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CONTENTS: INTRODUCTION CLASSIFICATION HISTORY IMPRESSION MATERIALS DENTAL LUTING AGENTS DENTAL CERAMICS DENTURE BASE RESINS CONCLUSION REFERENCES
INTRODUCTION:
The overriding goal of dentistry is to maintain or improve the life of the dental patient. The goal can be accomplished by preventing disease, relieving pain, improving masticatory efficiency, enhancing speech and improving appearance. The main challenges for centuries have been the development and selection of biocompatible, long lasting, direct filling tooth restoratives and indirectly processed prosthetic materials that can withstand the adverse conditions of the oral environment. Dental materials may be classified as
Around 600 A.D The Mayans used implants consisting of sea shell segments that were placed in anterior teeth sockets. The Incas performed tooth mutilations using hammered gold but the material was not placed for decorative purposes. Fauchard (1678-1761) the father of modern dentistry used tin foil and lead cylinders for filling the tooth cavities. Gold shell crowns were described by Monton in 1746. In 1756 Phlipp Pfaff of Germany described a method for making impressions of the mouth in wax from which he constructed a model with plaster of Paris. In 1774 Duchateau a French pharmacist designed a process for producing hard, decay proof porcelain dentures. In 1808 Fonzi an Italian dentist developed an individual porcelain tooth form that was held in place with an embedded platinum pin. Planteau, a French dentist first introduced porcelain teeth in 1817. Ash further developed an improved porcelain tooth in England around 1837. In 1839 Charles Goodyear has invented vulcanized rubber denture bases, and in 1935 polymerized acrylic resin was introduced as a denture base material to support the artificial teeth. In 1907 Taggert developed a more refined method for producing cast inlays. Mason developed a detachable facing to a crown to hold an artificial tooth. In prosthetic dentistry auxiliary materials play a major role in fabrication of removable and fixed prostheses.
IMPRESSION MATERIALS
These materials can be classified according to the mode through which the ingredients react (set or harden) to solids, their mechanical properties, and their uses.
Compatibility with cast and die materials Accuracy in clinical use. No release of gas or other by products during the setting of the impression or cast and die materials.
Composition:
Agar- 13-17% is an organic hydrophlilic colloid (polysaccharide) extracted from certain types of sea weed. Borates- 0.2-0.5% strengthens the gel Sulfates- 1-2% accelerator Diatomaceous earth, clay, silica, wax, rubber can be used as fillers Thymol- bactericidal agent Glycerin- plasticizer
Manipulation:
The hydrocolloid is usually supplied in two forms syringe material and tray material. The manipulation includes liquefying the gel, placing it in the impression tray, tempering it to a lower temperature that the patient can tolerate and maintaining it in its fluid state to capture the details of the oral structures. The equipment includes 3 compartments for liquefying the material, storing after boiling and tempering the tray hydrocolloid.
Recent techniques:
Laminate technique:
A recent modification of the conventional procedure is the combined agar alginate technique. The hydrocolloid in the tray is replaced with a mix of chilled alginate that bonds with the agar expressed from a syringe. The alginate gels by a chemical reaction whereas the agar gels by means of contact with cool alginate rather than with the water circulating through the tray.
Since the agar not the alginate is in contact with the prepared teeth maximum detail is reproduced.
Advantages
syringe agar records tissues more accurately Water cooled tray is not required Sets faster.
Disadvantages:
Agar alginate bond failure can occur Viscous alginate may displace agar Technique sensitive
ALGINATE HYDROCOLLOID
The word alginate comes from the term algin. The term was coined by a scotttish chemist S.Williams received the first patent to use alginate as an impression material. It is a mucous extract obtained from certain brown sea weed. The substance is called anhydro-beta d-manuronic acid or alginic acid.
Composition:
Potassium alginate 18%- to dissolve in water and react with calcium ions Calcium sulfate dehydrate 14% - to react with potassium alginate to form an insoluble calcium alginate gel. Potassium sulfate, potassium, zinc flouride, silicates or borates 10% - to counteract the inhibiting effect of the hydrocolloid on the setting of gypsum, giving a high quality surface to the die.
