity reaction to their acrylic ocular prosthesis within 48
hours.
• Symptoms include ocular irritation, pruritus and excess mucus discharge
• The first patient was successfully switched to a glass eye. The prosthesis
of the second patient was treated with an extra long curing cycle, after
which, the patient was able to tolerate their prosthesis with no
complications.
67
Features and Management of an Acute Allergic Response
to Acrylic Ocular Prostheses
Conclusion: The residual unpolymerized monomer that is present within
poly-methyl methacrylate (PMMA) can rarely cause an allergic reaction.
As an alternative to a glass eye the prosthesis may be subjected to an
extended curing cycle converting more of the monomer to polymer

IMPRESSION MATERIALS
⮚Irreversible hydrocolloids :- Inhaling
fine airborne particles (dust) can cause
silicosis & pulmonary hypersensitivity.
Dustless/Dustfree alginate is preferred
⮚Elastomers :- Cellular toxicity levels
Polyether > Addition Silicone >
Polysulphide
Hypersensitivity potential of polyether
catalyst system
68

LABORATORY MATERIALS
⮚Cyanide solution : used as an
electrolyte for the electroplating of
cast & dies is very poisonous
⮚Siliceous particles : used in silica
bonded investment materials can
cause silicosis
69

PULP RESPONSE TO SPECIFIC AGENTS AND
TECHNIQUES
Chemically Cured Restorative Resins :
⮚Despite the presence of fillers, they still cause chronic
pulpitis for an indefinite period of time even in cavities of
ordinary depth.
⮚ To avoid this, the cavity must be properly lined.
⮚The response to composite restorations takes several days
to 3 weeks to develop a massive pulp lesion.
71

Visible Light Cured Resin Composites:
⮚It is important to obtain as complete a polymerization as possible to
minimize pulp response
⮚VLC systems provide the advantage of:
Greater depth of cure
Shorter curing times
Less porosity
More wear resistant composite restorations.
⮚Volumetric shrinkage with the resulting microleakage is still of
great concern.
72

Resin Based Composite Cements (Dual Cure):
• These are indicated for
✔ all ceramic crowns
✔ metal ceramic crowns
✔ ceramic veneers
✔ porcelain inlays
• They have - relatively low viscosity
- adhesive and bonding potential
• However, if the adequate light curing time is not used,
polymerization is not complete 🡪 the remaining uncured
resin causes excessive pulp response.
73

✔When used as a base i.e. as a thick putty like mass, zinc phosphate
cement is not a highly toxic substance.
✔However when it is used as a cement or a liner, i.e. as a thin mix,
the response is very different.
When the cement is subjected to biting force, phosphoric acid is
forced into the dentinal tubules in such a quantity that after 3-4
days it creates a widespread 3-D lesion involving all the coronal
pulp tissue.
74
ZINC PHOSPHATE CEMENT:

The best protection against phosphoric acid penetration is provided by
coating the dentin with 2 layers of appropriate:
⮚varnish
⮚dentin bonding agent
⮚liner
⮚thin wash of calcium hydroxide (this mechanically plugs the dentinal
tubules and neutralizes acids)
⮚hydrophilic resin primers 75

ZINC OXIDE EUGENOL CEMENT
▪ Eugenol from ZOE,
depresses cell respiration and
reduces nerve transmission
with direct contact.
• Their pH is approx. 7 at the
time of placement, which
potentially makes them least
irritating of all dental
materials.
76

GIC:
⮚The pulp response is classified as bland, moderate and less
irritating than silicate cements, zinc phosphate and
chemically cured resin cements.
⮚Blandness is attributed to the absence of strong acids and
toxic monomers.
• Polyacrylic acids are much weaker than phosphoric acid
• As polymers, they have much higher mol. wts which limits
their diffusion through the dentinal tubules to the pulp.
77

• GIC appears to be a pulp irritant only when
used as a luting agent.
The remaining dentin thickness is a
determining factor of the pulp response.
0.5mm or less of RDT may cause
✔ pulp abscess
✔ intense hemorrhage
Therefore a small dab of calcium hydroxide
maybe applied in areas of extensive crown
preparation.
78

CONCLUSION
✔ Biocompatibility is especially relevant to Prosthodontists and
other restorative dentists because the practitioners rely heavily
on materials that remain in intimate contact with living tissues
for long periods.
✔ Biocompatibility of dental material depends on its
composition, location and interactions with the oral cavity.
✔ Decisions about biological safety of prosthodontic materials
are as much philosophical as scientific. Since no material can
be proven 100% safe, the decision to use a material in the
mouth must balance the potential risks and benefits.
79

REFERENCES
✔Philips Science of Dental Materials - Kenneth J. Anusavice
✔Dental Materials – Properties & Manipulation - Craig
✔Biocompatibility of Dental Materials Kenneth R. St. John, PhD
Dent Clin N Am 51 (2007) 747–760
✔ Biocompatibility: It’s future in Prosthodontic Research; JPD
1993,69:406-415
✔Principles of Biocompatibility for Dental Practitioners; JPD
2001,86:203-209 80

✔Toxicity of Methyl Methacrylate in dentistry; IDJ 2003,53:126-
130
✔Hensten Peterson perceived side effects of biomaterials in
dentistry; JPD 1991,65-1:138-144
✔Textbook of Oral Pathology; Shafer 4th edition
✔Animal tests for biocompatibility of dental materials-relevance,
advantages and limitations; R. M. Browne J. Dent. Suppl. 2,
1994; 22: S21 -S24
✔Biocompatibility of some materials used in dental
implantology: histological study” Collolds and Surfaces B.
Biointerfaces, 1(19933)23-32 81

✔In vitro models of biocompatibility: A review Carl T. Hanks’,
Dent Mater 12:186-l 93, May, 199
✔Principles of biocompatibility for dental practitioners John C.
Wataha ; J Prosthet Dent 2001;86:203-9
82

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