Uses and Techniques of Polytetra Uoroethylene (PTFE) in Dentistry

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Uses and Techniques of Polytetraﬂuoroethylene (PTFE) in Dentistry
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Gerardo Hernández Tecanhuey
Uses and Techniques of Polytetrafluoroethylene (PTFE) in Dentistry
Faculdade de Ciências da Saúde
Porto, 2018
Faculdade de Ciências da Saúde
Porto, 2018
Dissertation submitted to Fernando Pessoa University
As part of the requirements for obtaining
the Master’s Degree in Oral Medicine
-------------------------------------------

Abstract
Due to its versatility, polytetrafluoroethylene ( PTFE ), is widely applied in dentistry and

offers many advantages for its clinical use. The need to put in one paper the largest number
of techniques, in which PTFE is used, is the main reason for conducting this literature review.
The source of literature were international data bases: B-on, Pub Med, SciELO,
ScienceDirect, Web of Science, searched by keywords with inclusion and exclusion criteria
for a previous selection of the papers.
For the analysis these techniques will be grouped in the different areas of dentistry to which
correspond, such as : conservative dentistry, peri-implant surgery, orthodontics, endodontics
and oral hygiene. The organization and description of techniques conducted in this study
allows to identify the main functions that PTFE serves in dentistry, which are: mechanical
barrier; filling or packing material; spacer element to simulate cement layer; surface coating;
biofilm removal instrument.
Keywords: Polytetrafluoroethylene; Teflon; Teflon tape; Dense polytetrafluoroethylene;

Expanded polytetrafluoroethylene; Plumber’s tape.
v
Resumo
Devido à sua versatilidade, o politetrafluoretileno (PTFE) é amplamente aplicado na

odontologia e oferece muitas vantagens para o seu uso clínico. A necessidade de colocar num
documento o maior número de técnicas, nas quais o PTFE é utilizado, é a principal razão
para a realização desta revisão de literatura. A fonte da literatura foram bancos de dados
internacionais: B-on, PubMed, SciELO, ScienceDirect, Web of Science, pesquisados usando
palavras-chave com critérios de inclusão e exclusão para a seleção prévia dos artigos.
Para sua análise estas técnicas serão agrupadas nas diferentes áreas da odontologia a que
correspondem, tais como: odontologia conservadora, cirurgia peri-implantar, ortodontia,
endodontia e higiene bucal. A organização e descrição das técnicas conduzidas neste estudo
permitem identificar as principais funções que o PTFE atende em odontologia, que são:
barreira mecânica; enchimento ou material de embalagem; elemento espaçador para simular
camada de cimento; revestimento de superfície; instrumento de remoção de biofilme.
Palavras-chave: Politetrafluoretileno; Teflon; Fita Teflon; Politetrafluoretileno denso;

Politetrafluoretileno expandido; Plumber’s tape (Fita do canalizador).
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TABLE OF CONTENTS
Abstract ................................................................................................................................... v
Resumo .................................................................................................................................. vi
Index of Abbreviations .......................................................................................................... ix
Index of figure ........................................................................................................................ x
1. Introduction ..................................................................................................................... 1
2. Conservative Dentistry ....................................................................................................... 2
2.1. Polytetrafluoroethylene (PTFE) tape, one-step techniques. ........................................ 2
2.1.1. PTFE tape to avoid accidental etching of teeth ..................................................... 2
2.1.2. PTFE tape to protect the dental alveolus after tooth extractions........................... 3
2.1.3. PTFE tape to isolate bridges during rebasing or cementing procedures ............... 3
2.1.4. PTFE tape to adapt the matrix in second class restorations .................................. 4
2.2. Polytetrafluoroethylene (PTFE) tape, multi-step techniques ....................................... 4
2.2.1. Using existing crowns and Teflon tape to repair fractured abutments (cores)...... 4
2.2.2. Occlusal Stamp Techniques .................................................................................. 5
2.2.3. Simplified clinical procedure for fitting and removing inlays/onlays prior to
cementation ..................................................................................................................... 6
2.2.4. Techniques to prevent cement sticking to the transgingival segment of the

implant abutment during cementation of a crown ........................................................... 6
2.2.5. PTFE tape for the management of implant screw access channel in Implant-
supported prostheses ....................................................................................................... 7
3. Peri-implant Surgery: Guided Bone Regeneration (GBR) and Guided Tissue

Regeneration (GTR) using PTFE membranes ........................................................................ 9
4. Orthodontics: PTFE coating on orthodontic archwires and brackets ............................... 10
5. Endodontics: PTFE tape as temporary restorative material during endodontic treatment11
vii
6. Oral hygiene: PTFE tape as an oral hygiene method, compared to the common nylon
dental floss for the removal of dental biofilm ...................................................................... 12
7. Discussion......................................................................................................................... 13
8. Conclusion ........................................................................................................................ 15
References ............................................................................................................................ 16
Appendix 1 - Using an existing crown to Repair a Damaged Cast Post and Core Restoration
.............................................................................................................................................. 18
Appendix 2 - Technique for repair of multiple abutment teeth under preexisting crowns .. 19
Appendix 3 - Occlusal Stamp Technique ............................................................................. 20
Appendix 4 - Opposing Occlusal Stamp Technique ............................................................ 21
Appendix 5 - Simplified clinical procedure for fitting and removing inlays/onlays prior to
Cementation .......................................................................................................................... 23
Appendix 6 - Technique for controlling the cement for an implant Crown ......................... 24
Appendix 7 - A technique to eliminate subgingival cement adhesion to implant abutments

by using polytetrafluoroethylene tape .................................................................................. 25
Appendix 8 – Polytetrafluoroethylene (PTFE) tape for the management of implant screw

access channel in Implant-supported prostheses .................................................................. 27
viii
Index of Abbreviations
d-PTFE Dense Polytetrafluoroethylene
e-PTFE Expanded Polytetrafluoroethylene
FPD Fixed Partial Denture
GBR Guided Bone Regeneration
GTR Guided Tissue Regeneration
IRM Intermediate Restorative Material
PE Polyethylene
PTFE Polytetrafluoroethylene
RBSD Rutherford Back Scattering Detection
RS Resistance to Sliding
VPS Vinyl Polysiloxane
ix
Index of figure
Figure 1. Using an existing crown to repair a damaged cast post and core
restoration……………………………...………………………………….…………….18
Figure 2. Technique for repair of multiple abutment teeth under preexisting

crowns………………………………………………….………………………………..19
Figure 3. Occlusal stamp technique…………………………………………...…………20
Figure 4. Opposing occlusal stamp technique………………………………..………….22
Figure 5. Simplified clinical procedure for fitting and removing inlays/onlays pior to
cementation………………………………………………………………………….…..23
Figure 6. Technique for controlling the cement for an implant crown…………………...24
Figure 7. Technique to eliminate subgingival cement adhesion to implant abutments by

using polytetrafluoroethylene tape…………………..…………………………………..26
Figure 8. Polytetrafluoroethylene (PTFE) tape for the management of implant screw

