A.

Application of biomaterials in Dentistry

1. 2. 3. 4. Impression materials to copy contours of gums Bases ,liners, and varnishes for cavities Appliances and denture to replace grinding surfaces. Cavity filling: Dental amalgam is an alloy made of liquid mercury and other solid metal particulate alloys made of silver, tin, copper, etc. The solid alloy is mixed with (liquid) mercury in a mechanical vibrating mixer and the resulting material is packed into the prepared cavity. 5. Gold and gold alloys are useful metals in dentistry as a result of their durability, stability, and corrosion resistance. Gold fillings are introduced by two methods: casting and malleting. 6. Metals (Ti and its alloys, CoCr alloys, stainless steels, Au, Ag, Pt, etc.) are used in dental root implants and also Alumina is used for same purpose. 7. Bioactive or surface reactive ceramics are used:
a. For correcting periodontal defects. b. In replacing subperiosteal teeth. 8. Ti-Ni alloys are used for making dental arch wire. 9. Ceramics are used as dental crowns.

10. Dental composite resins are very commonly used to restore posterior teeth as well as anterior teeth. B. Poly-l-lactide (PLLA) is used as surgical meshes to facilitate wound healing after dental extraction. Stress strain behavior of bone:

1. When load is converted to stress and deformation converted to strain by engineering formulas, the relationship between stress and strain in bone follows a curve called the stressstrain curve. 2. The slope of the stressstrain curve within the elastic region is called the elastic or Youngs modulus (E). 3. The Youngs modulus is a measure of the intrinsic stiffness of the material. 4. The height of the curve is the ultimate strength. a. The maximum stress and strain the bone can sustain are called the ultimate strength and ultimate strain, respectively. b. It should be noted that strength, as it is defined by the stressstrain curve, is an intrinsic property of bone. c. That is, these strength values are independent of the size and shape of the bone. 5. The yield point represents a transition, above which strains begin to cause permanent damage to the bone structure. 6. Post-yield strain is inversely proportional to the brittleness of the bone. 7. The area under the stressstrain curve is a measure of the amount of energy needed to cause material failure. 8. This property of a material is called energy absorption or modulus of toughness or just toughness. 9. The force required to break the bone is different from the intrinsic strength, because ultimate load will vary with bone size. 10. It is important to keep this distinction in mind because intrinsic strength and ultimate load can show different trends in drug or genetic studies, especially if the drug or gene affects the size of the bone.

C. Biocompatible materials and its applications

Biocompatible material:
A. Synthetic or natural material used in intimate contact with living tissue (it can be implanted, partially implanted or totally external). B. Biocompatible materials are intended to interface with biological system to EVALUATE, TREAT, AUGMENT or REPLACE any tissue, organ or function of the body. C. Examples of such materials which are widely used are: a. Synthetic polymers: i. Poly-lactic acid (PLA) and its isomers and copolymers ii. Poly-glycolic acid (PGA) iii. Poly-caprolactone (PCL) iv. Poly(dioxanone) v. Poly-lactide-co-glycolide. vi. Applications are: 1. Thoracic and abdomen rebuilding 2. Filling Defect of the soft tissue 3. Cranio-facial reconstruction 4. Surgical Suture

5. Vascular prosthesis 6. Absorbable mini plates and screws b. Magnesium alloys based: i. Mg, Zn, Li, Al, Ca and rare earths are the main elements used. ii. Applications are: 1. Mini plates and screws 2. Orthopedic prosthesis 3. Surgical tools D. Magnesium alloys degrade too fast in biological environment and they dissolve in the body, not permitting the correct vascular remodeling. Mg is an element that exists naturally into the body, and then it is good tolerated. E. Polymers degrade slower than magnesium alloys. Fundamental to care about degradation product concentration, which may be toxic A biocompatible device must be fabricated from materials that will not elicit an adverse biological response.

Biocompatible material features

1. Absence of carcinogenicity (the ability or tendency to produce cancer) 2. Absence of immunogenicity (absence of a recognition of an external factor which could create rejection) 3. Absence of teratogenicity (ability to cause birth defects) 4. Absence of toxicity. 5. The degradation time of the material should match the healing or regeneration process.

