This document summarizes the results of a 4-year study evaluating the performance of the N'Durance composite material from Septodont. 52 restorations using N'Durance were placed on 30 patients. At the 4-year evaluation, 26 restorations on 15 patients were assessed using modified USPHS criteria. The results found that most categories scored 100% Alpha, indicating the composite demonstrated satisfactory esthetics and strength over 4 years. Specific results included 73% Alpha for color match, 77% Alpha for marginal adaptation, and 96% Alpha for polishability. The study concluded that N'Durance performed well over 4 years for anterior restorations.
This study evaluated the marginal and internal adaptation of class II composite inlays made with or without different resinous bases after mechanical loading. Forty human molars were prepared with class II cavities and assigned to five groups: four with different resinous bases (two flowable composites, a compomer, and a restorative composite) and one control with no base. Composite inlays were made for each tooth and subjected to mechanical loading. Marginal and internal adaptation were assessed before, during, and after loading using scanning electron microscopy. Preliminary results found marginal tooth fracture ranged from 30.7-37.6% across groups, while marginal opening in dentin ranged from 9.2-30.1% depending
The document reviews new resins being developed for dental composites. It discusses the history and composition of composites. Shortcomings of traditional composites like polymerization shrinkage and techniques sensitivity are addressed. New materials aim to reduce shrinkage through modified monomers and fillers. Bulk-fill composites allow thicker placement in less time. Self-adhesive composites bond without separate bonding steps. Bioactive materials incorporate antimicrobial or remineralizing agents. Future areas of research include further reducing stresses during curing and improving resistance to degradation in the oral cavity.
Evaluation of Marginal integrity and Depth of Cure for three ‘bulk fill’ comp...pratiklovehoney
Evaluation of Marginal integrity and Depth of Cure for three ‘bulk fill’ composites : SDR, Tetric Evoceram Bulk Fill Composite and EverX Posterior Bulk Fill Composite - An In Vitro study
The document summarizes a clinical study that evaluated a packable resin composite material called SureFil for posterior dental restorations over a period of 3 years. Fifty-five restorations were placed in 36 patients and evaluated periodically according to the Ryge criteria. After 3 years, 40 of the 47 remaining restorations were rated as excellent, with only 6% failure rate. The study concluded that SureFil packable resin composite can be considered successful for Class I and II restorations with acceptable clinical performance over 3 years.
Direct pulp capping involves placing a protective material directly over an exposed dental pulp to encourage healing and formation of reparative dentin. It is a conservative treatment alternative to root canal therapy to save a tooth's vitality when the exposure is small. Success rates range widely from 13-98% depending on factors like the type of exposure, quality of the restoration, and operator skill. Calcium hydroxide and mineral trioxide aggregate are commonly used capping materials that induce healing, but newer options like Biodentine show promise as well. Future trends may involve techniques like lasers, gene therapy, or stem cells to further improve pulp capping outcomes.
This document discusses root canal sealers and their use in endodontic treatment. It provides information on the rationale and timing of obturation after root canal treatment. The key purposes of root canal sealers are to seal the root canal system, fill any irregularities or voids, and entomb any remaining bacteria. Common types of sealers discussed include zinc oxide-eugenol based, calcium hydroxide, and resin-based sealers. Properties of an ideal sealer and factors influencing the selection and performance of different sealer materials are also outlined.
This document discusses pulp capping, which involves placing a biocompatible material over exposed dental pulp to avoid pulp tissue exposure and promote healing. It describes indirect pulp capping, which leaves decayed dentin behind to avoid pulp exposure, and direct pulp capping, which dresses small pulp exposures with calcium hydroxide or resin bonding agents. Successful pulp capping requires maintaining pulp vitality without pain or pathology and promoting dentin bridge formation. Calcium hydroxide is commonly used but can degrade over time, while resin bonding agents may provide a better seal but with less evidence of success.
Effect Of Solvent Type On Microtensile Bond Strength Of TotalEtch One-Bottle ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study evaluated the marginal and internal adaptation of class II composite inlays made with or without different resinous bases after mechanical loading. Forty human molars were prepared with class II cavities and assigned to five groups: four with different resinous bases (two flowable composites, a compomer, and a restorative composite) and one control with no base. Composite inlays were made for each tooth and subjected to mechanical loading. Marginal and internal adaptation were assessed before, during, and after loading using scanning electron microscopy. Preliminary results found marginal tooth fracture ranged from 30.7-37.6% across groups, while marginal opening in dentin ranged from 9.2-30.1% depending
The document reviews new resins being developed for dental composites. It discusses the history and composition of composites. Shortcomings of traditional composites like polymerization shrinkage and techniques sensitivity are addressed. New materials aim to reduce shrinkage through modified monomers and fillers. Bulk-fill composites allow thicker placement in less time. Self-adhesive composites bond without separate bonding steps. Bioactive materials incorporate antimicrobial or remineralizing agents. Future areas of research include further reducing stresses during curing and improving resistance to degradation in the oral cavity.
Evaluation of Marginal integrity and Depth of Cure for three ‘bulk fill’ comp...pratiklovehoney
Evaluation of Marginal integrity and Depth of Cure for three ‘bulk fill’ composites : SDR, Tetric Evoceram Bulk Fill Composite and EverX Posterior Bulk Fill Composite - An In Vitro study
The document summarizes a clinical study that evaluated a packable resin composite material called SureFil for posterior dental restorations over a period of 3 years. Fifty-five restorations were placed in 36 patients and evaluated periodically according to the Ryge criteria. After 3 years, 40 of the 47 remaining restorations were rated as excellent, with only 6% failure rate. The study concluded that SureFil packable resin composite can be considered successful for Class I and II restorations with acceptable clinical performance over 3 years.
Direct pulp capping involves placing a protective material directly over an exposed dental pulp to encourage healing and formation of reparative dentin. It is a conservative treatment alternative to root canal therapy to save a tooth's vitality when the exposure is small. Success rates range widely from 13-98% depending on factors like the type of exposure, quality of the restoration, and operator skill. Calcium hydroxide and mineral trioxide aggregate are commonly used capping materials that induce healing, but newer options like Biodentine show promise as well. Future trends may involve techniques like lasers, gene therapy, or stem cells to further improve pulp capping outcomes.
This document discusses root canal sealers and their use in endodontic treatment. It provides information on the rationale and timing of obturation after root canal treatment. The key purposes of root canal sealers are to seal the root canal system, fill any irregularities or voids, and entomb any remaining bacteria. Common types of sealers discussed include zinc oxide-eugenol based, calcium hydroxide, and resin-based sealers. Properties of an ideal sealer and factors influencing the selection and performance of different sealer materials are also outlined.
This document discusses pulp capping, which involves placing a biocompatible material over exposed dental pulp to avoid pulp tissue exposure and promote healing. It describes indirect pulp capping, which leaves decayed dentin behind to avoid pulp exposure, and direct pulp capping, which dresses small pulp exposures with calcium hydroxide or resin bonding agents. Successful pulp capping requires maintaining pulp vitality without pain or pathology and promoting dentin bridge formation. Calcium hydroxide is commonly used but can degrade over time, while resin bonding agents may provide a better seal but with less evidence of success.
Effect Of Solvent Type On Microtensile Bond Strength Of TotalEtch One-Bottle ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study evaluated the clinical performance of a self-etching adhesive system (Clearfil SE Bond) and a one-bottle adhesive system (Prime&Bond NT) in non-carious Class V restorations over 2 years. 98 restorations were placed in 32 patients using the two adhesive systems. At 2 years, the retention rates were 93% for Clearfil SE Bond and 91% for Prime&Bond NT, showing very good clinical performance for both systems with no statistically significant differences in failure rates. A few restorations showed slight marginal discoloration or adaptation issues, but no restorations exhibited postoperative sensitivity, recurrent caries or changes in anatomical form.
The document provides information on various techniques for removing dental caries, including:
- Conventional excavation using burs produces homogeneous smear layers but can over-prepare tooth structure. Newer polymer and ceramic burs aim to be more conservative.
- Hand excavation is effective at caries removal in deciduous teeth when balanced with time and control of remaining bacteria.
- Air abrasion uses kinetic energy of propelled abrasives to remove tooth structure with less pain than rotary instruments but lacks their precision.
This document provides an overview of various materials that can be used for root repair, including root-end fillings, perforation repair, and root regeneration. It discusses both traditional materials like amalgam, gutta percha, and zinc oxide eugenol, as well as more recent bioactive materials like mineral trioxide aggregate (MTA) and Biodentine. MTA has become the material of choice for many root repair procedures due to its biocompatibility and ability to stimulate hard tissue formation. The document provides details on the composition and setting reaction of MTA and reviews its advantages and limitations for different clinical applications in root repair.
The document discusses bioceramic materials used in endodontics, focusing on mineral trioxide aggregate (MTA). It provides details on the composition, properties, and clinical applications of MTA. MTA has favorable biocompatibility and bioactivity, stimulating tissue regeneration. It forms an excellent seal with good marginal adaptation and push-out bond strength to dentin. MTA is useful for pulp capping, pulpotomies, apexification, and other procedures due to its ability to encourage hard tissue formation.
