Vidyasagar Biomedica REGIMEN (MDS)

Dental Cements & Miscellaneous

(A) Dental Cements

(B) Soldering & Welding

(C) Tarnish & Corrosion

(D) Abrasive agents

References (1) Phillips, 11th Edition & 12th Edition.

&
Diagram (2) Craig, 12th Edition.
Credits

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Classification and Uses of Dental Cements

(A) DENTAL CEMENTS
Secondary
Cement Principal Uses
Dental cements are used for the purpose of pulp Uses
protection and luting in direct restorations. Liners, bases Metal-modified Conservative
and varnish are used for the former purpose. glass ionomer posterior restora-
tions; core buildups.
Various irritants to pulp :
1. Disease process itself e.g. caries, trauma, attrition, Resin Luting agent for Temporary
abrasion and erosion. restorations and restorations.
orthodontic
2. Mechanical irritation during cavity preparation e.g.
appliances.
excessive heat, pressure and desiccation.
Calcium Pulp capping agent;
3. Certain chemical components of cavity preparation hydroxide thermal-insulating
e.g. phosphoric acid of zinc phosphate and acid bases.
etchants.
4. Thermal irritation from metallic restorations. SILICATE CEMENT & GLASS IONOMER
5. Microleakage that allows microorganisms and toxins CEMENT
access to pulp.
Classification and Uses of Dental Cements SILICATE CEMENT
Secondary 1. COMPOSITION:
Cement Principal Uses
Uses
Zinc phosphate Luting agent for Intermediate Powder Liquid
restorations and restorations; i) Silica - 40% i) Phosphoric acid - 52%
orthodontic thermal insu- ii) Alumina - 30% ii) Aluminum phosphate - 2%
appliances. lating bases. iii) NaF iii) Magnesium phosphate - 6%
Zinc Temporary and Root canal Cryolite 19% iv) Water - 6%
oxide-eugenol intermediate restorations, CaF2
restorations; Periodontal iv) Calcium
Temporary and surgical phosphate
permanent luting dressing. 2. The purpose of fluoride salts is to lower the fusion
agent for resto- temperature of the glass. Thus they are called as
rations; thermal- ‘CERAMIC FLUXES’.
insulating bases;
cavity liner; pulp 3. Setting time is 3-8 min.
capping agent. 4. Average life of silicate cement is 4 years.
Polycarboxylate Luting agent for Luting agent 5. PROPERTIES:
restorations; for orthodontic
thermal-insulating appliances;  Silicate is the strongest of all dental cements. It
bases. intermediate has a compressive strength of 180 Mpa.
restorations.  Its hardness (70 KHN) and coefficient of
Silicate Anterior restorations thermal expansion is closer to dentin.
Silicophosphate Luting agent for Intermediate  It is a severe irritant to the pulp. At the time of
restorations restorations; insertion it has a pH of 2.8 and even after one
luting agent month, it remains below 7.
for orthodontic  Silicate has high solubility and disintegrates
appliances. readily in oral fluids. They become stained over
Glass ionomer Anterior resto- Pit and fissure a period of time.
rations; luting agent sealant;  It has anticariogenic property due to release of
for restorations and thermal-
fluoride and so the incidence of secondary caries
orthodontic insulating
and contact caries is less.
appliances; cavity bases.
liners.

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 Its refractive index is similar to enamel and A. History of GIC’s

dentin. It is used as an anterior esthetic resto-
rative material. 1972 Development of GIC by Wilson and Kent
1955 Addition of Copolymer of polyacrylic acid and
 It is contraindicated in mouth breathers, as its
Itaconic acid
surface becomes rough and opaque when
allowed to dry. 1984 Tunnel preparation by Hunt and Knight
5. Finishing and polishing should be delayed for 1985 Cermets by Mc Lean and Gasser and Sandwich
several days. The surface should be protected by restoration by Mc Lean
coating with varnish. 1989 Resin modified GIC by Antonucci and Mitra
 Powder is a ceramic = silica + alumina + fluoride 1994 ART technique
compounds + Ca – salts; all are fused at 1400o C.
 Fluoride compounds melt at lower temperature are B. Classification Of Glass Ionomer Cements
ka = CERAMIC FLUXES; act as fusing agents. Type I – Luting
 Liquid = water + phosphoric acid + buffer salts. Uses – Cementing crowns, bridges, inlays and
 Gives severe pulp response. (pH <3; after 1 month < orthodontic appliance
7 i.e. normal pH is not attained). Powder: Liquid ratio – 1.5: 1
 Anti-caries = due to presence of fluorides (approx Film thickness < 20 m
15% of F is present in powder). Fluoride compounds
Type II – Restorative
make enamel surface resistant to acid
decalcification, decreased acid solubility. Type II - 1 Restorative esthetic
 Fluoride compounds act as enzyme inhibitor Uses – Class III, Class V, tunnel restoration
preventing the carbohydrate metabolism. Powder Liquid ratio 3: 1 or greater
Auto curing or resin reinforced
 Plaque associated with the silicate cement has
HIGHER CARBOHYDRATE – TO – N2 RATIO, Type II. 2 Restorative reinforced
which shows that metabolism of carbohydrate is
inhibited or bacteria are less. So very less / 3% Uses – Core buildup, root caries, tunnel
chances of secondary caries. restoration, deciduous restorations
Powder: Liquid ratio – 3 : 1 or greater
 Compressive strength is more than tensile strength;
so brittle. Type III – Lining or base
 Severe pulp irritant = so a pulp – protection is needed. Uses – Lining / base below amalgam and
composite restoration
GLASS IONOMER CEMENT Powder: Liquid ratio – 1 : 5 : 1 (lining)
3: 1 or greater (base)
Glass ionomer cements were developed by Wilson and Kent
Autocured or resin modified.
in 1972 and were viewed as a replacement for silicates.
C. Classification According To Use
 Setting reaction and adhesion to tooth involve =
ionic bonds. Type I - Luting cement
 Used for anterior aesthetic restoration in class III and Type II - Restorative cement
V cavities. Type III - Liner
 True adhesive bond is achieved; so conservative Type IV - Fissure sealant
restoration of eroded areas can be done; no need of
mechanical retention; (adhesion to tooth surface is Type V - Orthodontic cement
due to PAA), (poly acrylic acid). Type VI - Core build up cement
 Not recommended for class II, IV restorations as it Type VIII Posterior packable GIC for
lacks = fracture toughness and is more susceptible to Type IX Atraumatic restorations
wear.