access channel in implant-supported prostheses………………………..……………….28
x
1. Introduction
The integration and adaptation of new materials into dentistry that fulfill biocompatibility
requirements have contributed to the field’s continuous improvement. Materials such as
gutta-percha, fiberglass, titanium or polytetrafluoroethylene were not specifically created for
their use in dentistry, but because of their characteristics have been adapted for applications
in the medical and dental field. Dentistry in recent years has become increasingly
conservative and aesthetic. As a result of these tendencies, versatile materials like the
polytetrafluoroethylene (PTFE) are gaining ground.
PTFE is a fluoropolymer that was accidentally discovered by Roy Plunkett while he was
working for DuPont in 1938. Initially, PTFE polymers seemed to have no practical use.
Nevertheless, an early use was in the Manhattan Project, which used PTFE to contain
corrosive uranium hexafluorides. It was not until 1947 that DuPont made PTFE
commercially available under the brand name Teflon. Teflon since then has been used in a
wide range of areas, such as chemical processing, electronics, construction, architecture,
cookware, bakeware, and medical markets (Teng, 2012).
PTFE is a linear polymer of tetrafluoroethylene. The chemical structure of PTFE is similar

to that of polyethylene (PE), except that the hydrogen atoms are completely replaced by
fluorine atoms. PTFE’s characteristics include: very low coefficient of friction, which results
in a high surface smoothness; chemically inert; insoluble in water and in any organic
solvents; non-stick; resistant to high temperatures without degradation below 440 °C (PTFE
materials can be continuously used below 260 °C); low dielectric constant, which makes it a
great electrical insulator; malleable. PTFE also has some limitations in its applications, such
as: poor weldability; low creep resistance; low radiation resistance; high microvoid content
(Teng, 2012). Due to its characteristics PTFE, has become a popular material used in
dentistry in many forms, such as Teflon tape, surgical sutures, dental floss, a membrane for
guide bone regeneration (GBR), and for the coatings of accessories and dental instruments.
When used in surgical sutures and GBR membranes, there are basically two presentations of
these material: d-PTFE (dense) and e-PTFE(expanded) (Liu and Kerns, 2014). The most
1
commonly used is d-PTFE, which will be explained later.
Teflon tape, also known as plumber’s tape, has many uses, mainly in conservative dentistry.
It is a cheap, easy to find product. It has no expiration date, and it’s possible to sterilize in an
autoclave at 121 °C (Chiodera et al., 2016). Different varieties of Teflon tape are available
on the market, varying in thicknesses and color. The generic white tape found at hardware
stores is typically 30 to 35 μm in thickness(although thickness depends on the brand); pink
“high-density” tape is 65 to 70 μm, and the yellow PTFE tape used for gas lines is 120 μm
(Geissberger et al., 2002). These dimensions permit tape placement in interproximal and
intrasulcular areas, during impressions immediately after tooth extractions, and beneath
inlays, onlays, and crowns. More procedures currently used in dentistry that employ PTFE
will be described below, grouped in the different areas of dentistry to which correspond.
1.1. Materials and Methods
Search strategies: B-on, Pub Med, SciELO, ScienceDirect and web of science was
electronically searched for articles from 2000 to 2018. The following keywords were used to
ensure the identification of the maximum number of papers: Polytetrafluoroethylene; PTFE;
Teflon; Plumber’s tape; Dentistry. Exclusion criteria: articles published in languages other
than English, Spanish, Italian and Portuguese. Studies in which the main topic was not related
with PTFE and its use in dentistry, full text articles that were not available on the database
and duplicate articles. The initial search resulted in a list of 320 articles. Appling the
mentioned keywords and exclusion criteria, 21 articles were included in the study.
2. Conservative Dentistry
2.1. Polytetrafluoroethylene (PTFE) tape, one-step techniques.
2.1.1. PTFE tape to avoid accidental etching of teeth

PTFE tape is very useful as an insulator during the etching process, as it is for bonding
2
procedures. Due to its highly resistance to the orthophosphoric acid, it can be applied over
the adjacent teeth to protect them from accidental etching. In addition, coating the
neighboring teeth with PTFE tape avoids bonding overflows, allowing polishing. The
application of PTFE tape requires the material to be appropriately stretched in order to pass
through the interproximal spaces. The PTFE tape can be stabilized using a common matrix
ring to avoid accidental movements of the material during clinical procedures. An alternative
way to stabilize the PTFE tape is to cover it with the same bonding and then polymerize it
(Chiodera et al., 2016).
2.1.2. PTFE tape to protect the dental alveolus after tooth extractions
In some tooth extractions, the surgical procedure is combined with many other conservative
procedures, such as cementations of provisional restorations or bonding or etching on
neighboring teeth and dental impressions in order to fill the resulting gap and restore the
aesthetics. That is why protecting the socket immediately after tooth extractions is essential
for carrying out said procedures so as not interfere with the healing process.
PTFE tape, due its characteristics, turns out to be the best material to avoid the entrance of
external substances into the dental alveolus, while protecting surgical suture knots (Chiodera
et al., 2016). Due to its thickness of 50 μm, it does not interfere significantly in the dental
impression. Note that to achieve better outcomes during dental impressions, PTFE tape
should not be rough in order to reproduce the correct anatomy of the gap.
2.1.3. PTFE tape to isolate bridges during rebasing or cementing procedures

To ensure the success of fixed prosthetic restorations is important to prevent postoperative
complications associated with residual cement. For this issue, it is important to archive an
effective removal of excess cement to avoid soft-tissue inflammation, peri-implant disease,
gingival bleeding, and subsequent crestal bone loss (Hess, 2014).
A traditional method to isolate bridges during rebasing or cementing is usually performed

with dental floss. As an alternative to this procedure, PTFE tape can be used for the same
3
purpose. The technique using PTFE tape is largely the same. The main difference is that
PTFE tape must be twisted to form a cord before rolling it to isolate intermediate elements
of the bridge, both in the relining and in cementation procedures, reducing excess material
(Chiodera et al., 2016). The ends of the cord shall be directed to the occlusal face of the
bridge to facilitate their removal.
2.1.4. PTFE tape to adapt the matrix in second class restorations

In conservative dentistry, rebuilding interproximal walls in second-class restorations has
always been a challenge. To achieve correct interproximal contact points, many tools have
been developed, such as wooden wedges, plastic wedges, a metal matrix, the Supercurve
matrix (Triodent), WedgeGuard (Triodent), Wave-wedge (triodent), rings, etc (Wirsching et
al., 2011). Depending on the complexity and difficulty of the case, or in the case that the
surgeon is unable to adapt the matrix, PTFE tape helps to fit the matrix properly by pushing
the Teflon tape between the wedge and the matrix (Chiodera et al., 2016).
2.2. Polytetrafluoroethylene (PTFE) tape, multi-step techniques
2.2.1. Using existing crowns and Teflon tape to repair fractured abutments (cores)
Fractures of previously crowned abutments are common. Tooth fracture accounts for 56% of
retreatments, whereas carious and loss retention account for 24% of retreatments (Chan,
2003). Two simple procedures will be described below. In both of them, PTFE tape is used
to create the necessary space (50 μm) for the cement and to recreate the structure of the
abutment over which the crown will be placed.
To remove the remnants of tooth substance and luting cement inside crowns, it is
recommended to clean with high-speed carbide round burns, followed by air-abrasion and
pressure steaming. Subsequently, the use of a lightly coat of petroleum jelly on the internal
and external parts of the restoration helps to adhere the PTFE tape to the crown and further
protect the exposed surface and prevent excess material from sticking (Chan, 2003).
4
These procedures enable the clinician to solve emergency clinical situations in short amount
of time by using existing crowns and Teflon tape. The first procedure presented here concerns
an endodontically treated tooth in which the cast post was removed and exchanged for a
fiberglass post (See Appendix 1 for details), while in the second technique, a fixed partial
denture (FPD) was dislodged because of the fracture of one of the pillars and carious in the
other pillar, pending further restoration with endodontic treatment and cast post and core
procedure (See Appendix 2 for details). It is important to note that the remaining tooth portion
after the fracture has an impact on the success of the new abutment. The cementation of a
fiberglass post to root canals is recommended to increase resistance and retention (Arabolu
et al., 2014). In both cases, a follow-up is recommended.
2.2.2. Occlusal Stamp Techniques

