Trends Biomater. Artif. Organs, Vol 20(1), pp 40-43 (2006) and Ashima Valiathan 40 A.

Sivakumar

http://www.sbaoi.org

Dental Ceramics and Ormocer Technology - Navigating the Future!

A. Sivakumar and Ashima Valiathan
Department of Orthodontics. Manipal College of Dental Sciences, Manipal
The use of ceramics in dentistry is a multi-billion dollar industry, involving many different proprietary materials. Current applications of ceramics in dentistry include fillings, crowns, veneers, implants and dental brackets. Dental pins are devices which are inserted into the mandible and are used to hold prosthetic teeth in place. They are usually made from bioactive materials such as low silica glass or hydroxyl apatite. They are used because of their ability to bond to biological tissues permanently. Composites such as ceramic filled polymers and short fiber reinforcements are also being used. Ormocer is one such material. Ormocer materials contain inorganic-organic copolymers in addition to the inorganic silanated filler particles. It is synthesized through a solution and gelation processes (sol-gel process) from multifunctional urethane and thioether(meth)acrylate alkoxysilanes. Ormocers are described as 3-dimensionally cross-linked copolymers. Ormocer was formulated in an attempt to overcome the problems created by the polymerization shrinkage of conventional composites because the coefficient of thermal expansion is very similar to natural tooth structure.Ceramics in dentistry will be explored and challenges facing the ceramics community will be emphasized. The key words for dentistry may soon be "fast" and "ceramic. ... And that's where ceramics come in.

Introduction Teeth function in one of the most inhospitable environments in the human body. They are subject to larger temperature variations and pH changes in the range 0.5 to 8. Add to this, the stresses associated with chewing may vary from 20 to about 100MPa. While having to be stable in this kind of environment and able to withstand the loads associated with chewing, dental materials need to satisfy another criteria, aesthetics. With society becoming increasingly self conscious, any dental materials that are used in visible locations must have colour and translucency as close to natural teeth as possible. These requirements are almost fulfilled by ceramics, especially porcelain materials. Dental ceramics were first used about 225 years ago. The first application was porcelain dentures. Interestingly porcelain is still quite widely used in dentistry. Current applications of ceramics in dentistry include dental restorations, crowns, veneers, implants

and orthodontic brackets. Traditionally, fillings have been made from silver amalgams. However, resin based filling materials are rapidly gaining in popularity for health and aesthetic reasons. These resins are usually filled with 3585% ceramic fillers such as silicate glasses, colloidal silica or quartz. Despite the advantages of using ceramic filled resins, these materials may be susceptible to wear when applied to chewing surfaces. Porcelain fused to metal (PFM) materials constitute about 75% all crowns. The porcelain used is a feldspathic porcelain. The porcelain also contains varying amounts of crystallized leucite. The amount of crystallized leucite influences properties such as strength and thermal expansion. Thermal expansion is critical in the manufacture PFM implants to avoid cracking of the ceramic, which could lead to failure during manufacture or in operation. PFM materials are also used for veneers to cover damaged front teeth and crowns, although ceramic cores are being used in some crowns. All ceramic crowns are

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normally coated with porcelain so that colour and translucency can be matched. Dental implants are used as an alternative to bridges where a tooth has been lost or removed. These are also made of PFM, where a biocompatible metal post made out of a material such as titanium, is anchored into the jawbone and the porcelain crown is affixed to the post. The metal post may also be coated with hydroxyapatite to aid bone bonding and rapid osseointegration. Bioglass posts are sometimes used for this purpose for the same reason. The most recent use for ceramics in dentistry is orthodontic brackets. The development and demand for these items has been driven solely by aesthetics. Polycrystalline alumina is the material of choice in this application. Ceramics for Direct Restorations Until the moment, all the process of conventional composite resins had been carried through exclusively in load particles (crystalline quartz, colloidal silica, barium glass) that they compose the diverse types of composite resins. Ever since, the introduction of dimethacrylates in the form of bisphenol A glycidyl dimethacrylate (Bis GMA), there is not much change in the restorativeadhesive system. This is because the material has proved to be relatively reliable for both restorative and orthodontic purposes. On the other hand, some recent research indicated that, the bisphenol A component in the structure of the monomer BisGMA is suspected of having an estrogenic effect whereas the Bis GMA itself has also been found to be cytotoxic in a number of cell culture systems [1,2]. In an attempt to overcome some of the limitations and concerns associated with the traditional composites, a new packable restorative material was introduced called Ormocer, which is an acronym for organically modified ceramic technology. Ormocer materials contain inorganic-organic copolymers in addition to the inorganic silanated filler particles. It is synthesized through a solution and gelation processes (sol-gel process) from multifunctionalurethaneandthioether(meth)acrylate alkoxysilanes. Ormocers are described as 3dimensionally cross-linked copolymers. The abundance of polymerization opportunities in these materials allows Ormocers to cure without