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D. Composition F. Conditioning of tooth before placing GIC.

10% polyacrylic acid for 10 – 15 second is best.
Powder Liquid Advantages
i) Silica - 35-50% i) Polyacrylic acid - 45% 1. Lowers surface energy, increasing wet ability.
ii) Alumina - 20-30% ii) Itaconic acid 2. It removes smear layer while retaining smear
Malic acid - 5% plugs
Tricarballylic acid
(Decreases viscosity) 3. Residues will not interfere with setting
reaction, being part of the GIC system.
iii) NaF - 3-6% iii) Tartaric acid - increases
working time G. Miscellaneous Points:
1. GIC was introduced as a potential replacement for
iv) AlF3 -1.5-.5% iv) Water - 50%
silicate cement. It has been evolved as a hybrid from
v) Aluminum the silicate and polycarboxylate cement.
phosphate - 4-12%
vi) Traces of barium, 2. Light polymerization:
Strontium for The powder contains initiators for light curing and
radiopacity liquid component is modified with hydroxyl ethyl
methacrylate (HEMA).
The powder is referred to as ‘ion leachable glass’ The polymerization starts when exposed to light
 Acids in liquid increase the reactivity of liquid; and subsequently followed by acid base reactions.
and decrease the viscosity. This is called ‘DUAL CURE” GIC.
 Tartaric acid = improves handling 3. Properties
characteristics; and decreases the tendency of i) GIC has low fracture toughness and wear
increasing the viscosity with time. resistance.
 If PAA is in powder form = mix with water and ii) Very sensitive to moisture, especially during
tartaric acid = gives a water – settable cement; fast initial setting reaction. During this period,
setting. absorption of water leads to weak cement
 Water is most important constituent of cement and over drying will lead to cracks in the
liquid. It is the reaction medium = it hydrates cement. Therefore, the surface of cement
the reaction products. should be protected by coating with varnish
 Main component of GI powder = SiO2 > Al2O3 > or cocoa butter during setting.
CaF2 in concentration. iii) Bonds chemically to tooth structure – The
 Silica gel matrix is formed = it sheaths unreacted bond of enamel is always higher than that of
glass particles. dentin.
 Dominant phase of matrix = slow forming iv) Relatively biocompatible – The pulpal
aluminum polysalts, which can be washed / reaction is greater than ZOE but less than
leached away by initial water contact, so protect zinc phosphate cement.
the filling immediately after placement apply v) Anticariogenic property is due to fluoride
varnish/vaseline. release.
 Matrix band is applied = to protect the setting 4. Powder liquid ratio is 3:1 by weight. Mixing
cement from the environment during the initial set should be done by agate or plastic spatula.
= for at least 5 mins. Then surface is protected by Mix should be glossy which shows presence of
VARNISH, etc. free polyacids and helps in adhesion.
E. Setting reaction and structure of set cement 5. 10% polyacrylic acid should be used for
Stage I Dissolution : The surface of glass particles conditioning the cavity surface before insertion of
is attacked by polyacids and ions are released. the cement.
Stage 2 : Precipitation of salts, gelation and 6. Final finishing is done after 24 hours of insertion.
hardening. Crosslinking within the hardening mass
due to Ca ions (first) and then Aluminum ions.  Adhesion = occurs by reaction of carboxyl groups
of polyacids with calcium of hydroxy – apatite
Stage 3 : Hydration of salts : During maturation of crystals of enamel / dentin.
salts leading to an improvement of physical
properties.