These techniques reproduce the original occlusal anatomy of large composite restorations
and save time by avoiding corrections after removing the rubber dam. After a long session,
the patient can’t bite properly because of muscular spasms and the anesthesia effect. These
procedures allow to check the occlusion without false positives (Maroun-Motawie et al.,
2017). When the preoperative anatomy of the tooth is intact and there is no loss of dental
structure, the “occlusal stamp method” is utilized to achieve the correct duplicate through
the use of Flow composite or Liquid Dam (See Appendix 3). It is recommended to clean the
occlusal surfaces with manual or ultrasonic devices prior to the placement of the stamp
material in order to eliminate interference and to obtain an exact copy (Chiodera et al., 2016).
In case of cavities due to carious lesions, the “Opposing Occlusal Stamp Technique” may be
used (See Appendix 4). It is important to consider that using the Occlusal Stamp Technique
or the Opposing Occlusal Stamp Technique to restore Class II cavities is possible through
their previous modification into a Class I by restoring the proximal walls (Maroun-Motawie
et al., 2017).
In both of variants of the occlusal stamp technique described below, PTFE tape was applied
to the occlusal surface of the teeth to avoid composite sticking to the stamp and to compensate
for the volumetric shrinkage of the Acrylic resin, Flow Composite, or Liquid Dam.
5
2.2.3. Simplified clinical procedure for fitting and removing inlays/onlays prior to
cementation
Indirect restorations can be particularly difficult for clinicians to remove after having
obtained a complete seating and confirmed the marginal fit during try-in (Geissberger et al.,
2002). Class I inlays can be even harder to remove because no surfaces are available to grasp
or manipulate, which might result in the subsequent clinical failure of restorations, especially
those fabricated from ceramic. To facilitate removal and minimize binding of cast
restorations during try-in, the angles of the preparation can be increased, though this action
increases the loss of tooth structure and reduces retention of the restoration (Geissberger et
al., 2002).
The use of PTFE tape as a liner is a good option to address this challenge. The application of
PTFE tape placed beneath restorations during try-in simulates the cement layer, and its
strength allows for its removal. When a rubber dam is not used, tying a knot over the
restoration using the same PTFE tape increases the level of safety, minimizing the chance of
swallowing or inhaling by the patient (See Appendix 5). This simple procedure is inexpensive
and easy to incorporate into any dental practice. (Geissberger et al., 2002).
2.2.4. Techniques to prevent cement sticking to the transgingival segment of the implant
abutment during cementation of a crown
One of the reasons for implant failure is the extrusion of excess cement from the restoration
into the mucosal margin, which can be difficult to remove. This cement, adhered
subgingivally to an implant abutment, has the potential to cause periimplant mucositis or
periimplant disease, as the soft tissue attached to the implant surface is more delicate than
the same tissue attached to a natural tooth surface as a result of the direction in which the
collagen fibers run, their reduced number, and the lack of Sharpey fiber insertion (Wadhwani
and Piñeyro, 2009). In addition, it must be considered that subgingival cement is difficult to
remove with instruments, the conventional way to remove the pass of cement into the sulcular
area is by the use of metal or plastic scalers, which may result in scratches and gouges on the
implant surfaces (Wadhwani and Piñeyro, 2009). Unfortunately, most dental cements lack
6
adequate radiopacity to be detected with conventional radiography (Hess, 2014). It is normal

that, after cementing the restoration, the sign will not be immediately apparent because those
soft tissue swelling, soreness, and bleeding or exudation. Probing can be delayed for months
or years after the cementation.
Since it is crucial to control the volume of cement, some techniques have been proposed. One
of the most well-known techniques requires an implant analog or practice abutment made of
acrylic resin, produced in a dental laboratory, but this is time consuming for the technician
and involves additional laboratory costs (Wadhwani and Piñeyro, 2009).
The techniques given below help us to save time and avoid additional costs. The first one is
to create one’s own implant analog of vinyl polysiloxane (VPS), and the second one involves
stretching Teflon tape around the abutment before sitting. Note that for both techniques,
PTFE tape, has been used in different ways. For the first technique described, “Technique for
controlling the cement for an implant crown,” Teflon tape provides a space of approximately
50 μm between the vinyl polysiloxane (VPS) implant analog and the intaglio surface, which
represents the cement between the abutment and the restoration (See Appendix 6). In the
second technique, “A technique to eliminate subgingival cement adhesion to implant
abutments by using polytetrafluoroethylene tape,” PTFE tape was stretched around the
abutment to ensure complete subgingivally removal of cement from transgingival segment
of the implant after seating of the crown (See Appendix 7). PTFE tape will not enlarge the
periimplant sulcus because it is less than 50 μm thick when stretched. Before intraoral use,
strips of PTFE tape should be sterilized by autoclave (Hess, 2014).
2.2.5. PTFE tape for the management of implant screw access channel in Implant-
supported prostheses
The main purposes of filling the implant screw access channel are to protect the screw head
of the abutment and to prevent bacterial colonization and accumulation of debris (Moráguez
and Belser, 2010; Cavalcanti et al., 2016). To achieve this objective, different materials have
been used, such as: cotton pellets, zinc oxide eugenol, composite resin, vinyl posysiloxane,
7
gutta-percha, and polytetrafluoroethylene (PTFE).
Pros and cons can be found for each of the aforementioned materials. Cotton pellets have
been commonly used due to their low cost and ability to be sterilized; however, cotton pellets
can be difficult to remove and may be associated with malodor. Composite resin requires
more time to apply and presents the risk of damaging the head of the screw during removal.
Zinc oxide eugenol reacts with the free radicals and thereby inhibits the polymerization of
the resin system. Gutta-percha and vinyl polysiloxane are easy to manipulate, but cannot be
sterilized and require more time to apply (Moráguez and Belser, 2010; Cakan et al., 2014).
Finally, PTFE can be sterilized, has a low cost, allows easy manipulation when placed as
well as removal, and its color helps to cover the metal of the abutment, improving the
aesthetics of the composite. However, the disadvantage is that “sealing with PTFE leads to
a progressive increase in microbiological leakage over the time” (Cavalcanti et al., 2016).
Two important aspects of these materials have been studied: their capacity to seal and avoid
bacterial leaking, and their uniaxial retentive force, which indicates the resistance on removal
of the temporarily cemented implant-supported restorations. After comparing the results of
each material, it was found that sealing implant screw access channel with gutta-percha was
significantly more effective than sealing it with PTFE tape against the penetration of
Escherichia coli (Cavalcanti et al., 2016). On the other hand, composite resin presented
statistically higher uniaxial retentive force on removal, which means that “removal of the
temporarily cemented restorations may be easier when the screw access channels are filled
with polysiloxane or PTFE” (Cakan et al., 2014).
The ideal material to fill the implant screw access channel should be easy to manipulate,
radiopaque, autoclavable, less associated with malodor when retrieved, and easy to remove.
Since none of the referred materials have all these characteristics, “the choice of the material
is at the present largely dependent on the operator’s preference and convenience and has
little scientific basis” (Moráguez and Belser, 2010). This simple procedure to seal the screw
access channel to protect the screw head of the abutment and crown screw in implant-
supported restorations using a single sterilized component of PTFE tape enables fast removal
8
of the filling material in a single step (See Appendix 8).
3. Peri-implant Surgery: Guided Bone Regeneration (GBR) and Guided Tissue