Resin adhesives in endodontics / /certified fixed orthodontic courses by Ind...Indian dental academy
This document discusses the use of resin adhesives in endodontics. It covers topics like adhesion to dentin, challenges bonding to coronal versus radicular dentin, and various resin-based root canal sealers and luting cements. Newer systems aim to create a solid resin monoblock in the root that effectively seals to dentinal walls. Factors like smear layer removal and moisture affect adhesion in the root canal. Resin adhesives show potential for rehabilitating weakened roots and restoring access cavities.
smear layer in endodontics/ rotary endodontic courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document discusses chemomechanical caries removal (CMCR), a non-invasive technique that uses a chemical agent to dissolve infected dentin. It originated in the 1970s using sodium hypochlorite to remove organic materials from root canals. Later products like Caridex and Cariosolve were developed using amino acids that selectively dissolve demineralized dentin while preserving healthy tissue. Cariosolve uses sodium hypochlorite and three amino acids in two syringes. It has advantages like less pain, tissue preservation, and suitability for uncooperative patients. However, it may still require instruments and can be time-consuming.
The bond strength of endodontic sealers to root /prosthodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This study assessed the effect of 2% chlorhexidine digluconate (CHX) pretreatment on the immediate and six-month microshear bond strength (μSBS) of an etch-and-rinse adhesive to sound and eroded dentin. Bovine teeth were subjected to either a control treatment or erosive challenge to create sound and eroded dentin substrates. Specimens received adhesive with or without prior CHX application. μSBS was measured initially and after six months. CHX pretreatment minimized but did not prevent the reduction in μSBS over time, especially for eroded dentin. While CHX helped maintain higher bond strengths after aging, the effectiveness of bonding to
This document discusses acetal resin, a thermoplastic material that can be used to create flexible dentures. Acetal resin is an alternative to metal alloys that provides aesthetics and flexibility. It can be used to make dentures that engage deep undercuts for retention. The resin is biocompatible and durable. It comes in various tooth colors and pink shades. Flexible dentures made of acetal resin are indicated for patients with bilateral undercuts or metal allergies. The resin can be used for temporary restorations like dentures or space maintainers. However, it cannot be used for patients with a closed bite due to its flexibility.
Vital pulp therapy aims to maintain pulp vitality by removing irritants and placing protective materials over exposed pulp. Indirect pulp capping covers deep caries with a biocompatible material to stimulate tertiary dentin formation and arrest decay. Direct pulp capping places protective dressings directly over pulp exposures to induce reparative dentin bridges. Calcium hydroxide and mineral trioxide aggregate are commonly used capping agents. Apexification forms apical barriers in open-apexed teeth while pulpotomy removes coronal pulp to preserve radicular vitality. Gentle techniques and accurate diagnoses are important for predictable outcomes of vital pulp therapies.
His eva of caoh&bond agnt in direct pulp capping/ rotary endodontic courses b...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Methods of detecting microleakage/ orthodontic course by indian dental academyIndian dental academy
This document discusses various methods used to detect microleakage between dental restorations and tooth structures. It describes several penetration studies methods using dyes, isotopes, bacteria, and chemical tracers to evaluate microleakage. Additional methods covered include air pressure testing, fluid conduction studies, electronic monitoring, and microscopic examination techniques like scanning electron microscopy and replication studies. The document provides an overview of the goals, procedures, and applications of different microleakage detection methods.
This document discusses factors that affect bonding to intraradicular dentin in endodontics. It covers differences between coronal and radicular dentin, how instrumentation can create a smear layer, and how various endodontic materials and procedures like irrigation, bleaching, and retreatment can impact bonding. Root canal anatomy and the inability to control moisture present unique challenges for achieving effective adhesion. Resin-based sealers and core filling materials that utilize adhesive technology are also discussed as ways to potentially improve bonding and sealing of root canals.
dental Monoblock obturation technique or concept in endodonticsAhmed Ali
dental Monoblock obturation technique or concept in endodontics which are classified into primary ,secondary & tertiary based upon resin , now the bioceramics
This document discusses flexible dentures as an alternative to conventional rigid acrylic dentures. It outlines the disadvantages of cast and acrylic dentures including brittleness, fracture, and irritation of tissues. Flexible dentures made of nylon are introduced in 1955 as having advantages like flexibility, light weight, and biocompatibility. Both advantages and disadvantages of flexible dentures are provided. Indications include bilateral undercuts and contraindications include unilateral extensions and low vertical dimension. The document describes the composition, manipulation through injection molding, and various commercial flexible denture products. Thermoplastic resins are discussed for uses beyond dentures.
This study evaluated the clinical performance of a self-etching adhesive system (Clearfil SE Bond) and a one-bottle adhesive system (Prime&Bond NT) in non-carious Class V restorations over 2 years. 98 restorations were placed in 32 patients using the two adhesive systems. At 2 years, the retention rates were 93% for Clearfil SE Bond and 91% for Prime&Bond NT, showing very good clinical performance for both systems with no statistically significant differences in failure rates. A few restorations showed slight marginal discoloration or adaptation issues, but no restorations exhibited postoperative sensitivity, recurrent caries or changes in anatomical form.
The document provides information on various techniques for removing dental caries, including:
- Conventional excavation using burs produces homogeneous smear layers but can over-prepare tooth structure. Newer polymer and ceramic burs aim to be more conservative.
- Hand excavation is effective at caries removal in deciduous teeth when balanced with time and control of remaining bacteria.
- Air abrasion uses kinetic energy of propelled abrasives to remove tooth structure with less pain than rotary instruments but lacks their precision.
This document provides an overview of various materials that can be used for root repair, including root-end fillings, perforation repair, and root regeneration. It discusses both traditional materials like amalgam, gutta percha, and zinc oxide eugenol, as well as more recent bioactive materials like mineral trioxide aggregate (MTA) and Biodentine. MTA has become the material of choice for many root repair procedures due to its biocompatibility and ability to stimulate hard tissue formation. The document provides details on the composition and setting reaction of MTA and reviews its advantages and limitations for different clinical applications in root repair.
The document discusses bioceramic materials used in endodontics, focusing on mineral trioxide aggregate (MTA). It provides details on the composition, properties, and clinical applications of MTA. MTA has favorable biocompatibility and bioactivity, stimulating tissue regeneration. It forms an excellent seal with good marginal adaptation and push-out bond strength to dentin. MTA is useful for pulp capping, pulpotomies, apexification, and other procedures due to its ability to encourage hard tissue formation.
Resin adhesives in endodontics / /certified fixed orthodontic courses by Ind...Indian dental academy
This document discusses the use of resin adhesives in endodontics. It covers topics like adhesion to dentin, challenges bonding to coronal versus radicular dentin, and various resin-based root canal sealers and luting cements. Newer systems aim to create a solid resin monoblock in the root that effectively seals to dentinal walls. Factors like smear layer removal and moisture affect adhesion in the root canal. Resin adhesives show potential for rehabilitating weakened roots and restoring access cavities.
smear layer in endodontics/ rotary endodontic courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document discusses chemomechanical caries removal (CMCR), a non-invasive technique that uses a chemical agent to dissolve infected dentin. It originated in the 1970s using sodium hypochlorite to remove organic materials from root canals. Later products like Caridex and Cariosolve were developed using amino acids that selectively dissolve demineralized dentin while preserving healthy tissue. Cariosolve uses sodium hypochlorite and three amino acids in two syringes. It has advantages like less pain, tissue preservation, and suitability for uncooperative patients. However, it may still require instruments and can be time-consuming.
The bond strength of endodontic sealers to root /prosthodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This study assessed the effect of 2% chlorhexidine digluconate (CHX) pretreatment on the immediate and six-month microshear bond strength (μSBS) of an etch-and-rinse adhesive to sound and eroded dentin. Bovine teeth were subjected to either a control treatment or erosive challenge to create sound and eroded dentin substrates. Specimens received adhesive with or without prior CHX application. μSBS was measured initially and after six months. CHX pretreatment minimized but did not prevent the reduction in μSBS over time, especially for eroded dentin. While CHX helped maintain higher bond strengths after aging, the effectiveness of bonding to
This document discusses acetal resin, a thermoplastic material that can be used to create flexible dentures. Acetal resin is an alternative to metal alloys that provides aesthetics and flexibility. It can be used to make dentures that engage deep undercuts for retention. The resin is biocompatible and durable. It comes in various tooth colors and pink shades. Flexible dentures made of acetal resin are indicated for patients with bilateral undercuts or metal allergies. The resin can be used for temporary restorations like dentures or space maintainers. However, it cannot be used for patients with a closed bite due to its flexibility.
Vital pulp therapy aims to maintain pulp vitality by removing irritants and placing protective materials over exposed pulp. Indirect pulp capping covers deep caries with a biocompatible material to stimulate tertiary dentin formation and arrest decay. Direct pulp capping places protective dressings directly over pulp exposures to induce reparative dentin bridges. Calcium hydroxide and mineral trioxide aggregate are commonly used capping agents. Apexification forms apical barriers in open-apexed teeth while pulpotomy removes coronal pulp to preserve radicular vitality. Gentle techniques and accurate diagnoses are important for predictable outcomes of vital pulp therapies.
His eva of caoh&bond agnt in direct pulp capping/ rotary endodontic courses b...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Methods of detecting microleakage/ orthodontic course by indian dental academyIndian dental academy
This document discusses various methods used to detect microleakage between dental restorations and tooth structures. It describes several penetration studies methods using dyes, isotopes, bacteria, and chemical tracers to evaluate microleakage. Additional methods covered include air pressure testing, fluid conduction studies, electronic monitoring, and microscopic examination techniques like scanning electron microscopy and replication studies. The document provides an overview of the goals, procedures, and applications of different microleakage detection methods.