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 Bond to enamel is higher than the dentin; due to
greater INORGANIC CONTENT OF ENAMEL
and its greater morphologic homogeneity.
 P/L ratios influence ACIDITY = so luting cements
are more pulp irritating. So calcium hydroxide
protection should be given.
 Its pulp reaction is greater than ZOE.
 High initial water – solubility = due to rapid
leaching of soluble substance e.g. Na, F, in high
amounts. So protect with Vaseline / varnish after
placement.
 It decreases micro-leakage, releases fluorides as
anti – caries.
7. Modifications of GIC :
a) Miracle Mix (or) silver cermet :
b) Glass cermet or cermet :
Glass and metal (Silver-tin-titanium)
powders were sintered at high temperature
and made to react with liquid. It improved
the fracture toughness and wear resistance
and at the same time maintained the
esthetics.
c) Resin modified GIC :
BisGMA, TEGDMA are added to powder
and HEMA to the liquid. With exposure of
light polymerization is initiated along the
methacrylate groups. After that the liquid
reacts with glass particles through acid base
reaction. It improves the wear resistance and
decreases the sensitivity to water attack.
d) Compomer (Polyacid modified composite
resins) : It is a combination of composite
and GIC. Glass particles are partially
silanated (for bonding with the matrix) and
are added as fillers in the composite resin.
There is no water in the reaction. The
properties were inferior to composites but
superior to GIC and resin modified GIC.
e) Bilayered or Sandwich Restorations :
SANDWICH TECHNIQUE/ BILAYERED
RESTORATION
Light cure GIC base (RMGI) overlaid with composite.
Advantage is favorable pulpal response, adhesion,
fluoride release and decreased polymerization shrinkage
due to reduced proportion of composite.
Disadvantage :
1. Time consuming
2. Technique sensitive
3. Increases expense
REGIMEN (MDS)
f) Tunnel restorations :
Joining the occlusal lesion with the proximal
lesion by means of a prepared tunnel under the
involved marginal ridge. The marginal ridge
remains intact. GIC is used as the restorative
material in this technique.
Indications :
Small proximal caries without involvement of marginal
ridges.
Contraindicated in:
 Large proximal caries involving marginal ridge
 Difficult access
 Marginal ridge subjected to high occlusal loads
Advantages:
 Marginal ridge is preserved
 Conservative, therefore less scope for microleakage
 Adjacent tooth is protected against caries (fluoride
release)
Disadvantages :
 Poor visibility and control over caries removal
 Marginal ridge may get undermined. Glass and metal (Silver-t
g) ART technique (Atraumatic Restoration)
Involves removal of affected tooth structure with
hand instruments, followed by restoring with
GIC material (GC Fuji VIII).
Indications
 Occlusal pit and fissure cavities of small and
moderate size with adequate tooth structure to
surround the restoration.
 Remote areas where dental infrastructure materials
and health personnel are not readily available.
 Physically and mentally handicapped patients,
refugees, elderly patients who require home care
services.
Clinical procedure of ART
 Teeth are isolated with cotton rolls. In this technique GIC is u
 Undermined enamel is broken away using hand
instruments such as hatchets.
 Caries is excavated using spoon excavators.
 Highly viscous GIC cement is placed into the cavity
and pressed by means of gloved finger to fill the
adjacent pits and fissures also.
 Occlusion is checked and excess material is removed
before it hardens.
 The restoration is located with Vaseline/petroleum
jelly.
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Advantages Factor having the greatest effect on strength of a

 Conservative and minimally invasive.
 Benefit of GIC – adhesive, fluoride release,
biocompatibility.
 No need of sophisticated instruments or electricity.
 Minimal cost.
 Minimal discomfort.
Disadvantages
 Fatigue due to hand instrumentation.
 Lack of access and visibility in posteriors.
soldered joint in the presence of porosity in the solder
after solidification.
Improper cleaning, fluxing, spacing of parts or
application of the flame may cause porosity as does
overheating.
Brazing : The solid metal parts are joined by heating
them at suitable temperature below the solidus
temperature of substrate metal and a filler having
liquidus temperature above 450oC.

h) GIC as fissure sealant Soldering: The solid metal parts are joined by heating
Advantages them at suitable temperature below the solidus
1. Adhesion to enamel temperature of substrate metal and filler having liquidus
2. Fluoride release temperature below 450ºC.

Disadvantage Welding: Two or more metal pieces are joined simply

1. Does not flow into pits and fissures that are not
patent (more viscous) (< 100 m)
2. Retention rates are low.
i) Other names
 Polyalkenoate cement
 Man made dentin
 Dentin substitute
 Alumino silicate poly acrylic cement (ASPA)
(B) SOLDERING & WELDING
Soldering is the joining of metals by use of a filler metal
which has a substantially low fusion temperature than
that of the metal parts being joined. The process involves
the melting and flowing of the filler metal or solder via
capillary action between and around the parts to be
joined.
Flux: It means flow. In soldering fluxes are used to
dissolve surface impurities and protect the surface from
oxidation while heating.
An antiflux is any material that is placed on the work,
before the soldering flux is applied to confine the flow of
the molten solder.
Classification of dental solders:
(1) Hard solders – high fusing more tarnish resistant
(2) Soft solders
Composition :
 Base metals like gold, silver, copper, zinc.
 Tin to reduce fusion temperature.
 Phosphorous act as a deoxidiser
 Nickel replaces copper for a white solder.
by applying heat or pressure or both. The filler may or
may not be used.
Cast joining: Joining of two components of a fixed
partial denture by casting of molten metal into an
interlocking region between the invested components.
This process is useful in base metal alloys as are they are
sensitive to soldering and brazing technique.
Composition of :
1. Soldering flux
Borax glass - 55 parts
Boric acid - 35 parts
Silica - 10 parts
Flux = Removes oxide layer form the surfaces being
joined. It has 3 functions ie protective; reducing and
solvent. (RPS)
Borax and boric acid fluxes are mainly used = as Type
I = protective and Type 2 = are reducing.
Oxides on base metal alloys are more stable and so
fluoride is used to dissolve them = by Type 3 fluxes.
Fluoride acts as solvent.
Minimum flux should be used = otherwise weak joint is
formed.
Filler metal
 Should be compatible with the metals being joined.
 Flow temperature of filler should be approx 500 C
less than the solidus temperature of the metal parts.
 Overheating should be avoided to prevent weake-
ning, of joint by Recrystallization.