Regeneration (GTR) using PTFE membranes
In dentistry, PTFE membranes are often used as a barrier in guided tissue regeneration (GTR)
and guided bone regeneration (GBR) techniques. These membranes classified as non-
reabsorbable, act as a mechanical hindrance to prevent the invasive proliferation of
connective tissue cells, while at the same time giving additional benefits, such as protection
of the wound from mechanical disruption and salivary contamination. In order to assure a
successful implant placement, it is mandatory to ensure an adequate quantity of bone, either
before implant placement or simultaneously at the implant placement. Whatever the case, it
is important that “only cells from the neighboring bone or bone marrow can migrate into this
bone defect, without in-growth of competing soft tissue cells from the overlying mucosa”(Liu
and Kerns, 2014).
The first membrane to be used in dentistry as standard for bone regeneration was the
expanded polytetrafluoroethylene (e-PTFE) membrane in the early 1990’s. The e-PTFE is
sintered with pores between 5 and 20 μm in the structure of the material. Migration of
microorganisms through the membrane at exposure is a frequent problem. To fix this
complication, a new membrane was developed in 1993 with a nominal pore size of less than
0.3 μm, known as dense polytetrafluoroethylene (d-PTFE) (Liu and Kerns, 2014). It is
important to note that ingrowth of microorganisms occurs due to the high porosity of the e-
PTFE when the membrane is exposed in the mouth. On the other hand, the primary advantage
of d-PTFE is the ability to remain exposed while protecting the underlying defect and the
bone graft. The d-PTFE membranes are soft and flexible, which makes them easy to handle.
When the membrane is exposed in the mouth, it may be removed without the need for a
second surgery. Otherwise, when primary closure technique is used, the membrane may be
removed through a small incision in a flapless technique (Raoofi et al., 2015).
There is an alternative version of the e-PTFE membrane and the d-PTFE membrane that uses
9
titanium-reinforced PTFE. This reinforcement allows both kinds of membranes to be shaped

to fit a variety of defects without rebounding, which provides more stability. When no bone
grafts are added, titanium-reinforced PTFE membranes protect the space for blood clot
stabilization and provide better preservation of the original form of the regenerated ridge
during the healing period (Liu and Kerns, 2014).
Although PTFE membranes have shown excellent results, there are, however, a few
complications of non-resorbable membranes, such as: the need for a second surgery to
remove the membrane, this results in increased costs for the patient, discomfort, and the risk
of losing regenerated crestal bone caused by the flap elevation; soft tissue closure over the
membrane is vital to ensure success of the grafting procedure; as a result of incomplete
coverage or gingival recession during the healing, wound dehiscence is commonly found
when non-reabsorbable membranes are used; the exposure of the membrane to the oral
environment with resulting bacterial colonization can lead to premature removal of the
membrane.; due to the characteristics of PTFE membranes and their poor rigidity, miniscrews
and tacks for extra stabilization are often required (Liu and Kerns, 2014).
The information above shows that PTFE membranes for GTR and GBR have been constantly
improved. The alternative to using non-reabsorbable membranes are the so-called
reabsorbable or bioabsorbable membranes. These membranes permit a single – step
procedure, thereby reducing costs for a second procedure, which makes them more
comfortable for the patient and at the same time avoids the risk of additional mobility and
tissue damage. On the other hand, the main disadvantage is the unpredictable reabsorption
period. These membranes also need primary closure (Raoofi et al., 2015).
4. Orthodontics: PTFE coating on orthodontic archwires and brackets
The use of PTFE in orthodontics is limited to the surface coating of archwires to reduce the
resistance to sliding (RS), and recently to experimental prototypes of brackets coated with
PTFE to reduce biofilm formation. PTFE, from the orthodontic perspective, is an anti-
10
adherent and aesthetic material that has an excellent chemical inertia and good mechanical
stability. Considering that PTFE has a low coefficient of friction, Farronato et al., (2012)
concluded that archwires with PTFE coating have the potential to reduce RS compared to the
RS of uncoated archwires. The same study found that the best frictional results were obtained
with a combination of PTFE coated archwires and Quick brackets (Farronato et al., 2012).
Regarding to the PTFE coated brackets, a study conducted by Demling et al. (2010) based
on clinical research showed that the use of PTFE coatings reduces bacterial adhesion on
medical devices. Quantitative analysis of biofilm, performed with the Rutherford
backscattering detection (RBSD), found that uncoated orthodontic brackets are highly
susceptible to biofilm formation (22.2 ± 5.4 per cent of the surface), compared to PTFE –
coated brackets (4.0 ± 3.6 per cent of the surface). The difference between the two groups
was statistically significant (P < 0.005). Preventing biofilm formation is important for
preserving the integrity of oral hard and soft tissues by means of decalcification and
periodontal disease. The experimental PTFE coating on brackets clearly reduced biofilm to
a minimum (Demling et al., 2010).
So far, PTFE in orthodontics has been used to reduce the RS between the archwire and the
bracket slot, but it has not been used as an anti-adhesive coating to reduce biofilm formation.
An added advantage of PTFE coatings is that its color also fulfills aesthetic demands of
patients during fixed orthodontic treatment (Demling et al., 2010; Farronato et al., 2012).
5. Endodontics: PTFE tape as temporary restorative material during endodontic

