Professional Documents
Culture Documents
Introduction
History
Enamel
Dentin
Pulp
Pediodntium
Toxicity
Inflammation
Allergy
Mutagenic radians.
Types of Tests
In Vitro tests
Cytotoloxicity assays
Mutagenesis assays
Animal tests
Usage tests
Reaction of pulp
Microleakage
Amalgam
Bonding agents
Composite resins
Ceramics
Conclusion
INTRODUCTION
When a biomaterial is placed in contact with the tessiues and fluids of the
human body, there is inivariable some form of interaction between the material and
medicine, such as orthopedics, cardiology and vascular biology among others. In the
development of any biomaterial, one must consider the strength, esthetics and
materials perform more sophisticated functions in the body for longer time periods
Although the concept of ethical treatment of patients extends back to the line
of Hippocrates ( 460 – 377 B.C) the idea that new materials must be tested for safety
and efficacy before clinical use is more recent. As late as the mid 1800’s dentists tried
materials such as early amalgams. The concept of protecting the patient as a research
subject is only 30-40 years old and many of the regulations and ethics in this area are
still being challenged and defined today. In most cases a committee of clinicians,
basic scientists and laypersons regulate and oversee the testing of new materials in
humans.
knowledge of the biological proportions is unethical and illegal still over new material
must be inserted into a human for the first time at same point. Therefore many
alternative tests have been developed to try to minimize the risks to humans. The
systematic way evolved in the 1960’s as the need to protect patients became
The oversight for this testing in U.S now rests largerly with the Food and Drug
Administration ( FDA), but these activities are regulated by the American National
of materials has significantly evolved over the past 40 years. Since initially being used
on animal models. Many studies between the 1950’s and the 1970’s involved the use
at premolar teeth that were scheduled for orthodontic extraction. As well as cell
possible and the future will likely provide the ability to design materials that elicit
materials began some 30 yrs. After tissue culture was first established as a
technique in 1926.
Leirskar and Helgeland (1972) did the first study of cell culture tests using
Schmalz in 1982 was one of the first dental investigators to apply the agar
Be nontoxic
Classification of materials
biological compatibility
e) Those used in the dental laboratory, which though not used I the mouth,
Examples of hazards
a) some dental cement components are acidic and may cause irritation.
unreacted monomers.
restorative materials. The full effects of the oral anatomy on the biocompatibility of
materials are not known but these effect will be a major focus of anatomy of the tooth,
the periodontal attachment and to the peripical environment that have influences on
the biologic response to materials and all are sites of interface between materials and
tissue in dentistry.
ENAMEL
orientation with each other,and the orientation provides maximal strength because of
its high mineral (hydroxylapatile) content, enamel is much more bittele than dentin
and is soluibied to a greater extent by acid solution this property is used to advantage
with bonding agents, when acids are used to etch the enamel to provide
most oral molecules is quite low, and it seals the tooth to outside agents.
Peroxides in bleaching agents has been shown to penetrate intact enamel in just a few
seconds.
The dentin and pulp to be a single tissue the dentinial matrix (both ciassified
and unclassified forms the greatest bulk of the tooth collagen constitutes
approximately 85% of the organic portion of dentin and hydroxy apatite is the main
unorganic compound the dentenail matrix contains protein type 1 type 5 collagens,
osteoclasin and osteopontien, phosphoryjns dentinsealoprotien and dentin matrix
protein.