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Types of soldered joints:
Butt joints: This type of joint consists of one piece of
wire soldered at right angles to another piece.
Lap joint: This joint consists of two pieces of steel
soldered side by side.
Flow temperature : The temperature at which the filler
metal flows and wets the substrate metal to produce a
bond is called flow temperature.
Heat source : For soldering process, Gas-air or gas-
oxygen torch is used.
Fuel gas used for heating the solder assembly are:
a. Hydrogen b. Natural gas
c. Propane d. Acetylene
1. Acetylene gas has highest flame temperature and
greater heat content than H2 and natural gases, but
there is a temperature difference in flame from one
part to the other part by approx 1000 C, so
positioning of the torch is critical.
2. Propane and butane = has highest heat content and
best choice. Neutral / slightly reducing zone is used.
3. Furnace brazing =
Convection = heat transfer through air.
Conduction = heat transfer through furnace structure.
Radiant heat = heat transfer through heating coils.
Laser welding or plasma welding in an open gas
atmosphere is done to join titanium components of
crowns, bridge and partial denture frameworks.
(C) TARNISH & CORROSION
Tarnish = Surface discoloration; slight loss of surface
finish or luster; surface deposits; due to formation of
thin oxide films. It is often a forerunner of corrosion.
Corrosion = Actual deterioration of metal by reaction
with its atmosphere leads to disintegration. Chlorides;
oxides, sulfides are corrosion products.
Chemical corrosion = Discoloration of Ag by sulfur
forming silver sulfide.
Silver sulfide is the principle corrosion product of gold
alloys.
Dry corrosion = It occurs in the absence of water or
other fluid electrolytes.
Electrolyte or electrochemical corrosion = Wet
corrosion = As water and electric current as a path of
transport of current is required.
REGIMEN (MDS)
Anode = Where + ve ions are formed ie metal surface
which is corroding. Free electrons are produced, so
known as oxidation reaction.
Cathode = Electrons are consumed ie reduction reaction.
Cathode is the primary driving force in electrolytic
corrosion.
Metals which give up electrons and ionise = Act as anode.
Metals which accept electrons from external circuit =
Act as cathode.
More active metal is anode and more noble metal is a
cathode.
Galvanic corrosion or dissimilar metals = ie between
Ag and Au in opposing teeth leading to sharp pain.
Grain boundaries of heterogenised metals act as =
Anode; interiors of grains as cathode. So corrosion
occurs at grain boundaries.
Solder joints = Corrode due to different composition of
alloy and solder.
Stress corrosion = Stress incorporated especially at
grain boundaries. It is characterised by the fact that
eventual fracture occurs inter–granularly.
Burnishing / malleting / cold working localizes the
stress in some parts of the restoration leading to
corrosion = so excessive burnishing is contraindicated at
the margins of metallic restorations.
Concentration Cell corrosion = Crevice corrosion = It
is due to different types of electrolytes in system.
Corrosion at poor oral hygiene site occurs due to
difference in oxygen tension between parts of same
restoration = Greatest activity occurs around the areas
with least oxygen eg. pits; irregularities etc.
In pits = material at the base of pit acts as anode (no
oxygen gas) and material at the periphery of pit acts as
cathode.
So all metallic restorations should be polished to remove
pits etc.
Protection of corrosion = By using a noble metal
covering applied on base metal; but if noble layer gets
disrupted then the base metal / anode is attacked rapidly.
Passivating effect : Oxidation layer of some metals eg
chromium; a layer of adsorbed oxygen or closely packed
chromic oxide gives a Passivating effects.
But tensile stresses and chlorides can disrupt this
coating. So house hold bleaches should not be used to
clean cast partial dentures; removable orthodontic
appliances; which are alloyed with chromium.
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Alloys with < 65 % noble metal content get tarnished; so (8) TINOXIDE:
Au, Pt, Pd should be there with approx 50 % Au. - Also known as Putty powder.
Low Ag – Cu ratio is better for tarnish resistance. - Polishing agent for teeth & metallic
restorations.
Silver sulfide is the common corrosion product of gold
alloys containing silver. (9) CHALK: Calcium carbonate prepared by a
Pd enriches the surface of alloy with Au and Pd; precipitation method.
blocking sulfide formation.
(10) CHROMIC OXIDE: Polishing agent for stainless
Galvanic shock = Post – operative pain which usually
steel.
occurs immediately after insertion of a new restoration
(11) SAND: KHN  800
and gradually subsides.
(12) DIAMOND : KHN> 7000.
Best method to decrease galvanic shock = Paint an
external varnish on the surface of restoration. (13) ZIRCONIUM SILICATE:

(D) ABRASIVE AND POLISHING AGENTS Material Composition

Emery Natural oxide of aluminium known as
Abrasion  Is the wearing away of a structure or corundum.
substance by mechanical means. Al2O3 From bauxite
Levigated Al2O3 by water floatation process
- Abrasion occurs when a hard, rough surface slides alimina
along a softer surface & cuts or flows a series of Garnet Silicates of Al, Co etc; usually coated
grooves. It may be either a two body process or a on paper or cloth.
three body process.
Pumice Highly siliceous material
- Abrasives used in dentistry are applied to work by
Kieselguhr Siliceous remains of aquatic plants
means of Abrasive tools.
called as diatoms, called as
TYPES OF ABRASIVES: diatomaceous earth.
Tripoli 
(1) EMERY:- Rouge Is iron oxide; impregnated on a
- Consists primarily of a natural oxide of crocus cloth
aluminium called corundum. Tin oxide Putty powder.
- KHN2000 Chalk Calcium carbonate.
(2) ALUMINIUM OXIDE: Chromic oxide For stainless steal and metals; hard
- Manufactured from bauxite. powder.
- Extremely fine particles of Aluminium oxide Sand 
can be obtained by a water floatation process, Carbides Si, B, on wheels / disks
in this form, it is known as Levigated alumina. Diamond Hardest and most effective
(3) GARNET: Comprises of silicates of any Zr – silicates In dental pastes; disks / strips
combinations of aluminium, cobalt, magnesium Crocus disc For gold finishing; has FeO ie rouge.
iron & manganese. Lavigated For porcelain finishing
(4) PUMICE: alumina
- Highly siliceous material of volcanic origin. Al2O3 disc For composite restorations finishing.
- Can be used as an abrasive or a polishing Abrasive properties: It should be harder than the work
agent, according to its particle size. it abrades.
(5) KIESELGUHR :
Material KHN
- Comprised of the siliceous remains of minute
aquatic plants known as diatoms. Coarser form Sand 800
known as DIATOMACEOUS EARTH.
Emery 2000
(6) TRIPOLI : Originates from certain forms of rocks.
Silicone carbide 2500
(7) ROUGE: Red fine powder composed of iron
B – carbide 2800
oxide.
Diamond > 7000