treatment
In endodontics, many materials had been used to seal the root canal during endodontic
treatment and to keep root canals clean from irritants, microbial contamination, saliva, and
other debris that could get into the pulp space, which may induce periapical pathosis. The
ideal temporary restorative material should be easy to manipulate and remove, exhibit
minimal or preferably no leakage, be resistant to abrasion and compression, and have a lack
of porosity, a lack of dimensional changes, and good aesthetics. Among specialists, there are
11
some temporary restorative materials commonly used. Cavit and IRM are most widely used,
followed by glass-ionomer cement and zinc phosphate cement (Olcay et al., 2015). Note that
none of these materials fulfill all of the requirements of ideal temporary restorative materials.
A study conducted by Olcay et al. (2015) compared the sealing ability of temporary
restorative material (Ceivitron), glass ionomer cement, zinc oxide-eugenol cement and PTFE
tape, where the quality of coronal sealing was measured at 24 hrs. and 1 week. It was shown
that “At 24 hrs. PTFE tape showed similar leakage with Ceivitron, IRM and glass ionomer
cement but it showed higher leakage than zinc phosphate cement. At 1 week temporary
restorative material (Ceivitron) showed higher leakage than PTFE tape. Meanwhile, PTFE
tape showed similar leakage with IRM, glass ionomer cement and zinc phosphate cement”
(Olcay et al., 2015). It can be concluded that the sealing ability of PTFE tape and IRM
significantly increased over time, while for Ceivitron, glass ionomer cement and zinc
phosphate cement, leakage did not change from 24 hrs. to 1 week (Olcay et al., 2015). Other
advantages of using PTFE tape in endodontics include that it can be sterilized, it has
radiopacity, is easy to manipulate, and its low cost, which makes PTFE tape a good
alternative for creating a temporary restoration in endodontically treated teeth.
6. Oral hygiene: PTFE tape as an oral hygiene method, compared to the common
nylon dental floss for the removal of dental biofilm
The use of nylon dental floss for oral hygiene is a well-known method because of its efficacy
in removing biofilm in interproximal areas. In today’s market, many types of dental floss are
available, such as: dental tape or super floss for large gaps; waxed floss for tight spaces;
flossers or pre-measured floss strands for comfort of limited manual skills; spongy floss or
super floss to keep braces or bridges clean. In addition, we also have standard unwaxed floss
and PTFE floss, which fit into tight spaces but can be prone to shredding or breaking. The
main advantage of PTFE floss is that the material slides easily and is less likely to shred
compared to standard floss (Dental Floss Types - The Pros and Cons | Oral-B, 2018).
12
The most popular brand of PTFE floss is Oral-B Glide, manufactured by Gore®. This type
of dental floss is higher-priced compared to standard floss. With this in mind, a study
conducted by Tascón et al. (2006) attempted to identify the efficacy of PTFE tape as an
optional oral hygiene method for the removal of the proximal dental biofilm, compared to
common nylon dental floss. For the study, the oral hygiene of the participants was suspended
for 12 hours. Their dental surfaces were painted using a suitable disclosing solution.
Subsequently, the participants were asked to use the same technique with the two materials
(PTFE tape and nylon dental floss). The information was obtained using the Greene and
Vermillion Oral Hygiene Index (coronal division in thirds), modified to evaluate proximal
surfaces. In the dental floss group, the presence of the proximal biofilm was 72.6% before
and 11.2% after its removal, while for the second group where PTFE tape was used, the
presence of the proximal biofilm was 72.9% before and 11% after its removal. The study
showed no statistically significant difference (p>0.05), between the two groups. In addition,
is important to note that the cost of PTFE tape is, on average, 2.7 times cheaper than nylon
dental floss. Taking into account these advantages, PTFE tape may be considered as an
alternative method to remove dental biofilm for population groups who are in a less favorable
economic situation (Tascón et al., 2006).
7. Discussion
Due to the aforementioned characteristics of PTFE, this versatile material has significantly
gained ground in many areas of dentistry. PTFE offers many notable advantages and
functions for its practical use by the clinician. On the other hand, PTFE is better suited to
certain areas of dentistry than others, as it also has some disadvantages.
The essential functions of PTFE found after this review were mainly to serve as a mechanical
hindrance to prevent accidental etching of neighboring teeth; to avoid composite or bonding
sticking (Chiodera et al., 2016); to prevent the invasive proliferation of connective tissue
cells; to protect from biofilm and salivary contamination for GBR and GTR (Liu and Kerns,
2014). Another function is to serve as filling or packing material to protect the screw access
13
channel and screw head of the abutment in dental implants, to keep the root canal clean and
sealed during endodontic treatment, as a temporary restorative material from irritants,
microbial contamination and other debris (Moráguez and Belser, 2010; Cakan et al., 2014 ;
Cavalcanti et al., 2016); and to properly fit the matrix to rebuild interproximal walls in second
class restorations (Chiodera et al., 2016). PTFE also works as a spacer element to simulate
the cement layer for fitting and removing inlays/onlays prior to cementation and to increase
the level of safety during removal, minimizing the chance of swallowing or inhaling by the
patient (Geissberger et al., 2002). PTFE has a function in orthodontics, although minimal, as
a surface coating of archwires to reduce the resistance to sliding (RS) (Farronato et al., 2012)
and to decrease biofilm formation over the surface of brackets (Demling et al., 2010). Finally,
the last function found for PTFE after this review was to serve as biofilm removal instrument
and an alternative to dental floss (Tascón et al., 2006).
The main shortcomings for conservative dentistry and prostheses are the difficulty to apply,
adjust, stretch and twist the Teflon tape over the direct and indirect restorations (Chiodera et
al., 2016) and the progressive increase in microbiological leakage over the time when the
implant screw access channel is sealed with PTFE (Cavalcanti et al., 2016). Regarding peri-
implant surgery, PTFE membranes show ingrowth of microorganism due to the porosity of
the membrane (higher on e-PTFE membranes) when the membrane is exposed in the mouth
(Liu and Kerns, 2014), in addition to this, PTFE membranes require a second surgery when
primary closure technique is used (Liu and Kerns, 2014; Raoofi et al., 2015 ). In endodontics
the sealing ability of PTFE can’t be considered as ideal due the leakage that presents, as many
other temporary restorative materials (Olcay et al., 2015). Lastly, in oral hygiene PTFE due
its low creep resistance can be prone to shredding or breaking when fits into tight spaces
(Dental Floss Types - The Pros and Cons | Oral-B, 2018).
Taking into consideration the advantages and disadvantages of the material, it can be
confirmed that PTFE is better suited to conservative dentistry and prostheses than in other
areas because most of the functions found for PTFE can be applied in this specific area. PTFE
is a chemically inert material, insoluble in water and in any organic solvent. For that reason,
the saliva, microorganisms of the mouth and various materials, such as: acids, adhesives,
14
alginates or composites do not alter the PTFE’s structure. The non-stickness of PTFE allows
to control the high adhesion and viscosity that many of the aforementioned materials possess.
The flexibility and malleability permit to adjust and remove the material easily. Its thickness
allows to simulate the space corresponding to the adhesive and finally its resistance to high
temperatures makes it able to be sterilized. These qualities are necessary in many of the
procedures performed in conservative dentistry.
According to the reviewed literature, most of the scientific articles describe single procedures
where PTFE is used in comparison to “traditional” methods as an alternative to achieve the
same objectives. It is interesting that some of the procedures that use PTFE are considered a
little unorthodox. Finally it is worth mentioning that the use of PTFE depends on the skills,
needs, and preference of the clinician.
8. Conclusion
Based on information obtained through this literature review, it can be conclude that
polytetrafluoroethylene (PTFE) in its many forms, including Teflon tape (also known as
plumber’s tape), coatings, PTFE floss, and PTFE membranes, was easily adapted to the
different areas of dentistry thanks to its unique characteristics. The main functions that PTFE
serves thank to its versatility are: mechanical hindrance or barrier to prevent accidental
bonding or etching, to avoid sticking and to prevent proliferation of connective tissue cells
in GBR and GTR; filling or packing material to protect the screw access channel in implants
and to seal the root canal temporarily during endodontic treatment; a spacer element to
simulate cement layer on fitting and removing inlays/ onlays, increasing the level of safety
during removal; surface coating to reduce resistance to sliding(RS) and to decrease biofilm
formation; biofilm removal instrument through the use of PTFE floss, or twisted Teflon tape.
PTFE has many advantages for use in clinical practice. The choice to use it depends on the
preferences of the clinician. There is no doubt that PTFE will find more applications in
dentistry and new variants of this material will be developed.
15
References
Arabolu, M. et al. (2014) ‘Using an existing crown to repair a damaged cast post and core
restoration.’, Journal of international oral health : JIOH, 6(5), pp. 111–3.
Cakan, U. et al. (2014) Effect of screw access channel filling materials on uniaxial retentive
force of cement-retained implant restorations, Australian Dental Journal, 59(1), pp. 65–69.
Cavalcanti, A. G. de A. et al. (2016) Efficacy of Gutta-Percha and Polytetrafluoroethylene