The dentin matrix surrounds dentenial tubles that are filled with odontoblastic
processes. The tubules traverse the region between the dentino enameljunction (DEJ)
A serum like fluid fills the dentenial tubules this fluid has conteneity with the
pressure, which causes fluid flow into tubules to be directed from the pulp outward
towards the DEJ when enamel is removed.external hydrostatic and osmotic pressure
can also cause fluid movement toward or from the pulp. The positive or negative
either odontoblasts or pulpal nerve endings. These effects are the basis of
Smear layer is formed by the action of the beer or hand instruments on the
classified dentin matrix. this occludes the dentinal tubules to some extent and it is
The smear layer can be removed by acid etching. Which also deminiralyses
the openings of the tubules. The dentenial tubules establish continuity with the pulpal
fluid to facilitate the diffusion of molecules both natural or from materials into and
out of the pulp. The smear layer ,dentenial tubules and dentenial matrix are all
important in the application of dentenial bonding agents and the ability of components
The pulp of the tooth is a connective tessuie containing normal elements such as
fibroblasts,collages,capillarises and nerve pulp supplies the cells, which replace any
odontoblasts desriyed during cavity preparation or material placement and allowes the
PERIODONICAL ATTACHMENT:
Junction between the outside of the body (oral cavity) and the inside of the
body. The dentin of the root of the tooth is covered by a thin layer of the root of the
tooth is covered by a thin layer of cementum that may seal the dentenial tubules
cementum attaches the collages fubers of the periodontal ligament the genguia
normally extends above the level of the cementum and forms a potential space against
the enamel called periodontal pochet.the gingivial epithelium is also attached to the
is the site of the development of periodontal pocket is the site of the development of
Because many dental restorations are near or in the periodontal attachment area the
reach higher levels than are seen in the rest of the oral cavity the influence of dental
materials on the periodontal disease and the biting forces that strain the periodontal
ligament and supporting bone. It is often difficult to determine with certainty whether
material or some combination of these factors. the periodontal pocket has also been
used as a site to place materials that release therapeutic agents to combat periodontal
disease. It is likely that this approach will expand as better drug delivery materials are
developed.
PERIAPICAL AREA:
Another interface between materials and the inside of the body. The apex of the tooth
is the junction of the pulp of the tooth and the alueolar bone nerves and blood vessels
entire through the apical foramen. When the pulp of the tooth is destroyed by
pulpal space and these materials interface with the body through the apex of the tooth.
If the endodontic procedure is not performed correctly the filling materials may
extruded from the apex into the periapical area and cause additional physical damage.
The ability of the root canal material toward the apex is also an important
consideration.
The use of the retrograde approach to seal the apical foramen, the filling materials
will be in direct contact with the perapical tessuies. Thus biological responces to these
materials must be critically examined. As with the periodontal attachment area, the
release of substances from root canal filling materials may cause adverse responses
around the apex or may alter the body’s reaction to bacterial products that have
The delineation between the bacterial and material threats are not clear , and the
Dentin resin interface:-when resin based restorations material bonds to dentin. The
composite nature of the denture allows the mineralized matrix to be dissolved away
by acids which preserving the collagen network. If the network doesnot collapse,
If the resin material doesnot penetrate the collgenous network or debonds from it as
the resin shrinks during polymerization, a gap will form between the resin and the
dentin. this also occurs in enamel this few missions wide gap allows bacteria and oral
fluids to pucolate from the pulp outward or from the oral cavity onward. This leakage
is termed as microleakage.
1. It may allow bacteria or bacterial products to reach the pulp and cause
infection.
If the resin penetrate the collagen network of the dentin but does not penetrate it
completely a much smaller gap will exist between the mineralized matrix of the
products to penetrate the marginal gaps of the restoration and the pulp,fluid exchange
most likely occurs that can degrade the resin or the collagen network. That has been
uncompletely embedded with resin, thereby reducing the longevity of the dentin resin
bond this degradation process may also gradually increase the gap size until
Osseointegration:
The use of endosseous dental implants has uncriased tremendulously over the past
decade. the success of these implants relieves on the ability of the material to promote
2. titanium-aluiminium-vanaduim alloy.
3.tantalum
Materials that allow osseointegration have very low osseointegration have very low
degradation rates,and they tend to form surface oxides that promote bony
between the bone and material with no intervening space at all.when this integration
require a degradation of the ceramic to promote bone formation .no known desirabily
also important to understand that neither osseointegration nor bio integration munic
the normal ligamentous connection between a tooth root and alerolar bone.
behave some what differently in oral epitheluium and connection tessuie than in the
rest of the body and the biological responses to materials in the mouth may not always
parallel those seen in other locations the oral environment is not always equivalent in
structure or function to other areas of the body and that differences may alter the
TOXICITY
Material release certain substances which in convert concentration can lead to the
toxicity. It in the first screening test used for all dental materials. This is a close-
substances like mercury ,,nickel, berylluim released into the body, which can cause
INFLAMMATION
involves the activation of the host immune system inflammation may result toward off
some threat. toxicity or from allergy and often the inflammatory response precedes
sometimes may preceed toxicity. The pulpal and periodontal disease are largely
Hypersensitively is the abnormal reaction that occurs when the body is exposed to a
foreign material this materials sensitive the immune system, so that when the person
is repiately exposed to the same material the body responds with a hypersensitivity
system recognize the material as foreign the allergic reactions can manifest as
localized reaction in the tessuie which is directly in contact with the material allergy
eruptions,sneezing,erythema,breathing difficulties.