This document discusses factors that affect bonding to intraradicular dentin in endodontics. It covers differences between coronal and radicular dentin, how instrumentation can create a smear layer, and how various endodontic materials and procedures like irrigation, bleaching, and retreatment can impact bonding. Root canal anatomy and the inability to control moisture present unique challenges for achieving effective adhesion. Resin-based sealers and core filling materials that utilize adhesive technology are also discussed as ways to potentially improve bonding and sealing of root canals.
dental Monoblock obturation technique or concept in endodonticsAhmed Ali
dental Monoblock obturation technique or concept in endodontics which are classified into primary ,secondary & tertiary based upon resin , now the bioceramics
This document discusses flexible dentures as an alternative to conventional rigid acrylic dentures. It outlines the disadvantages of cast and acrylic dentures including brittleness, fracture, and irritation of tissues. Flexible dentures made of nylon are introduced in 1955 as having advantages like flexibility, light weight, and biocompatibility. Both advantages and disadvantages of flexible dentures are provided. Indications include bilateral undercuts and contraindications include unilateral extensions and low vertical dimension. The document describes the composition, manipulation through injection molding, and various commercial flexible denture products. Thermoplastic resins are discussed for uses beyond dentures.
Enterprise Europe Network is een groot netwerk voor ondernemers die internationaal business ontwikkelen, onderzoek uitvoeren en technologisch samenwerken. EEN wijst u de weg en verbindt u met relevante ondernemers in Europa.
Horeca & Leisure presentatie: "Friends Enterprice" door Ton Derks van Friends Enterprice.
Een groter klantenbestand en meer winst dankzij een vernieuwende samenwerking in de regio.
Duurzaamheid als basis voor innovatie. 4 V’s die in balans moeten zijn. Duurzaamheid en innovatie als basis om geld te blijven verdienen.
Door Otto Willemsen, Duurzaam4life
Welke kansen liggen er om gezonde producten op de markt te brengen?Kamer van Koophandel
Over samenwerking tussen agro, techniek en markt zodat bio-grondstoffen extra meerwaarde krijgen.
Door Ayla Hesp, HAS Kennistransfer en Bedrijfsopleidingen
Horeca & Leisure presentatie: "Samenwerking 2.0" door Jeroen van Bennekom van Van der Valk
Ervaringen van en tips voor ondernemers, over Samenwerking voor Horeca en Leisure – De kracht van samenwerking
O documento propõe a criação de comissões informativas permanentes sobre urbanismo, meio ambiente e ciência. Também propõe nomear um tesoureiro concelhio, criar áreas municipais e nomear conselheiros responsáveis, e nomear representantes do município em outros órgãos.
Fabrication of Complete Dentures for A Patient with Resorbed Mandibular Anter...QUESTJOURNAL
ABSTRACT: The loose and unstable lower complete denture is one of the most common problems faced by denture patients with highly resorbed ridge. The management of such highly resorbed ridges has always posed a difficulty to the prosthodontist.Obtaining consistent mandibular denture stability has longbeen a challenge for dental profession. The simplest approach often is to extend the denture base adequately for proper use of all available tisues.To achieve this goal impression of the resorbed mandibular ridge is very important. The objective is to develop a physiologic impression with maximum support of both hard and soft tissues.In such cases, an innovative technique of impressionmaking by using a close fitting tray and anelastomeric impression material tomake a proper impression to achieve maximum retentionand stability.This article describes an impression technique used for highly resorbed mandibular ridge using an all green impression technique, to gain maximum retention andstability
The document summarizes a clinical study that compared the performance of a two-step self-etching adhesive system (Clearfil Protect Bond) and a one-step self-etching adhesive system (Xeno III) over one year. 163 restorations were placed in noncarious cervical lesions in 35 patients using the two adhesive systems. The restorations were evaluated at baseline and 3, 6, 9, and 12 months using criteria such as color matching, marginal adaptation, retention, etc. At one year, the retention rate was 100% for the two-step system and 96% for the one-step system. Both systems showed excellent performance during the one-year clinical trial, though the two-step system
Strip Crowns Technique for Restoration of Primary Anterior Teeth: Case ReportAbu-Hussein Muhamad
Dental caries is the single most common chronic childhood disease affecting worldwide. In early childhood caries, there is early pulp involvement and gross destruction of maxillary anterior teeth as well as posterior teeth. Treatment of such caries represents a challenge to pediatric dentists especially, when teeth are badly destroyed. By the time the dentist sees the child, most of the coronal structure is lost. This case report describes challenging task of a Case of early childhood caries patients with mutilated maxillary incisors restored with a strip form composite restorations.
The document discusses relining and rebasing of complete dentures. It defines relining as resurfacing the tissue side of a denture with new material to improve fit, while rebasing replaces the entire denture base. Relining or rebasing may be needed when bone resorption causes poor denture fit. Direct relining involves adding new material chairside, while indirect relining uses impressions and lab processing. Common materials include soft liners for comfort and hard liners for stability. The procedures for both relining and rebasing aim to restore proper vertical dimension, occlusion, and support without altering the dental arch or teeth positions.
This study compared the clinical performance of a polyacid modified resin composite (Dyract eXtra) and a nanocomposite (Filtek Supreme) when used with an antibacterial adhesive system (Clearfil Protect Bond) to restore noncarious cervical lesions over 2 years. 100 restorations were placed - 50 of each material - and evaluated at baseline and 6, 12, and 24 months using criteria like color match, marginal adaptation, retention, etc. Both materials showed acceptable clinical performance, though Filtek Supreme had a significantly better retention rate (100% vs 96% for Dyract eXtra). Some Dyract eXtra restorations were lost or fractured. Overall both materials can be suitable options for restoring
This document discusses denture adhesives and denture cleansers. It provides background on denture adhesives including their history, formulations, modes of action, uses, and risks. It describes different types of denture adhesives including pads, powders, and creams. The document also discusses denture cleansers and the importance of cleaning dentures to remove plaque and maintain oral hygiene. Proper denture hygiene is an important part of patient care for edentulous individuals.
24th oct Pulp Therapy In Young Permanent Teeth.pptxismasajjad1
The document discusses various pulp therapy techniques for young permanent teeth including indirect pulp capping, direct pulp capping, Cvek pulpotomy, apexogenesis, apexification, and regenerative endodontics. Important factors to consider include assessing for signs of reversible pulpitis. Indirect pulp capping involves sealing a deep lesion near the pulp with a protective material while direct pulp capping places a material directly over an exposure site after controlling bleeding. Pulpotomy removes inflamed pulp from the crown while leaving healthy tissue in the root canals. Apexogenesis treats immature teeth to allow continued root development while apexification induces a barrier in nonvital open apices. Regenerative endodontics aims
This document reviews chemomechanical removal of caries as an alternative to traditional surgical removal. Chemomechanical caries removal uses chemical agents to soften infected dentin, which is then scraped away mechanically using blunt instruments. Several chemical agents have been developed for this technique, including Caridex and Carisolv. This technique aims to selectively remove only the outer, infected layer of dentin while preserving the inner, remineralizable layer. Studies show chemomechanical removal can be effective at removing caries, but may take longer than traditional drills and burs. It provides advantages of being less invasive and reducing pain compared to surgery. However, further research is still needed to optimize the technique.
This document discusses direct and indirect pulp capping procedures. Indirect pulp capping involves covering the deepest layer of remaining carious dentin with a biocompatible material to prevent pulp exposure and stimulate tertiary dentin formation. Direct pulp capping places a protective dressing directly over an exposed pulp to preserve its vitality. Various materials used for both procedures are discussed, along with their advantages and disadvantages. The document provides details on performing indirect and direct pulp capping clinically and factors affecting their success.
The document describes a modified neutral zone technique for improving the stability of mandibular complete dentures. The technique involves making an acrylic resin base with posterior occlusal rims, applying a thermoplastic denture adhesive, and having patients wear it for 2 days to record the neutral zone. The base is then used to make an acrylic resin complete denture. Most patients reported improved denture stability and reduced pressure sores. However, the technique is complex and not recommended for routine use.
This document discusses tissue conditioners and soft denture liners. It defines tissue conditioners as temporary resilient materials placed inside a denture for a short period to allow healing of traumatized tissues. Soft denture liners provide long-term cushioning and are made of materials like silicone or soft acrylic. The document outlines the ideal properties, uses, and application process for tissue conditioners. It also discusses the requirements for resilient denture liners to be biologically compatible, resilient, dimensionally stable, and resistant to staining and abrasion.
Soft And Hard Tissue Management Using LasersAndres Cardona
This document discusses the use of lasers in soft and hard tissue management for esthetic dental procedures. It provides background on the history and mechanisms of dental lasers. The erbium laser wavelength is highlighted as it allows conservative, less invasive treatment of both hard tissues like enamel and bone as well as soft tissues. Specific techniques described include laser-assisted cavity preparation and restoration, as well as cosmetic procedures like gingival contouring and osseous crown lengthening to enhance the smile. Case studies demonstrate how these laser techniques can be used to adjust gingival levels and proportions for esthetic outcomes.