Sodium phosphate 2% - to react preferentially with calcium ions to provide working time before gelation. Diatomaceous earth or silicate powder 56% to control the consistency of the mixed alginate and the flexibility of the set impression. Organic glycols in small amounts to make powder dustless. Winter green, peppermint, pigments in traces to present a pleasant taste. Pigments in traces to produce colour. Disinfectants like quarternary ammonium salts and chlorhexidine 1-2% to help in the disinfection of various organisms.
The antiseptic may be encapsulated in a microcapsule or clathrated in a cyclodextrin. 5. CAVEX Color change: The alginate impression material with color indications avoiding confusion about setting time. Color changes are visualizing the major decision points in impression making end of mixing time end of setting time ( tray can be removed from mouth) it indicates two color changes Violet to pink indicates the end of mixing time. Pink to white indicates end of setting time. Other advantages of this material are -improved dimensional stability (upto 5 days) Good tear and deformation resistance Dust free Smooth surface, optimum gypsum compatibility.
ELASTOMERIC
IMPRESSION
Elastomers refer to a group of rubbery polymers which are either chemically or physically cross linked. Chemically there are four kinds of elastomers used as impression materials. -poly sulfide ; introduced in 1950 - condensation silicones ; introduced in 1955 -addition silicones ; introduced in 1965 -poly ethers ; introduced in 1975 These impression materials are typically supplied in several consistencies - low (syringe or wash) - medium (regular) - high (tray) Addition silicones are available in these three viscosities plus --extra low --monophase and putty (extra high) Condensation silicones are usually supplied in --loe --putty consistencies Poly ethers were available in --low
--medium --high consistencies. Mixing systems Three types of mixing systems are available to mix catalyst and base --hand mixing --Static auto mixing --dynamic mechanical mixing
Hand mixing:
Equal lengths of catalyst and bases are dispensed on a paper pad, initial mixing is accomplished with a circular motion and final mixing to produce a mix free from streaks.
Automixing systems:
The base and the catalyst are in separate cylinders of the plastic catridge. The plastic catridge is placed in a mixing gun containing two plungers that are advanced by a ratchet mechanism to extrude equal quantities of base and catalyst. The base and catalyst are forced from the static mixing tip containing plastic internal spiral, the two components are folded over each other resulting in a uniform mix at the tip end.
Polysulfide:
They are supplied in tubes of base paste and catalyst paste. They are available in low , medium and high viscosities
Composition:
Base paste: Poly sulfide polymer- 80-85% Titanium dioxide Zinc oxide, copper carbonate or silica- 16-18% Accelerator paste: Lead dioxide 30% Dibutyl or dioctyl 17% Phthalate Sulfur 1-4% Other substances such as magnesium stearate and deodorants 2%
Reaction:
The lead dioxide catalyzes the condensation of the terminal and pendant SH with SH groups on other molecules, resulting in chain lengthening and cross linking. In the process the material changes from a paste to a rubber. This reaction is accelerated by increase in temperature and by the presence of moisture. Water is the byproduct in this condensation reaction.
Manipulation:
These materials are mixed on a mixing pad with a spatula Adequate mixing time is 45-60sec; the working time is about 5-7min. They stain clothing permanently, they can be electroplated, and some products can be silver plated. Polysulfides must be poured within 1hour and cannot be repoured. Polysulfide impression materials are low to moderately hydrophilic and make an accurate impression in the presence of saliva or blood. Because the material has a low wetting angle it makes impressions more easily than poly ether and poly vinyl siloxanes.
Impregum(F), Permadyne.
Composition:
Base paste; Imine terminated polymer (polyether) crosslinks to form the set material A colloidal silica as the filler gives bulk Glycol ether or phthalate acts as a plasticizer. Accelerator: Alkyl aromatic sulfonate initiates cross linkage. Colloidal silica as a filler to form the paste Plasticizers such as glycoether or phthalate.
Setting reaction:
When the base paste is mixed with the catalyst paste ionic polymerization occurs by ring opening of the ethylene imine group and chain extension. It sets by additional polymerization and no byproduct is formed. Cross linking occurs by cationic polymerization via the imine end groups The set material is hydrophilic. It can absorb water and swell resulting in dimensional change Setting time 8.3min Mixing time -30sec Improved polyether formulations such as soft polyethers are easier to remove, maintain proper rigidity for a wide range of applications nad capture fine details even in moist conditions. This material taste bitter, currently its flavoured to offset the taste.
