Therapeutic Dentistry

Questions 41-71 – Dental materials

41. The purpose of preparing cavities for composite materials?

 Cavity preparation is more conservative, hence no healthy tissue is removed
 Cavity is prepared for retention of composite restoration and removal of caries

42. Stages of preparing cavities for composite materials? And Q 43 Requirements for the
formation of cavities for composite materials?

1. Cavity is prepared by removing caries

2. Enamel itching
3. Restored carious cavity with composite material

Principles of composite material preparations:

 Less outline extension

 Axial or pulpal floor of varying depth
 Incorporation of enamel bevels
 Tooth preparation walls being rough
 Use of diamond stone

43. Requirements for the formation of cavities for composite materials?

44. Features, principles and techniques of preparing cavities by – ART- technique?

ART – Atraumatic restorative treatment (non-surgical management of dental caries)

1. Caries is removed using a chemical solvents e.g. carlisolv (composed of 3 amino acids and
sodium hypochlorite)
2. After 10-20 minutes the gel gets washed away and a bur may be used to get access to the lesion
3. After necrotomy with an excavator, the cavity is filled with anti-carious material like glass-
ionomer cements or compomers

45. Features, principles and techniques of treatment by tunnel cavities preparation?

Tunnel preparations are done to minimize damage to occlusal surface and preserving the
marginal ridge. This technique is not suitable if there is extensive proximal caries as the marginal
ridge will collapse. In this technique the contact point is preserved and access to carious cavity is
created from the occlusal surface. Tools required including turbine headpiece, round shape burs
and simultaneous cooling water
46. Features and methods of dental caries treatment by Heal Ozone system?

A device that generates ozone from oxygen which kills cariogenic bacteria via oxidation. The
hand piece with silicone cups which provide an air tight seal pumps ozone into the caries.
Features include:
 Only for superficial caries then remineralization therapy
 Fast (20 sec)
 Painless – good for kids
 Can’t be used to treat medium and deep caries

47. Features and principles of non-invasive treatment of caries?

48. Noninvasive method of cavity preparation?

49. System Carisolv: principle of use, features, methods?

It is a chemo-mechanical removal method of caries. It involves using a chemical solution which softens
the caries thus allowing easy removal. Local analgesia is not usually required. Sodium hypochlorite
dissolves organic material. The hypochlorite given sufficient time partially breaks down the organic
material and kills the bacteria rendering the lesion caries free.
After 10-20minutes the gel is washed away and cavity is restored with adhesive material. It is painless
and although a bur is not needed to remove carious dentine it may be required to gain access to the lesion

50. The classification of filling materials?

Filling material are classified depending on:

1. Group of teeth:
 Front teeth: filling material corresponds to high aesthetic requirements i.e. have
microfiller
 Posterior teeth: filling material should withstand high occlusal press i.e. have macrofiller
2. According to material of restoration:
 Metals: Amalgam, alloys, pure metals i.e. gold
 Non-metals: cements, resin, composite materials
3. According to purpose of filling:
 Temporary/permanent filling
 Isolative/insulating lining
 Therapeutic lining
51. Physical and chemical properties of filling materials?

 Set quickly
 Appropriate strength and set characteristics
 Non-toxic, non-irritant to pulp
 Sedative effect on pulp
 Acceptable color, taste and smell

52. Indications for use of different kinds of filling materials?

 Glass ionomer: cervical region and primary teeth and as an interim restoration
 Silver amalgam: filling class 1,2 and 5

53. Classification of dental cements?

Classification of cements based on uses:

a. Cavity lining
b. Luting applications:
c. Sealing root canals as part of endodontic treatment
d. Filling materials

Classification of dental cements on basis of composition:

1. Zinc oxide based cements: powder contains mainly zinc oxide which reacts with a variety of
liquids e.g. zinc polycarboxylate cement, zinc eugenol cement
2. Alumino Silicate Powder: silicate cement and glass ionomers
3. Miscellaneous cement: Calcium hydroxide cement, cavity varnish, dentin bonding agents
4. Resin cements

Classification of cements based on dental use:

1. Classification or Luting Cements: Zinc phosphate, Zincsilico phosphate, Glass ionomer

cement, Resin cement, zinc poly carboxylate cement
2. Temporary or intermediate restorations: Zinc phosphate cement, zinc poly carboxylate
cements, glass ionomer cement, zinc oxide eugenol cement
3. High strength insulating: zinc phosphate cement, zinc poly carboxylate cement, reinforced
oxide eugenol cement, glass ionomer cement
4. Pulp capping cements: calcium hydroxide, zinc oxide eugenol cement
5. Anterior teeth restoratives: silicate cement for class 3, Glass ionomer cement for class 3, 4
6. Periodontal pack: zinc oxide eugenol cement
7. Core build up material: metal reinforced glass ionomer cement

54. Zinc-sulfate cements, chemical composition, indications for use, mixing and filling instruments?
55. Zinc-phosphate cements, chemical composition, indications for use, mixing and filling
instruments?

It’s a powder/liquid formulation

1. Powder: Mainly amorphous zinc oxide with small amounts of magnesium and bismuth, Silica
(mainly fumed) are often added to aid in providing the right viscosity and yield stress. Calcium
and barium can be added to provide a smooth creaming mix
2. Liquid: Mixture of ortho phosphoric acid with small amount of aluminum and zinc phosphates
which acts as a buffer in reducing the reactivity of the free acid. Amount of water dictates the
setting time

Uses: for isolative liners, sometimes as permanent filling material for temporary teeth on the stage of
root resorption

Advantages Disadvantages
Good for heat insulating properties Considerable solubility and shrinkage
Little mechanical and chemical resistance
compared to silicates, silica, phosphate and other
types of cements

56. Poly-carboxylate cements, chemical composition, indications for use, mixing and filling
instruments? Also referred to as poly carboxylate or poly acrylate cements

Powder/Liquid composition

1. Powder:
a. Mainly fine sintered zinc oxide particles
b. 1-5% Magnesium oxide to aid in sintering process
c. Fumed silica helps with mixing and flow of cements
d. MAYBE: fluoride salts e.g. stannous fluoride maybe incorporated in small amounts to
improve mechanical strength and provide a source of leachable fluoride
2. Liquid: aqueous solution of poly-carboxylic acid typically homo-polymer of poly-acrylic acid or
copolymer of acrylic acid with itaconic or maleic acid

57. Glass ionomers, Chemical composition, and indication for uses, mixing and filling instruments?

Chemical composition:

Powder component: Fluoro alumino silicate glass

Liquid Component:
 1. Pigments and radio-opacifiers
2. Tartaric acid – used to control setting time and viscosity
3. Polymeric component: copolymers of acrylic acid with itaconic or maleic acid
4. Polycarboxylic acid

Indication for use:

1. Liners and bases for direct and indirect restoration

2. Atraumatic restorative techniques ART
3. Traditional GIC are useful for restoration of root caries in elderly patients
4. For rapid stabilization of dentition where there are multiple caries in patients with high
caries risk
5. Temporary teeth

Advantages Disadvantages
Release fluoride over long period of time Brittle, low fracture toughness, low diametral
tensile strength
Biocompatible Long setting time 24hrs
Like all polycarboxylate cements, the Sensitivity to presence of moisture during
conventional glass ionomers can bind to the hardening
calcium of hydroxyapatite of tissue

Mixing instruments: glass block and Metal spatula (may change colour of mix) or plastic spatula

Filling instruments: condenser

58. The concept of the contact point, the value of its improper restoration in periodontal diseases.
Instruments for its restoration?

Restorations involving interproximal surfaces i.e. class 2 or class 4. The restoration of contact point will
prevent the development of further periodontal diseases.
Instruments used: matrix band is placed to help retain the restorative material during placement, to give
shape to the proximal surface of the restoration and to allow close adaptation of the restorative material to
the cavity. Common types of restorative material include:
1. Siqveland: straight band and a holder. Both the band and the holder are removed from the tooth
directly sometimes results in removal of the part of newly packed amalgam
2. Tofflemine: in this system the holder is removed before the bend, this may prevent removal of the
restoration with the bend
3. Circumferential matrix: no holder, the band is tightened by spring mechanism
4. Ivory: metal band replaces only one proximal wall and therefore can’t be used for the cavities
involving both proximal walls