The document describes a novel surgical technique called nonincised papillae surgical approach (NIPSA) for treating periodontal defects. NIPSA involves making a single horizontal incision in the mucosa away from the marginal tissues to access the defect, leaving the marginal tissues intact. This preserves the integrity of the interdental soft tissues and blood supply. The technique is modified to incorporate connective tissue grafts to treat advanced periodontal defects associated with buccal bone loss. Four case studies demonstrate positive outcomes with reduced pocket depth and clinical attachment gain using NIPSA with connective tissue grafts. The grafts are thought to improve wound stability, prevent soft tissue collapse, and delay epithelial downgrowth to create optimal conditions
This document discusses various biological considerations related to dental restorations and periodontal health. It covers topics such as biologic width, margin placement, overhangs, and correcting biologic width violations. Key points include that supragingival margins have the least impact on the periodontium, biologic width violations can lead to inflammation and bone loss, and overhangs increase plaque and pathogens if placed subgingivally. The document provides guidelines for proper margin placement based on sulcular depth to avoid future recession. It also discusses procedures for tissue retraction and electrosurgery when placing subgingival margins.
recent advances in prosthodontics/dental lab technology courses by Indian den...Indian dental academy
This document summarizes several new developments in dental ceramics. It discusses materials like In-Ceram, Procera, and IPS Empress 2 which can be used for posterior dental restorations due to improvements in strength and toughness compared to conventional ceramics. In-Ceram cores are crystalline rather than glass-based, increasing strength. Procera uses a titanium substructure for strength while Empress 2 uses lithium disilicate glass ceramics with 60% crystal content for high strength without compromising translucency. These new materials allow for all-ceramic restorations in areas requiring more load bearing than previous ceramics.
Autogenous tooth fragment reattachment ; a 12 years follow-upAbu-Hussein Muhamad
The fractures of the anterior teeth are a common form of dental trauma that mainly affects children and adolescents. One of the therapeutic options for managing coronal tooth fractures when the tooth fragment is available and there is no or minimal violation of the biological width is the Autogenous reattachment of the dental fragment.. Reattachment of fractured fragment can provide good and long lasting esthetics. This is a report of a 12 -year follow-up of a coronal fracture case successfully treated using tooth fragment reattachment.
Keywords: Composite resins, coronal fracture, fragment reattachment
This paper aims to submit the report the aesthetic correction in a disharmonious smile and unsatisfactory composite restorations in anterior teeth who were treated with direct aesthetic restorative procedure. The results show the use of this technique to allows an immediate aesthetic quality, directly and inexpensively restoring the natural features of the smile.
Key words: Composite Resin,Class IV, Aesthetic.
Non surgical management of gingival recession- Dr Harshavardhan PatwalDr Harshavardhan Patwal
Treatment of gingival recession has become an important therapeutic issue due to the increasing number of cosmetic requests from patients. The dual goals of mucogingival treatment include complete root coverage, up to the cemento-enamel junction, and blending of tissue color between the treated area and non-treated adjacent tissues. Even though the connective tissue graft is commonly considered the “gold standard” for treatment of recession defects, it may not always be the best surgical option for every case. Dr Harshavardhan Patwal , Under non-experimental conditions, all root coverage procedures may be effective in terms of complete root coverage and excellent esthetics. Careful analyses of patient- and defect-related factors, however, are key considerations prior to selecting an appropriate surgical technique.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
2. 2
Since its foundation Septodont has developed, manufactured
and distributed a wide range of high quality products for
dental professionals.
Septodont recently innovated in the field of gingival prepa-
ration, composites and dentine care with the introduction
of Racegel, the N’Durance® line and Biodentine™, which
are appreciated by clinicians around the globe.
Septodont created the ‘Septodont Case Studies Collection’
to share their experience and the benefits of using these
innovations in your daily practice.
This Collection consists in a series of case reports and is
published on a regular basis.
The sixth issue is dedicated to three of these innovations:
Racegel, a unique reversible thermo-gelifiable gel for
gingival preparation that creates a dry and clean environment
for high quality impressions.
N’Durance®, the first universal composite based on our
exclusive Nano-Dimer Technology. N’Durance® unique
combination of low shrinkage and high conversion offers
extra biocompatibility and durability to your restorations.
Biodentine™ , the first biocompatible and bioactive dentin
replacement material. Biodentine™ uniqueness not only lies
in its innovative bioactive and ‘pulp-protective’ chemistry,
but also in its universal application, both in the crown and
in the root.
3. Racegel : Gel Retraction Material
Leonard A. Hess 04
A four-year prospective study of the use of
N’Durance composite, a nano-hybrid resin
Holli Cherelle Riter
07
The direct application of Biodentine™
under indirect ceramic restoration
C. Boutsiouki, Prof K. Tolidis, Prof P. Gerasimou
13
Apicoectomy treated with an active
biosilicate cement: Biodentine™
Dr. César A. Gallardo Gutiérrez
18
3
Content
4. 4
Racegel : Gel Retraction Material
Increasing the success and predictability of fixed prosthodontic
Leonard A. Hess, DDS
Private Practice, Monroe, North Carolina, USA
Introduction
In fixed prosthodontics, clinically acceptable
impressions are an absolute necessity (Fig. 1).
The laboratory fabricating the restoration is limited
in its final quality by the quality of the incoming
impression. The unfortunate reality is that most
impressions are clinically unacceptable.1
Some of the most common errors seen in impres-
sions include tears, bubbles, voids, debris
entrapment, tray burnthrough, material/tray sepa-
ration, and lack of catalyzation of the material.2
Unfortunately, many of these errors are most
evident at the restorative margin. Any lack of
detail at the margin forces the laboratory technician
to guess during die trimming. This area is highly
susceptible to the collection of blood, debris,
and lymphatic exudate. Considering the limited
hydrophilic nature of most impression materials,
issues can quickly compound.
The most predictable way to obtain a quality
impression is to start with healthy tissue. Pre-
restorative planning should include any necessary
periodontal treatment, patient hygiene instruction,
and caries control.3 Different options exist to aid
in tissue management. These would include the
use of retraction cord, chemical hemostatic
agents, a soft tissue laser, and tissue gels or
pastes, either alone or in various combinations.
Attention should also be given to the position of
the osseous crest and the compensating gingival
biotype. In a normal crest relationship, the depth
from the gingival margin to the bony crest is
3 mm to 4 mm apart. A distance greater than
this would indicate a low-crest relationship.
Depths of less than 3 mm would be indicative of
a high-crest relationship.4
Tissue with a low-crest position would be less
supported, more flaccid, and more prone to
recession as a result of trauma or over-manipu-
lation. Tissue associated with high crestal bone
is usually thicker, more fibrous, and more forgiving
of damage. However, high-crest bone is at higher
risk of biologic width violations.
This article will discuss impression techniques
using a new gel retraction and hemostatic aid
called Racegel (Fig. 2).
Fig. 1: An ideal indirect restoration impression. The material is
void-free, clear of debris, and exhibits clean capture of the
preparation margins.
Fig. 2: Racegel is dispensed from a single-barrel syringe. It is
colored to allow easy visualization in placement and to aid in
verification of its removal.
5. Case Report no.1
This posterior crown is a common example of a
low crest and deep sulcus restorative situation
(Fig. 3). Because of the sulcus depth, often one
cord is not adequate to fully displace the tissue
and obtain a quality impression. Instead of trau-
matizing the tissue with two cords, one small
cord was placed and then Racegel was injected
into the sulcus. This provided the necessary
retraction and hemostasis.
All-ceramic preparation margin designs will often
be at the level of the gingival margin (Fig. 4).
The premolar seen in this figure, which has a
normal gingival biotype, can be readied for
impression with Racegel as the sole source of
retraction.
5
The features of the Racegel include:
• Thermodynamic chemistry that provides increa-
sing viscosity in the oral cavity. The thermal
effect is reversed when rinsed with water for
ease of removal.5
• 25% aluminum chloride for optimal control of
bleeding and crevicular fluid.
• An orange color for easy viewing during place-
ment and for confirming complete removal.
• Can be used in conjunction with cord or simple
control of gingival bleeding.
Fig. 3: In cases with a thinner gingival biotype, Racegel can be
used as the sole source of hemostasis and tissue retraction.
Fig. 4: In this case Racegel was being used in conjunction with a
packed cord to control gingival bleeding and to aid in tissue
retraction.
Fig. 5: In this multi-unit case, Racegel was used in conjunction
with cord to control interproximal bleeding.
Fig. 6: The final impression from the case.
Fig. 7: The final lithium-disilicate veneer restorations. Note the
healthy tissue response associated with properly fitting
restorations.
Case Report no.2
Preoperatively, this case had generalized inter-
proximal decay and decalcification (Fig. 5), which
resulted in residual interproximal inflammation and
bleeding at the preparation visit. Dry cords were
placed in the sulcus, and Racegel was placed on
the bleeding areas. By controlling the tissue and
obtaining a high-quality impression (Fig. 6), properly
fitting restorations were created that allowed
optimal health postoperatively (Fig. 7).
7. 7
Composite filling material is intended to replace
missing tooth structure by replicating the look
and function of natural tooth structure as close
as possible. A desirable composite should be
highly esthetic, and functionally strong. In addi-
tion, good handling characteristics are important
for ease of placement. A highly radiopaque
composite is beneficial, as it enhances the
operator’s ability to differentiate the composite
from tooth structure or caries on a radiograph.