Type I-immedaite
TypeII-cyto-toxic hypersensitivity
Mutagenic Reactions
(arcinogenic,as the immune system supplies lot of cellular energies and mechanics to
Oestroginicity-
It is the dynamic interaction between the body and materials.it is the key
Osseointegration-
Formation of living body tissues with in 10 mm space from the implant materials
Biointegration :
Certain materials like bioglasses which undergo biointegration with the bone directly
Immunotoxicity:
it is due to the alteration in the cells of immune system by the matrials.this cause
Eg-mercury,palladium,HEMA
biocompatibility, this practice has not been acceptable for many years and current
materials must be extensively screened for biocompatibility before they are used in
humans. Several varieties of tests are currently used to unsure that new materials are
biologically acceptable.
a) in vitro test
conducted in a test tube, cell culture dish, flash, or other contains but they are
enzyme. The contact involves the exposure of a material and biological system
are a)direct
b) indirect
directly with the biological system where as indirect contact occurs through a barrier
measurement are evolving rapidly as more is known about the interactions between
dental materials and oral tissues as technologies for testing improve. Historically new
materials were simply tested in humans to assess their biocompatibility. However this
practice has not been acceptable for many years and current materials must be
extensively screened for biocompatibility before they are used in humans several
varieties of tests are currently used to ensure that new materials are biologically
accepted.
Types of Tests
There are three basic types of tests : the in vitro test, the animal test, and the
have been used as the first screening test to evaluate a new material. These tests may
be conducted in a test tube, cell culture dish, flask or other containers, but they are
biologic system the biologic system may consist of mammalian cells, cellular
organells tissue bacteria or some sort of enzyme. The contact between the biological
system and the material may be direct or indirect. Direct contact involves the
system where as indirect contact occurs through a barrier of some sort. Such as agar a
membrane filter or death. In vitro tests can be subdivided into tests that measure cell
growth or death, those that determine cellular function of some type, and those that
ADVANTAGES
Relatively fast
Less expensive
Can be standardized
Disadvantages
IN VITRO TESTS
SYTOTOXICITY ASSAYS
By these tests the effect of the material or its leachable products are studied on
the metabolic functions of the test cell system. In general cytotoxicity tests measure
events.
Quantifying results
Disadvantages include
culture.
Organ cultures
Cells in culture or
Cell organelles.
The most widely used biological systems for in vitro toxicity testing of dental
materials are cells in culture. Two types of cells can be used for in vitro assays.
Primary cells are those cells taken directly from an animal and cultured. These
cells will grow for only a limited time in culture but retain many of the characteristic
of cells in vivo.
Continuous cells or cell lines are primary cells that have been transformed
previously to allow them to grow more or less indefinitely in culture because of this
transformation. These cells do not retain all in vivo characteristic but they do
In all cytotoxicity tests the test system itself must be nontoxic, sterile and
Membrane permeability is the ease with which a dye can pass through a cell
membrane. This test used on the basis that a loss in membrane permeability is
membrane permeability is
It identifies cells that are dead or alive under the microscope. This feature is
important because it is possible for cells to be physically present but dead (when
There are two basic types of dyes used, vital dyes are actively transported into
viable cells where they are retained unless cytotoxic efforts increase the permeability
of the membrane. It is important to establish that the dye itself does not exhibit
cytotoxicity during this frame of the test. Eg. Neutral red Na2 Cr o4
Non vital dyes are not actively transports and are only taken up if membrane
permeability has been compromised by cytotoxic. Eg. Trypan blue and propidium
iodine.