Condensation silicones:
It was the first type of silicone impression material These materials are available two paste or paste-liquid-catalyst systems or putty in jars. Multi phase materials available in different viscosities Monophase- available in a single viscosity.
Composition:
Base paste; Poly dimethyl siloxane Colloidal silica or microsized metal oxide filler - Putty viscosity- 60-70% - Medium viscosity 35-75% - Low viscosity 5-15% Color pigments
Accelerator paste: Alkyl silicate such as orthoethyl silicate cross linking agent Stannous octoate catalyst Inert filler Setting reaction: stannous Dimethyl siloxane + ortho ethyl silicate +ethyl alcohol Octoate silicone rubber
Its a condensation reaction Cross linkage occurs between orthoethyl silicate and the terminal hydroxyl groups of dimethyl siloxane. Ethyl alcohol forms as a byproduct which results in shrinkage. Setting time 8-9 min, mixing time- 45 sec. The setting occurs at room temperature and so called as (room temperature vulcanization) RTV silicones. They are ideal for single unit inlays. Electroplating is possible. Because of the high polymerization shrinkage the cast or die must be poured as soon as possible.
Composition:
Base paste: Poly (methyl hydrogen siloxane) Other siloxane prepolymers Fillers to give bulk and viscosity Accelerator paste:
Divinyl poly siloxane Inert oils and fillers forms the bulk of the paste Palladium salt catalyst (chlorplatinic acid) Palladium or hydrogen absorber Retarder Filler Polyvinyl siloxane rubber Silane siloxane Pt salt + silicone
Its an addition polymerization reaction. The vinyl groups of the base paste reacts with the silane groups of the accelerator paste and cross linking occurs. There is no production of by product. If the pastes are in improper proportion, hydrogen gas may be liberated during the setting mechanism. Palladium is added to absorb hydrogen to prevent dimensional change. Latex gloves have been shown to adversely affect the setting reaction of addition silicones. Sulfur compounds that are used in vulcanization of latex rubber gloves can migrate to the surface of stored gloves. These compounds can be transferred on to the prepared teeth and adjacent soft tissues during tooth preparation. These compounds can position the platinum containing catalyst which reacts in retarded or no polymerization in the contaminated area of the impression. Vinyl and nitrile gloves donot have such an effect. Residual monomer in acrylic resin provisional restorations and resin composite cores has a similar inhibiting effect on the set of addition silicone materials.
Recent advancements:
Surfactants have been added to addition silicones by manufacturers to reduce the contact angles, improve wettability, and simply pouring of gypsum models, known as hydrophilized addition silicones. The hydrophilization of addition silicones is gained with the incorporation of non ionic surfactants as micelles. The molecules consist of a hydrophilized part and a silicone compatible hydrophilic part.
The mode of action of these surfactants is thought to be a diffusion controlled transfer of surfactant molecules from the poly vinyl siloxane in to the aqeous phase. In this manner the surface tension of the surrounding liquid is altered. This increased wettability allows the addition silicones to spread more freely along the surface. (ref: Craig pg298.) Miller and coworkers reported a significant reduction in the number of voids and an overall increased quality of polyvinyl siloxane impression when a modified polydimethyl siloxane wetting agent (extrinsic surfactant) was applied to the prepared tooth surface before impressions made. Recently radiofrequency glow discharge has been advocated for use as a didinifecting procedure for polyvinyl siloxane impressions. Whilst this procedure is claimed to clean and improve the wettability of the impression surface, its not clear if glow discharging results in sterilization. (ref: Polyvinylsiloxane impression materials: An update in clinical use, Australian dental journal, 1998, 43(6),428-434)
Manipulation:
The undercuts should be blocked out before making the impression. Transparent stock trays are available.