Finding a composite that satisfies the need for
esthetics and durability is a goal for modern
dentistry. Changing the quality and size of the
filler particles in a composite can affect the
esthetic quality and the mechanical property of a
composite (Narhi, 2003). Nano- and nano-hybrid
filler particles were developed with the goal of
increasing strength of the composite, and impro-
ving the esthetics by decreasing the filler size
(Ilie N R. A., 2011). The small size of the nano
particles, ranging from 1 to 100 nm in diameter,
has been reported to contribute to superior
mechanical properties, such as low polymerization
shrinkage, high flexural strength and low abrasion
(Papadogiannis D.Y., 2008). Smaller particles in
a composite are shown to have better wear
resistance as well as a higher polishablility (Van
Dijken J., 2011) (Palaniappan S, 2010).
Septodont, Confi-Dental Division, released the
composite N’Durance® that proposes to combine
high esthetics with strength and durability by
combining nano-hybrid fillers with a new dimer
A four-year prospective study of
the use of N’Durance® composite,
a nano-hybrid resin
Holli Cherelle Riter DDS
Loma Linda University School of Dentistry - California, USA
The purpose of this study was to evaluate the clinical performance of a new composite
resin material, N’Durance®, in anterior teeth. Class III, IV, V, diastema closures and facial
resin veneers were placed by one operator in the dentitions of the patients recruited to
the study. Fifty-two restorations in 30 patients were originally placed, and at the 4-year
recall, 26 restorations in 15 patients were evaluated. The results were collected using
modified USPHS criteria. The results at four years showed that the majority of the USPHS
categories were rated 100% Alpha at the 4-year evaluation, with the exception of color
match having 73% Alpha, marginal adaptation 77% Alpha, and Polishability 96% Alpha,
indicating satisfactory esthetic qualities and adequate strength and a high retention of
N’Durance® composite.
Introduction
8. 8
acid monomer technology (Bracho-Trachonis,
2008). The dimer acid monomer technology
helps to reduce shrinkage during polymerization,
and it has a higher degree of monomer conver-
sion (Ilie N R. A., 2011), which leads to less
uptake of water (Bracho-Trachonis, 2008) (Ilie
N H. R., 2011).
The N’Durance® composite offers good handling
characteristics, having a high viscosity and low
feeling of stickiness during placement. In addi-
tion, it has a high opacity on radiographs,
making it easy to differentiate it from tooth
structure (Fig. 1).
The purpose of this study was to evaluate the
clinical performance of N’Durance® composite
in anterior class III, IV, V, facial veneers and
diastema closure restorations over a four year
period of time. Fig. 1
Materials and Methods
A total of 52 restorations were placed in anterior
teeth throughout the anterior dentitions of 30
patients by one dentist at Loma Linda University
School of Dentistry. Prior to initiation of the
study, the protocol and the informed consent
were submitted to and approved by the Institu-
tional Review Board (IRB) of Loma Linda
University. Written informed consent was obtained
from each subject prior to the placement of the
restorations. Healthy adults who exhibited a
need for an anterior resin restoration were
recruited to the study. Class III, IV, V, diastema
repairs and facial veneer resins were included
in the study. All restorations were restored with
N’Durance® composite resin.
Pre-operative photographs and radiographs of
the sites were taken. Shade selection was made
prior to starting the procedure using the Vitapan
Classical Shade Guide (Vident, Brea, CA). Each
cavity was prepared using high speed diamond
burs and a conservative preparation design.
Any carious tooth structure was removed using
steel carbide round burs on a slow speed hand-
piece. Isolation was achieved using cotton rolls
and saliva evacuation, along with gingival cord
when needed. Rubber dams were not used
since all the restorations were placed on anterior
teeth where saliva was well controlled. The
preparations included etching on enamel and
dentin with Gel Etchant (Kerr, Orange, CA), a
37.5% phosphoric etching gel for 20 seconds,
and then thoroughly rinsed with water. The
excess water was removed. The preparations
were bonded with Opti-Bond Solo (Kerr, Orange,
CA) and light cured for 20 seconds according to
manufacturer’s instructions. They were then filled
with N’Durance® resin composite with a 1-2
mm incremental technique, curing each increment
for 30 seconds. The curing light (with a minimum
radiance of 500 mW/cm2) was held approximately
1 mm away from the tooth surface during the
light activation (curing). The restorations were
finished with carbide finishing burs and polished
with OptiDiscs (Kerr, Orange, CA), Jiffy Polishing
Points and Cups (Ultradent, Salt Lake City, UT)
and Jiffy Composite Polishing Brushes (Ultradent,
Salt Lake City, UT), as needed.
Restorations were evaluated at the baseline
(two weeks after placement), six months, one-
year, eighteen months, two-year, three-year and
9. 9
four-year using the modified United States Public
Health Service (USPHS) criteria (Bayne S., 2005).
Anatomic form, color match, marginal adaptation,
marginal discoloration, surface staining, retention,
secondary caries, fracture and polishability were
evaluated for each restoration, along with soft
tissue health and post-operative sensitivity. The
post-operative sensitivity data were obtained
by asking each patient to rate their sensitivity
based on a scale of 0 to 10, with 0 having no
sensitivity and 10 having extreme sensitivity.
Clinical photographs were taken at each of the
evaluations, and a radiograph of each site was
taken at each of the year evaluations. At the
four-year follow-up, 26 restorations in 15 patients
were evaluated. The remainder of the patients
was either dropped from the study, or unable to
be located for the four-year evaluation.
Subject 1
Subject 2
Results and Discussion
The results for the four-year evaluation of
N’Durance® composite are shown in Table 1.
All of the 26 restorations that were evaluated
were determined to have an Alpha rating in the
categories of Anatomic Form, Retention, Marginal
Discrepancy, Surface Staining, Secondary Caries
and Fracture. Nineteen of the restorations were
rated an Alpha in the Color Match category and
seven Bravo, showing a slight shade differen-
tiation. The color of the material had not changed
since the Baseline. Six of the 26 restorations
were rated a Bravo in the marginal adaptation,
noting some slight discrepancy present along
the enamel margin, not deemed to require any
sort of repair of the margin. The remainder was
rated Alpha for marginal adaptation. This is
similar to results seen in published comparable
composite studies (Van Dijken J., 2011) (Dukic
W, 2010). There was one restoration rated as a
Bravo in the Polishability category, showing a
less than ideally reflective surface. The rest was
rated Alpha for Polishability. The polishability of
N’Durance® composite was very high at the
four-year evaluation, and this seems to be one
of the strengths of this product.
There was no reported sensitivity with the
Pre-operative situation Restoration at baseline Restoration at 4 years
Pre-operative situation Restoration at baseline Restoration at 4 years
10. 10
Baseline Four-years
Total Restorations 52 (100%) 26 (100%)
Anatomic Form (Wear)
A 52 (100%) 26 (100%)
B 0 (0%) 0 (0%)
C 0 (0%) 0 (0%)
D 0 (0%) 0 (0%)
Color Match
A 39 (75%) 19 (73%)
B 13 (25%) 7 (27%)
C 0 (0%) 0 (0%)
D 0 (0%) 0 (0%)
Marginal Adaptation
A 50 (96%) 20 (77%)
B 2 (4%) 6 (23%)
C 0 (0%) 0 (0%)
D 0 (0%) 0 (0%)
Retention
A 52 (100%) 26 (100%)
B 0 (0%) 0 (0%)
C 0 (0%) 0 (0%)
Marginal Discoloration
A 52 (100%) 26 (100%)
B 0 (0%) 0 (0%)
C 0 (0%) 0 (0%)
D 0 (0%) 0 (0%)
Surface Staining
A 52 (100%) 26 (100%)
C 0 (0%) 0 (0%)
Secondary Caries
A 52 (100%) 26 (100%)
C 0 (0%) 0 (0%)
Fracture
A 52 (100%) 26 (100%)
B 0 (0%) 0 (0%)
C 0 (0%) 0 (0%)
Polishability
A 52 (100%) 25 (96%)
B 0 (0%) 1 (4%)
C 0 (0%) 0 (0%)
D 0 (0%) 0 (0%)
Table 1 – Clinical Results of Restorations
at Baseline and Four-years
N’Durance® composite restorations at any of
the evaluations. In addition, no significant gingival
inflammation was observed in relation to the
placement of the composite. In the patients
that did exhibit gingival inflammation, this was
a general condition in the patient’s mouth, and
not isolated to the areas around the composite
restoration.
Composites fail for a multitude of reasons,
among these are recurrent caries and fracture
(Watanabe H, 2008). Many studies have been
done evaluating the strength and clinical success
of composites both in anterior and posterior
teeth. Although we are evaluating only anterior
teeth in this study, the reasons for failure are
similar wherever the composite is placed. There
is an indication that the larger the restoration,
the higher the likelihood of failure (Moura F,
2011). In particular for anterior teeth it has been
reported that class IV composites failed at a
11. 11
higher rate than class III composite restorations
(Moura F, 2011). So far at the four-year evaluation,
the N’Durance® composite has shown very little
problems when used for larger class IV restora-
tions, including the larger diastema closures.
Secondary caries has also been identified as
one main reason for failure in previous composite
studies (Ferracane, 2013). There were no signs
of any secondary caries detected in this study.