The main disadvantages of this test is the managing of radioactive isotopes (a
growth after exposure to a material cells are plated in a well of a cell culture dish
where they attach. The material is then placed in the test system if the material is not
cytotoxic, the cells will remain attached to the well and will proliferate with time. If
the material is cytotoxic, the cells may stop growing exhibit cytopathic features or
detach from the well. If the material is a solid, then the density of cells may be
assessed at different distances from the material and a zone of inhibited cell growth
may be described. The cell density can be assessed either quantitatively, semi
( non cytotoxic) controls where as materials such as plasticized polyvinyl chloride can
activity of cells to assess cytotoxic response. Tests that measure DNA or protein by
cells is usually analyzed by adding radio isotope labeled precursors to the medium
thymidine)
A commonly used enzymatic test for cytotoxicity is the MTT test. This test
via several cellular reducing agents, to a blue, insoluble formazan compound. If the
dehydrogenases are not active because of the cytotoxic effects, the formazan will not
Recently developed indicator dyes such as alam blue have been formulated to
Indirect tests researches have long recognized that in vivo direct contact does
not exist between cells and the materials separation of cells and materials may occur
One such test is the agar overlay method in which a monolayer of cultured
cells is established before adding 1% agar plus a vital stain such as neutral red to a
fresh culture media. The agar forms a barriers between the cells and the material
which is placed on top of the agar sold test sample or liquid samples adsorbed onto
However the agar may not adequately represent barriers that occur in vivo,
correlate the intensity of color or width of the zone around or material with the
A second barriers assay is the Millipore filter assay. This technique establishes
a mondayer of cells on filters made of cellulose esters. The culture medium is then
replaced with medium containing 1% agar and this mixture is allowed to get over the
cells, finally the filter monolay get is detached and turned over so that the filter is on
top for placement of solid or soluble test samples for 2 or more hours. After exposure
to the test samples the filter is removed and an assay is used to determine the effect of
the sample on acellular metabolic activity toxicity in the Millipore filter test is
assessed by the width of the cytotoxic zone around each test sample.
Dentin barriers tests have shown improved correlation with the cytotoxicity of
dental materials in usage tests in teeth and are gradually being developed for
screening purpose. A number of studies have shown that dentin forms a barrier
The thickness of the dentin correlates directly with the protection offered to
the pulp thus assays have been developed that incorporate dentin disks between the
The use of dentin disks offers the added advantage of directional diffusion
In vitro assays to measure immune functional or other tissue reaction have also
material to alter cell cycle or activate complement. Material that activate complement
MUTAGENESIS ASSAYS
They assess the effect of materials on a cells genetic material. There is a wide
range of mechanisms by which materials can affect the genetic material of the cell.
Genotoxic mutagens directly alter the DNA of the cell through various types of
mutations. Each chemical may be associated with a specific type of DNA mutation
Genotoxic chemicals may be mutagens in their native states or may require activation
mutagens may or may not be carcinogens and carcinogens may or may not be
mutagens. Thus the qualification and relevance of tests that attempt to measure
The Ames test is the most widely used short term mutagenesis test and the
only short term test that is considered thoroughly validated. It uses mutant stocks of
not require expgenous histidine. Exclusion of histidine from the culture medium
allows a chemical to be tested for its ability to convert the mutant strain to a native
strain. Chemicals that significantly increase the frequency of reversion back to the
because they significantly alter genetic material performance of this test requires
experience in the field and special strains of salmonella to produce meaningful results.
A second test for mutagenesis is the styles cell transformation test. This test on
mammaion cells was developed to offer an alternative to bacterial tests ( Ames test)
which may not be relevant to mammation systems. This assay quantifies the ability of
potential carcinogens to transform standard cell lines so that they will grow in soft
agar untransformed fibroblasts normally will not grow within an agar get whereas
genetically transformed cells will grow below the gel surface. This characteristic that
correlate with the ability of cells to produce tumors in vivo. However there has been
ANIMAL TESTS
After screening by initial tests of the materials developed for a specific use
animal tests for biocompatibility are used in mammals such as mice rats hamsters or
guinea pigs. Animal tests are distinct from usage tests in that the material is not placed
in the animal with regard toxic use. The use of an animal allows many complex
occur. The biological responses in animal tests are more comprehensive and may be
Disadvantage include
Expensive
Time consuming
Relevance of the test to the in vivo use of a material can be quite unclear,
represent a human.
abraded skin. This test is conducted by placing the test materials and positive and
negative controls into contact with hamster’s cheek pouch tissue or rabbit oral tissue.