Tape to Microbiologically Seal the Screw Access Channel of Different Prosthetic Implant
Abutments, Clinical Implant Dentistry and Related Research, 18(4), pp. 778–787.
Chan, D. C. N. (2003). Technique for repair of multiple abutment teeth under preexisting
crowns, Journal of Prosthetic Dentistry, 89(1), pp. 91–92.
Chiodera, G. et al. (2016). L’uso corretto del teflon nella pratica clinica quotidiana, Dental
Cadmos, 84(6), pp. 395–398.
Chiodera, G. et al. (2016). 50 Shades of Teflon - Part 1, Styleitaliano, pp. 1-6.

https://styleitaliano.org/50-shades-of-teflon-1 (Accessed: 30 april 2018).
Chiodera, G. et al. (2016). 50 Shades of Teflon - Part 2, Styleitaliano, pp. 1-7.

https://styleitaliano.org/50-shades-of-teflon-part-2 (Accessed: 30 april 2018).
Demling, A. et al. (2010). Reduction of biofilm on orthodontic brackets with the use of a
polytetrafluoroethylene coating, European Journal of Orthodontics, 32(4), pp. 414–418.
Dental Floss Types - The Pros and Cons | Oral-B (2018). Available at: https://oralb.com/en-
us/oral-health/solutions/floss/dental-floss-types-pros-cons (Accessed: 12 May 2018).
Farronato, G. et al. (2012). The effect of Teflon coating on the resistance to sliding of
orthodontic archwires, European Journal of Orthodontics, 34(4), pp. 410–417.
Geissberger, M. J. et al. (2002). Simplified clinical procedure for fitting and removing
inlays/onlays prior to cementation, Journal of Prosthetic Dentistry, 87(4), pp. 395–398.
Hess, T. A. (2014). A technique to eliminate subgingival cement adhesion to implant

abutments by using polytetrafluoroethylene tape, Journal of Prosthetic Dentistry. Editorial
Council for the Journal of Prosthetic Dentistry, 112(2), pp. 365–368.
Liu, J. and Kerns, D. G. (2014). Mechanisms of Guided Bone Regeneration: A Review, The
Open Dentistry Journal, 8(1), pp. 56–65.
Maroun-Motawie et al. (2017). Opposing Occlusal Stamp Technique: MOOS technique,

Styleitaliano, pp. 1-13. https://styleitaliano.org/opposing-occlusal-stamp-technique-moos-
16
technique-by-maroun-motawie-et-al/ (Accessed: 16 may 2018).
Moráguez, O. D. and Belser, U. C. (2010). The use of polytetrafluoroethylene tape for the
management of screw access channels in implant-supported prostheses, Journal of Prosthetic
Dentistry. The Editorial Council of the Journal of Prosthetic Dentistry, 103(3), pp. 189–191.
Olcay, K. et al. (2015). Polytetrafluoroetylene Tape As Temporary Restorative Material: a

Fluid Filtration Study , Journal of Istanbul University Faculty of Dentistry, 49(3), p. 17.
Raoofi, S. et al. (2015). Histomorphometric Analysis of Periodontal Tissue Regeneration by

the Use of High Density Polytetrafluoroethylen Membrane in Grade II Furcation Defects of
Dogs, Jounral of dental biomaterials, 2(3), pp. 110–117.
Tascón, J. E. et al. (2006). Valor comercial y eficacia de la cinta de politetrafluoretileno (

PTFE ) para la remoción de la biopelícula dental interproximal comparado con la seda dental
de nylon en adolescentes y adultos jóvenes, Colombia Médica, 37, pp. 287–292.
Teng, H. (2012). Overview of the Development of the Fluoropolymer Industry, Applied

Sciences, 2(4), pp. 496–512.
Wadhwani, C. and Piñeyro, A. (2009). Technique for controlling the cement for an implant
crown, Journal of Prosthetic Dentistry. The Editorial Council of the Journal of Prosthetic
Dentistry, 102(1), pp. 57–58.
Wirsching, E. et al. (2011). Influence of matrix systems on proximal contact tightness of 2-

and 3-surface posterior composite restorations in vivo, Journal of Dentistry, 39(5), pp. 386–
390.
17
Appendix 1 - Using an existing crown to Repair a Damaged Cast Post and Core
Restoration
Technique
1. Glass fiber post of diameter 1.5 mm (Flexi-Post, ColteneWhaledent) bonded to tooth

using dual-cured composite resin (Paracore, ColteneWhaledent) (Figure 1).
2. 2 . Adaptation of 50 μm polytetrafluoroethylene (PTFE) (Teflon) tape on the tissue

surface of the existing crown (Figure 2).
3. Adual-curedcorebuild-upcompositeresin(Paracore,ColteneWhaledent)is injected into

the crown and positioned under light digital pressure over the bonded post (Figure 3).
It was then light polymerized for 40 s.
4. Crown removal leaving the core bonded to the post and the tooth structure. The core
was light polymerized again for 40 s (Figure 4).
5. Remove the Teflon tape from the crown and proceed with the cementation using glass
ionomer (GIC gold label glass ionomer luting and lining cement), (Arabolu et al.,
2014) .
Figure 1. Using an existing crown to repair a damaged cast post and core restoration,
Figures 1 -4 (Arabolu et al., 2014).
18
Appendix 2 - Technique for repair of multiple abutment teeth under preexisting crowns
Technique
1. Remove carious and soft dentin on abutments and prepare the tooth substrate surface for
bonding by proper etching, priming, and application of adhesive (Figure 1).
2. Adaptation of PTFE tape inside the crown and over the margins (Figure 2).
3. Add autopolymerizing composite resin for core buildup (Encore with fluoride; Centrix Inc,
Shelton, Conn.) to the cavity in the abutment crowns as well as onto the tooth surfaces.
Seat the FPD in place under light digital pressure to ensure proper fitting. Allow core
buildup material to polymerize under pressure (Fig. 3).
4. Remove FPD by gently tapping with a Morrell Crown Remover (Franklin Dental Supply
Inc, Valley Stream, N.Y.). Trim excess material with hand instruments such as a scaler
(Hu-Friedy Mfg Co, Chicago, Ill.) and 5850 diamond bur (Brasseler USA, Savanna,Ga.).
Refine core to desired form and existing tooth margins (Figs. 4 and 5). Cement FPD core
with temporary cement (Temp Bond; Kerr Manufacturing Co, Romulus, Mich.). Use resin-
modified glass ionomer cement if additional retention is desired (Chan, 2003).
Figure 2. Technique for repair of multiple abutment teeth under preexisting crowns,
Figures 1 – 5 (Chan, 2003).
19
Appendix 3 - Occlusal Stamp Technique

