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CRE Revision

BNF - dosage, frequency, route, forms, interactions / cautions / side effects
- dose varies with age, renal / liver disease, pregnancy, terminal care
Dental - Aspirin 600-900mg 4-hourly antipyretic X (<12, bleeding, GI, asthma, liver)
- Ibuprofen 400-600mg TDS antipyretic X (GI, asthma, liver disease)
- Paracetamol 1g QDS no anti-inflammatory, antipyretic, effective with codeine
- Carbamazepine
Hospital - Diclofenac Sodium 50mg TDS - Naproxen
- Opioids CNS depressant (addiction, respiratory, pupillary, urinary, nausea, GI)
- Codeine Phosphate 30-60mg every 4-hourly, moderate, short-term
- Morphine 10mg every 4-hourly / 30mg BD, requires laxative
- Buprenorphine sub-lingual 200-400ug TDS
- Diamorphine (heroin) 1-2mg IV
- Tramadol 50-100mg 4-hourly
- Gabapentin 300mg 3.6g / day, used in epilepsy and neuropathic pain
- Pregabalin 150-600mg / day, used in epilepsy, neuropathic pain and GAD
- PCA - computer system delivering micro-doses

Anti-Inflammatory (Steroids)
Topical - Hydrocortisone Mucoadhesive Buccal tablets
- Benzydamine
- Betamethasone Phosphate tablets
- Hydrocortisone 1% and Oxytetracycline 3%
- Hydrocortisone 1% and Miconazole 2%

Systemic - Hydrocortisone Sodium Succinate 100mg IM (prophylaxis)

- Prednisilone 10-20mg
- Methylprednisolone 40mg/mL
- Dexamethasone 4mg/mL

Steroid-Sparing Agent - Azathioprine

- Thalidomide

Antidepressants (co-analgesics, helpful with facial pain)

Amitriptyline (also for neuropathic pain) 50-200mg OD multiple side effects
Dosulepin (good for facial arthromyalgia) 75-150mg OD multiple side effects
Nortiptyline 10-30mg
Tranylcypromine (a MAOI / monoamine oxidase inhibitor) 10mg TDS
Citalopram / Sertraline / Fluoxetine / Paroxetine (all SSRIs)

Antiemetics Prochlorperazine / Metocloptamide / Domperidone / Ondansetron / Cyclizine

Anxiolytics / Sedatives / Hypnotics / Tranquillisers benzodiazepines for anxiety



Amoxicillin 250-500mg TDS 5 days
Metronidazole 200-400mg TDS 5 days (effective with anaerobic bacteria, no alcohol)
Erythromycin 250-500mg QDS

Antivirals (herpes)
Acyclovir 200mg 5x / day

Antifungals (candidiasis)
Miconazole (angular cheilitis)
Fluconazole 50mg OD

Antihistamines (allergy)
Chlorphenamine 4mg QDS
Promethazine 10-20mg BD / TDS
Alimemazine 10mg BD / TDS

Decongestants (sinusitis)
Ephedrine nasal drops
Xylometazoline and oxymetazoline nasal drops

Carbamazepine (antiepileptic) 100-200mg BD/TDS/QDS
Vitamins B, C, Folate, Iron
Artificial Saliva
Topical Anaesthetics 5% lidocaine (before LA) / EMLA & tetracaine (for oral lesions)

Drugs Affecting Dental Treatment

Warfarin <4 INR risk of bleeding with XLA / RSD / surgical
Bisphosphonates risk of MRONJ

Alarm Bells
Liver Failure
Renal Disease


CERAMICS = aesthetics [translucent], minimally invasive [PJC/Veneer], wear resistant

= brittle (crack propagation), can be opaque (veneered), wears opposing tooth,

Glass-Matrix Ceramics (translucent, etchable (HF), resin bonding cement)

[Glass - most brittle]
Feldspar - SiO2-Al2O3 (inclusion increases strength slightly, translucent)
Leucite - +K2O (leucite reinforced dispersion strengthening)
Lithium Disilicate - SiO2-Li2O (stronger, pressable [in mould], but more opaque)
[Glass-Infiltrated - inclusions of Mg-Al / Al / Zirconia]
Oxide / Polycrystalline Ceramics (glass-free, opaque veneer, non-etchable sandblast +
[Alumina Oxide - first glass-free ceramic]
Y-TZP (Yittria-stabilised Tetragonal Zirconia Polycrystal) - transformation toughened

Strengthening Brittle Ceramics

Reducing Fusion Temperature:

- repeated firing/fritting
- more Feldspar inclusions (Na/K/Al) in dental ceramic
- Large Metal Ion inclusions (Boron/Calcium/Lithium)
- Silica Network Modifiers

Reduce/Distribute/Localise Porosities within Grain during fabrication:

- Compaction (condensation whilst mixing powder and liquid)
- Firing (condensation, Hot Isostatic Pressing [HIP], vacuum)
- Glazing (final firing for surface porosities)

Interrupting Crack Propagation:

- Inclusions (Alumina/Large Metal Ions)
- Transformation Toughening (tetragonal to monoclinic phase in Y-TZP increases fracture

Ion Exchange (swap small Na for larger K compressive stresses)

Metal Bonding (via Contraction [CTE mismatch], Micromechanical [sandblast/burr], Chemical

[oxide layer])

Amalgam / Metals Lichenoid Reactions / Burning Sensation / Swelling
Acrylic Resin / Latex / Nickel / Acrylates (HEMA/resin) Allergic Contact Dermatitis (Type IV)

ALLOYS (Substitutional, Interstitial, Intermetallic)

- Substitutional solute replaces similar sized solvent (Gold replaces
- Interstitial solute in between solvent atoms (Carbon [small solute] + Iron [big solvent] = Steel
- Intermetallic Compounds specific metallic lattice structure, hardness/brittle/Tm, [Amalgam])
Temporary Liners (direct/indirect pulpal cap)
- Dycal (Calcium Hydroxide + Zinc Oxide) - alkaline (helps tertiary dentine)
- MTA (Mineral Trioxide Aggregate) - sets with water Calcium Hydroxide (good seal), long
setting time
- Biodentine (calcium-silicate) releases calcium HA formation, dentine replacement, faster
Luting Cements (thin, long working time, rapid set, adhesive, radiopaque)
- ZOE neutral pH, bactericide, mild pulp irritant, inhibits/discolours composite resin
- Zinc Phosphate 15 min set (accelerated by moisute/heat/more powder), pH 2 6
- Zinc Polycarboxylate adhesive to tooth, higher initial pH
- EBA Cement modified ZOE (lower solubility, higher strength)
HEMA (bi-functional coupling agent) - Hybrid Layer between dentine (hydrophilic) / resin
BBC DMs - Biocompatible, Bond Strength, Compatible, Dimensionally Stable, Microleakage,

Type 1 (rod centre removed [honeycomb]) | Type 2 (rod sheath removed [cobblestone]) | Type 3

COMPOSITE RESIN free-radical addition polymerization with 470nm blue light

Resin (Teg-DMA [diluent] / Bis-GMA / UDMA) increases fluidity/shrinkage
Filler (Silica/Quartz) Micro (less wear) / Nano (more polished) decreases fluidity/shrinkage
Silane-Coupling Agent enhances bond
Photoinitiators camphaquinone (a-diketone)

Adv - aesthetics, minimally invasive (micromechanical retention / adhesive), durable

Dis shrinkage (microleakage), technique sensitive (moisture/adhesive/incremental), soggy
bottom (toxic)
Biocompatability incomplete polymerisation soggy bottom / leaching, plaque retentive

GLASS IONOMER CEMENT acid-base reaction chemical bond

Calcium Fluoro-Aluminosilicate glass particles + Strontium (radio-opacity)
Itaconic Acid + Tartaric Acid (polyacids)

1) Dissolution polyacid attack glass particles ion release

2) Gelation + Hardening - Siliceous Hydrogel (Ca2+ bind to carboxylate groups Al3+ cross-links)
3) Hydration 4-6 months water uptake (expansion)

Adv chemical bond, fluoride release, no significant overall shrinkage, little moisture control,
white filling
Dis - wear resistant, aesthetics (not tooth coloured), Early Water Contamination solubility /
Biocompatability minimal pulp irritation rapid recovery

Trituration (Mercury + Silver, Tin, Copper) undertriturated (crumbles, hard) / overtriturated
(soupy, soft)
Condensation compact to achieve continuous matrix phase, prevent voids
Setting finishes when all the mercury has reacted and formed gamma-1

Low Cu: + Hg 1 + 2 + (gamma-2 increases creep, increases corrosion,

contains voids)
High Cu: + Cu + Hg 1 + + + (engma/epsilon phases replace gamma-2 phase)

Adv high strength, rigid, little moisture control, cheap, easy to handle
Dis aesthetics, not minimally invasive, mercury, corrosion/creep failure, thermoelectric
Biocompatability corrosion, thermal conduction to pulp, lichenoid reactions

BIOCOMPATABILITY - non-toxic to living tissues (effects of material on tissue and vice

Testing - in vitro (predicts in vivo), specificity (teeth), sensitivity (suitable), controls
- clinical trials follow (expensive, consent, ethical)
- as per ISO Part 5 (cytotoxicity) + ECVAM guidelines
Biosafety (exclusion of harmful effects)
Biofunctionality (+ beneficial host response)