leaving a residual monomer, thus having greater biocompatibility with the tissues. Ormocer was formulated in an attempt to overcome the problems created by the polymerization shrinkage of conventional composites because the coefficient of thermal expansion is very similar to natural tooth structure. ORMOCER Technology These are organically modified nonmetallic inorganic composite materials. This new material group for restorative dentistry was developed by Fraunhofer Institute for Silicate Research, Wrzburg, in cooperation with partners from the dental industry and introduced as a dental restorative for the first time in 1998. The use of ORMOCERs is not limited to compact materials for dentistry. These materials have been successfully used for a number of years e.g. in electronics, micro system technology, refinement of plastics, conservation and corrosion coatings, functional coatings of glass and anti-scratch protective coatings. ORMOCERs can be classified between inorganic and organic polymers and have an inorganic as well as an organic network. The monomeric molecular pre-stages are characterised by three structural segments. The inorganic condensing molecule segment is used to build up the inorganic network. An inorganic Si-O-Si network is produced through targeted hydrolysis and inorganic polycondensation in a sol-gel process. The organically polymerizing molecular segment has (meth)acrylate groups which form an additional highly cross-linked network matrix after induction of a radical-based polymerization. The inorganic poly-condensation and the organic polymerization result in the formation of an inorganic-organic co-polymer. The variable linking segment can largely be modified, just as the other structural units. The toxicological and allergological potential of this material class is considered lower than that of conventional composite restoratives since the acrylates and methacrylates are silane-bound and thus covalently linked to the inorganic network. To improve handling, dimethacrylates are added to dental ORMOCERs. The ORMOCER-based composites are an innovative variation of traditional composites with organic matrices and do not differ from these in their practical

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application by the dentist. By incorporating filler particles a pasty material for dental restoration is produced. After this production process the ORMOCER-based composites have already developed their inorganic network through polycondensation. The additional organic polymeric structure is established in the cavity through light-induced radical-based polymerization of the plastic ORMOCER restorative. In order to build a bond to the tooth, enamel and dentine are conditioned and an adhesive system is used. Effectively the new class of material combines the surface properties of the silicones, the toughness of the organic polymers and the hardness and thermal stability of ceramics. Nature and Characteristics Laboratory testing of Ormocer materials suggests a significantly lower wear rate compared with composites [3, 4, 5]. On the other hand, Cattani-Lorente et al [6] found that the shrinkage of Ormocer was equal to that of hybrid composites despite having less filler content. The authors attributed their findings to the difference in the resin matrix of Ormocer. As a result, it was suggested that the advantages of Ormocer include low shrinkage, high abrasion resistance, biocompatibility, and protection against caries [7]. According to the manufacturer (Fraunhofer Institute), this material does not liberate any residual monomer after polymerization. Applications in Dentistry Direct restoration for all types of cavities [8, 9] Cosmetic veneers,Protective sealant for child teeth, Protective varnish as caries prophylaxis Orthodontic bonding adhesive [10] References
1.