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ABRASIVE ACTION: Essentially a cutting action.
DESIRABLE CHARACTERISTICS OF AN
ABRASIVE:
1. Should be irregular in shape so that it presents a
sharp edge.
2. Should be harder that the substrate it abrades.
3. It should possess a high impact strength or body
strength.
4. Should posses attrition resistance so that it does not
wear.
FACTORS AFFECTING THE RATE OF
ABRASION:
1. Size: Larger the particle, the deeper the scratches in
the surface & the faster the surface is worn away.
2. Pressure of work against the abrasive: Greater the
pressure, the deeper the scratch & the greater is the
tendency for the abrasive particle to be dislodged or
fractured.
3. Speed: Increasing the speed, increases the rate of
abrasion.
TYPES OF ABRASIVES:
3 types:
1. Finishing abrasives: Generally hard coarse abrasives
used primarily for developing desired contours of
restoration or tooth preparation & for removing
gross irregularities on the surface.
2. Polishing abrasives: Finer particle size.
- Used to smooth surfaces that have been
roughened by finishing abrasives.
3. Cleansing abrasives: Soft materials with small
particle size.
- Used to remove softer materials that adheres to
the enamel or restorations.
Abrasives found in prophylactic pastes are :
- Quartz, feldspar, aluminium hydroxide, kaolinite &
talc.
Abrasive found in Dentifrices:
- Calcium carbonate, dibasic calcium phosphate
dehydrate, anhydrous dibasic calcium phosphate,
bicalcium phosphate, calcium pyrophosphate, sodium
monoflurophosphate, hydrated alumina and silica.
REGIMEN (MDS)
FINISHING & POLISHING AGENTS:
Finishing & polishing are meant to remove excess
material & to smoothen roughened surfaces. The
materials used for the same are primarily abrasives.
FINISHING ABRASIVES POLISHING
- Generally hard, coarse ABRASIVES
abrasives - Have finer particle
- Used generally for size
developing desired - Used to smoothen
contours surfaces after
finishing abrasives
ABRASIVE AGENTS USED FOR FINISHING:
1. Aluminium oxide : Manufactured from bauxite.
- The particles are most commonly applied to a
paper or plastic disk.
2. Cuttle: Manufactured form bones of fish.
3. Diamond: Hardest known substance.
4. Garnet: Abrasive that is mined.
5. Sand: Form of quartz.
6. Silicon carbide: Second hardest of dental abrasives.
Aerosol hazards of the finishing process : Dental
aerosols contain tooth structure, dental materials and
micro-organisms. Silicosis, also called grinder’s disease,
is a major aerosol hazard in dentistry because a number
of silica-based materials are used in processing and
finishing of dental restorations. Silicosis is a fibrotic
pulmonary disease that debilitates the lungs and doubles
the risk of lung cancer.
These hazards can be controlled in three ways :
1. Use of adequate infection control procedures,
water spray and high volume suction.
2. Use of safety glasses and disposable face masks.
3. Adequate ventilation system that efficiently
removes any residual particles in air.
BUR DESIGN:
- The term bur is applied to all rotary cutting
instruments that have bladed cutting heads.
- This includes instruments intended for such
purpose as finishing metal restorations or surgical
removal of tooth as well as for tooth preparation.
Many shapes and sizes of dental burs are available
for various purposes in preparation and finishing
of cavities and restorations.
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Composition: - There is a tendency towards reduced spiral

(a) Carbon steel burs (steel burs) angles on burs intended exclusively for high
(b) Tungsten carbide burs (carbide burs) speed operation where a large spiral is not
needed to produce smooth operation and a
ADDITIONAL FEATURES IN HEAD DESIGN: smaller angle produces more efficient cutting.
5. Cross cut:
A large numbers of factors other than head size are - Cross cut bur design have notches in the blade
important in determining the effectiveness of a bur edges to increase the cutting effectiveness at low
design. They are: & medium speeds.
BLADE DESIGN
1. Head length: - The actual cutting action of a bur takes place in a
- Must be long enough to reach the full depth of very small region at the edge of the blade.
normal preparation.
2. Taper angle: - Each blade has 2 faces:
- Should approximate the desired occlusal
divergence of the lateral walls of the preparation.
3. Neck diameter:
- Neck that is too small will result in a weak Rake face Clearance face
instrument unable to resist lateral force & too
large a neck diameter may interfere with - That which is in the - Is the other face of the
visibility & may restrict access for coolants. As direction of rotation blade which follows
the head of the bur increases in length or & makes contact behind the edge as the
diameter the moment exerted by lateral force with the tooth bur rotates.
increases & the neck needs to be larger. structure being
4. Spiral angle: removed
- In low & medium speed ranges spiral bur blades - The cutting edge of the blade is at the intersection of
tend to produce smoothness of cutting action. these 2 faces.