The light bodied material is syringed and the heavy body material is placed above it. Blue light is used for curing. The exposure should be done from the posterior to anterior region. Each region should get an exposure of 30sec. After removal the impression can be filled and re exposed to light. Advantages: Long working time, but short setting time. Impressions can be corrected. Dimensional stability, flow, detail reproduction. Disadvantages Expensive Requires special equipment The effect of disinfection and a wetting agent on the wettability of addition silicone impression materials Paul J.Milward et al. had conducted a study on the effect of disinfection procedure and the use of surface wetting agent on the wettability of 4 addition polymerized silicone impression materials. They use testing specimens made from 4 addition silicone materials (light bodied president, light bodied Extrude, medium bodied Extrude, and Aquasil) Two disinfection solutions (actichlor and perform) were used. They concluded that application of an external disinfectant actichlor is recommended in preference to Perform the wettability of materials. Treatment with a surface wetting agent after disinfection is recommended to obtain accurate and void free casts and dies. (Ref: JPD 2001, 86,165-7)
LUTING CEMENTS
A dental cement used to attain indirect restorations to prepared teeth is called a luting agent . Luting agents may be definitive or provisional depending on their physical properties and the planned longevity of the restoration.
REQUIREMENTS:
It must not harm the tooth or tissues. It must allow sufficient working time to place the restoration. It must be fluid enough to allow complete seating of the restoration. It must not dissolve or wash out and must maintain a sealed intact restoration. It must quickly form a hard mass strong enough to resist functional forces.
It must not dissolve or wash out and must maintain a sealed intact restoration.
Classifications:
Craigs classification based on the chief ingredients eg: zinc phosphate, zinc silicophosphate, zinc oxide eugenol, zinc polyacrylate, glass ionomer, and resin. OBrien classified dental cements by matrix and bond type (eg: phosphate, phenolate, poly carboxylate, resin, resin modified glass ionomer) Donovan classified cements into conventional (eg:zinc phosphate,polycarboxylate, glass ionomer) and contemporary (eg:resin modified glass ionomer, resin )
Compomers:
The compomers , also known as polyacid- modified composite resins appeared in the late 1990s, and were described as being a combination of composite resin (comp) and glass ionomer (omer), offering the advantages of both. Compomers are anhydrous resins that contain ion leachable glass as part of the filler and dehydrated poly alkenoic acid. The physical behaviour of the compomers is more like composite resins than glass ionomer, with higher compressive and flexural strength than RMGI, but inferior to unmodified composite. Tooth addition is very little, fluoride release is very limited and its less than that of conventional glass ionomer .
Resin:
Resin cements are methyl- methacrylate, Bis- GMA dimethacrylate or Urethane dimethacrylate based with fillers of colloidal silica or barium glass 20-80% by wt. They are available as powder/liquid, encapsulated or paste/paste systems and may be auto, dual or light cured to form the polymer matrix.
Resin bonding to enamel is by mechanical interlocking into an acid etched surface. Bonding to dentin is also micromechanical but is more complex usually requiring multiple steps that include removal of the smear layer and surface demineralization, then application of unfilled resin bonding agent or primer to which the resin commercially bonds. Non eugenol provisional cement is recommended for provisional restorations, when resin will be used for definitive restoration. Since the residual eugenol from provisional cement can interfere with the setting reaction of the bonding agent. Many new resin luting systems have recently appeared that reduce luting procedures by including the use of a self etch primer built in. eg:Unichem by 3M ESPE,Maxcem by Kerr Orange ,California. Light cured resin cements are cured more completely after initial placement. Where as auto and dual cured resins slowly gain strength. Resin cements chemically bond to etched silane treated prcelainit has been postulated that resin cement bonded to considered tooth on oneside and etched /silane coated porcelain on the other helps diffuse stresses across the tooth. Compressive and tensile strength, toughness and resilience of resin cement equal or exceed those of other luting agents. The resin luting cement offers no fluoride release or uptake, film thickness maybe relatively high, removal of restoration may require total destruction. They are more technique sensitive and expensive.