The next step is to place a wedge at the cervical region of the band normally from buccal aspect –
functions of the wedge:
 Help retain band space
 Shapes the band at cervical margin of tooth
 Prevents excess material at the cervical area of the cavity forming a ledge
  It separates the teeth slightly so that when the matrix band is removed there is no space between
the adjacent teeth and a tight contact is formed

59. Finishing and polishing of fillings: instruments, methods?

Restorative aesthetic include 1. Dual cure and 2. Autocure

Type 1: Restorative aesthetic:

1. Dual cure:
a. Contour and polish immediately after light activation working from restoration to tooth
only
b. Begin with fine polishing diamonds at intermediate high speed (40,000RPM under air
or/water spray)
c. Continue with even finer diamonds at lower speeds still under air/water spray
d. Finally complete using aluminum oxide graded polishing discs at low speed undder
air/water then seal with a viscosity resin glaze
2. Autocure:
a. because of slow setting chemistry, do not attempt to contour or polish the cement for
at least 24hr
b. Gross contour can be achieved with very fine sintered diamonds under air/water spray
at 20,000 RPM
c. Refine the surface with graded rubber polishing points and cusps at 5000RPM under
air/water spray
d. Finish to gloss with graded polishing discs at 3000RPM uner air/water spray, then seal
with a low viscosity resin glaze

Type 2: Restorative Reinforced:

 Because of rapid setting chemistry, these cements can be contoured and polished at 6 minutes
from the start of mix
 Gross contour can be achieved with very fine sintered diamonds under air/water spray at 20,000
RPM
 Refine the surface with graded rubber polishing points and cusps at 5000 RPM under air/water
spray
 Interproximal surfaces can be contoured and polished with the Profin directional system,
equipment using diamond or polishing blades

Equipment: polishing discs, polishing cusps and fine graded polishing stones an diamonds

60. Materials for insulating linings: types, indications for use, features of theirs placement. Requirements
for the imposition of isolative linings in different classes of carious cavities?

61. Therapeutic lining: groups, properties, indications for use?

62. Materials for treatment linings based on calcium hydroxide. Composition, properties, characteristics
and technology of use?

Indications: deeper cavities with less than 2mm dentine

Application: no more than 0.3mm thick, use a ball ended instrument placed in a thin layer in the deepest
part of cavity. Usually placed as lining material beneath resin and composite filling materials

Composition
Paste 1 Calcium hydroxide – 50% - primary reactive ingredient
Ethyl Toluene sulphonamide – 39.5% - oil compound acts as a carrier
Zinc oxide – 10%
Zinc stearate – 0.5% - accelerator
Paste 2 Glycol Salicylate – 40% - primary reactive ingredient
Titanium dioxide – inert fillers and pigments are radiopacifiers
Calcium Sulphate
Calcium tungstate

Reasons for application i.e. pulp capping

1. Protect from chemicals
2. Protect from temperature
3. Seal the dentinal tubules
4. Therapeutic effect – bactericidal, remineralization of dentine, stimulate odontoblasts

63. Materials for treatment linings based on zinc-eugenol cements. Composition, properties and
application features?

Composition
Powder Zinc oxide – primary reactive ingredient
Zinc acetate 1-5% - accelerator
Liquid Eugenol – leaches with time and has a bactericidal effect – primary reactive ingredient
Olive oil 5-15% – control viscosity

Mainly used as thermal insulation under amalgam filling as it forms an effective thermal barrier
as it has a thermal conductivity value similar to dentine

Peculiarities of Zn-Eugenol:
 Un-Aesthetic
 Lack compressive strength
 May have taste
 Quick and easy to insert and remove

64. Amalgam. Classification, composition, characteristics, negative and positive properties?

Dental Amalgam is a mixture of mercury and alloy containing silver and tin with added copper and zinc.
The alloy and Mercury are held together in a capsule with the 2 components separated by a plastic
diaphragm. When the diaphragm is broken and the capsule is placed in the mixing machine
(amalgamator) the 2 components are mixed together (triturated) to from silver paste.
Positive and negative properties of amalgam:

Positive properties Negative properties

High clinical success Marginal break down
Low cost Poor appearance
Known performance Concerns about health and environment
Easy to manipulate Fracture
Doesn’t adhere to dental tissues

Composition of amalgam: includes mercury mixed with dental amalgam alloy

Metal Weight % in DENTAL ALLOY

Silver 40% min
Tin 32% max
Copper 30% max
Zinc 2% max
Mercury 3% max

Classification of Amalgam: amalgam maybe classified by

1. Shape of particles that make up the powder:
a. Spherical:
b. Irregular/Lathe cut: gives more resistance when packing into cavities
c. Dispersed phase/ admixed amalgam: spherical silver/copper particles and lathe cut
silver/Tin particles, it has good handling characteristics

Properties of Amalgam:
 Dimensional Change: setting reaction for amalgam involves a dimensional change
 Strength: Takes about 24 hours for strength to develop
 Plastic deformation/creep: undergoes certain amount of plastic deformation/creep under
dynamic intra-oral stresses
 Corrosion: amalgam tarnishes due to formation of Sulfide layer on surface and amalgam can
corrode
 Thermal properties: amalgam has high thermal diffusivity, therefore insulating cavity lining
material should be used before condensing the amalgam

65. Indications for use of amalgam fillings and method of placement?

Application:

1. Cavity Preparation: amalgam does not chemically bind to teeth tissues hence it requires tooth
preparation to create a shape of cavity that contains both retention and resistance forms to prevent
dislodging of the restoration. This is carried out by creating undercuts, dovetails, pits and grooves
in the dentine of the tooth. In large cavities dentine pins are used.
2. Matrices maybe used
3. Trituration: mixing the amalgam
4. Condensation: prepared amalgam is condensed into prepared cavity by:
a. Ultrasonic condenser: may produce local heating
 b. Amalgam condenser: hand instruments, shape and size chosen depends on cavity size
5. Carving: the objective is to remove mercury rich layer on amalgam surface and rebuild anatomy
of tooth reestablishing contact with the opposing dentition
6. Polishing: done after material achieved certain mechanical strengths, its done to improve
appearance and corrosion resistance

Indications: amalgam has high compressive strength but offers poor aesthetics and so is best suited for
restoration of premolar and molar teeth where heavy occlusal forces are experienced and where the
cavities are not suitable for composite resins. Also amalgam is very durable

66. Composite filling materials. Classification, composition, properties and application features?

Components of resin composites:

1. Resin matrix – commonly a fluid monomer
2. Filler particles of silica based glass
3. Silane – an agent that allows the resin and filler particles to bond together
4. Activator for the setting reaction: normally camphorquinone
5. Pigments

Composite Application features

1. Do not adhere to tooth tissue, they require an acid itch and the use of dental adhesives
2. Polymerization shrinkage of resin during curing (about 2-3%) may contribute to marginal and
cuspal defects – this can be reduced by incremental packing of curing composites
3. The setting reaction (monomers combining to form long chain molecules) is exothermic in
nature:
a. In chemical activated material: temperature rise of 1-5oC
b. In light activated material: temperature rise of 5-15oC

Classification based on curing method: (formation of radicals is required for the setting reaction to
occur, this can be achieved by)

1. Chemical Method: mixing two components e.g. 2 pastes where 1 component contains an
initiator e.g. 1% peroxide initiator and the other component has an activator e.g. 0.5% tertiary
amine activator
2. Light curing method: generally applied as a single paste which contains monomers,
comonomers, filler and an initiator which is unstable in the presence of UV or high intensity
visible light. For UV activated material, the most commonly used initiator is benzoin methyl
ether. For visible light activated material the initiator system compromise of a di-ketone and an
amine, camphorquinone is a commonly used di-ketone

Classification based on filling material:

1. Macro-filled: particle size1-50 micrometers, poor aesthetic properties (only used in posterior
teeth) and high strength and low wear
2. Microfilled: particle size 1-5 micrometers, high aesthetic properties, lower long term strength
and wear resistance and more polymerization shrinkage
3. Hybrid composite: suitable for posterior and anterior teeth. 75% 1-50µm and 8% submicron size
i.e. 0.04µm
67. Chemical hardening composite filling materials. Theirs types, properties and indications for use?