Cross-section of a bur

There are 3 important angles:

Rake Angle
Angle made between the Rake face & the
line connecting the Edge to the axis of the
Bur.
Most important design characteristic of bur
blade.
Extreme positive rake angles are used
when relatively soft & weak materials are
cut.
Edge Angle
Is the internal angle at the edge formed
by the two faces of the bur blade.
Closely related to the resistance of the
blade to fracture.
Greater the Edge angle, greater is the
amount of material reinforcing the
cutting edge & less likely is the edge of
the blade to fracture.
Clearance angle
Angle between the clearance face
immediately behind the edge &
tangent to the path of rotation.
Increase in clearance angle
causes a decrease in edge angle.

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Rake Angle Edge Angle Clearance angle

If on the other hand the material being cut Greatly dependent on the depth of the Serves 3 functions :
is tough & requires a high energy. cut of the bur. As the depth of the cut is Serves to eliminate rubbing
expenditure to remove material from its increased the force exerted by the Rake friction of the clearance face of
surface, negative rake angle is used also face of the blade against the tooth the blade against the new tooth
used for machining of hard brittle structure being removed is increased. surface behind the cutting edge.
materials.
Negative rake angles are most effective
when used at low & medium speeds.
Carbide burs normally have blades with slightly negative rake angles & edge angle of about 90 degrees.

SOLVED EXAMPLES

1. Which of the following is common to both zinc phosphate and silicate cement ?
(A) Powder-Zinc oxide
(B) Powder – Alumino silicate
(C) Liquid – Phosphoric acid
(D) Liquid – Polyacrylic acid

Ans. (C). Liquid – phosphoric acid

Cements can be broadly classified depending on the type of powder : (A) Based on zinc oxide (B) Based on
Aluminosilicate powder and depending on the liquid as (i) Based on phosphoric acid, (ii) Based on Polyacrylic
acid.

Zinc oxide

ZPC
Phosphoric PCC
Polyacrylic
acid Sili-
cate GIC acid

Silica

Cement Powder Liquid

Zinc oxide eugenol Zinc oxide Eugenol
Zinc phosphate Zinc oxide Phosphoric acid
Polycarboxylate Zinc oxide Polyacrylic acid
Silicate Aluminosilicate Phosphoric acid
Glass ionomer Aluminosilicate Polyacrylic acid

(Ref. Phillips, 11th Edition, Pg. 445, 449)

2. Working time for zinc polycarboxylate cement is approximately :
(A) 5 min (B) 3.5 min (C) 2.5 min (D) 1 min

Ans. (C). 2.5 min

The working time for polycarboxylate cement is much shorter than that for zinc phosphate cement, that is,
approximately 2.5 minutes as compared with approximately 5 minutes for zinc phosphate.

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Manipulation:
The cements of zinc polycarboxylate cement supplied with the polyacrylic acid in the liquid are usually mixed at a
powder / liquid ratio of 1:1 to 2:1. The mixed cement is pseudo plastic; that is, the viscosity decreases as the shear
rate increases, or in other terms, the flow increases as spatulation increases or as force is placed on the material. The
correct consistency is found in a mix that is viscous but that will flow back under its own weight when drawn up
with a spatula.
Dispense the liquid immediately before mixing to prevent evaporation of water and subsequent thickening. A
nonabsorptive surface, such as a glass slab or treated paper, will keep all the liquid available for the reaction and
facilitate spatulation. Mix polyacrylate cements within 30 to 60 seconds, with half to all of the powder incorporated
at once to provide the maximum length of working time (typically 2.5 to 6 minutes). Extend the working time to 10
to 15 minutes by mixing on a glass slab chilled to 4C. The strength of the mixed cement is not compromised by
this technique. Some manufactures supply the cement as a capsulated powder-liquid system for mixing in a
mechanical mixer.
Polyacrylate cements have been used to cement metal inlays and crowns and to make bases. Apply the cement to
clean cavity walls that are well isolated in a dry field. Use the mixed cement only as long as it appears glossy on the
surface. Once the surface becomes dull, the cement develops stringiness and the film thickness becomes too great to
seat a casting completely.
(Ref. Phillips, 11th Edition, Pg. 468-469; Craig, 12th Edition, Pg. 487-488)
3. All are true for flowable composite sealants EXCEPT :
(A) Depth of cure should be less than that of highly filled composites.
(B) Supplied in syringes or in compules.
(C) They can be used to cover the restored area and exposed pits & fissures.
(D) Can be deposited from the syringe to a paper pad surface & then applied to tooth using a ball – tipped
applicator or microbrush.
Ans. (A). Depth of cure should be less than that of highly filled composites
FLOWABLE COMPOSITE SEALANTS
Low-viscosity composites marketed as flowable composites are advocated for a wide variety of applications, such
as preventive resin restorations, cavity liners, restoration repairs, and cervical restorations. These applications are
not well supported with data, but their clinical use is widespread.
Flowable composites are usually packaged in syringes or in compules. These can be used for direct application to
the cavity or the tooth surface. These composites can also be deposited from the syringe to a paper pad surface and
then applied to the tooth using a ball-tipped applicator or a microbrush. In dispensing the material, care must be
exercised to avoid introducing air bubbles, which eventually become surface voids. Depth of cure after light
activation should be slightly better than that of highly filled composites.
Flowable composites provide an advantage when used as the sealant portion of a preventive resin restoration. A
bonding agent should be applied to the etched enamel and light-cured to provide the basic adhesion for retention.
The flowable composite can then be used to cover the restored area and the exposed pits and fissures on the occlusal
surface of molars and premolars. The high flow aids in restoring minimal cavity preparations involving fissures that
are cleaned or prepared with air abrasion techniques. Because they have higher filler content than most resin
sealants, flowable composites should have better wear resistance in this clinical situation. A current clinical study
has verified good retention and caries resistance after 24 months. Long-term clinical efficacy of preventive resin
restorations using flowable composite is yet to be established.
(Ref. Craig’s, 12th Edition, Pg. 173)
4. All are true for Resin modified GIC’s, EXCEPT :
(A) Liquid contains HEMA
(B) Powder contains HEMA
(C) Camphoroquinone is present in the liquid
(D) Powder contains radiopaque fluoro-aluminosilicate glass
Ans. (B). Powder contains HEMA
Composition: Self-cured resin-modified glass ionomer cement powder contains a radiopaque,
fluoro-aluminosilicate glass and a microencapsulated potassium persulfate and ascorbic acid catalyst system.