Adhesive resin:
In the early 1980s conventional Bis GMA resin cement was modified by adding a phosphate ester to monomer component to improve the degree of chemical bonding as well as micromechanical bonding to tooth structure and base metal alloys. Eg; Panavia contained the bifunctional adhesive monomer 10- methacryloyloxy deci dihydrogen phosphate (MDP) and was a powder/ liquid system. In 1994, Panavia was modified to include a dentin/enamel primer containing hydroxyethyl methacrylate (HEMA), N-methanyloyl 5- aminosalicylic acid and MDP intended to improve bond strength to dentin. Eg;Panavia 21, marketed as a two paste system offered 3 shades, tooth colored 9T.C, translucent), white (EX,semitranslucent) and opaque (OP). The current product Panavia F is a two paste system that is dual cured , self etching and self adhesive plus fluoride releasing. C&B metabond modified Bis GMA composite by decreasing filler and adding 3% 2 hydroxy-3b naphthoxypropyl methacrylate in methyl methacrylate with 4methacryloyloxy ethyl trimellitate anhydride (4-META) and tri-n-butyl borane. Its a powder liquid autocuring system and may be used for resin bonded prostheses. (Ref: DCNA, July 2007, vol51, No.3)
Development of a novel comonomer free light cured glass ionomer cement for reduced cytotoxicity and enhanced mechanical strength (Ref: Journal of Dental materials 23(2007), 994-1003). Dong xie, Youfun yang et al had developed a novel comonomer free light cured glass ionomer system based on 4 arm star shape poly acrylic acid. The mechanical strengths and invitro cytotoxicity of the formed system were evaluated and compared with those of several representative commercial glass ionomer cements. The 4- arm poly (acrylic acid) was synthesized using ATRP and tethered with glycidyl methacrylate (GM). The GM tethered polymer was formulated with water, photoinitiators and fujiII, fuji II LC and vitremer were used for comparision. Compressive strength (CS) and MTT assay were used as tools to evaluate the mechanical strengths and invitro cyto toxicity of the cements respectively. They concluded that this novel comonomer free light cured glass ionomer cement has significantly improved mechanical strength, and no invitro cytotoxicity observed.
Cavity liner:
Calcium hydroxide:commonly employed as adirect or indirect pulp capping agent. Two paste system employed as a direct or indirect pulp capping agent. Available as Twp paste systems containing base and catalyst pastes in collapsible tubes Light cured systems Powder and liquid Single paste system Commercial names: CRCS (calciobiotic canal sealer): Its essentially a zinc oxide eugenol sealer to which calcium hydroxide has been added for its osteogenic effect.
The base is zinc oxide with calcium hydroxide as aell as butyl benzene sulfonamide and zinc stearate. Calasept (by scania dental AB, Sweden ): it contains calcium hydroxide + potassium chloride + sodium chloride+ calcium chloride+ sodium bi carbonate + distilled water Calen; it contains calcium hydroxide + zinc oxide + colophony + poly ethylene glycol.
DENTAL CERAMICS
The word ceramics is derived from the greek word Keramos meaning pottery or burnt stuff. Ceramics is an inorganic compound with non metallic properties typically composed of metallic or semi metallic and non-metallic elements (eg. Al2O3 CaO and Si3N4).
Def:
An inorganic compound with nonmetallic properties typically consisting of oxygen and one or more metallic or semimetallic elements (eg: aluminium, calcium, lithium, magnecium, potassium, silicon, sodium, tin, titanium and zirconium) that is formulated to produce the whole or part of a ceramic based dental prosthesis. Ceramic: Def: an inorganic compound with non metallic properties typically composed of metallic (or semi metallic0 and non metallic elements (eg:Al2O3, and Si3N4) Ceramics can be classified in one of four categories silicate ceramics oxide ceramics non oxide ceramics glass ceramics Dental ceramics fall in category of silicate ceramics, which are characterized by an amorphous glass phase with a porous nature.
History:
The porcelain tooth material was patented in 1789 by French dentist de Chemant in collaboration with a French pharmacist Duchateau. In 1808, Fonzi an Italian dentist invented a terrometallic porcelain tooth that was held in place by a platinum pin or frame. Planteau, a French dentist introduced porcelain teeth to united states in 1817 and Peale an artist. Ash developed an improved version of the porcelain tooth in 1837.