Advantages of Biocompatible materials

1. 2. 3. 4. 5. More physiological repair Possibility of tissue growth Less invasive repair Temporary support during tissue recovery Gradual dissolution or absorption by the body afterwards.

D. Effects of degradation and corrosion

Degradation:
1. The deterioration of ceramic biomaterials takes place when water penetrates it. Even the fatigue strength of Alumina (bio inert) reduces when it comes in contact with water. 2. Polymer biomaterials are degraded by a combination of hydrolytic scission and enzymatic

(esterase) action producing glycolic acid which can either enter the citric acid cycle of body or is excreted in urine and can be eliminated as carbon dioxide and water.
3. Degradation due to physiological pH levels inside host. 4. In metallic biomaterials degradation/deterioration takes place due to corrosion only.

Effects of degradation:
1. Degradation under physiological pH conditions can locally reduce the biocompatibility near the implant surface. 2. Premature degradation of a biomaterial than its expected life leads to its removal process by surgery
which ultimately increases the cost and patients morbidity (disease).

3. Polymeric biomaterials can have substances that may be issued in the body like monomers (toxic), catalysts and
additives during degradation.

4. 5. 6. 7. 8. 9.

Physical irritations. Chronic inflammatory local reactions. Thrombogenicity and long term endothelial dysfunction (for cardiovascular applications). Inability to adapt to growth. Not allowed or disadvantageous after surgery. Stress shielding, corrosion, accumulation of metal in tissues (for internal fixation applications). 10. Repeated surgeries may be required.

Effect of corrosion:
1. Corrosion of an implant in the clinical setting can result in symptoms such as local pain and swelling in the region of the implant, with no evidence of infection; cracking or flaking of the implant as seen on x-ray films, and excretion of excess metal ions. 2. Corrosion also plays a role in the mechanical failures of orthopaedic implants. 3. When an implant is subjected to stress, the corrosion process could be accelerated due to the mechanical energy. If the mechanical stress is repeated then fatigue stress corrosion takes place such as in the femoral stem of the hip joint and hip nails made of stainless steels. 4. As a material starts to corrode, the dissolution of metal leads to erosion which in turn eventually leads to brittleness and fracture of the implant. 5. Effects of Corrosion in Human Body Due to Various Biomaterials: a. Nickel: Affects skin - such as dermatitis b. Cobalt: Anemia B inhibiting iron from being absorbed into the blood stream. c. Chromium: Ulcers and Central nervous system disturbances. d. Aluminum: Epileptic effects and Alzheimers disease. e. Vanadium: Toxic in the elementary state.

Corrosion of Metallic Implants

If two dissimilar metals are present in the same environment, the one which is most negative in the galvanic series will become the anode, and bimetallic (or galvanic) corrosion will occur. Galvanic corrosion can be much more rapid than the corrosion of a single metal. Metals which are in current use as biomaterials include gold, cobalt chromium alloys, type 316 stainless steel, cp-titanium, titanium alloys, nickeltitanium alloys, and silver-tin-mercury amalgam. The noble metals are immune to corrosion and would be ideal materials if corrosion resistance were the only concern. Gold is widely used in dental restorations and in that setting it offers superior

performance and longevity. Gold is not, however, used in orthopaedic applications as a result of its high density, insufficient strength, and high cost. Titanium is a base metal in the context of the electrochemical series; however, it forms a robust passivating layer and remains passive under physiological conditions. Titanium implants remain virtually unchanged in appearance. Ti offers superior corrosion resistance but is not as stiff or strong as steel or CoCr alloys. Cobaltchromium alloys, like titanium, are passive in the human body. They are widely in use in orthopedic applications. They do not exhibit pitting corrosion. Stainless steels contain enough chromium to confer corrosion resistance by passivity. The passive layer is not as robust as in the case of titanium or the cobalt chrome alloys. Only the most corrosion resistant of the stainless steels are suitable for implants. These are the austenitic types316, 316L, and 317, which contain molybdenum. Even these types of stainless steel are vulnerable to pitting and to crevice corrosion around screws. The phases of dental amalgam are passive at neutral pH; the transpassive potential is easily exceeded, due to inter phase galvanic couples or potentials due to differential aeration under dental plaque. Amalgam, therefore, often corrodes and is the most active (corrosion prone) material used in dentistry.