After several weeks of contact the control and test sites are examined and the
gross tissue reaction in the living animals are recorded and photographed in color. The
animals are then sacrificed and biopsy, specimens are prepared for histological
Used in guinea pigs, the materials are injected intradermally to test for the
If hypersensitivity develops from the initial injector, the patch will elicit an
inflammatory response. The skin patch test can result in a spectrum from no reaction
to intense redness and swelling. The degree of reaction in the patch test and the
percentage of animals that show a reaction are the basis for estimating the
IMPLANTATION TESTS
These tests are used to evaluate materials that will contact subcutaneous tissue
or bone. The location of the implant site is determined by the use of the material and
may include connective tissue, bone or muscle. Although amalgams and alloys are
tested because the margins of the restorative materials contact the gingival most
subcutaneous tests are used for materials that will directly contact soft tissue during
separate sites and allowed to remain for 1 – 11 weeks. Alternatively an empty tube is
embedded first and the inflammatory reaction from surgery is allowed to subside. The
implant site is then reopened and the test material is placed into this healed site or is
packed into the tube and the test material is placed into this healed site or is packed
into the tube that was placed previously. At the appropriate time, the areas are excised
and prepared for microscopic examination and interpretation. The tissue response can
term tests except the materials remains in place for 1 to 2 years before examination.
materials have been developed by toxicologists. Those tests are employed with a
strategy tests are applied in a specific order and testing is stopped when any indicates
mutagenic potential of the material or chemical. The validity of any of these tests may
be affected by tissue of species tissue gender and other factors. Tests are generally
divided into
Limited in vivo tests that measure altered lives function or increased tumor
induction when animals are exposed to the chemicals for a fraction of their
lifetimes.
Long term invivo tests are performed by keeping the chemical in contact
USAGE TESTS
These tests may be done in animals or human volunteers. They are distinct
from other animal tests because they require the material be placed in a situation
identical to its intended clinical use. The usefulness of a usage test for predicting
biocompatibility is directly proportional to the fidelity with which the test mimics the
clinical use of the material in every regard include time location environment and
placement techniques. For this reason usage tests in animals employ larger animals
that have similar oral environment to humans such as dogs or monkeys. If humans are
These tests are gold standard in that they give the ultimate to whether or not a
Advantage
Disadvantage
Very expensive
careful uniformly sized cavity preparations under sterile conditions the compounds
are placed in equal number of anterior and posterior teeth of the maxilla and mandible
to ensure uniform distribution in all types of teeth. The materials are left in place from
1 to 8 weeks. Zinc oxide eugenol and silicon cements have been used as negative and
At the conclusion of the study, the teeth are removed and sectioned for
dentin and reparative dentin for each histological specimen is measured with a
phalomicrometer and recorded. The response of the pulp is evaluated based on its
appearance after treatment. The severity of the lesion is based on disruption of the
Slight
odontoblastic zone.
Moderate
of odontoblastic zone.
Severe
Efforts have been made to develop techniques that identify bacterial insults to
pulp. Usage tests that study teeth with induced pulpils allow evaluation of types and
Since various dental materials contact gingival and mucosal tissues, the tissue
Difficulties include
Bacterial plaque
Secondary factors are the surface roughness of the restorative material open or
The best estimations of the success and failure of implants are gained from
three tests.
the implant.
capsule around a subperiosteal implant or root cylinder was the natural reaction of the
body to a material. They argued that this was actually an attachment similar to the
isolate the implanted material as the material slowly degrades and leaches its
the most differentiated slab of that tissue fibrous capsule formation is a sign of
material. The ways by which these tests are used together however are controversial
and have evolved over the years as knowledge has increased and new techniques
developed.
materials were tested at the bottom of the pyramid and materials were weekend out as
the testing continued towards the top of the pyramid. Tests at the bottom of the
pyramid were unspecific toxicity tests of any type with conditions that did not
necessarily reflect those of the material use. The next layer shows specific toxicity
that presumably death with conditions more relevant to the use of the material. The
Later another pyramid schemes was proposed that divided tests into initial
secondary and usage tests. The philosophy was similar to the first scheme except the
types of tests were broadened to encompass biological reactions other than toxicity
was also added first only materials that passed the first lier of tests were graduates to
the second lier and only those that passed the second lier were graduated to the
clinical trials.