Dr Charles land introduced one of the first ceramic crowns to dentistry in 1903. The first commercial porcelain was developed by Vita Zahnfabrik in about 1963. A significant improvement in the fracture resistance of porcelain crowns was reported by Mclean and Hughes in 1965 when a dental aluminous core ceramic consisting of a glass matrix containing between 40 and 50 wt % Al2O3 was used. Improvements in all ceramic systems developed by controlled crystallization of a glass (dicor) was demonstrated by Adan and Grossman (1984) This glass was melted and cast in to a refractory mold and subsequently crystallized to form the dicor glass ceramic that contained tetrasilicic flouramina crystals in a glass matrix. Pressable glass ceramic (IPS Empress) was introduced in early 1990s, containing 34% vol. of leucite. A more fracture resistant, pressable glass ceramic (IPS Empress 2) containing appx. 70% vol. of Lithia disilicate crystals was introduced in the late 1990s.
Classification:
Dental ceramics can be classified based in many factors. 1. Based on chemical composition a)Silicate ceramics: Silicate ceramics have oxides of silicon and other atoms of aluminium, potassium, magnecium calcium eg:potash felds, sodium feldspar. b).Non silicate ceramics: Without silica the other ingredients being the same eg: alumina (Al2O3), Spinell (MgO, Al2O3) c).Non oxide ceramics: This includes silicon carbide, tungsten carbide or graphite. 2. Based on crystalline nature: Crystalline ceramics; eg:feldspathic porcelain contains leucite (crystal phase) Non crystalline ceramics eg:glass
The medium fusing and high fusing types are used for production of denture teeth. The low fusing and ultra low fusing porcelains are used for crown and bridge construction. 4. Based on type: Feldspathic porcelain Aluminous porcelain Glass infiltered alumina Glass infiltred spinell Castable glass ceramic Injection molded glass ceramics (IPS Impress: Optec) Leucite reinforced porcelain. 5. Based on the method of fabrication: Pressure moldingband sintering Condesnsation and sintering Casting and ceramming Slip casting Sintering and glass infiltration Milling by computer control Copy milling 6. Based on application Core porcelain Opaque porcelain Dentine or body porcelain Enamel porcelain 7. Based on sub structural material Cast metal poecelain Swaged metal porcelain Glass ceramic CAD-CAM porcelain Sintredceramic core
1. 2. 3. 4. 5.
8. Based on use Denture teeth Metal ceramicsveneer, inlays, onlays , crowns Fixed partial denture
9. Based on firing Air fired porcelain vaccum fired porcelain Diffusible gas firing 10. Classification based on recent types of ceramics castable glass ceramics eg: Inceram, alumina, Inceram, spinell pressable ceramics EG: Optec HSP, IPS empress CAD CAM ceramics eg: cere vitablock markI, vitablock mark II Injection molded ceramics eg: Optec HSP
1. 2. 3. 4.
Disadvantages: Limited use in low stress areas Inability to colour internally Low tensile strength.
Hot pressing:
Eg: IPS Empress, IPS Empress 2, IPS e max press, OPC Pressure molding is used to make small intricate objects. This method used a piston to force a heated ceramic ingot through a heated tube in to a molod, where the ceramic form cools and hardens to the shape of the mold.
IPS Empress is a glass ceramic provided as core ingots that are heated and pressed until ingot flows in to a mold. It contains a higher conc. Of leucite crystals that increase the resistance to crack propagation (fracture).
Machinable ceramics:
Computer aided design / computer aided manufacturing:the evolution of CAD CAM systems for the production of machined inlays, onlays and crowns led to the development of a generation of machinable porcelains. There are two popular systems available for machining all ceramic restorations CEREC System (siemens, Bensheim, Germany) Celay system (Mikrona technologies, Switzerland)
CEREC System:
CEREC is a dental restoration product that allows a dental practitioner to produce an indirect ceramic dental restoration using a variety of computer assisted technologies including 3D photography and CAD/CAM. The cavity preparation is first photographed and stored as a three dimensional digital model and proprietary software is then used to approximate the restoration shape using biogenic comparisions to surrounding teeth. When the model is complete a milling machine carves the actual restoration out of a ceramic block using Diamond Head cutters under computer control. CEREC is an acronym for chairside economical restoration of esthetic ceramics.