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The liquid is an aqueous solution of polycarboxylic acid modified with pendant methacrylate groups. It also
contains 2-hydroxyethylmethacrylate (HEMA) and tartaric acid. Another self-cured cement contains a mixture of
fluoro-aluminosilicate and borosilicate glasses in the powder. Its liquid is a complex monomer containing
carboxylic acid groups that can undergo an acid-base reaction with glass and vinyl groups that can polymerize when
chemically activated. One light-cured resin-modified glass ionomer cement contains fluoro-aluminosilicate glass in
the powder and a copolymer of acrylic and maleic acids. HEMA, water, camphorquinone, and an activator in the
liquid.
(Ref. Craig, 12th Edition, Pg. 486)
5. Which of the following is not an objective of high strength base ?
(A) To protect pulp form various irritants
(B) To encourage recovery of the injured pulp
(C) To provide mechanical support for the pulp
(D) None of the above

Ans. (D). None of the above

High strength bases, besides providing mechanical support, protect pulp from various irritants and might encourage
recovery of pulp by promoting secondary dentin formation.
Cavity bases are cements of about 1 to 2 mm thick placed under restorations in order to avoid chemical and thermal
insults to the pulp.
Ideal requirements of cavity bases:
1) Cement bases should have adequate strength to withstand forces during condensation of amalgam and to
remain stable under restoration during mastication. Minimum compressive strength should be 1.2 MPa.
2) Setting time of the cement should be adequate.
3) pH of the cement should be adequate (alkaline) so that it does not chemically irritate the underlying pulpal
issue.
4) Cement bases under metallic restorations should not conduct heat to the pulp, thus should provide thermal
insulation to the pulp.
5) It should prevent bacterial penetration into pulp through marginal leakage.
6) Provide mechanical support for the restoration and distribute local stresses to the dentin.
7) Block out undercuts if present in an inlay cavity.
8) Preferably base should have an Obtundant effect on pulp e.g. Zinc oxide Eugenol cement.
9) Calcium hydroxide base for example provides alkalinity which results in an anticariogenic effect and induces
secondary dentine formation.
Classification of Bases :
1) Acidity :
a) Alkaline : Calcium hydroxide cement
b) Neutral : Zinc oxide eugenol cement
c) Acidic : Zinc phosphate cement
2) Mechanical properties:
a) Weak or low strength bases:
i) Calcium hydroxide
ii) Zinc oxide eugenol modified
b) Strong or high strength bases:
i) Polymerized zinc oxide eugenol
ii) Zinc polycarboxylate
iii) Zinc phosphate
iv) Light cured Compomer base

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3) Mode of supply:
a) Powder and liquid form
i) Zinc phosphate
ii) Zinc oxide eugenol
b) Single paste system (Light cure)
i) Calcium hydroxide
ii) Conformer
c) Two paste system
i) Chemical cured Calcium hydroxide
(Ref. Phillips, 11th Edition, Pg. 459)

6. Which of the following are used as intermediate restorative materials (IRM) ?

(A) Zinc oxide-eugenol unmodified
(B) Modified zinc oxide eugenol
(C) Zinc polycarboxylate
(D) Glass ionomer

Ans. (B). Modified zinc oxide eugenol

Modified zinc oxide eugenol cements
EBA alumina
modified cements
Polymer reinforced
zinc oxide eugenol
cement or IRM :
(Intermediate
restorative material)
Al2O3 (alumina) is added to the powder and These cements were
ortho-ethoxy benzoic acid or ethoxy introduced in order to
benzoic acid is added to the liquid. attain improved
mechanical properties
compared to zinc oxide
eugenol cement.
Powder is surface treated and polymer This cement posseses
synthetic resins (Finely divided natural improved mechanical
polymethylmethacrylate resin) is added so properties than
as to improve its strength toughness and unmodified zinc oxide
abrasion resistance. eugenol cement.