Procedure
1) Prepare the tooth surface for the stamp by prophylaxis or scaling (Figure 1).
2) Apply the stamp material (Liquid Dam or Flow composite) over the occlusal surface
covering grooves and cusps in order to create more anatomical references for the Stamp.
Introduce a Microbrush in the more central and deepest part of the flow material to obtain a
handle and light polymerize(Figure 2).
3) Remove carious material, followed by etching and bonding (Figure 3).
4) Fill the cavity with a low stress bulk fill composite (Figure 4).
5) Apply PTFE tape on the occlusal surface of the tooth (Figure 5).
6) Place the Stamp over the PTFE tape and press until the Stamp fits properly (Figure 6).
7) Remove PTFE tape slowly, cut the borders of composite excess using fissure instruments,
and define the anatomy. Polymerize for 40 seconds and optionally apply some brown stains
to provide an illusion of depth and naturalness (Figure 7).
8) Finishing and polishing followed by the application of Glycerin gel on the occlusal
surfaces. Then, polymerize for 20 seconds (Figure 8), (Chiodera, G. et al., 2016).
Figure 3. Occlusal stamp technique, Figures 1 – 8 (Chiodera, G. et al., 2016).
20
Appendix 4 - Opposing Occlusal Stamp Technique

Procedure
1) For reference check the occlusion of the teeth to be restored (Figures 1 and 2).
2) Make a silicon key of the antagonist teeth using C-Silicone impression material (Figure
3).
3) Fill the silicon key with acrylic in order to obtain a duplicate. Fit the duplicate and check
stability in occlusion (Figure 4).
4) For Class II cavities, adapt sectional matrices using plastic wedges and rings to restore the
proximal walls (Figure 5).
5) Restore the proximal walls by filling the bottom of the cavity with low stress flowable
composite (SDR) and polymerize for 20 seconds (Figures 6 and 7).
6) Fill the Class I cavities with a low stress bulk fill composite (Figure 8).
7) Apply Teflon tape on the occlusal surfaces of the teeth, fit the acrylic duplicate over the
tape and press (Figure 9).
8) Remove the composite excess, define the primary and secondary anatomy using fissura
instruments. At this stage, use the acrylic duplicate a second time just to be sure that the
occlusion is still good while doing the anatomy. Polymerize for 40 seconds and apply some
brown stains (Figure 10).
9) After rubber dam removal check the occlusal contacts and apply glycerin gel on the
occlusal surfaces and then polymerize 20 seconds (Figure 11), (Maroun-Motawie et al.,
2017).
21
Figure 4. Opposing occlusal stamp technique, Figures 1 – 11 (Maroun-Motawie et al.,

2017).
22
Appendix 5 - Simplified clinical procedure for fitting and removing inlays/onlays

prior to Cementation
Technique
1) After having obtained anesthesia, place rubber dam, remove the provisional restoration
and clean (Figure 1).
2) Using scissors or a scalpel clade, cut 1/2 -inch width Teflon tape to a 5 to 10 cm length
and longitudinally section it into a segment approximately 3 mm in width. Then stretch the
tape segment very lightly over the preparation in a bucco-lingual direction (Figure 2).
3) To seat the restoration use a blunt instrument, making sure that no folding of tape occurs,
during seating, evaluate the interproximal contours and intaglio surfaces and adjust them, if
necessary, with the method of your choice. The tape may disclose binding spots via small
indentations or perforations (Figure 3).
4) After completed seating, asses marginal adaptation and adjust as necessary. Then grasp
the tape’s buccal and lingual extension with locking pliers or small forceps and remove the
restoration with coronally directed force. A preferred method is to first take the tape ends and
tie a square knot that contacts (as closely as possible) the occlusal surface of the restoration.
This helps ensure that the restoration will be lost during the application of displacing forces
(Figure 4).
5) Depending on the material of the restoration, cement with standard techniques (Figure 5),
(Geissberger et al., 2002).
Figure 5. Simplified clinical procedure for fitting and removing inlays/onlays pior to
cementation, Figures 1 – 5 (Geissberger et al., 2002).
23
Appendix 6 - Technique for controlling the cement for an implant Crown

Procedure
1) Ensure fit of implant restoration and abutment complex.
2) Line the intaglio surface of the implant restoration with polytetrafluoroethylene (PTFE)
tape.
3) Place the implant restoration completely onto the abutment to facilitate the adaptation of
the PTFE tape to the intaglio surface of the implant restoration.
4) Using a fast-setting vinyl polysiloxane (VPS) and an applicator with a smaller diameter
tip, completely fill the implant restoration and form a handle (Figure A).
5) Remove the VPS material along with the PTFE compare and contrast the implant abutment
to the VPS copy; ensure that no voids are present and that the abutment finish line has been
accurately duplicated (Figure B).
6) Use the luting agent of choice and line the intaglio of the implant restoration, then place
the crown onto the VPS model and wipe off the excess cement before the cement has
exceeded its working time (Figure C).
7) Remove the crown from the VPS model (there will be a layer of residual cement on the
VPS model) and add a thin layer of cement in the intaglio of the restoration. If any voids are
present, add a small amount of extra luting agent to fill the voids.
8) Place the implant restoration onto the implant abutment intraorally. Note that there should
be little or no excess cement (Wadhwani and Piñeyro, 2009).
Figure 6. Technique for controlling the cement for an implant crown, Figures A – C
(Wadhwani and Piñeyro, 2009).
24
Appendix 7 - A technique to eliminate subgingival cement adhesion to implant

abutments by using polytetrafluoroethylene tape
Technique
1) After checked the implant crown, remove it with an ICEAM (implant crown with an
esthetics adhesive margin used to improve aestethics) abutment from the cast and attach it
to a laboratory analog. This serves to ensure that no PTFE tape will be trapped between
the abutment and the implant when seating (Figure 1).
2) Apply a light coating of petroleum jelly to the porcelain on the ICEAM.
3) Stretch PTFE tape from the lingual to the buccal and twist the ends together. Etch the
gingiva margin of the ICEAM with 5% hydrofluoric acid and apply silane to the porcelain
margin (Figure 2.
4) Place ICEAM abutment and tighten to the manufacturer’s recommendation. Verify that no
PTFE tape is above the gingival margin. If PTFE tape is above, use a packing instrument
to slide it off the abutment margin into the periimplant sulcus (Figure 3).
5) Condense a small piece of sterile PTFE tape over the screw head to protect it from cement
intrusion.
6) Verify seating of the ICEAM abutment and crown with a bitewing radiograph. Etch the
crown with 5% hydrofluoric acid and silanate on the intaglio surface.
7) Apply resin adhesive (Optibond XTR Adhesive; Kerr) to the intaglio surface of the crown
and margin of the ICEAM. Load a small amount of resin cement to the margin of the crown
and seat the crown (Figure 4).
8) Wait until the gel state of the resin cement or initial polymerization. Remove excess
cement, apply glycerin, and light polymerize all surfaces (Figure 5).
9) Untwist the PTFE tape, and lift mesial and distal ends incisally (Figure 6).
10) Gently pull on 1 end of the PTFE tape toward the buccal (Figure 7).
25
11.If necessary, polish the margin with a composite resin polishing point (Enhance; Denstply
intl) to finish the restoration (Figure 8), (Hess, 2014).
Figure 7. A technique to eliminate subgingival cement adhesion to implant abutments by