HISTORY:
It was introduced by Werner H.Mormann (1980) at the University of Zurich. The first chair side CEREC introduced in 1985. In 1994 CEREC -2 was introduced. In 2000 CEREC -3 was introduced. In 2003 , 3D soft ware version is released, allowing users to see 3D views of teeth and models In 2008, Sirona release the MCXL milling unit, this milling unit can produce a crown in 4 minutes. CEREC I: introduced in 1985 chief indications are single and dual surface inlays and the material is vitablocs markII The concept of grinding inlay bodies externally with a grinding wheel along the mesiodistal axis suggested itself.
In this arrangement we could turn the ceramic block on the block carrier with a spindle and feed it against the grinding wheel which ground from the full ceramic and new contour with a different distance from the inlay axis at each feed step. CEREC -2 introduced in 1994 Additional cylinder diamond enabling the firm grinding of partial and full crowns. An upgraded 3D camera was provided.
CEREC -3 Skipped the wheel and introduced the two bur system. Its a compact windows based CAD- CAM system. In 2006 a step bur was introduced, reduced the diameter of the top one third of the cylinder bur to a small diameter tip enabling high precision form grinding with reasonable bur life. The three dimensional virtual display of the preparation of the antagonist and of the functional registration became available with the introduction of the three dimensional version of the soft ware in 2003. The current CEREC 3 System can fabricate inlays, onlays and posterior crowns as well as anterior crowns and veneers. Two materials can be used with this system: Vita mark II (VIDENT, BALDWIN PARK ca) Dicor MGC (Dentsply international, York, PA) Vita mark IIcontains sanidine (KAl Si3O8) as a major crystalline phase within a glassy matrix. Dicor MGC is a machinable glass ceramic similar to Dicor, with the exception that the materials cast and cerammed by the manufacturer.
Celay system:
The celay system (Mikrona technologie, spreitenbach, Switzerland) uses a copy milling technique to manufacture ceramic inlays or onlays from resin analogs. The Celay system is a mechanical device based on pantographic tracing of a resin inlay or onlay fabricated directly on to the prepared tooth or on to the master die (Eidenbenze U/1994). One ceramic system material available for use with the celay system is vita celay (vident, Baldwin park, CA). this material contains sanidine as the major crystalline phase within a glassy matrix. Recently, n-ceram presintered slip cast alumina blocks (vident, Baldwin park, CA) have been machined with the celay copy milling system used to generate coping for crowns and fixed partial dentures. (mclare and Sorensen)
The larger amount of leucite in the material contributes to a high thermal contraction coefficient. In addition the large thermal contraction mismatch between leucite (22-25x10-6/degreeC ) and the glassy matrix (8x10-6 /degreeC) results in development of tangential compressive stresses in the glass around the leucite crystals when cooled. These stresses can act as crack deflectors and contribute to increase the resistance of the weaker glassy phase to crack propagation.
Cera pearl (Kyocera, Sandiego CA) is a castable glass ceramic in which the main crystalline phase is oxyapatite transformable into hydroxyapatite when exposed to moisture (Hobo and Iwata 1985).
Future directions:
The future of ceramics for dentistry is clearly open to new technologies. Research is now focusing on fractrographic analysis of clinically failed restorations, measure of fatigue parameters and lifetime prediction of ceramic restorations. The metal ceramic technique is still the most commonly used procedure in restorative dentistry and the success of new all ceramic systems will depend as much on developmental as on analytical research.
4. Types of acrylic resins -based on their mode of activation -based on filler particles. 1. Based on duration of use: Temporary : its used to construct occlusal rims for jaw relations Permanent: its a final prosthesis Its made in heat cure resin or in casting alloys 2. Based on the material used Non metallic- acrylic resins and waxes Metallic - base metal alloys, type IV gold alloys. 3. Based on the chemical composition of the resins : Type1: acrylic Type2: dimethacrylate Type3: composites Types of acrylic resins:
Categories include the following types and classes: Type 1: heat polymerizable polymers (class 1 powder and liquid; class 2: plastic cake) Type 2: auto polymerizable polymers (class1: powder and liquid, class2: powder and liquid pour type resins) Type3: thermoplastic blank or powder Type4: light activated materials Type5: microwave cured materials The ADA specifications for non processed materials are The liquid should be as clear as water and free of extraneous material and the powder, plastic cake or procured blank should be free of impurities such as dirt and lint. A satisfactory denture base results when the manufactures instructions are followed. The denture base should be nonporous and free from surface defects. The cured plastic should take a high gloss when polished The processed denture should not be toxic to a normal healthy person The color should be as specified The plastic should be translucent The cured plastic should not show any bubbles or voids.
