Introduction:

Biomaterial: It’s that any non-vital material which used to interact with
biological systems or on human body. Dental materials used in the oral cavity so it’s
belong to biomaterials. [1]

Biocompatibility (Tissue compatibility): The ability of a biomaterial

to perform its desired function with respect to a medical (or dental) therapy, without
eliciting any undesirable local or systemic effects in the recipient , but generating
the most suitable response of cell or tissue in that specific situation.[3]

Biological Requirements of Dental Materials: [4]

1. To be non-toxic to the body

2. To be non-irritant to the oral or other tissues
3. Don’t produce allergies
4. To be non-mutagenic or carcinogenic.

Classification of Materials from a Biological Perspective

1. Materials which contact the soft tissues within the mouth

2. Materials which could affect the health of the dental pulp
3. Materials which are used as root-canal filling materials
4. Materials which affect the hard tissues of the teeth
5. Materials used in the dental laboratory which though not used in the mouth,
are handled and can be accidentally ingested or inhaled.

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Tests of Biocompatibility (fig. 1):

1. Vitro Tests ( Primary tests )

2. Animals Tests ( Secondary tests )
3. Usage Tests
Fig. 1

Tests of biocompatibility

Usage tests:

They’re tests which can be done in animals or in human study participants.

They’re different from other animal tests because they require that the material to be
placed in a situation just like to its intended clinical use. It’s used for predicting
biocompatibility which is directly proportional to the fidelity with which the test
mimics the clinical use of the material, including time, location, environment, and
placement technique. And for that, usage tests in animals usually use large animals
that have similar oral environments to humans, like dogs or monkeys. When humans
are used, the usage test is termed a clinical test. These tests are the gold standard,
because they give the ultimate answer to a material if it will be biocompatible and
clinically useful or not. [2]

Advantages Disadvantages
Expensive
Relevance to use of material is assured Last for long periods
Involve many ethical and somtimes
legal concerns
Difficult to control

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Types of Usage tests:
1. Dental & Pulp Irritation test
2. Mucosa and gingival usage tests
3. Dental implants in bone tests

1. Dental & Pulp Irritation test

Class V cavities are prepared as a traumatically then filled

by with the test material (fig. 2). This method is comparable to
the future mode of application on patients. After a period of days
to many months, the teeth are removed and histologically
prepared, and therefore the pulp is microscopically evaluated for
signs of acute or chronic inflammation and odontoblast reaction.
Then the space between test material and cavity wall is
investigated for bacterial penetration. These methods may be
Fig. 2
modified in such way that the pulp is exposed or a part of the pulp Prepared class V
is removed before the material is applied. By this way, materials
intended for direct pulp capping or pulpotomy can be assessed. [1]

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 Assessment: The important causes of pulp damage resulting from a
restorative procedure (in addition to cavity preparation) are the following:

 Toxic substances released from the material

 Bacteria and their toxins between the material and the cavity wall

The pulp can react to those irritations in the following ways:

 Inflammation, May be reversible (with subsequent healing) or

irreversible (with the formation of pulp abscesses and subsequent necrosis)
 Tertiary dentin formation; minor irritations can stimulate present
odontoblasts to create tertiary dentin (“reactive dentin”) within the pulp
combined with an obliteration of dentin tubules (dentinal sclerosis).

Toxic substances, bacteria, and bacterial toxins may only trigger a pulp reaction
if they may penetrate the dentin tubules toward the pulp. At the same time, dentin
exerts a particular barrier function despite dentin tubules. This barrier function is
increased when a smear layer is generated during preparation. An extra barrier factor
is that the obliteration of dentin below a carious lesion (dentinal sclerosis), which
can further reduce diffusion of substances. Permeability of dentin depends on the
topography: Permeability is lower than close to the pulp due to the lower number
and the smaller volume of dentin tubules in the dentin periphery. The barrier function
is also dependent on the dentin thickness; permeability increases exponentially with
decreasing dentin thickness.

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 2. Mucosa and gingival usage tests

It’s the tissue response to materials which is in direct contact of gingiva and
mucosa is assessed by placement in cavity preparations with sub gingival extensions.
The material’s effect on gingiva is observed and responses are categorized as slight,
moderate, or severe, counting on the quantity of mononuclear inflammatory cells
(mainly lymphocytes and neutrophils) within the epithelium and adjacent connective
tissues. A drawback of this sort of the study is that the frequent presence of some
degree of preexisting inflammation in gingival tissue because of the presence of
plaque, surface roughness of the restorative material, open or overhanging margins,
and over contouring or under contouring of the restoration.

Assessment: Due to their technical limitations, oral mucosa tests don’t seem to
be considered in most national and international standards, so that the number of
relevant publications is relatively small.

3. Dental implants in bone tests

Used for dental implants which inserted into the jaw of test animals like dogs and
monkeys (intraosseous implants).Tissue reaction is assessed histologically, with the
tissue in relation with the implant being of particular interest. [1]

The following terms are used to define different degrees of success: early implant
success for implants which survive for one to three years, intermediate implant
success for implants which survive for three to seven years, and long-term success
for implants which survive over seven years. There are three commonly used tests
to predict implant success: (1) penetration of a periodontal probe along the side of
the implant, (2) mobility of the implant, and (3) radiographs indicating either osseous

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integration or radiolucency around the implant (Fig. 3). A bone implant is considered
successful if it’s no mobility and no radiographic evidence of periimplant
radiolucency. Any fibrous capsule formation may be a sign of irritation and chronic
inflammation, which is probably lead to micro motion of the implant and ultimately
to loosening and failure. [2]

Fig. 3

Osseous integration

Assessment: Available data from these animal studies show that implants
from titanium, as an example, are generally well tolerated by the surrounding tissue.
A good correlation of these findings with patients’ situations may be expected.

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References:

1. Gottfried Schmalz Dorthe Arenholt-Bindslev / Biocompatibility of Dental

Materials / 2009 / page 1-3 & 20-24

2. Ronald L. Sakaguchi, & John M. Powers, / Craig’s RESTORATIVE

DENTAL MATERIALS / THIRTEENTH EDITION / page 94-95

3. Kenneth J. Anusavice, & Chiayi Shen, & H. Ralph Rawls, / Philips Science
of Dental Materials / Twelve edition / page 111

4. John J Manappallil / Basic Dental Materials / Second Edition / page 26