Thermal Conductivity, K = [(heat X distance) / (area X temp. gradient)] = constant of a material
Thermal Diffusivity, H = [Thermal Conductivity/(Specific Heat X Density)] = rate of temperature
Co-efficient of Thermal Expansion, CTE = increase in length per degree rise in temperature
Glass Transition Temperature, Tg = glassy brittle rubbery (for denture base / restorative
Energy required for a crack to form (ability to resist crack propagation) (metals>composite>GIC)
Kc = Ya (k = Stress Intensity Factor, Y material / crack shape, = stress, a = crack length)
HARDNESS resistance to indentation (wear), tests (Knoop, Vickers)
FATIGUE LIMIT stress value where failure occurs, after a specific number of loading cycles
ENDURANCE LIMIT the stress below which failure never occurs, for infinite loading cycles

RCT MATERIALS (long term seal, bactericidal, compatible with bone/tooth, good
Filler - GP (polymeric) - rubber, semi-plastic, pre-formed isomer (ZnO, GP, radio-opacifiers)
- Adv: shape adapts to canal, removable Dis: not rigid (difficult
to place)
- Amalgam (metallic) - Adv: cheap, plastic on insertion, radiopaque Dis: difficult to
condense, leaks
- Titanium (metallic) - Adv: new, bone integration, rigid Dis: expensive
Sealant - ZOE (used with GP, neutral pH, bactericide, biocompatible, inhibits/discolours composite


Osseoinduction induce stem cells (osteoprogenitor osteoblast)
Osseoconduction allow adjacent bone growth by direct apposition
Osseointegration direct structural and functional connection between living bone and load
bearing implant


A Accuracy A
DS Dimensionally Stable Dentist Said
TS Tear Strength The Silicone
MV Medium Viscosity Mould Verifies
WT Working Time Where The
ST Setting Time Sexy Toys
H Hydrophilic Have
B Biocompatibility Been
D Disinfect-able Dislodged

IMPRESSION MATERIALS Elastomers (ACS/CCS/PE) & Hydrocolloids

ELASTOMERS rubber, viscosity determined by body, macromolecules linked by VDWs

Addition Cured Silicone ()

Composition vinyl-terminated polydimethyl siloxanes, hydrogen (allows cross-link), platinum
Properties hydrogen surface pitting
Condensation Cured Silicone ()
Composition - hydroxy-terminated polydimethyl siloxanes, alkyl silicate (allows cross-link), tin
Properties hydrophobic blow holes, condensation shrinkage
Polyether ()
Polyether + Filler + Sulphonic Acid Ester (catalyst) allergic reaction, short working time, stiff set

HYDROCOLLOIDS Sol Gel state (fibrils = tear resistance), Imbibtion (uptake), Syneresis

Alginate (irreversible, Modified Alginates contains silicone detail + tear resistance)

Composition Sodium Alginate (Sol) + Calcium Sulphate + some Filler Calcium Alginate
Properties dimensionally unstable
Agar (reversible)
- Zinc Oxide + Eugenol - Zinc Eugenolate (thin cross section, detailed, brittle, not elastic)
- Impression Plaster B calcium sulphate hemihydrate + calcium sulphate dihydrate
ACRYLIC (Denture Base) - Denture Base (aesthetic, light, strong, high modulus, non-toxic,

PMMA (powder beads + initiator) [2.5] + MMA (liquid + activator + cross-linking agent) [1]

(excess polymer porosities | excess monomer shrinkage)

Initiation (initiator forms free radicals)

Propagation (free radicals attack double bond [MMA]) [exothermic]
Termination (two free radicals / disproportionation)

Curing - Heat - exothermic gradual temperature increase monomer evaporates

- Chemical - benzoyl peroxide (initiator) + tertiary amine (activator) free radicals
- Light - urethane dimethacrylate + microfine siica + camphorquinone
- Microwave - microwave radiation speeds setting, special container required, similar to heat

- High molecular weight
- Light weight
- Good aesthetics

Dis: [Dentures Would Be Perfect If Patients Took Care]

- Drying completely shrinkage/distortion
- Water Uptake (dimensional changes)
- Brittle
- Porosities (gas escaping)
- Insulator (loss of thermal stimulus due to low thermal conductivity/diffusivity)
- Plasticisation (residual monomers due to inadequate curing)
- Tg = 105C (cannot be cleaned with boiling water)
- CTE must be matched with tooth and base

Cast by the Lost Wax Technique (wax-up, add sprue, investment [ceramic], burnout wax, cast up metal)
Use: crowns/bridges/denture framework (more brittle due to small grains and many grain

Wrought by Cold Working (squeezing/drawing/bending to deform grain structure, allow the lattice to
Use: clasps/files/wire (good strength/elastic recoil, annealing [hammer/anvil increases