There was some slightly noticeable ditching
along the margins of a few of the restorations.
No repair was needed to the margins. Marginal
adaptation is highly correlated to the polymeri-
zation shrinkage of a composite (Baracco B,
2013). The decrease in the Alpha scores for the
marginal adaptation category is similar to related
studies (Baracco B, 2013) (Van Dijken J., 2011).
The esthetics of the N’Durance® composite was
very high. At the four-year evaluations, the poli-
shability was excellent. For all but one restoration,
the polishability remained in the highest evaluation
category, indicating a high shine replicating the
enamel surface. This is one of the most pleasing
characteristics of the N’Durance® composite.
The polished surface of the restorations at the
four-year evaluation was similar to the baseline
evaluations. This is likely contributed to the
small size of the particulates, which would allow
for a higher shine. Photos of some of the resto-
rations are included in this article.
The handling characteristics of N’Durance®
composite are very good. The stickiness of a
composite can be manipulated by altering both
the filler content and changing the monomer
formulations (Al-Sharaa K, 2003). A composite
that is too sticky when applying it can create
voids by pulling back from the preparation as it
sticks to the dental placement instrument (Al-
Sharaa K, 2003). N’Durance® composite has a
high viscosity feel to it, as well as the quality of
not sticking to the instruments during placement,
so that the restoration can be easily shaped
and formed.
In this study, we were able to evaluate 26 of the
original 52 restorations that were placed. This
is a 50% drop out rate, which appears to be
high for this type of study. Most of the dropped
subjects were due to their moving out of the
area or being unreachable. A couple of subjects
were dropped due to case selection not meeting
the study parameters; another two subjects
were withdrawn from the study due to their
tooth bleaching that occurred during the study,
thus affecting the color match outcome. A higher
retention rate would have been desirable but
was unachievable in this situation.
Subject 3
Subject 4
Pre-operative situation Restoration at baseline Restoration at 4 years
Pre-operative situation Restoration at baseline Restoration at 4 years
12. 12
References
01. Al-Sharaa K, W. D. (2003). Stickiness prior to setting of some light cured resin-composites. Dental
Materials, 182-187.
02. Baracco B, P. J. (2013). Two-Year Clinical Performance of a Low-Shrinkage Composite in Posterior
Restorations. Operative Dentistry .
03. Bayne S., S. G. (2005). Reprinting the classic article on USPHS evaluation methods for measuring the
clinical research performance of restorative materials. Clin Oral Investig , 209-214.
04. Bracho-Trachonis, C. (2008). N'Durance nano-dimer conversion technology scientific file. Louisville,
CO: Septodont, Confi-Dental Division.
05. Dukic W, D. O. (2010). Clinical Evaluation of Indirect Composite Restorations at Baseline and 36 Months
After Placement. Operative Dentistry , 156-164.
06. Ferracane, J. (2013). Resin-based composite performance: Are there some things we can't predict? Dental
Materials , 51-58.
07. Ilie N, H. R. (2011). Resin composite restorative materials. Australian Dental Journal , 59-66.
08. Ilie N, R. A. (2011). Investigations towards nano-hybrid resin-based composites. Clin Oral Invest.
09. Moura F, R. A. (2011). Three-year Clinical Performance of Composite Restorations Placed by
Undergraduate Dental Students. Braz Dent J , 111-116.
10. Narhi, T. (2003, 7). Anterior Z250 resin composite restorations: one-year evaluation of clinical performance.
Clin Oral Invest , 241-243.
11. Palaniappan S, E. L. (2010). Three-year randomised clinical trial to evaluate the clinical performance,
quantitative and qualitative wear patterns of hybrid composite restorations. Clin Oral Invest , 441-458.
12. Papadogiannis D.Y., L. R.-A. (2008). The effect of temperature on the viscoelastic properties of nano-hybrid
composites. Dental Materials , 257-266.
13. Van Dijken J., P. U. (2011). Four-year clinical evaluation of Class II nano-hybrid resin composite restorations
bonded with a one-step self-etch and a two-step etch-and-rinse adhesive. Journal of Dentistry , 16-25.
14. Watanabe H, K. S. (2008). Fracture toughness comparison of six resin composites. Dental Materials , 418-425.
Author: Holli Cherelle Riter
Holli Riter is a full time faculty member at Loma Linda University School of
Dentistry. She graduated from the School of Dentistry in 1998 and worked for
several years in private practice. She joined the faculty full time as an assistant
professor in 2005, and later joined the Center for Dental Research in 2007. She
enjoys both working with students as they learn dentistry and working in dental
research, with a focus on esthetic materials. She is an active member of the
International and American Association of Dental Research, the Academy of Cosmetic
Dentistry, and the Academy of Operative Dentistry.
Conclusion
Within the limitations of this study, it can be
concluded that, N’Durance® composite is a
favored choice for anterior resin restorations,
having both high physical properties and excellent
esthetics after four years.
Acknowledgements
This study was supported by a grant from by Septodont, Inc. The author received an honorarium for writing
this paper.
13. 13
Restoring posterior teeth with missing cusps is
always a challenge. Onlay restorations are usually
stratified when greater tissue loss is observed,
therefore rejecting direct restorations while still
demanding a conservative treatment (Walmsley
AD, 2007). These clinical situations always
involve the dentin-pulp complex. In an effort to
excavate carious dentin and differentiate between
infected and affected dentin (Tolidis and Bout-
siouki, 2012) cavity margins are sometimes
placed in close proximity with the dental pulp.
The situation becomes more severe, in cases
when estimated remaining dentin thickness is
smaller than 1.5 mm and pulp protection is
necessary. Beside choosing the correct material
and technique, it is crucial that restoration
margins should not allow any microleakage,
facilitating pulp healing. Beside conservative
preparation and superior esthetics, ceramic
onlays offer advantages such as seal of the
dentin-pulp complex, higher bond strength and
reduced postoperative sensitivity (Walmsley AD,
2007). Besides, marginal leakage in ceramic
restorations is minimized, due to the thin layer
of resinous cement, allowing for reduced poly-
merization shrinkage or thermal volumetric
changes.
Traditional pulp protection methods include the
use of liners, varnishes and bases under resto-
rations, in order to insulate pulp from exterior
stimuli, allowing for self-healing process to
progress. An ideal pulp protection material
should compensate for dentinal tissue loss,
simultaneously stimulating tissue regeneration
and a good pulp response. Base materials are
designed to compensate for larger tissue loss.
However, when a bioactive material was needed,
calcium hydroxide was available as a liner, which
should be followed by the placement of a base
material, such as glass ionomer cements
(Walmsley AD, 2007). Addition of Portland cement
and mineral trioxide aggregate (MTA) in the
dental armamentarium, has extended the capa-
bilities of pulp healing. Although biocompatibility,
tissue regeneration and induction of dentin
bridge formation have been clarified, handling
characteristics of calcium-based cements are
still under invesitgation, since moisture levels,
condensation technique, optimum pressure
during condensation and setting time are impor-
The direct application of
Biodentine™ under indirect
ceramic restoration
C. Boutsiouki, Prof K. Tolidis, Prof P. Gerasimou
Department of Operative Dentistry, Aristotle University of Thessaloniki, Greece
Introduction
14. 14
Case Report
tant factors determing the clinical outcome (Rao
et al. 2009). Setting time of MTA, which extends
up to more than 2 hours, makes a second
patient visit mandatory, for the placement of
the final restoration. There is no data in the
recent literature, indicating that an indirect resto-
ration can be fabricated over MTA, without the
mediation of a conventional base material.
Biodentine™, a comparable tri-calcium silicate,
has been developed as a dentine substitute in
deep cavities, possesing similar mechanical
properties with dentin, therefore superior to
MTA. Biodentine™ is biocompatible and is biolo-
gically active in contact with dentin, exhibing
very good results in deep carious lesions and
pulp capping in adults (Biodentine™ scientific
file). The material sets in 12 minutes and can be
used a long-term temporary restoration. Thanks
to the comparable mechanical properties with
dentin, Biodentine™ can be used under indirect
restorations, acting as a base, nonetheless follo-
wing the initial manufacturer’s instructions (Shala
et al. 2012). However, handling procedure after
initial setting has been recently revised. Bioden-
tine™ was initially suggested to allow for at
least 48 hours before preparation of its surface
for a direct or indirect restoration. If the material
had not been fully set, the soft surface could
not be easily prepared, the matrix would have
been vulnerable to an acid attack (during etching)
and the mechanical properties would probably
deteriorate. Recently material instructions have
been revised by the manufacturer, reccomending
safely the immediate preparation of Biodentine™
after its 12-minute set. Its superior in vitro
performance, compared with conventional base
materials (glass ionomer cements and flowable
composite resins) under direct composite resin
restorations bonded with self-etch bonding
system, proved that immediate restoration is
harmless to the cement (Tolidis et al. 2013)
(Fig. 1) and that its mechanical properties are
comparable to conventional base materials
(Yapp et al. 2012). It could further be assumed,
that continuation of setting process of Bioden-
tine™, allows for absorption of polymerization
shrinkage stresses from the overlying composite
resin, resulting in preservation of excellent
marginal seal and minimized microleakage (Tolidis
et al. 2013) (Fig. 1).
The combina-
tion of both
i n n o v a t i v e
procedures
(Shala et al.