Specific requirements: Water sorption shall not be more than 0.8mg/cm2 after immersion for 7days/ at 37degreeC. Stability shall not be more than 0.04mg/cm2 after water soaked specimen is dried to constant weight. Plastic shall show no more than a slight color change when exposed to a 24hr specified UV lamp test.
Main disadvantage of this system is difficulty in handling the fibers and inadequate degree of impregnation of fibers with the resin. Other materials used for reinforcement of acrylic resin materials are
Polymer-fiber composites:
Polymer fiber composites are materials that are composed of a polymer matrix and reinforcement. The fiber reinforcement is characterized by its length being much greater than its cross sectional dimensions. In polymer free composites the fibers are embedded in a polymer matrix which binds the fibers and forms a continuous phase surrounding the fibers. The polymer matrix transfers the loads to the fibers which are stronger component of the composite. The composites with long fibers are called continuous fiber composites and those with short fibers are called short fiber composites. The chemical bond between the polymer and the fibers should ideally be of a covalent nature. proper adhesion makes it possible to transfer the stresses from the matrix to the fibers.
Aramid fibers:
Aramid fiber is the generic name for aromatic polyamide fibers, which are more commonly called Kevlar fibers after the first commercially available AF produced by Du pont. Fibers have been shown to significantly increase the impact strength of acrylic denture base material. The Aramid yellow color of the aramid fibers might limit their use to certain intra oral applications.
Metal fillers:
They improve the thermal conductivity of PMMA and enhances its strength, but also contribute to poor esthetics for complete dentures.
The effect of unidirectional UHMP fiber reinforcement on the transverse strength of the PMMA depends on the amount of fibers present. Fiber contents as high as 40-70% wt considerably enhanced transverse strength of the composite.
Introduction of a denture injection system for use with microwavable acrylic resins;
GC lab technologies (LOCK PORT IL) introduced a denture base processing system that combines injection molding and microwave activation techniques that accelerate the polymerization process. In the GC INJECTION system a pneumatic press is used to force unpolymerized acylic resin into the mold cavity. A modified microwavable flask is used to facilitate this process. The modified flask has a small channel in its lid that permits a small diameter sprue (7mm) to pass from the external surface of the flask in to the mold cavity. Advantages: The injection process eliminates the need for direct handling of resin during the packing process Disadvantages: The additional cost of the pneumatic press and associated flask components. The necessity of adding and removing screws.
Ali pervizi (2004) et.al compared the three dimensional changes of 3 injection
molded denture base materials to that of conventionally processed polymethyl methacrylate (PMMA) Resin. They compare the dimensional accuracy of maxillary complete denture, which are processed in 4 types of materials. 1. PMMA (microlon). 2. Injection molded PMMA (Northern) 3.injection-molded nylon (valplast). 4. Injection molded styrene. They concluded that for all groups the greatest distortion occurred with nylon and the least with styrene. Development of a radio opaque auto polymerizing dental acrylic resin: There are many materials which can act as radio opaque additives Eg: Barium sulfate, Barium acrylate, Bismuth bromide) But these materials weaken the resin and decrease the transverse and impact strengths. Patrik A.Mattie et al (19940 proposed a component that is Triphenyl Bismuth found to be soluble in avariety of monomers and polymers seems to overcome the problems of the bismuth trihalides and has a very low level of cytotoxicity which indicates significant biocompatibility. TPB doesnot leach from the resin and provides radioopacityequivalentto aluminium. And the authors concluded that TPB doesnot significantly alter required performance and processing properties.
CONCLUSIONS:
It is the goal of medical procedure to provide the best treatment for the patient while following the Hippocratic oath: First, do no harm . As dentists, we are challenged to restore function while providing a highly esthetic result. The choices available for esthetic restorations are expanding continually as more private and public research is aimed at improving clinical results. An examination of material properties should lead us to select those systems engineered to provide the patient with best clinical out come with respect to esthetics , function , longevity and compatibility with surrounding natural tissues.
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