According to a recent study, within the initial half an hour after bonding, the new adhesive Admira can achieve shear bond strength values that are similar to those obtained with Transbond XT. On the other hand, as currently formulated, the thick adhesive paste of Admira needed to be forcibly pushed into the bracket base during the bonding process for it to engage the retention pad. As a result, it is suggested that for orthodontic usage, the manufacturer should consider reformulating the composition of Admira to make it into a relatively thinner and more flowable paste that can readily penetrate the mesh of the bracket base. Until the more flowable version of this new organically modified ceramic restorative system is developed, Ormocer should only be considered as potentially useful for bonding orthodontic brackets Conclusion With the sprouting of the ORMOCER, it has become fullfilled restoration of a tooth of the direct form, with lesser time expense and a low cost. The technique is simple, of easy accessible execution and to all the professionals. It is noticed, still, that the restoration with ORMOCER presents excellent final burnishing [11, 12], and with aesthetics, a privileged one in the final result, and still it demonstrates a minor contraction of polymerization (1.88%) and consequence reduction of microleakage. Having, as main advantages the reduction of the contraction of polymerization, greater resistance to the abrasion, better manipulation and final burnishing, it is believed that the ORMOCER material is an excellent option for posterior restorations.

2. 3. 4. 5.

Schedle A., Franz A., Rausch-Fan X., Spittler A., Lucas T., Samorapoompichit P., Sperr W., BoltzNitulescu G. Cytotoxic effect of dental composites, adhesive substances, compomers and cements. Dent Mater 14,429-440(1998). Prati C., Chersoni S., Mongiorgi R., Pashley D.H. Resin-infiltrated dentin layer formation of new bonding systems. Oper Dent 23,185-194(1998). Watts D.C., Marouf A.S. Optimal specimen geometry in bonded-disk shrinkage- strain measurements on light cured biomaterials. Dent Mater16, 447-451(2000). Yap A.U., Tan C.H., Chung S.M. Wear behavior of new composite restoratives. Oper Dent 20,26974(2004). Tagtekin D.A., Yanikoglu F.C., Bozkurt F.O., Kologlu B., Sur H. Selected characteristics of an Ormocer and a conventional hybrid resin composite. Dent Mater 20, 487-97(2004)

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6. 7. 8. 9. 10. 11.

12.

Cattani-Lorente M., Bouillaguet S., Godin C.H., Meyer J.M. Polymerization shrinkage of Ormocer based dental restorative composites. Eur Cell Mater 1, 25-26 (2001). Hickel R., Dasch W., Janda R., Tyas M., Anusavice K. New direct restorative materials. Int Dent J 48, 3-15 (1998). Hennig A.C., Helbig EB, Haufe E, Richter G, Klimm HW.Restoration of Class V cavities with the Ormocerbased filling system Admira. Schweiz Monatsschr Zahnmed 114,104-14 (2004). Rosin M., Steffen H., Konschake C., Greese U., Teichmann D., Hartmann A., Meyer G. One-year evaluation of an Ormocer restorative-a multipractice clinical trial. Clin Oral Investig 7,20-6 (2003). Ajlouni R., Bishara S.E., Soliman M.M., Oonsombat C., Laffoon J.F.,Warren J. The Use of Ormocer as an Alternative Material for Bonding Orthodontic Brackets. Angle Orthod 75,106-108 (2005) Baseren M. Surface roughness of nanofill and nanohybrid composite resin and ormocer-based toothcolored restorative materials after several finishing and polishing procedures. J Biomater Appl.19, 12134 (2004). Yap A.U., Yap S.H., Teo C.K., Ng J.J. Comparison of surface finish of new aesthetic restorative materials. Oper Dent. 29(1),100-4 (2004).

CALL FOR ABSTRACTS

FOURTH INTERNATIONAL CONFERENCE ON ETHICAL ISSUES IN BIOMEDICAL ENGINEERING

APRIL 20 - 22, 2007 Brooklyn, New York, USA
Subrata Saha, Ph.D. Conference Chair Department of Orthopaedic Surgery & Rehabilitation Medicine SUNY Downstate Medical Center 450 Clarkson Avenue - Box 30 Brooklyn, New York 11203 Email - subrata.saha@downstate.edu Office - (718)-613-8652 Fax - (718)-270-3983 http://138.5.102.101/grad/bmephd/Ethics2007.pdf Abstract submission deadline January 15, 2007