using polytetrafluoroethylene tape, Figures 1 – 8 (Hess, 2014).
26
Appendix 8 – Polytetrafluoroethylene (PTFE) tape for the management of implant

screw access channel in Implant-supported prostheses
Procedure
1) Place cotton rolls to isolate the area and maintain a dry field.
2) Tighten the screw according to the manufacturer’s protocol. Rinse the opening
channel, which has been previously airborne-particle abraded in the laboratory, with
0.1% chlorhexidine digluconate . Dry with air spray.
3) Depending on the size and depth of the screw access channel, cut an adequate length
of PTFE tape, fold to a double layer, twist into a spiral for ease of handling, and
sterilize in an autoclave for 19 minutes at 135 to 137°C.
4) Fill the screw access channel with 1 sterile piece of PTFE tape (Figure 1). Compact
it with a plugger (2 Goldstein Flexi-Thin XTS Composite Instrument; Hu-Friedy,
Chicago, Ill), leaving an occlusal space of 2 mm for the definitive restorative material
(Figure 2).
5) Cover the channel surface with silane (Monobond-S; Ivoclar Vivadent AG, Schaan,
Liechtenstein), allow to rest for 60 seconds, and dry with air spray. Apply a single
coat of bonding resin (OptiBond FL Adhesive; Kerr Corp, Orange, Calif ). Remove
excess and light polymerize, with the tip at a distance of 1 mm, for 20 seconds.
6) For an interim restoration, fill the access opening with light-polymerizing provisional
restorative material (Fermit-N; Ivoclar Vivadent AG) (Figure 3). Light polymerize
for 10 seconds, apply a coat of glycerin gel (Airblock; Dentsply DeTrey GmbH,
Konstanz, Germany) over the resin, and light polymerize for 20 seconds.
7) For a definitive restoration, fill the access opening with light-polymerizing resin-
based restorative material (Tetric EvoCeram; Ivoclar Vivadent AG). Light
polymerize each increment for 20 seconds, apply a coat of glycerine gel (Airblock;
Dentsply DeTrey GmbH) over the composite resin, and light polymerize for another
20 seconds.
8) Remove excess, evaluate occlusion, and polish with standard techniques14 (Figure
4), (Moráguez and Belser, 2010) .
27
Figure 8. Polytetrafluoroethylene (PTFE) tape for the management of implant screw access
channel in implant-supported prostheses, Figures 1 – 4 (Moráguez and Belser, 2010) .
28
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Uses and Techniques of Polytetrafluoroethylene (PTFE) in Dentistry

Universidade Fernando Pessoa

Faculdade de Ciências da Saúde

Uses and Techniques of Polytetrafluoroethylene (PTFE) in Dentistry

Universidade Fernando Pessoa

Faculdade de Ciências da Saúde

Uses and Techniques of Polytetrafluoroethylene (PTFE) in Dentistry

Dissertation submitted to Fernando Pessoa University

As part of the requirements for obtaining

the Master’s Degree in Oral Medicine

Gerardo Hernández Tecanhuey

Due to its versatility, polytetrafluoroethylene ( PTFE ), is widely applied in dentistry and

Keywords: Polytetrafluoroethylene; Teflon; Teflon tape; Dense polytetrafluoroethylene;

Devido à sua versatilidade, o politetrafluoretileno (PTFE) é amplamente aplicado na

Palavras-chave: Politetrafluoretileno; Teflon; Fita Teflon; Politetrafluoretileno denso;

Index of Abbreviations .......................................................................................................... ix

Index of figure ........................................................................................................................ x

2. Conservative Dentistry ....................................................................................................... 2

2.1. Polytetrafluoroethylene (PTFE) tape, one-step techniques. ........................................ 2

2.1.1. PTFE tape to avoid accidental etching of teeth ..................................................... 2

2.2. Polytetrafluoroethylene (PTFE) tape, multi-step techniques ....................................... 4

2.2.2. Occlusal Stamp Techniques .................................................................................. 5

2.2.4. Techniques to prevent cement sticking to the transgingival segment of the

3. Peri-implant Surgery: Guided Bone Regeneration (GBR) and Guided Tissue

4. Orthodontics: PTFE coating on orthodontic archwires and brackets ............................... 10

5. Endodontics: PTFE tape as temporary restorative material during endodontic treatment11

Appendix 3 - Occlusal Stamp Technique ............................................................................. 20

Appendix 4 - Opposing Occlusal Stamp Technique ............................................................ 21

Appendix 7 - A technique to eliminate subgingival cement adhesion to implant abutments

Appendix 8 – Polytetrafluoroethylene (PTFE) tape for the management of implant screw

d-PTFE Dense Polytetrafluoroethylene

e-PTFE Expanded Polytetrafluoroethylene

FPD Fixed Partial Denture

GBR Guided Bone Regeneration

GTR Guided Tissue Regeneration

IRM Intermediate Restorative Material

RBSD Rutherford Back Scattering Detection

VPS Vinyl Polysiloxane

Figure 2. Technique for repair of multiple abutment teeth under preexisting

Figure 3. Occlusal stamp technique…………………………………………...…………20

Figure 4. Opposing occlusal stamp technique………………………………..………….22

Figure 6. Technique for controlling the cement for an implant crown…………………...24

Figure 7. Technique to eliminate subgingival cement adhesion to implant abutments by

Figure 8. Polytetrafluoroethylene (PTFE) tape for the management of implant screw

PTFE is a linear polymer of tetrafluoroethylene. The chemical structure of PTFE is similar

commonly used is d-PTFE, which will be explained later.

1.1. Materials and Methods

2.1. Polytetrafluoroethylene (PTFE) tape, one-step techniques.

2.1.1. PTFE tape to avoid accidental etching of teeth

2.1.3. PTFE tape to isolate bridges during rebasing or cementing procedures

A traditional method to isolate bridges during rebasing or cementing is usually performed

2.1.4. PTFE tape to adapt the matrix in second class restorations

2.2. Polytetrafluoroethylene (PTFE) tape, multi-step techniques

2.2.2. Occlusal Stamp Techniques

adequate radiopacity to be detected with conventional radiography (Hess, 2014). It is normal

gutta-percha, and polytetrafluoroethylene (PTFE).

of the filling material in a single step (See Appendix 8).

3. Peri-implant Surgery: Guided Bone Regeneration (GBR) and Guided Tissue