Two newer schemes have evolved in the recent past with regards to using
Eg. Tests in animals for inflammatory response may be useful not only during
development of a material but also if a problem is noted with the material after it has
Secondly these new schemes recognize the inability of current test methods to
ongoing process.
BIOCOMPATABILITY
The first efforts of the ADA to establish guidelines for dental materials came
specifications for dental amalgam. Since then standardization has been difficult and a
practices for biological evaluation of dental materials. The committee that developed
this documents recognized the need for standardized methods of testing and for
sequential testing of materials to reduce the number of compounds that would need to
be tested clinically.
The original ANSI/ ADA documents 41 for biological testing was updated in
1982 to include tests for mutagencity. This specification uses the linear paradigm for
materials screening and divides testing into initial secondary and usage tests.
The initial tests include in vitro assays for cytotoxicity red blood cell
inflammatory or immune responses. Usage tests include tests for pulpal and bone
response.
The required tests for a given material are not listed specifically, rather it is up
to the manufacturer to select the tests and defined the selection to the ANSI /ADA and
The ISO 10993 document is the international standard for testing the
addition some specialized tests for devices are addressed such as the dentin barrier
test for restorative dental materials. In this standard usage tests are part of
supplementary tests. As the ANSI/ADA standard the selection of test is left to the
manufacturer who must defined the selection upon application for approval.
Reaction of pulp
Dentin protects the pulp and owes its validity and its sensitivity to
stimulation of the dental pulp. This intimate relationship has far reaching
clinical application.
The nature of pulp reaction that follows peripheral injury of the dentin
which depends on
1 Attrition abrasion
Responses
Mild irritation
Reparative dentin
Inflammation of pulp
3. Iatrogenic injuries
As pulp inflammation can also be iatrogenic in origin Do not Harm is the basic
result of microleakage.
techniques of cementation.
MICROLEAKAGE
There is evidence that restorative materials may not bond to enamel or dentin
with sufficient strength to resist the forces of contraction during polymerization wear
or thermal cycling when debonding occurs, bacteria, food debris or saliva may be
drawn into the gap between the restoration and the tooth by capillary action. This
irritation has been extensively studied early studies reported that various dental
However, several recent studies hypothesized that it was often the products of
microleakage, not the restorative materials that caused pulpal irritation. Subsequently
numerous studies should that bacteria were present under restoration and in dentinal
Secondary caries
Stains or discoloration
Pulpal pathology
AMALGAM
products released while in service. Corrosion in turn depends on the type of amalgam
whether it contains the y2 phase and its composition In cell culture screening tests,
free or non leaded mercury from amalgam is toxic with the addition of copper
amalgams become toxic to cells in culture but low copper amalgam that has set for 24
hrs. does not inhabit cell growth. Implantation tests show that low copper amalgams
are well tolerated but the high copper amalgams can cause severe radiations when in
direct contact with tissue. In usage tests, the response of the pulp to amalgam in
shallow or in deeper but lined cavities is minimal and amalgam rarely causes invisible
damage to the pulp however, pain results from using amalgam is deep unlined cavity
membrane adjacent to amalgam restoration is quite often Buccal mucosa and lateral
For many years a controversy has raged over the biocompatibility at amalgam
restoration because of the presence of element hg. The symptoms of chronic Hg.
Weakness
Fatigue
Anorxia
Weightloss
Insomnia
Irrilability
Tremois in extremities
Shyness
provide direct restorative materials that are mercury free, but appeared to be more
cytotoxic than high copper amalgams chemically these materials show much higher
The pulp responses from the insertion of cohesive and compacted gold are
pneumatic instrument.
The responses develop when the condensation occurs over freshly cut dentinal
lubules.( minimum of 2 mm sapiapulpal dentin thickness) but not when the dentinal
tubules are lined with pre-operatively formed reparative dentin induced from previous
Apparently it was found that when compact properly into sound tooth
structure produce only minimal pulp response showing least marginal leakage.
Burning sensation
economics requirement – There is no one alloy suitable for all applications e.g certain
base metal alloys contain Be, Ni, Co, Cr. And the biocompatibility of each metal
dental origin.