(Ref. Phillips, 11th Edition, Pg. 490)

7. Adhesive cements are :
(A) GIC (B) Polycarboxylate cement
(C) Resin cement (D) A and B

Ans. (D). A and B

Classification and Uses of Dental Cements:

Cement Principal Uses Secondary Uses

Zinc phosphate Luting agent for restorations and Intermediate restorations;
orthodontic appliances thermal insulating bases
Zinc oxide-eugenol – Temporary and intermediate – Root canal restorations
restorations – Periodontal surgical dressing
– Temporary and permanent luting
agent for restorations;
– Thermal insulating bases;
– Cavity liner;
– Pulp capping

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Cement Principal Uses Secondary Uses

Polycarboxylate – Luting agent for restorations; – Luting agent for orthodontic
– Thermal insulating bases appliances
– Intermediate restorations
Silicate Anterior restorations – Intermediate restorations;
– Luting agent for orthodontic
appliances
Silicophosphate Luting agent for restorations
Glass ionomer – Anterior restorations; – Pit an fissure sealant;
– Luting agent for restorations and – Thermal insulating bases
orthodontic appliances;
– Cavity liners
Metal-modified glass – Conservative posterior restorations;
ionomer – Core buildups
Resin Luting agent for restorations and Temporary restorations
orthodontic appliances
Calcium hydroxide – Pulp capping agent;
– Thermal insulating bases
(Ref. Phillips, 11th Edition, Pg. 443)
8. On a carbide bur, a greater number of cutting blades result in :
(A) Less efficient cutting and smoother surface
(B) More efficient cutting and smoother surface
(C) Less efficient cutting and rougher surface
(D) More efficient cutting and rougher surface

Ans. (A). Less efficient cutting and smoother surface

“Blades on a bur are uniformly spaced with depressed areas between them. These depressed areas are called flutes.
Greater the number of blades smoother is the cutting action at low speeds. Also as the number of blades increases,
space between two subsequent blades decreases & so bur will cut less of the surface i.e. efficiency is reduced by
increased blades on bur.”
Remember,
 Number of blades on a bur is always even.
 Excavating bur- usually has 6-10 blades
 Finishing burs – 12-40 blades
 Vibrations over 1300 cycles/sec are practically imperceptible to patient. Fewer the number of bur teeth,
greater the tendency for vibration.
 Higher RPM produce less amplitude & greater frequency of vibration.
 Rake Angle: Angle that the face of blade makes with the radial line from centre of bur to blade.
 Cutting efficiency: - +ve rake > radial rake > -ve rake. Hence burs with a +ve rake angle are usually desired.
 Clogging occurs in burs with +ve rake angle.
 Clearance angle: This angle provides clearance between the working & cutting edge.
 Run-out: Refers to eccentricity or maximum displacement of bur head from its axis of rotation.
Average value of clinically acceptable run out is about 0.023 mm.
 Minimum & maximum load applied by dentist through bur is :
- For low speed – 100 – 1500 gm.
- For high speed – 60 – 120 gm
 Diamond stones are hardest & most efficient abrasive stones for removing tooth enamel.
(Ref. Sturdevant, 5th Edition, Pg. 356; Marzouk, Pg. 74, 75)

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9. Negative rake angle :

(A) Used for relatively softer and weaker materials
(B) Used for hard or brittle materials
(C) Radial line leads the face such that the rake angle is on the inside of the radial line
(D) None of the above

Ans. (A). Used for relatively softer and weaker materials

Negative Rake angle :
When using a negative rake angle instrument you cut by applying downward pressure which creates a compression
wave ahead of the blade. It is used for relatively weaker material.
(Ref. Sturdevant, 5th Edition, Pg. 356)
10. Electrochemical corrosion is an example of :
(A) Chemical corrosion
(B) Dry corrosion
(C) Electrolytic corrosion
(D) Galvanic corrosion

Ans. (A). Chemical corrosion

Chemical corrosion is seldom isolated and almost invariably is accompanied by a second type of corrosion known
as electrochemical corrosion. This type is also referred to as wet corrosion, because it requires the presence of water
or other fluid electrolytes.

Electro chemical or wet or aqueous or electrolytic corrosion: This type of corrosion occurs in presence of water
or other fluid electrolytes hence it is called wet or aqueous corrosion. Further the process to continue requires a
pathway for transport of electrons, an electric current. The factors in the ora cavity such as wet environment, saliva
acting as an electrolyte, change in pH and temperature contribute an environment for electrochemical or wet
corrosion.

Types of electro chemical corrosion or galvanic corrosion :

1) Galvanic corrosion due to dissimilar metals
2) Corrosion due to in homogenous surface
3) Stress corrosion
4) Corrosion due to heterogenous composition
5) Crevicular cell corrosion
Electro chemical corrosion:
To understand the process of electro chemical corrosion in oral cavity it is imperative to know how an electro
chemical cell is formed in the oral cavity i.e. with its components.
i) Anode
ii) Cathode
iii) Electrolyte
Anode is represented at the metal surface where positive ions are formed. This is where the metal surface is
corroding and the electrons are released.
The reaction at Anode is oxidation. It is represented as – (‘M’ is Metal).
M  M +e–
Cathode is represented by metal surface that consumes free electrons produced at anode. The following reduction
reactions may occur at cathode. It is represented as:

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Diagram of an electro chemical cell consisting of an amalgam anode; gold alloy as cathode and saliva as
electrolyte
M+ + e–  M
2H+ + 2e–  H2 (Hydrogen ions may be converted into Hydrogen gas)
2H2O + O2 4e–  4 (OH)– (Hydroxyl ions may be formed)
This is an example of galvanic or corrosion cell.
Electrolytes supply the ions needed at the cathode, and to carry away the corrosion products at anode. For
electrochemical corrosion to be a continuous process the number of electrons produced at anode must be exactly
balanced by the number of electrons consumed at cathode.
The primary driving force in electrochemical corrosion is the reaction occurring at cathode. This is an important
consideration in determining the rate of corrosion process and can be used to advantage to reduce or eliminate
corrosion.
(Ref. Phillips, 11th Edition, Pg. 58-61)

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