Typically it’s a two paste system where each paste contains a blend of resin and filler. One paste contains
≈ 1% peroxide initiator e.g. benzoyl peroxide while the other paste contains ≈0.5% tertiary amine
activator such as N, N dimethyl-p-toluidine. The ensuing reaction is a free radical addition
polymerization.

Other systems which rely on chemical hardening include:

1. Powder/Liquid systems: in which powder contains filler particles and peroxide initiator while
the liquid contains monomer, comonomer and chemical activator
2. Paste/Liquid materials: in which the paste contains monomers, comonomers, filler and peroxide
while the liquid contains monomers and chemical activators
3. Encapsulated materials: in which the filler mixed with peroxide is initially separated within a
capsule from the monomers and comonomers containing the chemical activator. On breaking the
seal between the two parts of the capsule the reactive components come in contact and are mixed
mechanically

Advantages: they optimally polymerise whatever the depth or availability of light making them ideal for
deep cavities and underneath crowns and veneers.

Disadvantages: there is no control over working time and material may set sooner than expected or
conversely slump from position while waiting for the setting reaction to occur.

68. Light curing composite filling materials. Theirs types, properties and indications for use?

UV or visible light (quartz tungsten halogen lamp) can be used to activate polymerization of filling
materials. The use of UV has diminished due to possible danger of long term exposure to UV.
For visible light-activated materials the initiator system compromises a mixture of a di-ketone and an
amine. Camphorquinone is a commonly used di-ketone which rapidly forms free radicals in the presence
of an amine and radiation of the correct wavelength and intensity. Light-activated materials requiring the
use of a special light source, capable of delivering radiation with appropriate characteristics to the surface
of the freshly placed material (450-500nm)

Light activated material are generally supplied as a single paste which contains monomers, co-
monomers, filler and an initiator (e.g. Camphorquinone) which is unstable in the presence of high
intensity visible light

Advantage: light curing allows the operator to be in control of working time although the material will
start to cure in the presence of the dental surgery light giving the operator a few minutes to place the resin
composite before the paste becomes partially set and less manageable. Less wastage of material as only
small amount needs to be dispensed as there is only 1 paste.

Disadvantage: sufficient light of the correct wavelength needs to satisfactorily penetrate the material in
order to get a high enough degree of polymerization for the resin composite to have optimal properties.

69. Features of carious cavity filling with chemical hardening and light curing composite materials?

1. Choose shade:
 2. Acid Itching: For Chemical hardening, acid itching with phosphoric acid creates pores within
the enamel into which adhesive flows to create tags. The micromechanical retention is very
reliable unless there has been contamination of the etched surface by saliva or blood. For light
curing composites; acid gel is applied to both enamel and dentine causing demineralization of
dentine, removal of hydroxyapatites from the dentinal tubules and as a consequence a mechanical
interlocking is achieved by adhesive resins flowing into dentinal tubules to form resin tags.
Stages of acid etching: 1. the etching time 2. The washing stage 3. The drying time
3. Apply resin and harden
4. Polish and finish: fine finishing is done with carbide finishing burs then with diamond burs.
Polishing the resin begins with medium discs and finishing with superfine discs. Polish paste
applied to a rubber cup completes the step

70. Adhesive systems. Composition, mechanism of action, characteristics of generations?

71. Types of light-curing lamps: purpose, physical and technical characteristics. A safety rules while
working with light-curing lamps?

Types of curing lamps:

 Conventional quartz halogen lamps: used to harden/cure certain materials e.g. composite,
sealants. The material should be built up and cured in increments of 2mm. must use amber shield
for eye protection. The output of light has to remain above 400mw otherwise the composite will
not cure fully
 LED: cures at a high density allowing greater depth of curing. Must be used with amber shield
for eye protection. Generate light in wavelength may not have a fan. LED units are efficient,
small and portable. They have a narrow bandwidth 450-480nm means that they will work well
with composites containing camphorquinone but will not cure resins not containing that indicator
 Plasma/ xenon lamps: produce rapid conversion of the resin but this can produce high shrinkage
stresses and the narrow bandwidth means some composites will not cure

Amber shield is an orange filter which provides protection from the blue light