2012, Tolidis et
al. 2013, Yapp
et al. 2012) has
been applied
to the follo-
wing case
report. A large dental tissue loss was restored
with a ceramic restoration, directly after dentin
was substituted by Biodentine™.
Fig. 1
A 27-year-old female patient presented in the
dental clinic for a routine dental examination.
The patient had excellent oral hygiene and a
few, minor restorations. During clinical exami-
nation, special attention was given to the first
maxillary molar, due to a Class II composite
resin restoration with bad anatomy and appea-
rance and signs of secondary caries at the
cervical margin (Fig. 2). Bite-wing radiographs
were taken to complement the examination of
the suspected first molar and check for initial
Fig. 2
15. 15
caries in mesial and distal areas of all posterior
teeth. Secondary caries was found in the radio-
graph under the existing composite resin
restoration and restoration margins were not
acceptable. Moreover the radiograph revealed
an initiated osteolysis at the bone crest of the
supporting bone between the second premolar
and the first molar, probably owing to an incorrect
contact point which allowed for food debris
accumulation (Fig. 3). Therefore it was decided
to replace the restoration. Tooth vitality testing
(cold) was positive.
Composite resin was removed under local anes-
thesia with a cylindrical high speed bur with
water spray irrigation and secondary caries was
clinically, directly confirmed. During composite
resin removal, the mesial palatinal cusp broke
due to great undermining by caries (Fig. 4).
Caries was removed by means of an excavator
and a low speed round bur. At the mesial area,
caries extended below the gingiva, therefore
local gingivectomy with an electrotome took
place in order to increase visibility. Cavity was
finished with unsupported enamel prisms removal
and resulted in a greater tooth loss, both in
extent and in depth, than initially planned. Taking
into account the subgingival extent of the cavity
mesially and the amount of tooth substance
loss, including cusps, it was decided to restore
the tooth with an onlay, by substituting the lost
dentin and protecting the young vital pulp with
an appropriate material. The patient was
concerned about esthetics and longevity of the
restoration and since she was not a bruxist, a
ceramic onlay restoration was regarded as the
treatment of choice. Biodentine™ was chosen
as a dentin substitute and pulp protection under
the ceramic restoration. Restoration margins
were prepared with a high speed cone bur with
rounded edge, the remaining distal cusps were
occlusally reduced in order to attain 2-mm
space for the ceramic and an additional mesio-
distal groove was prepared to provide mechanical
stability to the restoration. Margins were rounded
to avoid stress concentration on the restoration
and on the tooth. Proximal walls were flared
10-12o in total, 6o for each wall, using the
appropriate cone-shaped diamond bur, paying
extra care to avoid undercuts (Fig. 5). Bioden-
tine™ placement fully covering the prepared
cavity, waiting at least 48 hours with Biodentine™,
acting both as dentin substitute and as a tempo-
rary restoration, before continuing the restorative
process at the next patient visit would be the
conventional procedure. Based on previous
experimental studies (Yapp et al. 2012, Tolidis
et al. 2013), it was decided to immediately
continue with the restoration process, after
Biodentine™ placement and setting. Biodentine™
was applied, right after the cavity was formed.
Biodentine™ was placed in a 2-mm thick layer
at the deepest part of the cavity located mesially,
covering the undercuts on the pulpal wall, was
condensed and was protected from moisture
and allowed to set for 12 minutes according to
the manufacturer’s instructions. Subsequently,
Biodentine™ surface was finished with a low-
speed carbide bur. Dentinal walls of the onlay
preparation, which were covered with cement,
were finished with a low-grit high-speed diamond
Fig. 3
Fig. 4 Fig. 5
16. 16
bur taking extra care (Fig. 6). In cases when the
clinician decides to continue with the restorative
process directly after Biodentine™ setting, either
with a direct or with an indirect restoration, it is
safer to prepare Biodentine™, if needed, with
low speed burs, to avoid complete removal of
the cement from the cavity (Tolidis et al. 2013).
Retraction cord was placed in the gingival sulcus
at the mesial area, where the preparation
extended subgingivally and impression was
taken with vinyl-poly-siloxane (Fig. 7). Shade
A2 was chosen for the ceramic restoration,
matching the neighboring and opposite teeth of
the young patient. The preparation was covered
with a temporary light-cured material (Fig. 8),
which is easily removed at the delivery appoint-
ment with an explorer. During the second patient
visit, the ceramic onlay was tried in using special
carrying sticks to prevent loss or damage to the
restoration while handling (Fig. 9). Ceramic resto-
ration was glazed. Before cementation, the inner
surface was cleaned with 37% phosphoric acid
applied for 30 seconds (Fig. 10), followed by the
application of a silane primer according to the
cementation technique. Self-etching bonding
agent was applied on the tooth structure, avoiding
the area covered by Biodentine™ and the resto-
ration was adhesively cemented with a dual-
cure resinous cement, in order to increase
retention (Fig. 11). Excess resinous cement was
removed with an explorer and contact points
were checked with dental floss. The restoration
was light cured for 40 seconds from each side
and occlusion was checked with occlusion
paper and properly adjusted in maximum inter-
cuspation and in mandibular moves. Visible
margins were also finished with fine cone-
shaped diamonds and silicon points. Patient
was instructed for daily oral hygiene and was
advised to avoid biting on hard objects or food
at the area of restoration. No post-operative
sensitivity or other symptoms appeared. The
patient was followed-up in 6 months (Fig. 12,
13, 14). Intraoral examination, radiographs and
pulp vitality testing proved the success of the
material choice and of the restoration process.
Reactionary dentin formation is evident when
comparing the two radiographs (Fig. 3 and
Fig. 14). Last but not least the mesial restoration
and the tooth margins were visually checked in
high magnification photograph (Fig. 13) as well
as clinically with an explorer, confirming that
the radiolucency shown in this area in the radio-
graph seems to be of no importance.
Fig. 6 Fig. 7 Fig. 8
Fig. 9 Fig. 10
17. 17
Author: Christina Boutsiouki (christinaboutsiouki@gmail.com)
Christina Boutsiouki graduated in 2011 and works as a general dentist. She is
studying in the post-graduate MSc course in the Department of Operative
Dentistry, in Aristotle University of Thessaloniki, Greece. She is actively involved
in research since 2008, focusing on dental materials, operative dentistry and
pediatric dentistry.
She participates in dental conferences and has published 23 scientific articles.
References
01. Shala AJ, Simon J, Darnelll L. Biodentine as a base under CEREC restorations. Poster Session AADR
2012, Tampa, Florida, USA.
02. Tolidis K, Boutsiouki C. Decay diagnosis camera: Is it a valid alternative? The International Journal of
Microdentistry 2012;3(1): (ahead of publication).
03. Tolidis K, Boutsiouki C, Gerasimou P. Comparative evalutation of microleakage in direct restorations with
Ca3SiO4 bioactive material (Biodentine) under composite resin. Clin Oral Invest 2013;17(3):1083.
04. Walmsley AD, Walsh TF, Lumley PJ, Trevor Burke FJ, Shortall AC, Hayes-Hall R, Pretty IA. Restorative
Dentistry, 2nd Edition, 2007, Churchill Livingstone, Elsevier.
05. Yapp R, Strassler H, Bracho-Trochonis C, Richard G, Powers J. Compressive deflection of composite
layered on Biodentine and two bases. Poster Session AADR 2012, Tampa, Florida, USA.
Conclusion
By utilizing this innovative approach, number of
patient visits was reduced and the compromised
first maxillary molar was treated indirectly, provi-
ding an esthetic restoration with long-term
survival. Since it has been experimentally exhi-
bited that direct application of the restorative
material over Biodentine™ is effective and time-
consuming, this case report represents the
extension of this treatment idea in indirect
ceramic restorations. It should be however
emphasized, that Biodentine™ needs extra care
in handling when restored directly.
Fig. 11 Fig. 12 Fig. 13
Fig. 14
18. 18
Apicoectomy treated with
an active biosilicate cement:
Biodentine™
Case report of a tooth Apicoectomy, endodontically treated with a retrograde filling
material based on an Active Biosilicate cement, Biodentine™ Septodont.
Dr. César A. Gallardo Gutiérrez
Departement of Endodontics, Universidad Cientifica del Sur, Lima, Peru
In clinical practice, we encounter complex proce-
dures that often involve errors in the development
of the endodontic treatment, both in the prepa-
ration and the obturation, and which lead to the
persistence of the periapical lesion via the migra-
tion of antigens in the region.
The alternative we then have is retreatment,
which is not indicated in cases of complex
over-obturations or teeth that have been restored
with posts, which complicates the procedure
and could result in the loss of the tooth due to
fracture or perforation.1
In the case we present below, we saw that the
conditions for a successful retreatment were
unfavorable, we thus decided to perform peria-
pical surgery.
Periapical surgery consists in the exposure of
the periapical zone and the removal of the
affected tissue followed by a retrograde resto-
ration consisting in the apical preparation of a
cavity and its filling to ensure a hermetic seal
and prevent percolation.2
Endodontics has made great progress in the
last decade in the development of new equip-
ments, new instruments, advances in imaging
and the development of new materials.1
In this case among the new materials we used
Biodentine™ developed by Septodont, as a
new class of dental material that combines high
mechanical properties and biocompatibility, with
a calcium silicate (Ca3SiO5)-based formulation,
which is a proven dentin replacement material
whenever dentin has been damaged.3
Case Report
A 48 years old female patient without pertinent
medical history came to the consultation with
pain in tooth 12, she mentioned having been
treated a year ago.