However, under controlled conditions, when inhalation of dust and fumes can
It may result in
Acute form
Chronic form
To pulmonary dysfunction
identified Ni. And Ni. Compound as carcinogenic. The major hazardous route
is aspiration. The use of nickel has been controversial for many years because
Dermatologic
Systemic effect that may result from patient and personal exposure to
cobalt alloys.
serum proteins suggesting that protein binding or buffering in inflamed pulp tissue
may play an important role in detoxifying these materials in vivo. The initial
response after exposing pulp tissue to these highly alkaline pulp capping agents is
hemorrhagic exudates of the superficial pulp shortly after necrosis occur neutrophils
infiltrate into the subnecrotic zone. After 5-8 weeks only a slight inflammatory
response remains within weeks to months however the necrotic zone undergoes
When resins are incorporated, the Ca(OH 2) become less irritating and are able
to stimulate reparative dentin bridge formation mere quickly than Ca(OH) 2 suspension
alone with no zone of necrosis and reparative dentin is laid down adjacent to the liner.
This indicates that replacement odontoblasts form the dentin bridge in contact with
the liner.
The liners such as copal vanishes and polystyrenes are not generally used
under resin based materials, because resin components dissolve the film of vanish.
Because liners are used in such thin layers, they do not provide thermal
insulation but do initially isolate the dentinal tubule contents from the
cavity preparation.
They may also reduce penetration of bacteria or chemical substances for a
time.
CERAMICS
Among the most biocompatible materials used for dental restorations are
ceramics and the use of dental constructions manufactured using ceramics has
increased during the past few decades, new ceramics materials have been used both as
basis of studies of traditional feldspathic porcelains and the low corrosion rates of
feldspathic materials studies showed clearly that all ceramics materials are not
equivalent in their initial state of fabrication with aging after polishing procedure.
GROUP II
lesion involving all the coronal pulp tissue as the phosphoric acid within
The P-11 of the cement 3 minute after mixing is 3.5 the P-11 rapidly
pulp occurs during the first few hours after insertion of the cement, this
agents.
Glass ionomers have been used as both cement ( luting agent) and as a
restorative material light cured ionomer systems have been introduced these systems
use BISGMA or other oligomers as pendant chains on the polyacrylate main chain.
GROUP III
SILICATE CEMENT
It has high irritational potential
It is an ideal material for the control in studies that evaluate pulp reactions
to restorative materials.
The ptt is below 3 at the time of insertion and the ptt remains below
RESINS
effects in humans.
low.
Theoretically, such reaction( toxic and allergic) could occur after contact
dermatitis.
Finally inhalation of monomer vapour may be detrimental therefore, the
COMPOSITE RESINS
activated (UV/VL) are found irritating to the pulp. In vitro, freshly set chemically
cured and light cured resins often cause moderate cytotoxic reaction in cultured cells
over 24 to 72 hrs. of exposure although several newer systems seem to have minimal
toxicity. The cytotoxicity is significantly reduced 24-48 hrs. after setting and by the
Evidence indicates that the light cured resins are less cytotoxic than
chemically cured systems, but this effect is highly dependent on curing efficiency of
BONDING AGENTS
Numerous bonding agents have been developed and are applied to cut dentin
during restoration of the tooth. Many of these reagents are cytotoxic to cells if tested
alone, however when placed on dentin and rinsed with water between applications of
Long term in vitro studies suggest that compounds of the bonding agent may
metabolism for upto 4 week after application suggesting that residual unbound
bonding systems is at least 100 times less toxic in tissue culture than BIS GMA
studies using long term in vitro systems have shown, however that adverse effects of
resins occur at much lower concentrations when exposure times are increased to 4-6
weeks. Many cytotoxic effects of resin compounds are reduced significantly by the
presence of a dentin barrier studies have shown that combinations of HEMA and
other resins found in dentin bonding agents may ad synergistically to cause cytotoxic
effects in vitro.
Calcium hydroxide cavity liner come in many forms, ranging from saline
suspensions with a very alkaline PH( above 12) to modified forms containing Zinc
mild to moderate cytotoxic effects in both cut and long term set conditions.
CONCLUSION
interaction within the oral cavity. Diverse biological response to these materials
depends on whether they release their components and whether those components are
interactions between the material and the body influence the biocompatibility of the
material. In the end, no material can be shown to be 100% safe or risk free, further
more the clinician must rely on clinical judgement, data available and analyze the risk
ceramics but these elements are not particularly hazardous. In cytotoxicity assays by
have not been reported to have known toxic effects and several of the ions in dental