We observed in the clinical examination that the
tooth has a ceramic metal crown. No increase in
the tissue volume was observed at the vestibular
level (Fig 1), there is no sign of fistula, pain mani-
festation on palpation and vertical percussion.
Introduction
19. 19
The X-ray examination showed that the ceramic
metal crown was not sealed at the cervical
level, through the radiotransparency of the crown
filling we noticed a fiber post, with absence of
filling in the entire lumen of the canal prepared
for the post, we also observed an over-obturation
of approximately 3 mm and extravasation of
the sealing cement, located in a radiotransparent
area compatible with a chronic periapical process.
(Fig 2)
Treatment Plan
After the evaluation of the patient's conditions
we recommended:
1- A surgical treatment, thus planning the exeresis
of the extravasated material and the granu-
lomatous tissue, apicoectomy with retrograde
restoration,
2- Secondly, we recommended a new crown
restoration with adequate cervical seal.
Treatment
We started the treatment with infiltration anes-
thesia in the zone with 2% Lidocaine. The incision
was made with a No. 15 scalpel blade, vertically
away from the radiotransparent zone. We obtained
a flap of the total thick-
ness, with two discharge
incisions resulting in a
rectangular flap. The zone
was detached with a
periosteal elevator without
evidence of vestibular
bone fenestration. (Fig 3)
Once the zone to be
treated was exposed, we
performed an osteotomy
with a No. 10 round
surgical bur, once we
reached the periapical
zone we carried out the
curettage, the over-obturated material and the
surrounding granulomatous process was
removed, and washed abundantly with saline
solution to verify the removal of all the patholo-
gical tissue. The apicoectomy was performed
with a fissure bur, creating as little bevel as
possible and following the direction of the apical
process. The apical chamber was prepared with
a round bur following the direction of the root
canal, at a 3 mm depth, it was thoroughly
washed with saline solution and the cavity was
dried with paper cones. (Fig 4)
Septodont’s Biodentine™, an active biosilicate-
based retrograde obturation material was prepared
according to the manufacturer's instructions,
mixing 5 drops of the liquid (Aqueous calcium
chloride and excipients solution) with the powder
Fig. 1 Fig. 2
Fig. 3 Fig. 4
20. 20
(tricalcium silicate) for 30 seconds in the Henry
Schein amalgamator Model: HS-1. (Fig 5, 6)
We then placed the appropriate amount of mate-
rial in the prepared cavity and condensed it,
after 12 minutes, completely isolated from fluids,
according to the manufacturer's recommendation
(Fig 7), the excess was removed. (Fig 8)
We placed Genox® Org Genius-Baumer bovine
liophylized bone in the cavity to fill-in the bone
defect. (Fig 9)
We closed with 3-0 black silk suture, and treated
with amoxicillin plus clavulanic acid 500 mg,
every 8 hours for 7 days and ibuprofen 400 mg
every 8 hours for 4 days, as well as recommen-
ding a 0.12% Chlorehexidine Gluconate mouth
wash 3 times a day for 7 days. A control X-ray
was taken. (Fig 10)
Discussion
It was decided to perform the periapical surgery
because it was impossible to eliminate the over-
obturated material and the surrounding material
in any other way.1
Many materials have been used for retrogade
restoration, such as:
-Cohesive gold, which has very good properties.
However the very long working time involved
is a major disadvantage.
-Gutta-percha, which does not have an accep-
table sealing degree and is affected by the
compaction given as well as the humidity of
the zone.
-Zinc phosphate and eugenol
cements, which have a high
level of solubility and irritation
of the surrounding tissue.
-Resin modified ionomers which
release monomers on polyme-
rization provoking persistent
toxicity in the zone, and whose
ionomeric part has a high solu-
bility and therefore is not
recommended for this type of
treatment.4
Thus, the most commonly usedFig. 7 Fig. 8
Fig. 5
Fig. 6
21. 21
material and with the greatest number of literature
references is silver amalgam, which is known
for its mercury toxicity, it can tattoo the surroun-
ding tissue with corrosion and the seal is poor
as it depends on a retentive preparation.
Another material which is increasingly used is
MTA (Mineral Trioxide Aggregate), which is a
mixture of small hydrophilic particles of tricalcium
silicate, tricalcium aluminate, tricalcium oxide
and silicon oxide, whose biocompatibility has
been widely demonstrated, as well as the ability
to induce the precipitation of calcium phosphate
at the level of the periodontal ligament propitious
to the formation of surrounding bone repair5.
On the other hand the seal it forms in the cavity
is superior to other materials, improving with
time due to the absence of solubility, thus
preventing percolation.
The main problem with MTA is that it is hard to
handle and to position in the retrogade cavity
especially when they are small or thin.
Another disadvantage is the setting time which
can last up to 4 hours after its application, with
the possibility of degradation during this period.6
After this overview, we conclude that there is
no ideal material for retrograde restoration, for
this reason Septodont developed Biodentine™
as a new class of dental material that can
combine high mechanical properties and biocom-
patibility, with a calcium silicate (Ca3SiO5)-based
formulation, which is a proven dentin replacement
material whenever dentin has been damaged.
Following what we presented above concerning
the disadvantages of the materials previously
used, Septodont tries to improve the clinical
times by adding to the active biosilicate settling
accelerators and softeners, as well as a faster
and safer preparation with exact amounts for a
predictable mixture in pre-dosed capsules to
be used in a mixing device, which makes it
more practicable and safe to use.7, 8
Calcium hydroxide forms as part of the chemical
hardening reaction of Biodentine™.9
The metal impurities observed in "Portland
cement" silicates are eliminated in the manufacture
of Biodentine™ biosilicate. The hardening reaction
is the hydration of the tricalcium silicate, which
produces a calcium silicate and calcium hydroxide
gel. Precipitates similar to hydroxyapatite are
formed in contact with phosphate ions.10
An evaluation of the dentin-Biodentine interface
showed micro-structural changes in the dentin,
and revealed an increase in the carbonate content
of the dentin interface, suggesting the intertubular
diffusion of mineral from the biosilicate hydration
products creating a hybridization zone.11
Fig. 9 Fig. 10
22. 22
Author: Dr. César Antonio Gallardo Gutiérrez (cgallardo03@gmail.com)
Endodontics and Cariology Specialist
Master in Education and Research
Post-graduate professor of the Endodontics Specialization Universidad Científica
del Sur, Peru
Degree in Oral Rehabilitation, Universidad Científica del Sur, Peru
References
01. Cohen S., Hargreaves K., (2008) Vías de la Pulpa, Novena edición, editorial Elsevier España pp 737, 972
02. Sotelo y Soto Gustavo Alfonso, Trujillo Fandiño Juan José. Técnicas quirúrgicas en exodoncia y cirugía
bucal, 2ª Ed. México, Textos universitarios Universidad Veracruzana, 2008.
03. Biodentine™ - Publications and Communications 2005-2010. Research & Development Septodont, Paris
2010.
04. Meneses V, Técnica De Apicectomia en paciente de sexo femenino de 49 años de edad (Caso Clínico)
Tesina Para Obtener El Título De: Cirujano Dentista Universidad Veracruzana Facultad Odontología Poza
Rica, Veracruz Junio 2012
05. Parirokh M, Torabinejad M (2010). Mineral trióxido agregado: Una revisión exhaustiva de la literatura-
Parte I: química, física y propiedades antibacterianas. J Endod. 36:16-27.
06. Parirokh M, Torabinejad M (2010). Mineral trióxido agregado: Una amplia revisión de la literatura-Parte III:
Aplicaciones clínicas, las desventajas y mecanismo de acción. J Endod. 36:400-413.
07. Wang X, Sun H, J Chang (2008). Caracterización de Ca3SiO5/CaCl2 cemento de composite para
aplicación dental. Dent Mater. 24:74-82.
08. Wongkornchaowalit N, Lertchirakarn V (2011). Ajuste de la hora y la fluidez del cemento Portland acelerado
mezclado con superplastificante de policarboxilato. J Endod. en prensa :1-3.
09. Sobre I, Laurent P, O. Tecles Bioactividad de Biodentine:. Un sustituto dentina Ca3SiO5 basado Dent Res
J . 2010; 89: Resumen n. 165.
10. Colón P, F Bronnec, Grosgogeat B, Pradelle-Plasse Interacciones N. entre un cemento de silicato de calcio
(Biodentine) y su entorno. Res J Dent . 2010; 89: Resumen n. 401.
11. Atmeh A. Dinámica interfaz bioactivo con los tejidos dentales. 45 ª Reunión de la División Continental
Europea de la IADR (CED-IADR) con la División escandinavos (NOF). 2011; no abstracta. 1.
Conclusion
The material has acceptable properties guaran-
teeing the quality of the mixture by its pre-dosing,
resulting in an easy to handle homogeneous
composition.
The biocompatibility advantages of active biosi-
licate are known which gives us a high safety
margin of periapical biological response.
The disadvantage observed in the retrograde
restoration was a low radiopacity of the material
in comparison with amalgam, which complicates
the evaluation of the quality of the obturation
seal.
The first results observed in clinical practice are
highly promising.
23. Racegel is the only gel that creates a dry and clean environment to
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